Tramadol Use, Addiction, and Effects

What is Tramadol and What is it Prescribed For?

Tramadol (pronounced tra' ma dole) is a pain relief medication that requires a doctor's prescription. Tramadol falls within the opioid medication class, which includes more commonly known drugs such as morphine and heroin. First introduced to the United States in 1994 as a medicine to treat pain, tramadol has become widely used across the world for its pain-relieving, or analgesic, properties¹.

As a substance, tramadol is a white powder with a bitter taste that may be given to patients orally (by mouth) or intravenously (through a person's veins). When given orally, tramadol may come as:

• A tablet: Taken every 4-6 hours
• An extended-release (long-acting) tablet: Taken once a day
• An extended-release (long-acting) capsule: Taken once a day

For both regular tablets and extended-release tramadol, the maximum recommended daily dose is 400 milligrams per 24 hours. All oral forms of tramadol can be taken with or without food. In hospitals, tramadol may be given intravenously through a person's veins² by a medical professional.

Typically, tramadol is used over a shorter time period and prescribed by doctors to treat mild to moderate pain. For example, it may be prescribed after a person has undergone surgery or has an injury. However, extended-release tablets may be given to people who need consistent pain relief around the clock. For example, individuals with cancer or fibromyalgia may benefit from extended-release tramadol¹.

Tramadol works by changing the way the brain and nervous system respond to pain in the body. The therapeutic qualities provided by tramadol are what classify this medication as a "narcotic analgesic," otherwise known as a pain relief medication. Due to its pain-relieving effects, tramadol is classified in the United States as a DEA Schedule IV controlled substance. This means tramadol has some risk of being addictive for those who use it regularly, but it is not as addictive as some other opioids, such as morphine or heroin³.

If you regularly use tramadol, it is important that tramadol is not mixed with alcohol or any other drugs. Mixing tramadol with other substances may lead to fatal poisoning. In addition, tramadol should not be used during pregnancy. This is because babies can become dependent on the opioid and experience withdrawal when they are born. If you are pregnant and experiencing tramadol addiction, be sure to talk with your provider¹.

What are the Side Effects of Tramadol?

When you first begin using, the most common tramadol side effects include dizziness and stomach discomfort such as nausea. Within the first 24-72 hours of using the medication, you may experience life-threatening breathing problems. Breathing problems can also occur when your tramadol dosage is increased. It is important to be mindful of this risk when beginning treatment with tramadol or starting a higher dose of the medication².

In addition to these risks, other tramadol side effects include²:

• Sleepiness
• Difficulty falling asleep or staying asleep
• Headaches
• Nervousness
• Uncontrollably shaking one part of the body
• Mood changes
• Heartburn or indigestion
• Dry mouth
• Muscle tightness

While less common, tramadol use may also cause additional adverse effects, including:

• Seizures
• Hives
• Rashes
• Blisters
• Hallucinations

If you or someone you know who takes prescription tramadol experiences any of these effects, inform your doctor or call 911, as these effects are serious and potentially life-threatening¹.

Long term tramadol use also carries a risk of reduced interest in sex, impotence, and infertility, and may also increase the risk of serious liver damage or disease¹.

Is Tramadol Addictive?

While considered to be less addictive than other opioid medications such as morphine, tramadol use and abuse does carry a risk of physical and/or emotional dependence. Tramadol addiction may occur when you use the drug for more than several weeks or months at a time, so it is important to take tramadol exactly as directed by your provider. Do not take tramadol more often or in higher doses than directed by your doctor².

If tramadol is being considered as a treatment option for you, make sure to talk to your doctor honestly about your treatment goals. It is important to discuss the length of tramadol treatment as well as other ways to manage your pain. In addition, always be sure to talk to your doctor about any history of substance use in you or any of your family members. Factors such as drinking large amounts of alcohol, previous or current use of street drugs, or overusing prescription medications currently or in the past all increase a person's risk of tramadol addiction.

If you have a history of depression, mental illness, or suicidal thoughts/behaviors, you should also not use tramadol, as these put you at a higher risk of overusing or becoming addicted to the medication².

Signs of Tramadol Addiction

You may become addicted to tramadol if you use the medication over a longer period of time or use the medication in ways not directed by your doctor, such as taking the medicine more often or in higher doses. Signs of tramadol addiction include things such as:

• Using tramadol compulsively
• Visiting multiple doctors to get more of the medication
• Neglecting responsibilities at home or at work because of tramadol use
• Problems with others because of the substance use
• Having to take higher doses of the medication to feel the same effect (which is also known as drug tolerance)⁵

In addition, you may realize you are struggling with tramadol addiction if you experience symptoms of withdrawal when you stop taking tramadol or take it at a lower dose².

