Search Results for: Tramadol

Tramadol Overdose

Tramadolis the generic name for the drug Ultram, which is an opioid painkiller medication prescribed to treat moderate to moderately severe pain in adults 1.

Opioid medications have a high addiction potential, and overdose can be deadly—in fact, a startling 17,536 people died in 2015 due to opioid painkiller overdose 2. Learning how to recognize the symptoms of a tramadol overdose may one day mean the difference between life and death.


Signs and Symptoms

People who abuse tramadol in any way put themselves at some risk of overdosing, though toxicity is rare when the drug is used in isolation. Typically, overdose occurs in the case of tramadol use in combination with other drugs, such as other opioids or antidepressants (SSRIs, in particular). If a user presents with any of the following symptoms, call for emergency medical help immediately 3, 4, 5:

  • Respiratory distress
  • Irregular heart rate
  • Irregular heart rhythm
  • Changes in pupil size
  • Unconsciousness
  • Vomiting
  • Pale or clammy skin
  • Hyperthermia
  • Muscle rigidity
  • Muscle pain
  • Limp or weakened body
  • Purple or bluish color to nails and lips
  • Seizures

It is important to remember that an overdose can become life-threatening. Waiting to call for emergency help may mean the difference between life and death for a suffering individual.


Discover how treatment can help you begin again.

Risk Factors

Abusing tramadol is the main risk factor when it comes to overdose. People abuse the drug by:

  • Taking it without a prescription.
  • TConsuming it at higher doses than prescribed.
  • TUsing it in a way other than intended (for example, snorting or injecting).

Doing any of the above puts a person in danger of overdosing. Abusing tramadol can also lead to the development of a tolerance, meaning the user will need more and more of the drug to get the desired effects. Tolerance can cause the user to take increasing doses, which further increases their risk of overdosing.

Relapse is another major risk factor for tramadol overdose. When a recovering person relapses, they do not have the same level of tolerance as they had before becoming abstinent. They may attempt to return immediately to their pre-abstinence dose, which may be too high for their body to handle without the built-up tolerance. This can result in a deadly overdose.

tramadol and alcohol

Combining tramadol with other drugs can lead to a new, more dangerous, symptom profile that also increases the person’s risk of overdose. When taken with certain kinds of drugs, such as alcohol, the breathing and heart rate problems associated with abuse may be pushed to lethal extremes.

Another risky combination is taking tramadol while concurrently taking antidepressants like selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), venlafaxine, and bupropion 6. This combination can drastically heighten the risk for seizures and serotonin syndrome, which is an atypical type of overdose involving neuromuscular hyperactivity, autonomic hyperactivity, and disrupted mental functioning 6.

The only safe way to take tramadol is to closely follow the doctor’s prescription guidelines since abusing it may lead to tolerance, dependence, addiction, or even a deadly overdose. Never share your prescription with someone who does not have a doctor’s recommendation and never take it in a way other than intended.


What to Do If You Overdose on Tramadol

If you or someone you care about experiences any of the above symptoms after ingesting tramadol, call 911 immediately.

Tramadol overdose can be a deadly condition, and only medical professionals can ensure the best treatment for the suffering individual. While waiting for emergency crews to arrive, note everything you can about the person’s condition to report to the medical team. In addition, ensure that the overdosing person is awake and upright if you can. If they have stopped breathing, a trained individual should perform CPR.

Once the medical team arrives, the person’s heart rate, breathing, temperature, blood pressure, and other vital signs will be closely monitored and symptoms addressed as required. Sometimes the use of a medicine that blocks the effects of opioids, naloxone, may be administered 7. Naloxone can quickly block and reverse the dangerous effects of opioid overdose, which may save the person’s life.

Preventing Tramadol Overdose

Getting help for a tramadol abuse problem is the first step toward preventing an overdose. Professional recovery programs can help people struggling with addiction learn how to cope with cravings and resist future abuse. Program options include:

  • Inpatient treatment programs: The patient stays at the treatment facility for a predetermined amount of time while engaging in therapy, counseling, and relapse prevention training.
  • Outpatient treatment programs: The patient lives at home and regularly attends the treatment program for therapy sessions and sobriety assurance.
  • Self-help groups: Free community-organized programs that help recovering individuals develop a support network of peers to help supplement formal treatment.

Overdose prevention begins with professional treatment. Don’t wait until it’s too late—a tramadol overdose can be fatal. Formal treatment programs can provide the sobriety support needed to get clean and stay abstinent. Call our treatment support hotline at 1-888-744-0069Who Answers? to find the right program and begin your recovery journey today.


References:

  1. Drug Enforcement Administration. (2014). Tramadol.
  2. National Institute on Drug Abuse. (2017). Overdose Death Rates.
  3. World Health Organization. (2014). Information sheet on opioid overdose.
  4. Substance Abuse and Mental Health Services Administration. (2016). Opioid overdose.
  5. World Health Organization. (2014). Tramadol.
  6. Sansone, R. A. & Sansone, L. A. (2009). Tramadol: Seizures, Serotonin Syndrome, and Coadministered Antidepressants. Psychiatry, 6(4). 17–21.
  7. Substance Abuse and Mental Health Services Administration. (2016). Naloxone.

7 Signs You May Be Addicted to Tramadol

Tramadol is an opiate analgesic prescribed for the treatment of moderate to moderately severe pain.

The drug works by changing the way your brain and nervous system respond to pain. Because Tramadol is a milder form of opiate medication, people falsely believe the drug is not addictive.

Tramadol dependence can develop after continued use and this can lead to addiction. For this reason, it’s important to take only as directed by your doctor. Here are 7 signs to look out for if you think you may be addicted to Tramadol.

#1. Physical dependence.

Physical dependence on Tramadol can develop over time with prolonged and increased use. If dependence has developed, you may notice the following withdrawal symptoms if you stop using the drug:1

  • Sweating
  • Panic
  • Nervousness
  • Nausea and vomiting
  • Uncontrollable shaking/tremor
  • Muscle spasm
  • Runny nose
  • Sneezing

  • Cold chills
  • Diarrhea
  • Cough
  • Difficulty sleeping
  • Pain
  • Seizures (rare, but possible with chronic use)
  • Hallucinations (rare)

#2. Compulsive use of Tramadol despite negative consequences.

What ultimately separates addiction from dependence is compulsively using the drug despite any harm it may be causing in your life. Harmful consequences may include [3]:3

  • Health issues.
  • Relationship problems.
  • Missing work.
  • Failure to uphold personal or professional responsibilities.
  • Financial issues.
  • Neglecting personal hygiene.

#3. Taking the drug to get high.

Do you find yourself taking Tramadol for its euphoric effects, release of inhibitions, and feelings of peace and well-being? If your answer to this question is “YES” and you aren’t taking the drug as prescribed by your physician, you may have an addiction.

Because the drug can become habit forming, abusing the drug occasionally can quickly escalate into a serious addiction, as tolerance develops and you need more of the drug to “get high”.

#4. Using the drug without a prescription, taking higher doses, or using the drug in a way other than prescribed.

You may be addicted to Tramadol if you find yourself taking the drug without a prescription and obtaining it illegally.

Another sign of addiction is taking the drug in a way other than prescribed (crushing pills, snorting, injecting, mixing with other medications, etc.) or taking the drug in higher doses. As the brain and body become accustomed to the drug, higher doses are needed to achieve the same effect. For this reason, addicts will often start increasing their dosage as a means of chasing the initial high.

#5. Psychological dependence.

If you’re addicted to Tramadol, you may experience psychological dependence. If you’ve been abusing the drug for long periods of time, you may start to have compulsive cravings for the drug and feel like you need it to cope with the stress of everyday life, with its “ups and downs.”

#6. Drug seeking behavior.

