What is tramadol?
Tramadol is an opioid pain medication used to treat moderate to moderately severe pain. When taken as an immediate-release oral formulation, the onset of pain relief usually occurs within about an hour.
Tramadol is considered to be a milder form of opioid medication compared to drugs like oxycodone or hydrocodone and is approved by the Food and Drug Administration (FDA). Due to a lack of information, people misguidedly believed the drug was not addictive. In the ’90s, the drug was even prescribed as an effective ‘non-addictive’ pain killer with no common side effects.
Serious side effects associated with tramadol include seizures, increased risk of serotonin syndrome, decreased alertness, and drug addiction. Common side effects include constipation, itchiness, and nausea, among others. A change in dosage may be recommended in those with kidney or liver problems. It is not recommended for women who are breastfeeding or those who are at risk of suicide.
Tramadol has two different mechanisms. First, it binds to the μ-opioid receptor. Second, it acts as a reuptake inhibitor of serotonin and norepinephrine. The drug is marketed as a racemic mixture of both R- and S-stereoisomers. This is because the two isomers complement each other’s analgesic activity. It is often combined with paracetamol as this is known to improve the efficacy of opioid drugs in relieving pain.
Tramadol comes in many forms, including:
- Capsules (including extended-release capsules).
- Tablets (including extended-release tablet).
- Chewable tablets.
- Low-residue, effervescent, and/or uncoated tablets that can be taken sublingually and buccally.
- Tablets and capsules containing other drugs like aspirin.
- Ampoules of sterile solution for SC, IM, and IV injection.
- Solutions for injection by spinal routes (epidural, intrathecal, caudal, and others).
- Powders for compounding.
- Liquids both with and without alcohol for oral and sublingual administration.
How does Tramadol work?
Pain relief usually starts within an hour of consumption of oral medication. Tramadol is considered as powerful as drugs like morphine for mild to moderate pain, but less effective than morphine for severe pain. The drug is sold under the brand names Ultram, Ultram ER, ConZip, Ryzolt, among others. Street names for the substance include chill pills, beans, trams, trammies, and ultras. Like other opioid drugs, it is also commonly used as a psychoactive substance.
Tramadol works a little differently than other opioid drugs. In addition to reducing pain, it inhibits the reuptake of serotonin and norepinephrine, potentially resulting in more complex mood changes compared to a typical opioid analgesic.
- In the United States, emergency department visits attributed to tramadol use have jumped 250% from 2005-2011, according to the Substance Abuse and Mental Health Services Administration.
- An estimated 3.2 million people in the United States used tramadol for non-medical purposes in 2013.
- In 2019, synthetic opioids were involved in over 36,000 deaths in the United States
- In 2016, the substance was the 39th most prescribed medication in the United States, with more than 19 million prescriptions.
Tramadol – physical dependence, addiction & substance use disorder
Despite its relatively low potency, tramadol carries many of the same dangers as other opioid medicines. Like morphine, it binds with the brain’s opioid receptors and depresses the central nervous system. Tramadol overdose can cause respiratory depression and death.
Tramadol is often prescribed because it is considered less addictive than other opioid painkillers, even by some medical professionals. While most painkillers are schedule II substances under the Controlled Substances Act, Tramadol is a schedule IV opioid substance. This means that it is considered by the DEA to have an accepted medical use and lower potential of abuse compared to Schedule III drugs such as codeine.
Tramadol disrupts the body’s natural production of endorphins. Endorphins are chemicals produced by the body in response to internal and external triggers such as pain, fear, excitement, physical exercise, and love, among others. After frequent and long-term use of opioid drugs regularly, patients begin developing an addiction or tolerance. This means that a higher dose of tramadol is required to get the same effect. This can lead to drug abusers taking more than prescribed, which in turn can lead to opioid dependency or opioid use disorder (OUD).
Normally, our body produces just enough endorphins in response to the appropriate stimuli. Once the simulation has ended, the level of endorphins in our body goes back to its normal level. Opioid drugs such as tramadol suppress this body’s natural production of endorphins and cause the body to produce an additional number of endorphin receptors. The more opioid drugs a person introduces into the body, the more receptors are produced. This excess of endorphin receptors demands more stimulation from opioids, creating a never-ending cycle of demand and supply—this is what makes tramadol addictive and is where opioid use disorder can start to occur.
A person’s need for endorphin stimulation creates powerful neuro-biological demand for more opioids. Once the level of tramadol goes down between doses, or a person stops taking it altogether, they experience unpleasant and sometimes severe tramadol withdrawal symptoms.
Withdrawal symptoms caused by an addiction to tramadol are described as flu-like but can be much more severe. People with chronically painful conditions are more likely to become dependent and eventually addicted to opioid drugs, but people also use them for their physical effects. Individuals who abuse Tramadol usually feel relaxed and happy. That, and the ease of obtaining tramadol, are the reasons for its popularity among young people.
