By standard indicators, tramadol should not be as addictive as other notorious opioids of abuse like oxycodone or hydrocodone.

Tramadol, which is prescribed to treat moderate-to-severe pain in humans and animals, is classified as a Schedule IV controlled substance by the U.S. Drug Enforcement Administration (DEA), meaning it has a low potential for abuse relative to other substances — a much lower abuse potential than oxycodone and hydrocodone, which are Schedule II drugs.

However, tramadol has remained an object of abuse, and a 2019 Mayo Clinic study lends credence to this notion. “We found that people who got tramadol were just as likely as people who got hydrocodone or oxycodone to continue using opioids past the point where their surgery pain would have been expected to be resolved,” according to one of the authors of the study.

Tramadol certainly is not the first opioid that comes to mind when the opioid crisis receives headlines. Still, in 2012, it surpassed oxycodone to become the No. 2 most commonly prescribed opioid in the U.S.

Plus, it is capable of producing a host of troublesome withdrawal symptoms. It can also cause life-threatening effects in overdose. Though rare, tramadol abuse can lead to a condition known as serotonin syndrome, which can be fatal.

What is Tramadol?

The U.S. Food and Drug Administration (FDA) approved tramadol for use in 1995. It is sold under the brand names of ConZip and Ultram. As Ultram, it is available in immediate and extended-release tablets.

When combined with acetaminophen, tramadol is sold as Ultracet. When tramadol enters the body, it decreases serotonin and norepinephrine levels, two compounds associated with pain. In this manner, tramadol relieves pain.

When liver proteins break down tramadol, it is converted into a compound known as O-desmethyltramadol, which binds to the opioid receptor, states Medical News Today.

When people take tramadol in higher than standard doses or abuse it recreationally, it can produce a mellow euphoria.

One Reddit poster described tramadol’s effect as such: “…not as strong and without the immediate ‘rush’ but strong enough. And after a while, you could certainly nod off on them when nighttime rolled around after taking them all day…” However, some users report no euphoric effect whatsoever.

Nevertheless, patients who take tramadol for pain should not exceed 400 milligrams (mg) a day for the immediate release tablet. People who use the extended-release version should not take more than 300 mg daily, according to  When someone begins to exhibit addiction, their tramadol use will surpass the recommended dosage amount. They will also show specific signs of addiction.

What are the Signs of Tramadol Addiction?

Before someone begins to exhibit addiction, they will show signs of drug tolerance, which means they will require more of a substance over time to experience the effects that a smaller dose once produced.

With tolerance, a user may engage in a pattern of prolonged use that, once they stop, they begin to experience withdrawal symptoms.

Tramadol Withdrawal

With tramadol, as with other opioid medications, the withdrawal symptoms are not considered life-threatening. However, they are uncomfortable enough to get some people to reuse the drug.

According to Verywell Mind, common tramadol withdrawal symptoms can include:

  • Agitation
  • Hallucinations
  • Psychosis
  • Irritability
  • Fast breathing
  • Increased blood pressure or heart rate
  • Muscle or joint aches and pain
  • Loss of appetite
  • Panic, paranoia, or panic attacks
  • Sweating
  • Chills
  • Abdominal cramps
  • Restless leg syndrome
  • Confusion or delirium
  • Runny nose, sneezing, or coughing
  • Anxiety
  • Diarrhea
  • Nausea or vomiting
  • Insomnia
  • Goosebumps

Tramadol Addiction

That dependence can bloom into addiction when a person begins to exhibit compulsive behaviors toward obtaining tramadol.