Drug seeking behavior is a classic sign of addiction. Common drug seeking tactics include:

  • Doctor shopping (visiting multiple doctors in order to obtain prescriptions).
  • Emergency room visits to obtain the drug.
  • Physician visits near the end of office hours.
  • Repeated “loss” of prescriptions.
  • Refusal to undergo examination, testing, or referral.
  • Reluctance to provide medical records.
  • Tampering with medications.

#7. Physical symptoms.

Using Tramadol even as prescribed can result in side effects. Abusing the drug can cause many health problems and adverse effects such as:1,4

  • Muscle aches.
  • Dizziness.
  • Persistent drowsiness.
  • Nausea and vomiting.
  • Constipation.
  • Loss of appetite.
  • Sweating.
  • Weakness.

  • Headache.
  • Dry mouth.
  • Heartburn/Indigestion.
  • Fever.
  • Trouble concentrating.
  • Sleep problems.
  • Mood swings.
  • Depression.

If you regularly experience any of the above physical symptoms, you may be addicted to Tramadol. Call 1-888-744-0069Who Answers? today to talk to a treatment support specialist today.

Sources

1. U.S. National Library of Medicine. (2016). Tramadol.
2. National Institute on Drug Abuse. (2007). The Neurobiology of Drug Addiction: 10: Addiction vs. Dependence.
3. National Institute on Drug Abuse. (2012). Is there a difference between physical dependence and addiction?
4. Rosenthal, Norman. (2010). Federal and Drug Administration. Important Drug Warning.

Snorting Tramadol

Tramadol is a medication prescribed to treat moderate to moderately severe pain in adults and, in its extended release forms, to manage certain chronic pain conditions. Similar to other pain medications like oxycodone, morphine, and hydrocodone, tramadol is an opioid and primarily produces its pain-relieving effects by interacting with opioid receptors in the body. Tramadol is known by the brand names 1,2:

  • ConZip.
  • Ultram.
  • Ultram ER.
  • Ultracet – tramadol + acetaminophen.

When tramadol was introduced to the pharmaceutical market, it was heralded as having minimal abuse potential and significantly less respiratory depressing effects than that of the other, more commonly prescribed opioid narcotics 3. Whereas other painkillers like OxyContin are Schedule II controlled substances in the U.S., tramadol products are schedule IV, which indicates a certain degree of increased safety and lower risk. For these reasons, tramadol is prescribed at high levels, with nearly 44 million prescriptions written in 2013 2. This marks a significant increase from the 23 million prescriptions written in 2008 4. This increase is notable in the fact that in 2008, tramadol was an unscheduled drug. Now, even with its noted dangers, it is prescribed at much higher rates.

Despite the perception of safety, however, tramadol can be—and often is—abused. The Drug Enforcement Administration reports that about 3.2 million people in the U.S. admitted misusing tramadol at some point in their lives 2. Tramadol abuse can occur in various ways, which include 1,5:

  • Using the drug without a prescription/using someone else’s prescription.
  • Taking more of the medication than recommended.
  • Taking the substance for reasons other than prescribed.
  • Using tramadol in ways other than prescribed, such as crushing and snorting it, to increase the effects/to get high.

Is tramadol the new OxyContin?
Read more about the similarities between these two opioids.

Does Snorting Tramadol Cause a Faster High?

Altering the way a substance is delivered into the body can significantly change its impact in regards to the speed, intensity, or duration of the effects. The speed of the high depends on how quickly the substance enters the bloodstream. In the case of tramadol, snorting will increase the speed at which the substance’s effects are felt compared to ingesting the medication in pill form 6,7.

When a substance is snorted, it is absorbed into the blood vessels in the nose. It is then transported to the heart before it is spread to organs in the body, including the brain 6. Once in the brain, the tramadol binds to opioid receptors 5. As with many of the opioid painkillers, tramadol interacts with a specific subtype of opioid receptors which, when stimulated, trigger an associated (and artificially large) release of dopamine into the system. This surge of dopamine registers as a rewarding high to someone abusing the drug 5. Excess dopamine release and the positive feelings associated with the phenomenon set the stage for an individual to develop an addiction to tramadol, or drugs like it.

A note about extended-release tramadol: Those looking to get high quickly might try to get their hands on extended-release versions of tramadol to abuse. These variations are formulated with higher doses and have built-in mechanisms in place, like a time-release coating, to steadily release the substance over a longer duration of time. Crushing the tramadol to snort it effectively disables the extended-release mechanism, which allows the high doses to be absorbed in a shorter-than-intended amount of time, potentially resulting in a more intense—and dangerous—high 7.


Side Effects of Snorting Tramadol

Even when used as prescribed, tramadol has many side effects. These include 1:

  • Insomnia.
  • Muscle tension.
  • Headache.
  • Shakiness.
  • Feeling nervous or worried.
  • Shifting moods/irritability.
  • Sexual dysfunction.
  • Problems with breathing.
  • Difficulty swallowing.
  • Hoarseness.
  • Hallucinations.
  • Dry mouth.
  • Heartburn.
  • Poor appetite.
  • Nausea and vomiting.
  • Constipation.
  • Drowsiness.
  • Loss of consciousness.
woman ground due to seizure

Many of these are related to the drug’s opioid nature. Unlike other opioids, though, tramadol has another layer of effects that comes from its ability to interact with additional neurotransmitters like serotonin and norepinephrine. like seizures and serotonin syndrome 3.

Seizure risk, in particular, is highest in those with an existing seizure disorder 3. However, excessive consumption of tramadol has been found to be a major risk for any abuser. One study found that slightly more than 50% of people that abuse tramadol will experience a seizure at some point 3.

Serotonin syndrome is a condition that has the potential to be very dangerous. It results from the availability of excessive levels of the serotonin in the brain due to higher production and release, as well as lowered reabsorption (reuptake) 3. The risk of serotonin syndrome increases if the person is using other medications that increase serotonin availability in the brain (such as antidepressants). Serotonin syndrome is known to cause 3:

  • Tremulousness.
  • Muscle rigidity.
  • Muscle spasms.
  • Muscle spasms.
  • Perspiration.
  • Quickened heart rate and breathing.
  • Agitation.
  • Confusion.

Finally, because snorting tramadol increases the speed of onset of effects as well as their intensity, this method of use is associated with an increased risk of addiction. With less time from consumption to experiencing the high and the strong concomitant surge of dopamine, the addictive association in the brain is strengthened.  Over time, the desire to snort tramadol may become as strong as the urge for food, water, sex, and love 5,6,7.

Sinus and Nasal Cavity Damage

In addition to the typical side effects of tramadol, snorting it also leads to a specific set of symptoms related to this method of administration 8:

  • An inability to smell.
  • Nosebleeds.
  • Runny nose.
  • Difficulty swallowing.

Although these effects are commonly linked to cocaine snorting, there is growing evidence to support that the same effects occur with long-term nasal insufflation of opioids. Snorting opioids can end with significant damage to the soft palate inside the mouth and destruction of the nasal septum 9,10.

Learn more about the frightening consequences of snorting at our page, Dangers of Snorting and Sniffing Drugs.


Can Snorting Tramadol Cause an Overdose?

pinpoint pupils eyes

Yes. Snorting tramadol increases the intensity of the effects, thereby increasing the risk of overdose. Snorting prescription opioids has been found to be a risk factor contributing to non-fatal overdose 11. In fact, people with a history of snorting opioids were 3 times more likely to overdose 11.

This occurs because when the body is flooded with the substance, it becomes overwhelmed by the level of tramadol. This risk is much lower when the substance is used as directed, as serum concentrations of the drug rise in a much more controlled manner.

Using tramadol with other drugs that depress the central nervous system, like alcohol, other opioids, or benzodiazepines like Valium, also contributes significantly to increased risk of overdose 5. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), emergency room visits more than tripled from less than 6,300 in 2005 to more than 21,600 in 2011 4. Only about 30% of these visits involved tramadol alone, while 52% involved the combination of tramadol with 2 or more other drugs.