Tramadol Withdrawal Symptoms

Tramadol withdrawal may occur when you stop taking tramadol suddenly, take tramadol less frequently, or take it at a lower dose than your body is used to. Signs and symptoms that indicate tramadol withdrawal include²:

• Restlessness, nervousness, or panic
• Agitation
• Anxiety or depression
• Sweating
• Difficulty falling asleep or staying asleep (also known as insomnia)
• Tremors
• A tingling sensation in the skin
• Muscle spasms
• Stomach problems, such as abdominal cramping
• Runny nose or sneezing
• Cough
• Hair standing on end, or "goose flesh"
• Diarrhea

Less commonly, you may also experience "atypical" withdrawal effects. In these situations, you may experience:

• Severe anxiety
• Paranoia
• Hallucinations
• Tingling sensations
• Feeling detached from a person's surroundings (also known as derealization) ¹

Can You Overdose on Tramadol?

Since tramadol is an opioid medication, there is a risk of overdose if high doses of the medication are taken. Signs of tramadol overdose include¹:

• Slowed breathing
• Shallow breathing or difficulty breathing
• Sleepiness
• Not being responsive or not waking up
• Seizures
• Slow heart rate
• Vomiting
• Cold and/or clammy skin

When taking tramadol, it is important to discuss naloxone, a medicine used to treat opioid overdose, with your provider. It works by displacing the opioid from its receptors in the body, which sends someone into withdrawal from tramadol, and can save you if you overdose on an opioid, such as tramadol.

Anytime tramadol is prescribed, naloxone should be given to the person who is taking the medication. If you have naloxone, make sure to tell the people you live with and any caregivers that you have naloxone, in addition to where it is in the home and how to give it in the event of an overdose.

If you need to take tramadol away from home, bring the naloxone with you. Be sure to tell the people you are with that you have naloxone with you, where it is, and how to use it. In the event that you are with someone when they experience a tramadol overdose, the following steps are advised¹:

• Always call 911.
• Give naloxone if available.
• If the person is vomiting, lean them forward if they are sitting. If they are laying down, turn them onto their left side with their head facing down to reduce any risk of choking.
• Perform CPR if necessary.
• Try to maintain the person's body temperature with blankets.

In the event naloxone is given, remember that this medication reverses the effects of tramadol, immediately sending the user into a state of withdrawal, and so withdrawal symptoms may be noticed.

If you or someone you know is struggling with tramadol addiction, help is available and there are various evidence-based treatment options that should be discussed with your provider. If you have a tramadol addiction, you may need to be hospitalized when you stop taking the medication and begin going through withdrawal. Opioid withdrawal can be serious and potentially life-threatening, and so it is important to seek medical attention when quitting tramadol use¹.

Treatment for Tramadol Abuse and Addiction

Medication-assisted treatment has received considerable support from the research and is endorsed by The Substance Abuse and Mental Health Services Administration (SAMHSA). If you have a history of tramadol addiction, you may benefit from a daily regimen of a medication known as buprenorphine-naloxone. Buprenorphine is a medication approved by the FDA to treat opioid use disorder and can be prescribed by physicians. Buprenorphine reduces symptoms of tramadol withdrawal, reduces opioid cravings, and may lower the potential for opioid misuse. Before beginning a buprenorphine regimen, it is important to abstain from all opioid use for at least 12-24 hours⁴.

The length of time you need to be on a buprenorphine regimen differs from person to person. Some people may need the medication for a few months, while others find that staying on the medication indefinitely works for them to remain opioid-free. As buprenorphine has some opioid-like properties, naloxone is often added to the medication to decrease the likelihood of misuse⁴.

Counseling and Therapy

In addition to a medication regimen, if you have a tramadol addiction, you should also receive counseling and behavioral therapies. A combination of medication and therapy is found to be most helpful in treating people as a whole and helping individuals stay drug-free⁴. Other recommendations for ongoing addiction support include 12-step programs and recovery groups. For example, Narcotics Anonymous is a 12-step program that may be helpful if you're addicted to or abusing tramadol.

References

1. World Health Organization (2014, June). Tramadol Update Review Report, viewed November 2020.
2. U.S. National Library of Medicine (2019, January). Tramadol, viewed November 2020.
3. National Library of Medicine (2020). Tramadol, viewed November 2020.
4. Substance Abuse and Mental Health Services Administration (2020). Buprenorphine, viewed November 2020.
5. American Psychological Association (2018, November). Opioid Use Disorder, viewed November 2020.
6. Nicole Cupples, Troy A. Moore (2013). A case of tramadol dependence and successful treatment with buprenorphine/naloxone, Mental Health Clinician, 3 (6): pp. 283–285.