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Tramadol Addiction, Abuse, and Treatment

Tramadol (Ultram) is a commonly prescribed opioid painkiller. It is a synthetic version of codeine. Tramadol was ranked at number 32 on the list for the most frequently prescribed drugs in the United States in 2017.1 Read to learn about this drug and treatment options offered at drug rehab facilities.

What is Tramadol?

First introduced in 1995, tramadol is prescribed to treat mild to moderate pain. It is not as effective as other, more potent opioids, so it is not used to treat severe pain.

Tramadol is available as a generic drug and also under the brand name Ultram. It’s called Ultracet when combined with acetaminophen. Extended-release forms are also available under the brand name Conzip.

Is Tramadol Addictive?

Although tramadol is widely accepted as having a lower risk for causing dependence, one study found that the highest likelihood of continued opioid drug use after 1 to 3 years was seen in individuals who started on a long-acting opioid drug, followed by people who started on tramadol.2

In other words, tramadol was the 2nd highest cause of long-term opioid use. Also, researchers found that emergency room visits associated with tramadol and harmful reactions increased by 145% during the years 2005 to 2011.2

Tramadol's Drug Class

Tramadol is classified as an opioid agonist drug. It is also in a class of medications called opiate (narcotic) analgesics.

Where is Tramadol on the Schedule of Drug Classifications?

The DEA (Drug Enforcement Agency) Schedule of Drugs classifies drugs by number. The lower the number, the higher the potential for abuse and addiction. On the DEA Schedule of Drugs, tramadol is listed as a Schedule IV drug.3 Schedule IV drugs are drugs that have a low potential for abuse and low risk of dependence. Other Schedule IV drugs include Soma, Xanax, Valium, Darvon, Darvocet, Valium, Ativan, and Ambien.

How is Tramadol Used?

Tramadol is used for the relief of mild to moderately severe pain. The extended-release versions are for individuals who need constant pain relief. The drug works by changing the way the brain and nervous system react to pain.

Street Names of Tramadol

The street names for tramadol include:

Ultras

OxyContin lite

Chill pills

These street names are related to the various strength levels of Ultram, the brand name under which tramadol is sold.

Is Tramadol Safe?

Tramadol can be safe if taken at prescribed doses for short periods, but it can cause adverse reactions. Due to tramadol’s relatively lower risk of causing addiction and the fact that it is considered safer than other opioids, it is a popular choice for pain management. It’s now in wide use, with more than 18 million prescriptions dispensed each year.4 However, two serious harmful reactions to tramadol are possible: seizures and serotonin syndrome.5

These two dangerous reactions may occur even when a person takes tramadol as prescribed. It is more likely that someone misusing tramadol or using it with other drugs, such as antidepressants, will experience seizures or serotonin syndrome.

How Does It Stop Pain?

Tramadol holds back the reabsorption of the neurotransmitters serotonin and norepinephrine after they are transmitted. While this helps with its painkilling effectiveness, it also can be harmful.

In addition, when people who take tramadol simultaneously take antidepressants that also affect neurotransmitters, the combined effects of taking both these drugs can be quite dangerous. One study which looked at adverse drug interactions in people taking antidepressants along with other medications found that tramadol was the most frequent culprit.5

The way tramadol works on the brain may lead to:

Seizures

One research study looked at people who had their first seizure. The study found that 8% of people had their first seizure after taking tramadol at prescribed doses.5

  • People with seizure disorders are also at high risk of having more seizures due to tramadol.5
  • The risk increases when people misuse or take too much tramadol.5

Serotonin Syndrome (SS)

Serotonin syndrome, which can be fatal, is caused by an excessive release of serotonin in a person’s nervous system. SS can occur as a result of taking a drug as prescribed, taking a drug overdose, and taking several drugs. SS symptoms include:5

Tremors

Muscle spasms

Involuntary muscle twitching

Overactive reflexes

Body stiffness

Heavy sweating

Fever

Rapid heart rate

Hyperventilating

Agitation

Confusion

Anyone experiencing these symptoms when taking tramadol should seek medical help immediately.

Effects of Tramadol

Short-term Effects

Tramadol may cause severe or life-threatening breathing problems, especially during the first one to three days of taking the medication or when the dose is increased.6 When someone experiences breathing problems after taking tramadol, medical help should be provided immediately.

Other short-term effects of tramadol include:6

  • Dry mouth
  • Insomnia
  • Risk of seizures
  • Serotonin syndrome
  • Drowsiness
  • Difficulties falling/staying asleep
  • Headache
  • Nervousness
  • Uncontrolled shaking
  • Muscle tightness
  • Heartburn
  • Indigestion

Long-term Effects

The long-term and serious side effects of taking tramadol include:6

Hives

Blisters

Swelling of the face, eyes, throat, tongue, or lips

Hoarseness

Seeing or hearing things that are not there

Sweating

Elevated heartbeat

Muscle stiffness

Loss of coordination

Diarrhea

Dizziness

Changes in heartbeat

Rash

Difficulty swallowing or breathing

Swelling anywhere on the limbs

Agitation

Fever

Confusion

Shivers

Twitching

Vomiting

Loss of appetite

Weakness

Loss of consciousness

If someone experiences these symptoms when taking tramadol, medical help should be sought immediately.