Signs of tramadol overdose include 1:

  • Pinpoint pupils.
  • Profound, global muscle weakness.
  • Cyanotic skin, cold to the touch.
  • Labored, slowed, or altogether stopped breathing.
  • Marked drowsiness.
  • Dangerously slowed heart rate.
  • Unrousable loss of consciousness.
  • Coma.

In addition, an overdosing tramadol user may also experience seizures or serotonin syndrome (as described above).


Signs That Someone is Addicted to Tramadol

Knowing that someone is addicted to tramadol can be challenging to identify, especially if they have been prescribed the medication at some point. A primary indicator of tramadol addiction is reflected in the compulsive drug seeking and using behavior that occurs regardless of the negative outcomes. People addicted to tramadol will 12:

  • Have increased problems focusing on other life priorities like work or school.
  • Shift their social networks towards different friends or have more conflict with loved ones.
  • Encounter increased legal or financial stress.
  • Make multiple attempts to quit or reduce use unsuccessfully.
  • Experience unpredictable changes in mood.

Someone snorting tramadol may leave clues to their use, including:

  • The appearance of white powder on their face, hands, or clothes.
  • The presence of tools used to crush and snort the substance.
  • Behavioral changes like frequent sniffing or rubbing of the nose.

Getting Help for Tramadol Addiction

When someone dependent on tramadol suddenly slows or quits using the drug, they will often undergo a very uncomfortable withdrawal syndrome marked by 2:

  • Flu-like symptoms.
  • Restlessness.
  • Strong cravings that encourage further use.

Additionally, one out of ten people withdrawing from tramadol will experience atypical withdrawal symptoms that include 2:

  • Hallucinations.
  • Paranoid and delusional thinking.
  • Severe anxiety.
  • Panic attacks.
  • Confusion.
  • Numbness in the hands and feet.

The atypical psychological symptoms of tramadol withdrawal may distort the user’s judgment and decision-making and cause them to behave abnormally or even dangerously. Because of this, medically-assisted detoxification can be a great option to safely manage the acute symptoms of withdrawal. After detox, tramadol addiction treatment may begin and will include behavioral therapy that will help recovering users to develop skills to understand addiction and engage in a drug-free lifestyle 13. Learn more about what happens after detox on our Tramadol Withdrawal page.

If you know of someone that is having problems due to snorting tramadol or if you snort tramadol yourself, help is available. Substance abuse treatment can save your life. To begin the process, call 1-888-744-0069Who Answers? today.


References:

  1. U.S. National Library of Medicine: MedlinePlus. (2016). Tramadol.
  2. Drug Enforcement Administration. (2014). Tramadol.
  3. Sansone, R. A., & Sansone, L. A. (2009). Tramadol: Seizures, Serotonin Syndrome, and Coadministered Antidepressants. Psychiatry, 6(4), 17–21.
  4. Substance Abuse and Mental Health Services Administration. (2015). The DAWN Report: Emergency Department Visits for Drug Misuse or Abuse Involving the Pain Medication Tramadol.
  5. National Institute on Drug Abuse for Teens. (2016). Prescription Pain Medications: Opioids.
  6. National Institute on Drug Abuse. (2007). The Neurobiology of Drug Addiction.
  7. National Institute on Drug Abuse. (2014). America’s Addiction to Opioids: Heroin and Prescription Drug Abuse.
  8. National Institute on Drug Abuse. (2016). DrugFacts: Cocaine.
  9. Rosenbaum, C. D., Boyle, K. L., & Boyer, E. W. (2012). Nasopharyngeal Necrosis After Chronic Opioid (Oxycodone/Acetaminophen) Insufflation, Journal of Medical Toxicology, 8(2), 240–24.
  10. Greene, D. (2005). Total Necrosis of the Intranasal Structures and Soft Palate as a Results of Nasal Inhalation of Crushed OxyContin. Ear, Nose, Throat Journal, 84(8), 512, 514, 516.
  11. Silva, K., Schrager, S. M., Kecojevic, A., & Lankenau, S. E. (2013). Factors associated with history of non-fatal overdose among young nonmedical users of prescription drugs. Drug and Alcohol Dependence, 128(0), 104–110. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4184803/
  12. National Institute on Drug Abuse. (2016). What to Do If Your Adult Friend or Loved One Has a Problem with Drugs.
  13. National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide.

Shocking Threats Swirl Around Tramadol Abuse

Though Tramadol hasn’t yet achieved the publicity other opioids have in the states, it sure is making waves abroad.

Earlier this month, it was revealed that tramadol, an addictive synthetic painkiller believed to be as powerful as morphine, is claiming more lives in Northern Ireland than any other drug – including heroin and cocaine. And shockingly, it remains unregulated…on the recommendation of the World Health Organization (WHO) – something that’s helped spread abuse and addiction among developing and developed countries alike.

The Spread of Tramadol and Violence

Tramadol is a prescription opiate medication, but it’s regularly sold as an alternative narcotic on the black market. Simply put; tramadol is cheaper and more accessible.

Although it’s not a traditional street opioid, tramadol can produce a euphoria comparable to heroin, even at a single dose of 75 mg. It acts as a stimulant, but recreational users are quick to point out that tramadol doesn’t come with the cognitive impairment of OxyContin and other opioids. Its effects can also last for up to 12 hours – far longer than other painkillers.

Make no mistake; there are significant dangers involved with tramadol abuse. Not only are the withdrawal symptoms excruciating (therefore making it quite difficult to quit using it), but overdosing is quite common. Symptoms can involve seizures and a fast collapse.

And it’s no longer just the tramadol abusers who are facing danger; doctors in several countries are now being harassed and attacked by patients seeking the drug. Tom Black, a senior doctor with more than 20 years’ experience and chair of the British Medical Association’s GP committee, perfectly highlights the frightening situation.

“You can see the same names popping up looking for appointments to come in and they won’t leave the room without them (prescriptions),” said Dr Black. “Some of them threaten you, some of them threaten violence, and obviously that’s not acceptable and we won’t put up with that.”

“They literally won’t leave the room and they face you down,” he said.

Too Little, Too Late?

International regulators now realize tramadol is heavily abused in some places, but they are in a tight spot. When a drug comes under regulation, it can become difficult for doctors in poor countries to obtain it for legitimate use. And in African nations, such as Cameroon, tramadol is the only opioid available for people with cancer and post-surgical pain, leaving many to consider it an essential drug.

In the U.S., where citizens are already battling an opioid epidemic of their own, tramadol misuse is finally being recognized. In fact, it was reported that emergency-room visits related to tramadol misuse has more than tripled in 2011 from 2005, to 21,649.

Image Source: iStock

Tramadol Withdrawal

Tramadol is an opioid medication that works to relieve moderately severe pain by changing the way that the brain and nervous system perceive and respond to pain 1,2. The substance was prescribed more than 43 million times during 2013 according to the Drug Enforcement Administration (DEA) 2. In the U.S., tramadol is marketed under a number of brand names, including:

  • Ultram and Ultram ER.
  • Ultracet.
  • ConZip.

Like other pain medications including codeine, oxycodone, and hydrocodone, tramadol is an opioid painkiller and, like those other drugs, it carries the risk of abuse and dependence, alongside other unwanted effects of use like 1:

  • Drowsiness.
  • Headache.
  • Insomnia.
  • Mood changes.
  • Constipation.

If you’re struggling with a tramadol dependence and wish to quit, you may find you need help to do so. Quitting may trigger the onset of uncomfortable withdrawal symptoms that make staying off tramadol a significant challenge for many. Call 1-888-744-0069Who Answers? to find help today.


What Is Tramadol Withdrawal?

To better understand the issue of tramadol withdrawal, it is helpful to understand how the substance triggers the development of tolerance and physical dependence. When used, the substance interacts with opioid receptors, which leads to an alteration in pain perception, but also an accompanying increase in dopamine activity in the brain. Increases in dopamine neurotransmission such as this can lead to feelings of reward that encourage continued use 2,3,4.

