Does tramadol (tramadol hydrochloride) cross-react with oxycodone on a standard urine drug screen?

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Last updated: April 7, 2025 • View editorial policy

From the Guidelines

No, tramadol does not show up as oxycodone on a standard drug test. These are two different medications with distinct chemical structures that are detected separately on drug tests. Tramadol is a synthetic opioid analgesic that is typically tested for specifically in expanded or comprehensive drug panels, while oxycodone is a semi-synthetic opioid that has its own specific test. Standard drug tests (like the common 5-panel test) may not detect tramadol at all, as it requires specific testing. Some key points to consider:

  • False positives can occasionally occur due to cross-reactivity with other substances, but tramadol and oxycodone have different metabolic pathways and produce different metabolites in the body 1.
  • Confirmatory tests, such as gas chromatography and mass spectrometry, can positively identify a substance and generate quantitative concentrations, reducing the likelihood of false positives 2.
  • It is essential to disclose any prescribed medications to the testing facility before the test to avoid confusion about legitimate medication use versus illicit drug use.
  • The limitations of the selected matrix, the substances for which the drug panel tests, and potential cross-reactivity should be considered when interpreting drug test results 1.

From the Research

Tramadol and Oxycodone Detection

  • Tramadol is a synthetic opioid that can be detected in urine samples using gas chromatography-mass spectrometry (GC-MS) methods 3.
  • Oxycodone, on the other hand, is a semi-synthetic opioid that can be distinguished from other opiates, including tramadol, using GC-MS analysis of trimethylsilyl (TMS) ether derivatives 4.
  • A study has shown that tramadol, oxycodone, and other opioids can be simultaneously determined in human oral fluid using solid-phase extraction and GC-MS 5.
  • Another study has developed a GC-MS method for the simultaneous determination of ketamine, tramadol, methadone, and their metabolites in urine, demonstrating the ability to detect tramadol in urine samples 6.
  • GC-MS is a widely used technique for the screening and identification of drugs of abuse, including tramadol and oxycodone 7.

Cross-Reactivity with Oxycodone

  • There is no evidence to suggest that tramadol shows up as oxycodone on a standard drug test, as GC-MS methods can distinguish between the two substances 4, 5.
  • The studies suggest that tramadol and oxycodone can be detected and distinguished from each other using GC-MS analysis, indicating that tramadol is unlikely to be misidentified as oxycodone on a standard drug test.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.