Tramadol’s long-term effects can also include:

  • Erectile problems
  • Menstruation issues
  • Lower sexual desire

Overdose and Withdrawal

Is it Possible to Overdose on Tramadol?

It is possible to overdose on tramadol, just as on any other opioid drug. Opioids are responsible for most drug overdose deaths in the United States. In 2017, more than 70,000 Americans died from drug overdoses, making this the leading cause of death due to injury.7 Of those fatalities, almost 68% (47,600 people) involved a prescription or illegal opioid.7 Drug overdose deaths continue to rise in the United States.7

Overdoses of tramadol can cause respiratory failure or acute liver failure and are potentially fatal.4

Other symptoms of overdose from tramadol include:6

Severe drowsiness

Dilated pupils (black circles in the center of the eyes)

Cold, clammy skin

Muscle weakness

Difficulty breathing

Passing out

Coma

Slowed heartbeat

Anyone experiencing these symptoms when taking tramadol should seek medical help immediately.

Safe Ways to Stop Using Tramadol

It’s dangerous to stop taking tramadol without medical support. People who wish to stop taking tramadol should talk to their doctors or treatment centers. Without medical help, stopping or reducing tramadol use can lead to painful and harmful withdrawal symptoms.

What is Withdrawal from Tramadol Like?

Tramadol withdrawal can be difficult and painful. Some common withdrawal symptoms associated with tramadol include:8

  • Digestive system pain
  • Insomnia
  • Anxiety
  • Depression
  • Bone pain
  • Diarrhea
  • Excessive eye tearing
  • Nausea
  • Agitation
  • Persistent runny nose
  • Excessive sweating

In about 1 out of 8 cases of tramadol withdrawal, the following symptoms have been reported:8

Severe anxiety

Panic attacks

Confusion

Delusions

A sense of detachment from the world

A sense of detachment from oneself

Paranoia

Numbness

Tingling

Ringing in the ears

Hallucinations

In very rare cases, psychosis has been reported as a withdrawal symptom from tramadol.1

Treatment for Tramadol Abuse and Addiction

The first step in the treatment for tramadol abuse and addiction is a detoxification that is done under medical supervision. It is not recommended to try and stop tramadol unsupervised. Stopping or decreasing the use of tramadol without medical supervision can cause withdrawal symptoms that are distressful, painful, or dangerous.

Detox

A medically supervised detox can take place in a treatment center where the health care staff monitors the patient around the clock while they are slowly and carefully weaned off tramadol. The staff immediately treats any withdrawal symptoms. Also, replacement medications are given to prevent serious withdrawal symptoms from occurring.

If the withdrawal is not severe, medical detox is possible on an outpatient basis through a treatment center or clinic. An assessment by a doctor or a rehab center can help a patient make the best choice between inpatient and outpatient detox.

Detox is not a standalone treatment, but rather the first step in the recovery journey. Therapies provided by a treatment program are needed to help prevent relapse.

Outpatient vs. Inpatient Treatment Programs

Residential treatment happens away from the places and things that lead to the drug use. Detox and therapies are provided in a treatment facility for weeks or months. Inpatient rehab is a highly structured and fully monitored environment where clients live around the clock while in the program.

Outpatient programs have clients attend anywhere from one or two hours to several hours a day a few times a week. After treatment, clients return home. Outpatient programs are a good fit for people who have mild to moderate drug addictions and need to meet family, work, or school obligations.

While in either type of treatment, clients learn new habits and skills for sober living through therapies.

Medication Assisted Therapy

Also known as MAT, medication-assisted therapy is the long-term use of prescribed drugs that help combat cravings for opioids. MAT uses FDA-approved medications that help to regulate brain chemistry, block the “highs” that opioids can produce, relieve cravings, and regulate body functions without the negative effects induced by the abused drug. Each MAT program is customized to meet the specific needs of each person.

Counseling

Addiction treatment also looks beyond the physical dependence on drugs. Certain psychological and social factors, such as stress or proximity to people and places where drugs were used, can cause strong and continuous urges to use drugs again, and therefore increase the chances of a relapse. Counseling helps individuals in recovery manage these cravings and the things that cause urges, without using drugs.

There is no single treatment that works for everyone. A combination of individual and group therapies tailored to the individual’s needs is the best approach.

Therapies

  • Cognitive Behavioral Therapy (CBT)
  • Rational Emotive Therapy (RET)
  • Dialectical Behavior Therapy (DBT)
  • Family Therapy (FT)

Also known as CBT, cognitive behavioral therapy can help people struggling with tramadol use disorder to manage pain as well as drug-taking behaviors. “Cognitive” refers to the use of thinking and reasoning skills.

CBT for Pain Management

Pain-focused CBT can help individuals manage their pain better without the use of drugs. CBT can help people understand that their pain is a stressor that they can adapt to and cope with. The therapist and client engage in relaxation training and planning pleasant activities to help cope with pain.

