What Kind of Medicine Is Tramadol?
Tramadol (brand name: Ultram) is an opioid analgesic (painkiller). It is prescribed to treat moderate to moderately severe pain and is considered a safer alternative to other narcotic analgesics like hydrocodone (Vicodin, Lortab) and methadone.
Additional medications containing tramadol include Ultram ER, an extended release formulation for round-the-clock pain relief, and Ultracet, a combination of tramadol and acetaminophen (Tylenol).
Tramadol was originally considered to have a much better safety profile than other opioid analgesics like morphine or hydrocodone. The US Food and Drug Administration (FDA) originally approved tramadol for use in 1995, and recommended it not be classified as a controlled substance. However, due to mounting evidence of abuse among the general public, as well as evidence of withdrawal symptoms upon cessation, the Drug Enforcement Administration (DEA) published revised rules in 2014 making tramadol a federally controlled drug (Schedule IV).
When taken orally in pill form, the liver metabolizes tramadol into several chemicals including O-desmethyltramadol, which produces much more potent effects than tramadol itself. Taken orally at high doses, tramadol can produce a euphoric high similar to another commonly abused opiate medication, oxycodone (OxyContin).
Signs and Symptoms
There is a risk of seizures and convulsions in some patients taking tramadol.
When prescribed by a doctor, the desired effect of taking tramadol is consistent pain relief. However, like most medicines, Ultram can have undesired side effects. These are similar to other opioid drugs and include:
- Lightheadedness or dizziness.
- Loss of appetite.
- Dry mouth.
In individuals who use tramadol for non-medical purposes, these side effects can be a warning sign of abuse. In addition to opioid receptor activity, tramadol exerts some of its effects via its actions on serotonergic and noradrenergic neurotransmission. For this reason, there is also a known risk of seizures and convulsions in some patients taking tramadol, with this risk being even more elevated in abusers seeking the euphoric effects, or "high," produced by taking large doses of the drug.
Effects of Tramadol Abuse
As mentioned, in addition to its opioid-like effects, tramadol also increases brain levels of the neurotransmitters serotonin and norepinephrine, similar to the changes induced by antidepressant drugs including venlafaxine (Effexor).
Users have reported that such mood-elevating properties caused them to take higher doses of the drug - or take it more often - than had been prescribed.
In addition to the euphoric and mood-enhancing effects sought by tramadol abusers, taking this drug for nonmedical purposes, or taking it in a manner different from that prescribed by a doctor, can have negative and sometimes dangerous results. These include disturbed sleep patterns resulting in insomnia, and the aforementioned increased risk of convulsions or seizures.
Additionally, abusing tramadol can lead to tolerance and dependence.
Individuals who abuse tramadol for an extended period of time and develop psychological dependence may begin to experience compulsive cravings to take the drug and to feel that they need it to cope with everyday problems. People who are psychologically addicted to tramadol can feel anxiety if they do not have access to the drug and will engage in behaviors such as doctor shopping or prescription forgery in order to maintain their supply.
Dependence and Overdose Risk
Habitual users who become tolerant to tramadol need to increase the amount or frequency of the doses they take in order to achieve the desired effects. This puts them at risk of accidental overdose, symptoms of which include:
- Decreased size of the pupils of the eyes (miosis).
- Slow breathing or difficulty breathing.
- Extreme drowsiness.
- Cold, clammy skin.
- Slow or irregular heartbeat.
- Loss of consciousness.
Abusers who continue to take tramadol long enough and at high enough doses will eventually develop a physical dependence on the drug and experience unpleasant, or even dangerous, symptoms of withdrawal if they stop taking the medication.
The withdrawal symptoms caused by tramadol overlap with both opiate and anti-depressant withdrawal syndromes and include:
- Gastrointestinal pain.
- Numbness in the extremities.
- Ringing in the ears.
Treatment for Abuse
Tramadol abuse and dependence present many of the same challenges as addictions to other opiate drugs, and can be addressed by the same facilities and services. Medically supervised detoxification from tramadol is recommended to minimize the dangers presented by withdrawal syndrome.
Following detoxification, a range of rehabilitation facilities is available to help abusers get on the road to recovery.
- Inpatient treatment centers offer round-the-clock supervision and intensive care to patients for 28 days or more.
- Outpatient programs allow those who are able to continue living at home while attending therapy sessions multiple days or evenings per week.
- Peer recovery organizations such as SMART Recovery, LifeRing Secular Recovery, and 12-step groups provide a forum for people in recovery to share their experiences and offer support to one another.
Teen Drug Abuse
Tramadol abuse has also been documented among adolescents in high school, where the drug is also known by the slang name "ultras." Though there is scant reporting on national teen tramadol abuse, the Monitoring the Future survey revealed that 9.5% of high school seniors had ever taken a narcotic other than heroin - a group of drugs that includes tramadol - for non-medical reasons.
Furthermore, the availability of tramadol and other drugs from sources like Internet websites or friends with legitimate prescriptions mean parents should make sure their children are informed about the dangers of abusing any drug not prescribed to them specifically.
Although tramadol abuse is smaller in scope compared to other opiate painkillers, the number of people using this drug for nonmedical purposes and the consequences of that use are still significant. Some key tramadol statistics from the National Survey on Drug Use and Health and the Drug Abuse Warning Network include:
- More than 7 million Americans over the age of 12 used tramadol for recreational purposes in 2013--an increase of more than 500,000 from 2012.
- In 2013, the highest rate of tramadol abuse was found in young adults--with 2.8% of all people aged 18 to 25 taking it at some point for non-medical reasons.
Emergency room visits due to adverse reactions to tramadol increased from 10,000 in 2005 to nearly 27,500 in 2011. See the chart from SAMHSA below for a picture of the increase in ER visits related to adverse reactions to tramadol.
Learn more at our article, Tramadol History and Statistics.
Resources, Articles, and More Information
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