Symptoms and health effects from Tramadol use
Tramadol can have the following common side effects:
- Nausea and vomiting
- Muscle pain or spasms
- Loss of appetite
- Panic attacks
- Cold sweats or clammy skin
If opioid drugs are taken in a dose that the body is less equipped to tolerate, more severe health effects can emerge. Taking the drug in combination with other drugs like alcohol or additional opioids or medicines increases the risk of harmful effects. Opioids are what are known as central nervous system (CNS) depressants. CNS depressants slow down the functions of the central nervous system such as breathing and heart rate, which can have severely negative consequences if abused. CNS common side effects can include:
- Depressed respiratory system (slowed or ceased breathing)
- Brain damage
An additional array of health effects of tramadol abuse comes from what is known as serotonin syndrome. Serotonin syndrome is caused when an overabundance of serotonin (a chemical that affects mood, cognition, pleasure, reward, and many more) floods the brain and may not subside. This can cause the following symptoms:
- Shivering or fever
- A general feeling of poor health
- Sensitivity to loud noises or bright lights
- Confusion or bewilderment
- Muscle weakness
- Muscle aches
- Runny nose
- Lack of coordination
Signs of Tramadol or opioid abuse and addiction to drugs
Opioid addiction or abuse can have disastrous consequences for not only drug addicts, but for friends, family, and coworkers too. It is also difficult to overcome without adequate behavioral therapy or drug rehab programs and the road to recovery can sometimes be long.
If you or someone you know has been using the drug for a long time and feel any of these negative health effects of tramadol, you may wish to seek help from an opioid withdrawal symptoms treatment center:
- Using consistently larger amounts of opioids or medicines to have the desired effects of tramadol.
- Using tramadol for recovery from symptoms that were caused by withdrawal symptoms from drugs instead of seeking medical care.
- Doctor-shopping to get a high enough dose for your increased need.
- Being unable to cut back or stop taking tramadol when you want to.
- Neglecting regular activities you once enjoyed.
- Taking an increased dose of the drug despite it being a health risk.
- Continuing use despite it affecting loved ones, professional or social life.
- Taking tramadol despite the risk of potentially fatal overdose.
- Displaying uncharacteristic behavior, especially in front of friends and family.
- The onset or exacerbation of mental disorders or mental health disease.
- Mixing tramadol with alcohol or other drugs
Tramadol addiction, abuse & health risks of overdose
Opioid medicines take effect by binding to the body’s opioid receptors, producing feelings of pleasure, euphoria, and relaxation that interfere with the brain’s pain signals. Compared to many other opioids such as morphine or fentanyl, tramadol’s effect on the body’s mu-opioid receptors is not strong. However, it does produce analgesic effects, causing a chemical reaction that strongly affects the neurotransmission of norepinephrine and serotonin—meaning it can still deliver strong feelings of euphoria and initiate changes in behavior.
Addiction to tramadol often starts innocently, with the intention of pain relief and a prescription from a doctor. Unfortunately, its addictive nature can mean it has a high potential for abuse or dependence. When abuse/dependence on tramadol occurs, a patient will often become tolerant to the drug, and feel the need to take higher and higher doses to achieve the same high as they had felt initially—this is where the risk of overdose becomes high.
Symptoms of tramadol overdose include (but are not limited to):
- Needle-point/constricted pupils
- Depressed respiration/slowed or stopped breathing
- Depressed heart rate/slowed or stopped heartbeat
- Loss of consciousness
If you see someone exhibiting signs of opioid overdose, call 911 immediately and request emergency medical care.
Naloxone for opioid overdose
Naloxone is a drug used for mitigating or reversing the health effects of tramadol overdose. Naloxone works by binding to opioid receptors in much the same fashion as opioids themselves, thus blocking the opioid from taking effect. In the case of drugs like oxycodone or fentanyl, which are much stronger than most other opioid drugs, multiple doses of naloxone may be required to treat an overdose. In some states, naloxone can be dispensed at pharmacies or drug stores without a prescription.
Prescription opioid addiction & tramadol addiction
Tramadol is often prescribed to a patient for the treatment of moderate to severe pain. It can be found under a variety of different brand names in the United States, such as Ultram, Ultram ER, and Conzip. Oftentimes, the drug will be combined with the substance acetaminophen, a Schedule III antipyretic drug with analgesic effects. This combination drug can be found in brands such as Ultracet.
A prescription opioid like tramadol comes with a high risk for dependence. A patient can find themselves reliant on the drugs for pain relief or to avoid withdrawal symptoms when they try to stop cold turkey. When the patient can’t get these painkillers legally, they often turn to illicit drugs acquired through the black market—despite the risk of overdose, adverse effects, or even death.
If someone is developing an addiction that concerns the use of drugs or alcohol, it is known as substance use disorder, but these are not the only types of addiction. The list of addictions is almost endless. Some of the most common include:
- Gaming addiction
- Gambling addiction
- Alcohol addiction
- Synthetic marijuana addiction
- Crack cocaine addiction
- Sleeping pills addiction
- Heroin addiction
- Fentanyl addiction
- Meth addiction
- Prescription drug addiction
- Synthetic opioid addiction
Because of the different levels of danger that addiction symptoms can cause, some forms of addiction may require different levels of care and addiction therapies. Thankfully, there are many addiction recovery and substance use disorder treatment programs available. While some are available free of charge through charity or community resources, in other cases, you may need to pay for health treatment.
Click here to see what addictions we treat.
Accelerated Neuro-Regulation (ANR) is a medically assisted addiction treatment that aims to facilitate the recovery of the nervous system and restore balance by decreasing receptor production in the brain while allowing the body to resume healthy levels of endorphin production. ANR also allows the metabolizing and elimination of unnecessary exogenous opioids from the body. The ANR treatment is conducted at various ANR addiction treatment centers across the country.