All drugs can have side effects. Tramadol is no exception. It is a potentially addictive drug with opoid side effects on withdrawal. Too much of a dose can cause death. It definately increases the incidence of siezures. It falls somewhere near hydrocodone in its pain relieving quality. (not a substitute for Morphine or Demerol). It is prescription drug in the US. (Many potent drugs can be otained without a prescription in may parts of the world). I would not rely on it as the only pain drug for a transoceanic voyage. I would submit that there are situations where opiates are necessary for relief of pain, although there are risks, which if the patient is monitored are miminal. I certainly agree that contact with a physician is essential--and that is why before satellite phones, I advocated that all long distance cruising boats have amateur radio transcievers aboard. (Still a great idea). Having seen both sides of medical issues on small recreational vessels, the prologue of my lectures of medicine at sea, include a letter to the physician who will be preparing the medical kit. Part of this says, that if the voyager has the appropiate medications and tools, and a contact with a physician they will be able to handle most medical problems which occur. There is a slim chance that there will be an AMVER (Automated Mutual Assistance Vessel Rescue System) ship near, who has a physican aboard when that medical emergency arrises half way across an ocean. As for Ken's concerns about officials reaction about a medical kit. Part of SOLAS (Safety Of Life At Sea)/ IMO (International Maritime Organization) treaty is the right for all ships to carry medical supplies under the control of the captain of the ship. Virtually all nations which he will be involved with are signatories of these treaties. The SOLAS cat A medical kits include narcotics, such as Morphine Sulfate sulfate 10 mg/cc, with 10 ampules being part of the kit for a 10 man crew. (Granted this is for merchant ships, but yachts are covered under the same rules) All narcotics (and in my opinion seditatives, and any prescription drugs) need to be in a locked cabinet under the control of the captain. A good comprehensive medical kit for SOLAS A requirement is at: http://www.marmed.com/files/cat-a.pdf What you carry for a voyage of 20 to 30 miles may be entirely different. However one of my physcian friends almost lost his wife to an anaphylactic reaction half way between Catalina Island and Long Beach, due to not having appropiate medication aboard. Every time I was aboard an ocean racing sail boat which was going more than 15 miles offshore, we had a full medical kit aboard. Bob Austin