When take appropriately, it can be used to safely manage pain. However, when misused, the risks of both physical dangers and addiction increase. The DEA reports that 2:

  • In 2012, 3.2 million people reported having abused tramadol at some point in their lifetime.
  • In 2011, about 20,000 people presented to emergency departments due to complications related to tramadol misuse.

With time and continued use, the standard dose of tramadol will begin to elicit diminishing subjective effects. This decline in efficacy is explained by a phenomenon known as tolerance. To counteract the development of tolerance, users often begin to take increasingly large doses. With ever-increasing levels of tramadol in the system, the brain grows more accustomed to its availability and begins to depend on the substance to operate normally. At this point, the user is said to have become physically dependent on the opioid 3,4.

When a person that is physically dependent on the substance drastically decreases or abruptly stops use, an unpleasant withdrawal syndrome may occur 5. In the case of an acute withdrawal, the brain reacts to a relative deficit in activity of 2,3:

  • Dopamine, a neurotransmitter related to motivation, pleasure, emotion, and movement.
  • Serotonin, a neurotransmitter involved in sleep, emotion, and movement.
  • Norepinephrine, a neurotransmitter linked to attention, energy, and response to stress.

Note that it is not addiction, but rather the presence of physical dependence, that signals the likelihood of experiencing withdrawal symptoms. You can be addicted and not dependent, and vice versa. In fact, even someone taking it according to a prescription (not abusing it) may become dependent and experience withdrawal upon ending use of the drug 4,5.

The time needed to become dependent on tramadol will vary widely according to factors like duration of use, frequency of use, and dose 5.


Is Tramadol Withdrawal Dangerous

People that withdraw from tramadol will experience withdrawal effects quite similar to those associated with other types of opiate withdrawal. Tramadol withdrawal is often marked by flu-like symptoms and strong cravings for more tramadol 2,6:

detox psychological evaluation

Tramadol withdrawal is rarely life-threatening. The most common risk of tramadol withdrawal is the risk of relapse. Because of the severe nature of the withdrawal, it is not uncommon for those attempting to stop using to abandon their efforts in an attempt to stop the discomfort. Avoidance of withdrawal is, in fact, a major perpetuator of addiction.

Additionally, if the cravings become more difficult to resist, the individual may be compelled to resume use with a large dose and, in doing so, increase their risk of overdose.

NOTE: Certain psychological dangers may arise in a small percentage of people going through withdrawal. See “Atypical Withdrawal Symptoms” below for more information.


Signs and Symptoms

In general, 90% of tramadol users will have signs and symptoms that are common to other opioids. The other 10% may experience atypical withdrawal symptoms (described below).

The normal acute withdrawal symptoms will begin within a day or two of last use and continue for approximately 4 to 10 days 8. During this time, the withdrawal symptoms will change and develop.

Early in the process, the individual is likely to experience 5,6,8:

  • Anxiety.
  • Agitation.
  • Muscle aches and pain.
  • Fever.
  • Poor sleep.
  • Runny nose.
  • Watery eyes.
  • Increased sweating.
  • Frequent yawning.

After some time, these effects will give way to later symptoms of tramadol withdrawal like 5,6,8:

  • Cramping in the abdomen.
  • Dilated pupils.
  • Diarrhea.
  • Goose bumps.
  • Nausea and vomiting.
  • Muscle spasms.

Even when these acute symptoms of withdrawal fade, the individual is at risk of enduring protracted withdrawal 8, which is also known as post-acute withdrawal syndrome (PAWS), or extended withdrawal.

Protracted withdrawal involves symptoms that continue for a period longer than the expected timeframe. Protracted withdrawal symptoms can grow, change, and develop for weeks or months after the acute withdrawal period has ended. Protracted withdrawal symptoms associated with tramadol discontinuation include 8:

  • Anxiety.
  • Depression.
  • Poor sleep.
  • Fatigue.
  • Emotional blunting.
  • Irritability.
  • Poor focus and concentration.


Atypical Withdrawal Symptoms

Tramadol is unlike other opioid painkillers such as oxycodone, in that it relieves pain by way of two different mechanisms: 1) by stimulating opioid receptors and 2) inhibiting serotonin and norepinephrine reuptake. temporarily raising the activity of those neurotransmitters in the brain. Due to the fact that it is atypical in this way, some users will actually experience a whole set of symptoms not normally seen in opioid withdrawal.

anxiety tramadol withdrawal

This atypical withdrawal syndrome include a range of psychological symptoms marked by 2,7:

  • Hallucinations.
  • Intense paranoia.
  • High anxiety and panic.
  • Confusion and disorientation.
  • Depersonalization.
  • Unusual sensory experiences including numbness and prickling in the hands and feet.

Again, these symptoms might not be dangerous themselves, but they can lead to dangerous situations. People that are experiencing visual or auditory hallucinations, paranoia, and delusions can make poor choices—particularly so if these psychotic symptoms have a theme of persecution 7. The user’s safety and those around them may be at risk in these situations.


Tramadol Detox

The body has a natural ability to process and remove harmful toxins. This method is called detoxification. In terms of substance abuse treatments and procedures, detoxification is a group of strategies used to manage intoxication and withdrawal. The primary goal of detoxification is to minimize the harm caused by the substance. It is accomplished through 4:

  • Evaluation. In this stage, medical, psychological, and social factors are evaluated to determine the best course of action.
  • Stabilization. During this stage, the individual will receive medical supervision and psychological support to achieve a drug-free state.
  • Encouraging further treatment. Because detox is not a complete treatment for substance abuse, further treatment is recommended for sustained recovery.

Detox can take place in a number of settings, from inpatient hospitalization to regular visits in a treatment center. The appropriate setting will depend on factors like the individual’s 4:

  • Level of dependence.
  • How much support the recovering user has.
  • Living conditions.
  • Risk of violence and suicide.
  • Transportation.

What Happens After Detox?

A focus of detox will be to connect the person to follow-up treatment to maintain abstinence. Like detox, continuing treatment can occur in an inpatient, residential, or outpatient setting.

Tips to Handle Cravings

Since cravings are an expected part of tramadol withdrawal and recovery, you will need strong strategies to manage cravings like 10:

  • Delay, distract, and decide when faced with the choice to use, rather than making impulse decisions.
  • Speak positively to yourself about your ability to manage these cravings.
  • Use relaxation and imagery techniques to build a sense of calm and control over unwanted thoughts.

Beneficial treatment styles to support recovery include 4:

  • Cognitive Behavioral Therapy (CBT) – A treatment that investigates the connectedness of thoughts, feelings, and behaviors to understand triggers of use and methods to prevent relapse.
  • Motivational Interviewing (MI) – A style that strives to increase the person’s own internal motivation for change.
  • Contingency Management (CM) – A method that provides immediate, tangible rewards to people in recovery for completing recovery-focused activities and behaviors.
  • Family Therapy—A general term that applies to the inclusion of family members and significant others in treatment to reinforce healthy habits.

If you need help quitting tramadol, don’t wait. Treatment programs are available to help you end your use for good. Call 1-888-744-0069Who Answers? to learn more.


References:

  1. S. National Library of Medicine: MedlinePlus. (2016). Tramadol.
  2. Drug Enforcement Administration. (2014). Tramadol.
  3. National Institute on Drug Abuse. (2014). Research Report Series: Prescription Drug Abuse.
  4. National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide.
  5. S. National Library of Medicine: MedlinePlus. (2016). Opiate and Opioid Withdrawal.
  6. Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.
  7. Rajabizadeh, G., Kheradmand, A., & Nasirian, M. (2009). Psychosis following Tramadol Withdrawal. Addiction & Health, 1(1), 58–61.
  8. Substance Abuse and Mental Health Services Administration. (2010). Protracted Withdrawal.
  9. S. Food and Drug Administration. (2016). FDA Approves First Buprenorphine Implant for Treatment of Opioid Dependence.
  10. Australian Government: The Department of Health. (2003). Phase 4: Strategies to Cope with Cravings.