These types of engagements can help relieve the intensity of pain, improve overall quality of life, and assist in the improvement of physical and emotional functioning. Also, the therapist works to point out the emotional and mental factors that influence the perception of pain as well as behaviors that come along with having pain.

CBT for Opioid Abuse​

CBT focused on drug abuse helps clients recognize and stop negative patterns of thinking and behavior. In therapy sessions, CBT therapists focus on teaching coping skills, including how to manage stress and change the thoughts that cause the misuse of opioids.

Rational emotive therapy is a form of CBT that concentrates on resolving upsetting areas of a person's life. Also known as RT or REBT (rational emotive behavioral therapy), this approach acknowledges that individuals who are upset are thrown off-center. Feeling upset and off-kilter are gateways to drug use for many.

RET recognizes that most of these upsets are based on faulty beliefs that harm rather than help. RET works to raise awareness of these faulty beliefs so they can be set aside. RET also emphasizes doing away with negative thought patterns. This leads to personal empowerment as limiting beliefs are discarded, and healthy behaviors take their place.

Dialectical behavior therapy is another form of therapy that uses aspects of CBT, but it focuses more on mental and social aspects. It is based on the recognition that some people tend to react disproportionately or more intensely to emotional situations within their personal relationships. These extreme emotional reactions go unchecked because these individuals do not have the coping skills needed to deal with these surges of emotions. DBT teaches the skills needed to help cope with intense reactions.

Addiction doesn't take place in a vacuum. The whole family is affected by it. Successful addiction treatment involves family and friends. Counseling sessions can include the person's spouse and other family members.

Family therapy can harness the healing powers that come from loving relationships. Including the family can also increase the likelihood the individual will stay in treatment. FT helps heal the damage that addiction has caused. It also teaches family members healthy ways to help someone dealing with addiction and sobriety.

Other Important Treatment Options

Dual Diagnosis Treatment

When someone has both a drug use disorder and a mental health disorder, this is called a dual diagnosis. Some common mental health illnesses seen along with a substance use disorder (SUD) are depression, anxiety, and post-traumatic stress disorder (PTSD).

Sometimes it is difficult to determine which disorder came first. In some cases, individuals had some form of mental illness and then self-medicated with drugs to relieve their symptoms. In other cases, people took drugs that affected their brains and nervous systems in ways that led to the development of a mental health disorder.

Whatever the case, it is important that both disorders are treated at the same time for a positive outcome. Many of the behavioral therapies we discussed here for the treatment of addiction can also be adapted to treat mental health disorders.

Gender-specific Treatment

Treatment that is gender-specific may also help address substance use disorders. There are neurological and behavioral differences between men and women that can affect treatment approaches. Also, when trauma is involved, both men and women may feel more comfortable in a treatment setting where there are none of the opposite sex present. These are generalizations, as there may be other factors involved that can influence a person’s outlook, such as age, culture, race, and sexual preferences.

12-Step Programs

Made popular by Alcoholics Anonymous (AA), 12-step group programs can help people in their struggles with opioid use disorder. 12-step groups offer opportunities to meet people who have experience with successful recovery. People new to the group then gain the knowledge and experience of successful sobriety from those who have achieved it by using the 12 steps to their advantage.

New Friends

Another great advantage of attending 12-step groups is that they allow all participants to make new friends and build strong support networks. This can be invaluable in times of cravings and urges. Reaching out to someone who understands what it’s like to want to use and how to avoid using can be a powerful support during recovery.

Positive Reinforcement

Group support reinforces the new behaviors that sobriety brings. Emotions that surface when a person is changing are powerful and can hinder recovery, but reinforcement can help combat backsliding.

Safe Place

Another advantage of 12-step groups is that they can be a safe place from the resistance people in recovery may experience from themselves and their friends and families. The group helps address that resistance, and the anxiety it can create, so the person can continue in recovery.

Finding the Right Help

Recovery is possible with the right help. The first step is reaching out for professional help by talking with a doctor, mental health counselor, or treatment center. Professionals have the education, training, and experience to help patients break the cycle of tramadol abuse and addiction. A renewed and revitalized life is possible in recovery.


Resources

  1. Tramadol Hydrochloride Drug Usage Statistics, United States, 2007-2017,” CliniCalc.
  2. Shah, A; Hayes, CJ; and Martin, BC. “Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use — United States, 2006–2015.” Morbidity and Mortality Weekly Report 2017; 66:265–269.
  3. Drug Scheduling,” United States Drug Enforcement Association.
  4. Tramadol,” from LiverTox: Clinical and Research Information on Drug-Induced Liver Injury, December 2012.
  5. Sansone, Randy A., and Sansone, Lori A., “Tramadol,” Psychiatry: Edgmont, April 2009.
  6. Tramadol,” Medline Plus.
  7. CDC’s Response to the Opioid Epidemic,” Centers for Disease Control and Prevention
  8. Rajabizadeh, Ghodratolah; Kheradmand, Ali; and Nasirian, Mansoureh, “Psychosis following Tramadol Withdrawal,” Addiction & Health, Summer 2009