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
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
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:
- “Help. Tramadol withdrawals.”
- “Tramadol: A WARNING. Not the usual warning.”
- “Tramadol seizure risk?”
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
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.
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
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.
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.