Infographic: Tramadol Timeline

Tramadol was once thought of as one of the safest opioid painkillers; however, it has become a drug of abuse with an acknowledged addictive potential. Concerns over tramadol abuse and addiction have risen sharply in recent years.

View the infographic below to see how tramadol moved from a safe alternative to a major point of interest in the opioid epidemic.

Tramodol Timeline

Welcome to a New Tramadol Nightmare

People seeking safe opiate detox in Alaska were recently left out in the cold – in more ways than one. Only two state facilities currently offer detox services to Alaskans – and both of them were recently shut down, thanks to one of the DEAs newer classification regulations.

Red Tape to the Rescue?

Neither of the detox facilities were administering new or highly controversial drugs; they weren’t understaffed or under-financed. So…what changed?

One word: Tramadol.

The drug itself didn’t change, but its DEA classification did. In 2014, the Drug Enforcement Administration re-classified tramadol, making it a Schedule IV controlled substance. What does this mean? The drug now has additional regulations on its use. Specifically, the DEA ruled that only DEA-certified medical providers could administer tramadol for detox.

What that ruling translated to in Alaska was a shutdown of detox programs. The physician’s assistants that were administering tramadol could no longer legally do so. They didn’t have the newly required DEA-certification, which meant they were violating federal regulations. Without qualified staff on-site, both facilities could no longer take opiate detox patients.

Tramadol 101

Tramadol is an opiate, but it’s often used to wean people off other opiates such as Oxycontin or heroin. Once thought of as a “safe alternative” to opiates, tramadol abuse has become a real issue. In fact, it was the rising tide of tramadol abuse that ultimately prompted the DEA to change its classification.

  • In 2011, tramadol sent over 20,000 people to the emergency room.
  • In 2012, 3.2 million people used Tramadol for non-medical purposes.

Two years after the classification change, both Alaska detox centers realized they had been operating in violation of the new federal standards. Hoping to avoid huge fines and stiff penalties, facility directors shut the doors and self-reported to the DEA.

What Happens Now?

The Ernie Turner Center in Anchorage and the Gateway to Recovery Center in Fairbanks offered the only opiate detox beds in the state of Alaska. Staff at both facilities are currently working on plans that will eventually allow them to offer safe opiate detox without violating regulations. With our nation’s opiate epidemic showing no signs of slowing, there’s simply no time to waste. We need all hands on deck.

Image Source: iStock

The Rise of Tramadol: Exploring the Dangers and Conversations Around This Opioid

header

Tramadol, also known as Ultram, is a prescription opioid medication used for the treatment of postoperative pain, cancer-associated pain, and chronic pain conditions. While Tramadol is similar to other prescription opioid pain relievers such as OxyContin and Vicodin, it has a variety of additional effects that uniquely set it apart. Tramadol has slightly different interactions with opioid receptors than these other narcotic painkillers. In addition, it can also alter levels of the neurotransmitters serotonin and norepinephrine, similar to the effects of some antidepressant medications.

Although Tramadol has been considered a “weaker” opioid than other opioid pain relievers, and is often viewed as having less susceptibility to recreational abuse, Tramadol’s multiple mechanisms of action can make it particularly dangerous in cases of overdose. Tramadol can increase the risk of seizures and other harmful conditions such as serotonin syndrome, and can have a variety of interactions with other medications that prescribers and patients may not be aware of.

We’ve examined trends in the prescribing and abuse of Tramadol, as well as public discussions surrounding the drug and its risks. Those taking Tramadol, whether by prescription or illicitly, should keep in mind the potential dangers that can be associated with this medication.

Yearly Prescriptions Issued for Tramadol

asset-1

In comparison to many other opioid painkillers, the development of Tramadol is relatively recent. At the same time that the United Nations was already labeling oxycodone (used in OxyContin) as a dangerous drug in the 1960s, Tramadol was being synthesized by a German pharmaceutical company.

The drug was intended to serve as an alternative painkiller with a lower risk of respiratory depression – a potentially fatal side effect of opioids which can cause a person to stop breathing. Tramadol did not reach the German market until 1977 and was not approved by the United States Food and Drug Administration until 1995.

Today, Tramadol is used extensively in the U.S. and has seen an almost meteoric rise. From 2008 through 2013, prescriptions of Tramadol in the U.S. have increased from 23.3 million a year to 44 million. The growth of Tramadol prescriptions has outpaced that of other opioid pain relief medications such as oxycodone/acetaminophen (Percocet) as well as hydrocodone/acetaminophen (Vicodin, Lortab, Norco).

One reason for this disparity may be that Tramadol was only recently rescheduled by the Drug Enforcement Administration to Schedule IV in 2014. Around the same time, hydrocodone-containing medications such as Vicodin were classified under the stricter Schedule III but were being rescheduled to the even more stringent Schedule II. As other painkillers become more difficult for patients to access due to increasing regulation, prescribers may prefer Tramadol instead.

Tramadol Discussions on Reddit

asset-3
The social news–sharing site reddit.com has become host to many discussions about Tramadol, opioid painkillers in general, and other drugs. Reddit now features a variety of frank conversations about both medical and illicit use of substances, as users can start their own communities on the site and use pseudonyms to discuss these topics anonymously. It offers a valuable resource for examining the real experiences of individuals taking Tramadol.

We searched Reddit for mentions of Tramadol, then tabulated sections of the site – “subreddits” – to see which host the most conversations about this drug. The Drugs subreddit, which is largely focused on the recreational and illicit use of substances, placed first out of all subreddits with 1,399 mentions of Tramadol; many of these mentions highlight the dangers of misusing this drug. This section contains questions and self-reports such as the following:

The Opiates subreddit, which focuses specifically on opiate and opioid drugs, was a close second. It featured 1,376 total Tramadol mentions, seen in topics like “Too much tramadol, advice” and “Be careful with Tramadol.

Outside of these specifically drug-focused sections, mentions of Tramadol are much less common. Home to 11.2 million readers, the AskReddit section, a large, general-purpose forum for nearly any question, placed third with only 395 instances of Tramadol in discussions.

However, the Kratom section – with about 8,500 readers – places fourth with 371 Tramadol mentions. Kratom is a leaf with narcotic effects commonly found in Southeast Asia and used with increasing frequency in the U.S. Many users in this section report recreationally taking kratom with Tramadol at the same time.

Medically Recommended Uses of Tramadol

When taken as directed, Tramadol is intended to be used for the treatment of moderate to severe pain. Doctors may prescribe Tramadol to be taken on an as-needed basis or in an extended-release form for around-the-clock pain management.

Tramadol can still cause slowed or stopped breathing, and should not be taken in larger amounts than prescribed. Crushing or chewing of extended-release Tramadol pills can lead to potentially fatal overdoses. Tramadol should not be taken after recently using other narcotics, sedatives, tranquilizers, or alcohol. It should not be taken with other around-the-clock narcotic pain relievers.

Illicit and Recreational Use of Tramadol

Tramadol has long been reported to be diverted from its intended usage as a prescription medication and abused recreationally. Similar to other opioid medications, users of Tramadol can develop a physical dependence and addiction to the drug, and taking higher doses is associated with greater likelihood of developing addiction. However, this susceptibility to abuse may also be due to Tramadol’s unique mechanisms of action in addition to its opioid effects.

Medications like naltrexone, which prevent the action of narcotic drugs at the body’s opioid receptors, are only partially effective at blocking the effects of Tramadol. And Naloxone (Narcan), commonly used as an emergency-rescue drug for those experiencing an opioid overdose, reportedly reverses only 30 percent of Tramadol’s activity. Abuse of Tramadol in higher doses can be associated with a greater risk of seizures as well as stopped breathing, and naloxone may not be effective at preventing seizures in cases of Tramadol intoxication.

The metabolism of Tramadol is affected by the CYP2D6 liver enzyme, and the activity of this enzyme can vary widely between individuals and can be influenced by numerous other medications. This can make even identical doses of Tramadol unpredictable when used in different people. Those who are predisposed to metabolizing Tramadol at different rates may be exposed to more severe effects of the drug, and they can even fatally overdose from normal clinical doses.

