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Tramadol Addiction

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Tramadol is an opioid analgesic medication prescribed for pain relief.1 Used as prescribed, tramadol can be effective for managing moderate to moderately severe pain.1

Like other prescription opioid painkillers, it has the potential for misuse, which could lead to potentially adverse health effects or even tramadol addiction.2 If you or a loved one feel that you are misusing tramadol, this article will help you understand:

  • What tramadol is.
  • Signs of tramadol abuse.
  • Symptoms of tramadol withdrawal and overdose.
  • Treatment for tramadol addiction.

What is Tramadol?

Tramadol is an opioid analgesic prescribed to help manage pain. It is available in various generic formulations in addition to being marketed under several brand names, including Ultram.

Though tramadol is in the same family of drugs as medications like oxycodone and hydrocodone, it works in a somewhat unusual way compared to more standard opioid painkillers.2 Like other opioid analgesics, tramadol changes how the body responds to pain through its interaction with opioid receptors. Opioid receptor activation is also associated with increased dopamine activity, which can reinforce repeated use of tramadol.4

Tramadol was not initially considered a controlled substance when it was approved by the Food & Drug Administration (FDA) in 1995. In 2014, after years of reports of people diverting tramadol for illicit misuse, tramadol was revised to be a Schedule IV controlled substance—meaning that it has a recognized potential for abuse and dependence.2

Is Tramadol Addictive?

Tramadol, like all opioid analgesics, has the potential for misuse and addiction. While it is considered to have a lower potential for dependence (unlike opioids such as morphine), tramadol dependence can still occur, particularly if used for longer periods of time.3

With long-term tramadol use, a person’s brain can get used to its effects; this is known as tolerance. As a person develops tolerance, they may begin to need higher doses to experience the same effects as before.4

After repeated tramadol use, people may develop physiological dependence. When dependence develops, should tramadol be abruptly stopped, a person may experience a range of potentially uncomfortable withdrawal symptoms.4

Neither tolerance nor physical dependence alone necessarily mean someone is addicted to tramadol. However, both tolerance and dependence may in some cases contribute to compulsive patterns of use that are common to opioid use disorders. Tramadol addiction and other opioid use disorders are characterized by compulsive or uncontrolled use that can lead to potentially harmful consequences and/or long-lasting changes to the brain.4

Signs of Tramadol Abuse

Substance use disorders, like those involving tramadol, are not always easy to recognize. Thus, diagnosis is best left to a medical professional. However, if within a 12-month period you or a loved one show two or more of the following examples of problematic tramadol use, you may meet the criteria for diagnosis of a substance use disorder involving tramadol.

The Diagnostic and Statistical Manual of Mental Disorders (5th edition) criteria for an opioid use disorder involving tramadol include:6

  • Using more tramadol than was originally intended.
  • Taking tramadol even though you know it makes a physical or emotional issue worse.
  • Spending a good deal of your day looking for tramadol, using tramadol, and recovering from using tramadol.
  • Increased conflict with loved ones over using tramadol.
  • Failing to meet expectations at work, school, or home due to your use of tramadol.
  • Giving up hobbies that you used to like to keep using tramadol.
  • Using tramadol in high-risk situations, such as driving under the influence of tramadol.
  • Making unsuccessful attempts to cut back or stop taking tramadol.
  • Cravings to use tramadol.
  • Developing a tolerance to tramadol, so you need to keep taking more of it to feel its effects.
  • Experiencing physical withdrawal when you stop taking tramadol.

It is important to note that tramadol abuse may be more likely in people who have a personal or family history of substance abuse and/or mental illness.3, 5

Symptoms of Tramadol Overdose

It is possible to overdose on tramadol, though it does not happen frequently when taken as prescribed by a doctor. Overdose is more likely to occur when taken inappropriately, such as taking more than the prescribed dose, taking someone else’s medication, or taking it illicitly.3

Mixing tramadol with other opioids, with alcohol or other central nervous depressants, as well as some types of illicit drugs can dangerously increase the potential for oversedation, respiratory depression, coma, and even death.5 Symptoms of a tramadol overdose include:1,7

  • Slow or shallow breathing.
  • Extreme sleepiness.
  • Oversedation that could progress to stupor or coma.
  • Constricted or pinpoint pupils.
  • QT prolongation on EKG.
  • Slow heartbeat.
  • Low blood pressure.
  • Muscle weakness.
  • Clammy, cold skin.
  • Seizures.

