N,O-Didesmethyltramadol is an opioid derivative which is one of two active metabolites of the opioid analgesic medication tramadol. It is many times less potent than the other active metabolite O-Desmethyltramadol but is still more potent as a mu opioid receptor agonist than tramadol itself, unlike the other metabolites N-desmethyltramadol, N,N-didesmethyltramadol, and N,N,O-tridesmethyltramadol which are entirely without opioid activity. As with tramadol and O-desmethyltramadol it is found as a mixture of the (1S,2S)- and (1R,2R)-enantiomers, although the separate enantiomers of N,O-didesmethyltramadol have not been studied individually. It is specifically listed as a Schedule I drug in Canada, presumably due to concerns it may be subject to abuse as a designer drug in a similar manner to other opioid active metabolites such as O-desmethyltramadol and nortilidine.