Tramadol Abuse in the News

With prescriptions of Tramadol on the rise, incidents involving its side effects as well as its illicit use and sale have increasingly made headlines. In early 2016, Libyan security discovered a shipment of 45 million Tramadol pills being smuggled into the country from India. A stunning 130 million Tramadol pills had been seized at the same port in the year prior. Illicit Tramadol has been confiscated within the U.S. as well; officials seized over 3,000 pills from an Ohio home in 2016.

Several members of a New Zealand rugby team were also found to have recreationally taken Tramadol and energy drinks at the same time, a potentially life-threatening combination. Tramadol’s interaction with other substances can be fatal: the use of alcohol while taking Tramadol recently led to the death of an 18-year-old in Belfast, Ireland.

Tramadol has also drawn attention in professional cycling. Some high-profile riders are reportedly given Tramadol during difficult stretches of cycling tours to mask pain and enhance performance. Altogether, an estimated 5.2 percent of professional cyclists are using Tramadol. While the World Anti-Doping Agency does not currently ban the use of Tramadol, advocacy groups have campaigned to have the drug prohibited from use by riders.

Tramadol Use and Sizures

asset-8

Recreational use of high doses of Tramadol is associated with an increased risk of seizures or convulsions. In one study, 48 percent of patients with severe Tramadol poisoning also experienced seizures. However, some individuals taking Tramadol in normal, prescribed doses have nevertheless had seizures as well. Tramadol-associated seizures have been linked to a condition known as serotonin syndrome, where excess levels of serotonin result in a potentially life-threatening bodily crisis. Use of Tramadol while taking other medications that affect serotonin, including many modern antidepressants, can increase the risk of serotonin syndrome. In one study, use of paroxetine at the same time inhibited the metabolism of Tramadol and increased systemic exposure to Tramadol by 37 percent. Despite this risk, physicians continue to prescribe Tramadol at nearly the same rate to patients who are taking SSRI antidepressants as they do to those who are not.

We searched for mentions of seizures alongside Tramadol in comments on Reddit, identifying which sections of the site feature the most discussion about this dangerous side effect. While the Drugs subreddit placed first for overall discussions of Tramadol, with 38.9 percent of such discussions, it also placed first for conversations about seizures while taking the drug. This illustrates that many recreational Tramadol users are aware of this risk or may have even experienced seizures. Similarly, the Opiates subreddit, which nearly tied with the Drugs forum for overall Tramadol mentions on Reddit, also was host to 22.19 percent of comments discussing Tramadol and seizures.

asset-10 (3)

In addition to posts discussing seizures and Tramadol, we also tracked other terms that were mentioned alongside Tramadol in comments on Reddit to determine which Tramadol-related phrases were most commonly used. With 147 occurrences overall, the most frequently appearing phrase was “mg of Tramadol.” It was often seen in posts in the Drugs subreddit that discuss dosages of Tramadol being bought, sold, or taken recreationally. The phrases “dose of Tramadol” or “doses of Tramadol” placed second with a total of 75 mentions. Users posted these expressions in reference to their dosage experiences. “Codeine and Tramadol” was the third most frequently used phrase with 66 mentions, typically seen in the context of comparisons between these two opioid drugs, their effects, and their addictive potential.

Tramadol and Fatal Overdoses

asset-12 (3)

While fatalities due to Tramadol use are rare overall, hundreds of overdose deaths caused by Tramadol have occurred from 2006 to 2013. The number of accidental deaths worldwide due to Tramadol – 265 over this period – is less than half the number of intentional suicides using Tramadol (557). The U.S. makes up the vast majority of both of these categories when compared with worldwide rates, with 212 accidental deaths and 525 suicides from 2006 to 2013.

Finding Help for Tramadol Dependence and Addiction

Tramadol is mostly used for the effective treatment of various pain conditions. At the same time, this drug is habit-forming like other opioid pain relievers. It can cause uniquely hazardous side effects when used in excess. As we’ve seen, addiction to Tramadol can place substance users at risk of life-threatening symptoms, especially when taken with other drugs.

If you or someone you know is struggling with Tramadol use or dependency, DrugAbuse.com can help. With professional rehab and treatment programs that are tailored to fit your lifestyle and personal needs, you’ll get the assistance you need to overcome substance abuse. Contact DrugAbuse.com today at 1-888-744-0069Who Answers?, and begin taking your life back from addiction.

Sources

  • //www.drugabuse.com/library/tramadol-history-and-statistics/
  • http://www.cesar.umd.edu/cesar/drugs/oxycodone.asp#history
  • http://www.who.int/medicines/areas/quality_safety/5.2TramadolCritReview.pdf
  • http://www.emedexpert.com/facts/tramadol-facts.shtml
  • https://www.imshealth.com/files/web/Corporate/News/Top-Line%20Market%20Data/US_Top_25_Medicines_Dispensed_Prescriptions.pdf
  • https://www.imshealth.com/files/web/IMSH%20Institute/Reports/Medicines_Use_and_Spending_Shifts/Medicine-Spending-and-Growth_1995-2014.pdf
  • http://www.deadiversion.usdoj.gov/fed_regs/rules/2014/fr0702.htm
  • http://www.deadiversion.usdoj.gov/fed_regs/rules/2014/fr0822.htm
  • https://www.reddit.com/r/Drugs/comments/1e6kka/help_tramadol_withdrawals/
  • https://www.reddit.com/r/Drugs/comments/3l97jd/tramadol_a_warning_not_the_usual_warning/
  • https://www.reddit.com/r/Drugs/comments/1g1tp7/tramadol_seizure_risk/
  • https://www.reddit.com/r/opiates/comments/3duwop/too_much_tramadol_advice/
  • https://www.reddit.com/r/opiates/comments/3wve5t/be_careful_with_tramadol/
  • http://www.nytimes.com/2016/01/03/us/kratom-an-addicts-alternative-is-found-to-be-addictive-itself.html?_r=1
  • http://www.drugs.com/tramadol.html
  • http://www.deadiversion.usdoj.gov/drug_chem_info/tramadol.pdf
  • http://www.samhsa.gov/data/sites/default/files/report_1966/ShortReport-1966.pdf
  • http://www.drugandalcoholdependence.com/article/S0376-8716%2812%2900382-1/abstract
  • https://www.sciencedaily.com/releases/2012/09/120926123813.htm
  • http://onlinelibrary.wiley.com/doi/10.1111/anae.12972/abstract
  • http://www.ncbi.nlm.nih.gov/pubmed/22809771
  • http://www.libyaobserver.ly/inbrief/45-million-tramadol-pills-seized-tobruk-port
  • http://wkbn.com/2016/03/17/pain-pills-cash-seized-in-youngstown-drug-raid/
  • http://www.stuff.co.nz/sport/league/79549210/warriors-players-abused-relationship-with-their-doctor-in-taking-prescription-drugs
  • http://www.u.tv/News/2016/05/03/Funeral-held-in-west-Belfast-for-Aaron-Strong-58380
  • http://www.cyclingnews.com/news/tramadol-abuse-in-the-cycling-peloton/
  • http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4268194/
  • http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3550327/pdf/13181_2009_Article_BF03161089.pdf
  • http://www.cmaj.ca/content/185/8/E352.full
  • http://onlinelibrary.wiley.com/doi/10.1002/pu.20187/abstract
  • http://www.clinicaltherapeutics.com/article/S0149-2918%2815%2900437-3/abstract
  • http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm
  • http://www.who.int/medicines/areas/quality_safety/6_1_Update.pdf

Methodology

Using Google’s BigQuery, we pulled a year of Reddit comments that contained “Tramadol.” From there, we used WordStat to analyze the comments and find common terms and their frequency within these comments.

Please note that this page is not meant to provide any diagnosis or medical advice. If you have a question about your Tramadol use, or that of a loved one, please contact your physician, health care professional, or our treatment helpline.

