Do you routinely monitor urine toxicology for primary care patients prescribed tramadol for chronic pain?  

Yes, still an opioid and can be misused.

I get a urine at least once per year for someone on a daily opioid agonist for a chronic pain syndrome. Tramadol carries the same risks as other opioid analgesics. For anyone on chronic opioid therapy, I also complete a controlled substance agreement, which I try to approach like an informed consent...