Tramadol, also known by the brand names Ultram or Ryzolt, is an opioid pain medication for moderate to moderately severe pain. The shorter-acting version may be used after an acute illness or surgery, while there is a longer-acting form that may be used to treat chronic pain. Tramadol is most commonly seen as a tablet, although it is available in a liquid suspension.
Tramadol is only available with a prescription. Since the United States Drug Enforcement Agency listed tramadol as a Schedule IV medication in 2014, it is considered to have a low potential for abuse and a low risk for addiction, but both are still possible. In fact, reported abuse of tramadol is why the medication is now a controlled substance, limited to five refills per prescription; when introduced in 1995, tramadol was not even listed as a controlled substance.
How Tramadol Is Used
When prescribed by a physician, tramadol should be taken exactly as directed. Taking more of the medication than prescribed, taking it more often than prescribed, and taking it for a longer period of time than prescribed are considered forms of misuse. Using tramadol for purposes other than as prescribed is considered abuse. Selling the medication or a prescription is not only abuse, but also illegal.
If tramadol is combined with other depressants, such as alcohol or other narcotics, its effects may be intensified. This can be dangerous, as it can cause an individual’s breathing to slow or even stop, resulting in coma or death.
Effects on the Body
Tramadol works by targeting the central nervous system to relieve pain, and at times, it may produce mood-elevating effects.
Tramadol can produce multiple side effects, most of which are similar to those of other opioid pain medications. Some of these side effects are:
- Allergic reaction
- Skin reactions that may be fatal
- Slowed or shallow breathing
- Suicidal thoughts or actions
- Withdrawal symptoms
- Angioedema (swelling under the skin)
- Orthostatic hypotension (a drop in blood pressure upon standing)
- Serotonin syndrome (a condition that occurs when individuals are taking two medications that affect serotonin, causing a buildup of serotonin in the brain)
As previously stated, tramadol can cause suicidal thoughts or actions, especially in individuals with a history of mental health diagnoses. If individuals experience this effect, it is crucial that they seek the advice of a medical professional. In fact, the United States Food and Drug Administration urges physicians not to prescribe tramadol for individuals who may be suicidal.
Individuals who have experienced seizures should avoid tramadol, although it can also cause seizures in those without a seizure disorder as well.
In a study published in Clinical Toxicology, it was reported that in a group of 57 individuals with a history of tramadol abuse, seizures occurred in 31 individuals – 54.4 percent of the group.
Adverse Effects and Overdose
According to the Substance Abuse and Mental Health Services Administration, there were approximately 54,397 emergency room visits in 2011 that were related to tramadol – half were due to an adverse reaction. The DEA states that the American Association of Poison Control Centers reported 13,067 tramadol exposures in 2012; nine deaths resulted from such exposure.
Adverse effects may occur if individuals use tramadol with other medications. Medline Plus recommends discussing other medications with a physician before using tramadol.
The FDA warns that individuals should not take more tramadol than prescribed by a physician. Since tramadol can cause individuals to develop both a tolerance and dependence, the risk for accidental overdose can be quite high. Individuals may increase their dose of the medication in order to achieve the effect they desire, not realizing that they are taking a dangerous dose. If an overdose has occurred, individuals may show the following symptoms:
- Difficult and irregular breathing
- Loss of consciousness
- Pale or blue-tinged lips, fingernails, and skin
- Shortness of breath
- Slow or shallow breathing
In the event of an overdose, emergency services should be contacted immediately.
Dependence on Tramadol
The National Institute on Drug Abuse describes the difference between dependence and addiction. Physical dependence, unlike addiction, develops when the body is exposed to tramadol for a prolonged period of time. Addiction, while it can include physical dependence, occurs when individuals have developed certain behaviors, such as drug-seeking behaviors and the use of tramadol even if they have experienced negative consequences from its use. Dependence is often coupled with tolerance, meaning that individuals will need to increase the amount of tramadol they take in order to achieve the initial effect.
Since tramadol is an opioid, it does have the potential to cause addiction as well as physical and psychological dependence. For individuals with a history of drug or alcohol dependence or addiction, this risk may be increased; however, an article published by Prescrire International warns that dependence can occur in those who have no history of drug abuse. An article from the United States National Library of Medicine found that tramadol dependence can occur in individuals taking doses within the recommended dosage range.
Some individuals may engage in illegal behavior to obtain tramadol, including doctor shopping. Doctor shopping occurs when individuals attempt to obtain prescriptions by visiting multiple doctors, and it is both illegal and dangerous. Others may even forge prescriptions if their physician will no longer prescribe tramadol, which is also highly illegal. Individuals may also ask for refills earlier, claim their tramadol was lost or stolen when it was not, or ask loved ones to obtain a tramadol prescription for use. If individuals become addicted, they may find themselves in financial trouble as well, as they may devote large amounts of money to purchase the medication illegally.
If individuals become addicted to or dependent on tramadol, they may exhibit the following signs:
- Taking tramadol in larger amounts or for longer than prescribed
- Inability to stop using tramadol, even if they express a desire to do so
- Development of withdrawal symptoms (These can occur even if tramadol is being used at a prescribed dose.)
- Development of a tolerance
- Spending large amounts of time to obtaining, taking, and recovering from tramadol use
- Failure to manage responsibilities at home, work, and school
- Strain on personal relationships due to tramadol use
- No longer participating in work or social events due to tramadol use
- Continuing tramadol use, even if it has exacerbated a physical or mental illness
- Feeling as if tramadol is necessary to function normally
- Increased absences at work and school
- Experimenting with other medications or drugs due to lack of tramadol
Those wishing to recover from a tramadol addiction and/or dependence should first remember that they should never stop taking tramadol abruptly, as advised by Prescrire International.
Rarely, individuals may experience what are called atypical symptoms, which are symptoms that usually do not accompany tramadol withdrawal. An article published in Drug and Alcohol Dependence offers an example of these symptoms: panic attacks, confusion, delusions, hallucinations, tinnitus (ringing in the ear), numbness and tingling, and paranoia.
The University of Utah suggests that the best option for those who wish to stop taking tramadol, regardless of whether the drug is used as prescribed or abused, is to see a physician. A physician can prescribe an appropriate tapered dose plan for individuals to follow so the incidence of withdrawal symptoms may be decreased. If needed, a physician can provide a referral to an addiction treatment specialist or appropriate treatment center.
If individuals enroll in a licensed treatment facility, the first step will likely be medical detox. While medical detox is not a standalone treatment, it is an important first step in the recovery process. Medical detox is a natural process by which the body processes the tramadol in its system. As with all opiates, tramadol withdrawal may include uncomfortable withdrawal symptoms, which can be managed with medical detox. In some instances, a long-term maintenance medication like methadone or buprenorphine may be used to slowly ease clients off tramadol. The use of such medication is determined on an individual basis.
Following medical detox, clients begin behavioral therapies. Cognitive Behavioral Therapy (CBT) is one of the most well-known therapies used for addiction. This type of therapy is shorter in duration than other behavioral therapies, and it helps individuals identify any drug-related behaviors so they can be changed. Individuals will learn how to recognize which situations put them at a risk for using tramadol, as well as how to avoid these situations. They will also learn drug refusal skills and ways to cope with cravings for tramadol.
For individuals with chronic pain, the American Association of Retired Persons offers some medication-free ways to relieve pain, including exercise, yoga, meditation, nutritional supplements, diet, and massage. If pain management is necessary, treating professionals will address the issue as part of the client’s tailored treatment plan.