Newsflash: Tramadol Really is an Opiate

For years, tramadol was thought of as a safe alternative to opiates. It was viewed as less habit-forming and easier to tolerate than its “stronger” counterparts like oxycodone. Doctors handed out free samples of Ultram (tramadol’s brand name), with little restriction on usage due to its drug classification.

Then things sort of fell apart.

Did the drug change? No; tramadol was and has always been an opiate – so why the sudden turn-about?

Digging for the Truth

The DEA defines tramadol as a “centrally acting opioid analgesic.” Centrally acting refers to its interaction with the central nervous system, while analgesic simply means “painkiller.” In short, tramadol binds with opioid receptors in the central nervous system and blocks pain signals.

So, what did change? Awareness. Members of the healthcare industry began to see that patients experienced severe reactions to tramadol. It seemed the drug’s potency had been underestimated. Like other opiates, they realized this drug is addictive and has a high risk of abuse.

Potential Dangers

Structurally similar to other opiates like codeine and morphine, tramadol is dangerous. People have experienced severe side effects while taking tramadol. These side effects include:

  • Vomiting
  • Constipation
  • Headache
  • Nausea
  • Drowsiness
  • Dizziness
  • Difficulty Breathing
  • Depression
  • Seizures

People who stop taking it abruptly can experience withdrawal symptoms including diarrhea, pain, tremors, nausea, anxiety, sweating and insomnia.
Due to its interactions with brain receptors, tramadol can be habit-forming. Its euphoric effects are often sought by those abusing the drug. Increased tolerance combined with physical and psychological dependence create a cycle of addiction that can prove lethal.

What’s in a Name?

The rising use and abuse of tramadol prompted the FDA to issue an advisory in 2010. Doctors were directed not to prescribe tramadol to anyone suffering from depression or at risk for addiction. But this wasn’t enough. In fact, 2011 saw over 20,000 ER visits that were linked to tramadol.

In 2012, 3.2 million people were using tramadol for non-medical purposes. And by 2014, the DEA had seen enough evidence to classify tramadol as a controlled substance.

With this re-classification came stricter regulations. Now, tramadol prescriptions must be written on tamper-resistant prescription pads, the prescribing doctor must personally sign and date all prescriptions the day they are given and physicians cannot delegate signature authority.

In addition, tramadol prescriptions can only be given by a practitioner who has evaluated the patient in person. This means no more phone-in prescriptions without seeing the doctor. Limits on the length of prescriptions and number of refills are also in place. Tramadol can only be refilled up to five times within a six-month period after the prescription is written. At this point, a new prescription is needed.

Moving Forward

The truth about tramadol is slowly sinking in, but many are still unaware of the dangers involved with the use and abuse of this drug. Public awareness of this opiate must increase if we are to decrease the numbers at risk.

Image Source: iStock

Is Tramadol the New OxyContin?

People walking in city

The epidemic of painkiller addiction is well known, and OxyContin (oxycodone) has arguably been the most notorious prescription opioid at the center of this public health emergency. Drugs like OxyContin have filled the news in recent years due to rampant overprescribing, “pill mills,” and staggering rates of abuse.

To counteract the spiraling threat of opioid addiction, drug and medical care providers have taken numerous steps to formulate and dispense drugs that have a lower risk of abuse and dependence than many of the opioid analgesics (painkillers) that exist on the market. Tramadol (another opioid analgesic) was initially thought to be a “safe” alternative to other opiates. However, evidence is showing that abuse rates for tramadol are beyond what anyone expected and that the drug may actually be much more addictive than originally believed.

Don’t be fooled. Tramadol has very real dangers.
Learn more now.

Is Tramadol as Addictive as OxyContin?

The Food and Drug Administration (FDA) first approved tramadol for use in the US in 1994. Results from animal and human studies indicated that tramadol was less addictive than other opiates, so it was classified as a non-scheduled drug. This meant that tramadol was not regulated by the Drug Enforcement Administration (DEA), and there were far fewer restrictions on its use than other narcotic painkillers.

Some human studies have shown that high doses of tramadol have similar effects to oxycodone, an opioid painkiller with a well-known risk of abuse and dependence. Opioid abusers that were given high-dose tramadol reported that it gave them an enjoyable “high” that was similar to codeine and somewhat less intense than oxycodone 1. Subjects in another study were given a dose of tramadol often prescribed to patients, and they rated the drug as pleasurable and something they would like to “take again” 2.

In addition to positive effects, individuals taking tramadol sometimes experience withdrawal effects. These withdrawal symptoms have been reported both when tramadol is stopped suddenly and sometimes even when a doctor decreases a patient’s dose. Many of these symptoms of withdrawal are similar to those caused by withdrawal from other opiates, including oxycodone.

Tramadol’s Unique Withdrawal Symptoms

Tramadol withdrawal symptoms – somewhat unique amongst the opioid analgesics – may include 3:

  • Severe anxiety and panic attacks.
  • Confusion.
  • Delusions.
  • Paranoia.
  • Numbness.
  • Tingling.
  • Tinnitus (ringing in the ears).
  • Hallucinations.

Symptoms of acute opioid withdrawal may consist of some or all of the following 3:

  • Nausea.
  • Abdominal cramps.
  • Diarrhea.
  • Sweating.
  • Chills and goose bumps.
  • Muscular and/or bone aches and pains.
  • Lacrimation (watery eyes).
  • Rhinorrhea (runny nose).
  • Anxiety.
  • Depression.
  • Restlessness.
  • Insomnia.

Despite the similarities, there are also some important differences between tramadol and typical opioids. Most of these differences are due to the fact that tramadol not only activates opiate receptors but also increases the brain levels of two important neurotransmitters, serotonin and norepinephrine.

Tramadol’s actions on serotonin and norepinephrine contribute to its pain-relieving effects and also cause side effects and withdrawal symptoms not normally seen with other narcotics.

Tramadol’s unique effects also render the usual antidote for opioid overdose, naloxone, less effective in cases of tramadol overdose, making it more difficult to treat individuals who overdose on this drug.


OxyContin: The Well-Known Danger

In 2013, nearly 59 million oxycodone prescriptions were filled by US pharmacies 4, and its abuse has been a major concern in recent years.

Several studies have shown that when taken either in pill form or injected, oxycodone produced a “high” similar to that of heroin 5. Additionally, heroin-dependent participants in another study described oxycodone as the “Rolls Royce” of opioids and described it as producing a “smooth” high 6.

Following the introduction of an extended-release form of the drug – marketed as OxyContin –rates of oxycodone abuse skyrocketed. This is because each pill of OxyContin contains a high dose of the drug that is intended for slow, controlled release over several hours. However, abusers quickly discovered that by snorting or injecting crushed OxyContin tablets, they could release the full dose all at once and experience the full brunt of its extremely potent and dangerous effects.

Oxycodone is well known to result in the development of physical dependence and, ultimately, opioid addiction in individuals who abuse the drug. Long-time users who stop taking oxycodone suddenly often suffer from classic symptoms of opiate withdrawal.

Oxycodone has been recognized for its abuse potential since the 1960s. The allure of the opioid high is so strong, that problematic users are at high risk of progressing towards heroin abuse should they lose access to a steady supply of pills, or if oxycodone becomes too expensive—and both phenomena happen quite often. In fact, the transition of opioid-dependent individuals from pills to heroin has been largely blamed for the dramatic increase in heroin use in the last decade 7.


Tramadol: The Emerging Concern

close up of man looking upward

Concern is growing that tramadol may become the new opioid of choice for abusers. This drug has addictive potential, and studies in animals and humans have shown that it can produce a euphoric high similar to oxycodone and heroin. Concern is growing that tramadol may become the new opioid of choice for abusers. This drug has addictive potential, and studies in animals and humans have shown that it can produce a euphoric high similar to oxycodone and heroin.

