Emergency department visits involving misuse or abuse of the narcotic pain reliever tramadol increased 250% between 2005 and 2011, with the largest increase among adults 55 and older, according to a new report from the Substance Abuse and Mental Health Services Administration. “Prevention efforts targeted to this population as well as their medical care providers may help reduce ED visits and subsequent hospitalizations, and should remain a public health priority,” the report states. About half of the estimated 54,397 ED visits involving tramadol in 2011 were attributed to adverse reactions and 40% to mis use or abuse. The potential for adverse reactions underscores the importance of careful clinical management of patients prescribed the drug, according to a separate report on that issue. Tramadol is now the second most commonly prescribed narcotic pain reliever, outranking oxycodone in 2012.