According to the Mayo Clinic, the following are symptoms or behaviors often exhibited by a person who is the grips of drug addiction:

  • Over time, you feel the need to take more of the drug to get the same effect (tolerance).
  • You have intense urges for tramadol, which blocks out any other thoughts.
  • You experience withdrawal symptoms when you make attempts to stop taking tramadol (dependence).
  • You take larger amounts of tramadol over an extended period than you intended.
  • You do not meet obligations and work responsibilities.
  • You cut back on recreational or social activities because of drug use.
  • You spend money on tramadol, even when you can’t afford it.
  • You ensure that you maintain a supply of the drug.
  • You continually use tramadol even though it’s causing problems in your life like physical or psychological harm.
  • You need to use tramadol regularly — daily or even several times a day.
  • You do things to get tramadol that you usually would not do like stealing.
  • You drive or do other risky activities when under the influence of the drug.
  • You spend a good deal of time obtaining tramadol, where you are either using or recovering from its effects.
  • You fail in your attempts to stop using the drug.

Other observable signs of addiction include shopping for doctors, hiding tramadol use, mixing tramadol with other drugs or alcohol, and using it differently than its intended purpose such as crushing and snorting the tablets.

How Does Treatment for Tramadol Work?

Tramadol is an opioid, and opioids have an uncanny ability to hijack the brain. Someone attempting to cold turkey detox from opioids is susceptible to relapse. Though it is not as addictive as other opioids, tramadol is no different.

Professional treatment is essential to achieving meaningful, sustained recovery. The process starts with medical detox, where a team of doctors, nurses, and other medical staff provide 24/7 supervision as the substance is gradually removed from your body. The medical team will also treat withdrawal symptoms that crop up.

Clients who have severe cases of abuse or engage in tramadol use, along with other substances, may be recommended for residential treatment.

A residential program provides housing and treatment to clients, who will be the beneficiaries of a comprehensive program intended to address the mental and emotional aspects of addiction.

Here are the evidence-based therapy approaches employed in residential treatment:

  • Life skills training
  • Behavioral therapy
  • Group therapy
  • Motivational interviewing
  • Family therapy
  • Mindfulness

Milder cases of addiction are recommended for outpatient treatment, which gives clients access to therapy and counseling. The difference is they receive treatment on a part-time basis and live at home or some other independent housing.

Once treatment is complete, recovery is not. Because addiction is a lifelong affliction, having access to a supportive community is essential to avoiding relapse.

That’s where relapse prevention comes in. Through this program, you can get connected to an inspiring community that is vested in your long-term recovery.

How Dangerous is Tramadol?

Tramadol overdose is life-threatening. Chief among those deadly effects is respiratory depression, a condition in which breathing slows, becomes shallow, or stops completely resulting in death.

The threat of overdose increases when people abuse tramadol with other substances.

The following are overdose symptoms associated with tramadol, according to

  • Pinpoint pupils
  • Unconsciousness
  • Coma
  • Slowed heartbeat
  • Difficulty breathing
  • Cold, clammy skin
  • Extreme drowsiness
  • Muscle weakness

Though rare, users who take too much tramadol risk succumbing to a condition known as serotonin syndrome.

This condition can occur when someone accumulates too much serotonin, resulting in “symptoms that can range from mild (shivering and diarrhea) to severe (muscle rigidity, fever, and seizures). Severe serotonin syndrome can be fatal if not treated,” states the Mayo Clinic.  The mild symptoms of serotonin syndrome include:

  • Goosebumps
  • Shivering
  • Headache
  • Agitation or restlessness
  • Loss of muscle coordination or twitching muscles
  • Rapid heart rate
  • High blood pressure
  • Muscle rigidity
  • Confusion
  • Dilated pupils
  • Heavy sweating
  • Diarrhea

The life-threatening effects of serotonin syndrome include:

  • Seizures
  • Unconsciousness
  • High fever
  • Irregular heartbeat

If you suspect that you or a loved one has succumbed to tramadol overdosed or is showing signs of serotonin syndrome, please call 911 immediately or go to the nearest emergency room.

Tramadol Abuse Statistics

  • In 2016, almost 19.5 million tramadol prescriptions were written, according to
  • The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that between 2005 and 2011, tramadol related emergency department (ED) visits increased by 250 percent.
  • Illustrating the dangers this drug poses to older adults, SAMHSA also states that between 2005 and 2011, tramadol-related ED visits for patients 55 and up rose by 481 percent.
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