Despite having similar effects to these drugs, tramadol is also up to 20 times cheaper than oxycodone and easier to get from Internet pharmacies 8. This is because, until 2014, tramadol was not a controlled substance and is still offered to those without a prescription by some less reputable online suppliers.

Because of concerns about the possibility of tramadol abuse, the prescribing and usage patterns of this drug were monitored for several years after it was first marketed in the US. After 3 years, abuse rates were reported to be fewer than 2 patients per 100,000 9, which seemed to confirm the idea that tramadol abuse was not a major issue. However, despite this early evidence suggesting that tramadol was not addictive, many experts remained concerned about possible abuse because nearly all known narcotics that activate µ-opioid (mu-opioid) receptors had eventually proven themselves addictive.

These concerns seem well founded according to the following statistics:

  • The National Survey on Drug Use and Health (NSDUH) reported that 2 million Americans aged 12 or older used tramadol for non-medical purposes in 2012 10.
  • Visits to emergency departments due to side effects of tramadol rose from just over 10,000 in 2005 to nearly 26,000 in 2010.

Because of the evidence of rising tramadol abuse and concerns over its potentially harmful effects, the DEA began regulating the drug as a Schedule IV controlled substance on July 2014 12. Schedule IV drugs are subject to governmental controls but are considered to have a relatively low potential for abuse and dependence.

In seeking public comments on the proposal to regulate tramadol, the DEA received more comments supporting the change than opposing it. One comment from a local prescription drug abuse task force summed up widespread concerns, designating tramadol as a “loophole” drug – both addictive and abused – with a deceptive status as a non-controlled substance leaving many patients and doctors unaware of its dangers 13.

It is very important to realize that abusing tramadol is dangerous, and can even be lethal. Some tramadol abusers crush pills with an extended release form of the drug (Ultram ER) in order to release a large dose all at once, similar in the way some individuals crush OxyContin tablets to get a more intense high. Just as with oxycodone, this method of abusing tramadol can have deadly consequences, especially because the traditional opiate antidote, naloxone, does not completely reverse tramadol overdoses.


The Lesser-Known Dangers of Tramadol

In addition to the typical dangers of an opioid drug, tramadol – with its atypical pharmacologic mechanism of action – can result in a few extra side effects that are relatively unknown but potentially lethal.

Ambulance rushing to scene

Increased serotonin levels in the brain due to excessive tramadol levels can lead to a potentially life-threatening condition known as serotonin syndrome. Left untreated, serotonin syndrome is a potentially grave condition and is marked by widespread muscle spasms and dangerous changes to an individual’s to heart rate, blood pressure, and body temperature. Patients taking antidepressants and those abusing tramadol at high doses are at particular risk of serotonin syndrome 14.

Taking tramadol also appears to carry a risk of seizures, an issue not typically associated with opiate use. Though not well understood, the risk of this side effect is higher in individuals with a history of seizures and those who combine tramadol with antidepressants, antipsychotics, alcohol, or illicit drugs 15.


Get Help for Tramadol Addiction

Treatment for addiction to tramadol, like other opioids, begins with the process of detoxification, or detox. Professional detox centers can provide medical supervision for individuals detoxing from tramadol and give them the best chance to successfully complete the process.

You can begin again.
Call 1-888-744-0069Who Answers? to get help now.

They can help patients through a process of drug tapering, or slowly decreasing the dose they take over several days or weeks, to minimize the most uncomfortable symptoms of opiate withdrawal. Detox centers can also provide a safe environment for people experiencing symptoms specific to tramadol withdrawal such as hallucinations and panic attacks and keep them from putting others around them in danger.

Following detox, people recovering from tramadol dependence are strongly encouraged to complete an inpatient or outpatient drug treatment program. Rehabilitation programs can last from several weeks to several months and offer both medical and behavioral therapies to help their clients permanently break the cycle of addiction.

The cycle of addiction can be difficult, if not impossible, to stop alone. If you or a loved one is struggling with tramadol dependence, there are resources available to help. Call us today at 1-888-744-0069Who Answers? to start hearing about the solutions that are out there. We can help you find out about your options and decide what next steps make the most sense for you.


References:

  1. Babalonis, S., Lofwall, M. R., Nuzzo, P. A., Siegel, A. J., & Walsh, S. L. (2013). Abuse liability and reinforcing efficacy of oral tramadol in humans. Drug Alcohol Depend, 129(1-2), 116-124. doi:10.1016/j.drugalcdep.2012.09.018
  2. Zacny, J. P. (2005). Profiling the subjective, psychomotor, and physiological effects of tramadol in recreational drug users. Drug Alcohol Depend, 80(2), 273-278. doi:10.1016/j.drugalcdep.2005.05.007
  3. Senay, E. C., Adams, E. H., Geller, A., Inciardi, J. A., Munoz, A., Schnoll, S. H., . . . Cicero, T. J. (2003). Physical dependence on Ultram (tramadol hydrochloride): both opioid-like and atypical withdrawal symptoms occur. Drug Alcohol Depend, 69(3), 233-241. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12633909
  4. Drug Enforcement Administration. (2014). Oxycodone. Retrieved from http://www.deadiversion.usdoj.gov/drug_chem_info/oxycodone/oxycodone.pdf
  5. Stoops, W. W., Hatton, K. W., Lofwall, M. R., Nuzzo, P. A., & Walsh, S. L. (2010). Intravenous oxycodone, hydrocodone, and morphine in recreational opioid users: abuse potential and relative potencies. Psychopharmacology (Berl), 212(2), 193-203. doi:10.1007/s00213-010-1942-4
  6. Comer, S. D., Sullivan, M. A., Whittington, R. A., Vosburg, S. K., & Kowalczyk, W. J. (2008). Abuse liability of prescription opioids compared to heroin in morphine-maintained heroin abusers. Neuropsychopharmacology, 33(5), 1179-1191. doi:10.1038/sj.npp.1301479
  7. Kuehn, B. M. (2013). SAMHSA: Pain medication abuse a common path to heroin: experts say this pattern likely driving heroin resurgence. JAMA, 310(14), 1433-1434. doi:10.1001/jama.2013.278861
  8. Dasgupta, N., Freifeld, C., Brownstein, J. S., Menone, C. M., Surratt, H. L., Poppish, L., . . . Dart, R. C. (2013). Crowdsourcing black market prices for prescription opioids. J Med Internet Res, 15(8), e178. doi:10.2196/jmir.2810
  9. Cicero, T. J., Adams, E. H., Geller, A., Inciardi, J. A., Munoz, A., Schnoll, S. H., . . . Woody, G. E. (1999). A postmarketing surveillance program to monitor Ultram (tramadol hydrochloride) abuse in the United States. Drug Alcohol Depend, 57(1), 7-22. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10617309
  10. Center for Behavioral Health Statistics and Quality. (2014). Results from the 2013 National Survey on Drug Use and Health: Detailed Tables. Retrieved from http://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs2013/NSDUH-DetTabs2013.htm
  11. Bush, D. M. (2015). The CBHSQ Report: Emergency Department Visits for Adverse Reactions Involving the Pain Medication Tramadol. Retrieved from Rockville, MD: http://www.samhsa.gov/data/sites/default/files/report_1965/ShortReport-1965.html
  12. Administration, D. E. (2014). Tramadol. Retrieved from http://www.deadiversion.usdoj.gov/drug_chem_info/tramadol.pdf
  13. Drug Enforcement Administration. (2014). Final Rule: Placement of Tramadol Into Schedule IV. Retrieved from http://www.deadiversion.usdoj.gov/fed_regs/rules/2014/fr0702.htm
  14. Beakley, B. D., Kaye, A. M., & Kaye, A. D. (2015). Tramadol, Pharmacology, Side Effects, and Serotonin Syndrome: A Review. Pain Physician, 18(4), 395-400. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26218943
  15. Boostani, R., & Derakhshan, S. (2012). Tramadol induced seizure: A 3-year study. Caspian J Intern Med, 3(3), 484-487. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/24009919