There is some evidence which suggests that the use of Irish stick weapons may have evolved in a progression from a reliance on long spears and wattles, to shorter spears and wattles, to the shillelagh, alpeen, blackthorn (walking-stick) and short cudgel.
Moreover, most of the associated drugs fatalities including tramadol have been reported with other central nervous system (CNS) depressants, particularly benzodiazepine [9], [10], [11], [13] and [14]. In certain cases, benzodiazepine levels were in the therapeutic range or slightly higher.
Tramadol is marketed as a racemic mixture of both R- and S-stereoisomers. This is because the two isomers complement each other's analgesic activity. It is often combined with paracetamol (acetaminophen) as this is known to improve the efficacy of tramadol in relieving pain.