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.
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 RxList.com. When someone begins to exhibit addiction, their tramadol use will surpass the recommended dosage amount. They will also show specific signs of 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.
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:
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:
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.
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:
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.
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 MedlinePlus.gov:
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:
The life-threatening effects of serotonin syndrome include:
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.
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Mayo Clinic. (2017, January 20). Serotonin syndrome. from https://www.mayoclinic.org/diseases-conditions/serotonin-syndrome/symptoms-causes/syc-20354758
Mayo Clinic. (2019, May 01). Tramadol (Oral Route) Description and Brand Names. from https://www.mayoclinic.org/drugs-supplements/tramadol-oral-route/description/drg-20068050
Mayo Clinic Staff. (2019, May 14). Historically 'safer' tramadol more likely than other opioids to result in prolonged use. from https://www.sciencedaily.com/releases/2019/05/190514090953.htm
Osborn, C. O. (2019, January 31). How Long Does Withdrawal From Tramadol Last? from https://www.verywellmind.com/tramadol-withdrawal-4177612
Reddit. (n.d.). R/opiates – tramadol gets too much hate. from https://www.reddit.com/r/opiates/comments/asu9p0/tramadol_gets_too_much_hate/
RxList.com. (n.d.). Tramadol for Pain: Side Effects, Dosages, Treatment, Interactions, Warnings. from https://www.rxlist.com/consumer_tramadol/drugs-condition.htm