ABSTRACT Background: Opioid use disorders related to tramadol (OUD-T) were under-reported in Egypt. The objective was to estimate the prevalence and associated correlates of OUD-T among male psychiatric patients. Methods: A total of 168 male inpatients and outpatients with Axis-I psychiatric disorders was randomly selected from Zagazig University Hospitals, Egypt. The patients were interviewed using Structured Clinical Interview for DSM-5 disorders (SCID-I), Drug Use Disorders Identification Test (DUDIT), and urine screening for drugs. Results: The prevalence of OUD-T was 48.8%, with the highest prevalence in patients with depressive disorders (58.5%). Old age (OR 1.2, 95% CI: 1.1, 1.2), and cannabis use (OR 46.9, 95% CI: 10.8, 118.7) predicted OUD-T. About 45% of patients with OUD-T used tramadol alone whereas the rest used at least one drug plus tramadol. Tramadol-related problems and dependence were positively correlated with the tramadol daily dose, smoking, alcohol and heroin use, and inversely with the psychiatric disorder remission and age of smoking onset and substance use disorders (SUDs). Conclusions: OUD-T were common among male psychiatric patients, with a considerable relationship between OUD-T and use of other substances (cannabis). Further longitudinal studies need to investigate the relationship between OUD-T and other SUDs, and psychiatric disorders.