If you suspect a tramadol overdose, call 911 immediately.

Health Effects of Tramadol

Tramadol use may be associated with certain side effects, the severity of which may be increased when misused nonmedically. Some of the risks and side effects of tramadol include:7

  • Sedation.
  • Dizziness
  • Nausea.
  • Vomiting.
  • Constipation.
  • Risk of serotonin syndrome, a potentially life-threatening condition.
  • Increased risk of seizures (risk may be further increased when used with other drugs).
  • Increased risk of abuse in people with addiction history.

Tramadol Withdrawal Symptoms

When a person is physically dependent on tramadol and stops taking it or drastically reduces use, they may experience withdrawal symptoms, which can include:7

  • Insomnia.
  • Restlessness.
  • Irritability.
  • Excessive yawning.
  • Runny nose.
  • Sweating.
  • Chills.
  • Weakness.
  • Joint and muscle pain.
  • Loss of appetite.
  • Nausea.
  • Vomiting.
  • Stomach cramps.
  • Diarrhea.
  • Increased respiratory rate.
  • Elevated blood pressure.
  • Rapid heart rate.

Treatment for Tramadol Addiction

Getting treatment for a substance use disorder can feel scary, but it’s a courageous step toward making positive changes in your life and beginning the life-long journey of recovery.9

Effective treatment plans can be tailored to your individual needs.8 Individualized treatment may be particularly important if you have another medical condition or co-occurring mental health diagnosis.

Medical Detox

Medical detox at the start of treatment can be helpful because suddenly quitting tramadol may lead to extremely uncomfortable withdrawal symptoms.7 Supervised medical detox and withdrawal management can provide you with the oversight to keep you safe and comfortable while detoxing from tramadol.

Withdrawal from opioids like tramadol is not often life-threatening, but can be very hard to cope with on your own. Medical detox during early recovery is increasingly becoming the standard of care when managing opioid use disorders, as non-pharmacologic withdrawal management can lead to unnecessary discomfort.10

In rare cases, opioid withdrawal may be associated with certain medical complications, such as dehydration and electrolyte disturbances in people who experience severe gastrointestinal symptoms. Additionally, people with pre-existing cardiac disease could experience a worsening of their heart issues as a result of an increased heartbeat or high blood pressure.10

Some medications can be used to assist with tramadol withdrawal. These include: 11

  • Buprenorphine, a partial opioid agonist, can help to manage opioid withdrawal symptoms and reduce cravings.
  • Methadone is a long-acting full opioid agonist. As with buprenorphine, methadone can help to reduce withdrawal symptoms and control cravings for tramadol.

Behavioral Therapy

There are several behavioral approaches to help treat substance use disorders. Effective treatment strategies for opioid use disorders often combine behavioral therapies with medication. Commonly used behavioral therapeutic approaches include:

  • Cognitive-behavioral therapy (CBT): used to help identify and change problematic behavior patterns by learning and applying new skillsets, like developing more positive coping strategies and better avoiding relapse triggers.12
  • Motivational enhancement: a commonly used approach that uses motivational interviewing techniques that help people overcome any hesitance they may have to better engage with treatment efforts. Some programs use motivational enhancement with CBT.13
  • Family behavioral therapy (FBT): primarily used for adolescents and their families. FBT is used with substance abuse as well as behavioral problems and family conflict. FBT can also be used with adults, as long as there is another family member to work with the person in therapy.14

If you or someone you care about is struggling with tramadol addiction, know that help is available. American Addiction Centers (AAC) offers a free, 24/7 helpline at 1-888-744-0069 . Call today to speak to a caring admissions navigator who can provide information about addiction treatment options and help you quickly verify your benefits to start your recovery journey today.

Learn more about Tramadol

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Dr. Thomas received his medical degree from the University of California, San Diego School of Medicine. During his medical studies, Dr. Thomas saw firsthand the multitude of lives impacted by struggles with substance abuse and addiction, motivating him to seek a clinical psychiatry preceptorship at the San Diego VA Hospital’s Inpatient Alcohol and Drug Treatment Program. In his post-graduate clinical work, Dr. Thomas later applied the tenets he learned to help guide his therapeutic approach with many patients in need of substance treatment. In his current capacity as Senior Medical Editor for American Addiction Centers, Dr. Thomas, works to provide accurate, authoritative information to those seeking help for substance abuse and behavioral health issues.
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