A cross-sectional study was conducted on 58 follow-up patients who use heroin and 37 patients who misuse tramadol. The patients were assessed using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I) for substance use disorders and comorbid psychiatric disorders. Patients were screened for drugs using a urine test. It was found that patients who misuse tramadol were more likely to be older, have a higher level of education, be married, and have a skilled profession compared to patients who use heroin. Heroin users were more likely to have a higher rate of smoking, a younger age of smoking onset, a stronger family history of substance use disorders, and a higher rate of incarceration compared to patients who misuse tramadol. The study concluded that patients who misuse tramadol have more similarities than differences when compared to patients who use heroin. Although tramadol has a dual mechanism of action and is perceived as a molecule with low misuse potential, its use disorder should be treated as an opioid use disorder.