Tramadol abuse and addiction has become more prominent in recent years than ever before.
The Centers for Disease Control and Prevention (CDC) September 2018 MMWR publication estimated that 50 million Americans suffer with chronic pain. This amounts to around 20% of the adult American population. 8% or 19.6 million suffer from high-impact chronic pain.
With such a high number of Americans suffering daily from pain, is it any wonder more than 41 million prescriptions for tramadol (a cheap and powerful analgesic) were dispensed in 2017 in the US?
What Is Tramadol?
Tramadol Hydrochloride (Ultram) is a narcotic pain-relieving medication that is a synthetic analog of codeine. It was first approved for prescription in the United States in 1995.
Tramadol has a wholesale cost of less than US$0.05 per dose. Generic tramadol is widely available, and the drug is marketed under various FDA-approved brand names:
- Ultram ER
- Rybix ODT
- Ultracet (acetaminophen/tramadol combined)
Tramadol is often prescribed as a safer and cheaper alternative to more expensive opiate painkillers such as Morphine, Oxycontin and Codeine.
Due to tramadol’s contribution to the ongoing opioid crisis in America, this drug is only legal with a doctor's prescription. Tramadol is classified as a Schedule IV controlled substance in all 50 US states.
Is Tramadol an Opioid?
Tramadol is a synthesized drug manufactured to mimic the effects of opiates. It works by attaching to the opioid receptors in the brain and changing the brain's perception of pain. It is therefore classified as an opioid drug.
In addition to working on the brain's opioid receptors, tramadol also inhibits the serotonin and norepinephrine reuptake inhibitors, inducing euphoria - making it a choice drug for abuse.
Tramadol has similar side effects and withdrawal symptoms to other drugs of the opiate class.
Is Tramadol Addictive?
Tramadol is very addictive, both physically and psychologically, especially when it is abused and not taken as prescribed. Even those that follow a tramadol prescription for a genuine condition can become physically dependent if they take tramadol for more than a few weeks/months.
When tramadol was originally approved for medical use it was thought to be less addictive, safer and have less side effects than other opiate drugs. This has since proved not to be the case.
As well as being an effective opioid analgesic, tramadol also produces feelings of elation, relaxation, confidence and contentment. These effects are much sought after by those addicted to opiates who abuse tramadol purely for this reason.
Tramadol is prescribed for moderate to severe pain conditions in the cases where over-the-counter medicines do not provide adequate pain relief. Some people who take tramadol regularly do not realize that they have developed a physical addiction until they try to stop.
When taking this drug regularly and for a period of time, tramadol will stop working effectively and opioid withdrawal syndrome can occur. In order to achieve the same effects as before, the individual will have to increase the dosage of tramadol they take. This is known as drug tolerance.
Tramadol addiction occurs when an individual becomes compelled to take tramadol whether there is a physical need or not.
Addiction is not the same as dependence. Tramadol dependence can occur through abuse of the drug or as a byproduct of taking a regular prescription.
Addiction in its truest form is a chronic, progressive and life-threatening brain disease. It can manifest in many forms and attach to many substances and to behaviors. In an individual that is pre-disposed to developing addiction or has a history of addiction, there is a higher risk of them becoming addicted to tramadol.
For an individual to suffer from tramadol addiction there needs to be an element of psychological attachment and compulsion. Addiction is characterized by an overwhelming craving and compulsion that surpasses all reason.
Those that suffer from tramadol addiction will go to extreme lengths to hide their addiction from others. They will be compelled to seek out and take the drug regardless of the cost to their own well-being and to their loved ones’ peace of mind.
Tramadol abuse is sadly very common and is just as dangerous as tramadol addiction. Many who abuse tramadol will go on to develop an addiction; many that are addicted will regularly abuse it.
Tramadol quick release capsules, pills and elixirs hold the potential to be easily abused. They can be abused by crushing and snorting or injecting. Both routes of administration provide a quicker and more potent “high.”
Tramadol is abused by taking it off prescription, taking more than is prescribed or by mixing it with alcohol or other sedative or opiate drugs. Abuse of tramadol can be deadly - it can lead to overdose, slowed breathing and respiratory arrest.
Tramadol Withdrawal Symptoms
Tramadol withdrawal symptoms include, but are not exclusive to:
- Upper respiratory symptoms
- Dilated Pupils
- Panic attacks
Tramadol withdrawal symptoms are much the same as opiate withdrawal symptoms, however seizures and serotonin syndrome are more associated with tramadol side effects and tramadol withdrawal than other less complex opiates.
Tramadol withdrawal is not considered dangerous. It is however very unpleasant and there is a high risk of relapse during detox. Physical withdrawal symptoms last for approximately one week but can be prolonged over several weeks/months if you have been taking the drug for a long period of time or in high amounts.
Tramadol withdrawal symptoms can be eased by undergoing a medically assisted tapering off regime.
Where Tramadol addiction has been identified, a SAMHSA certified opioid treatment program is recommended.
When it comes to finding safe alternatives to tramadol the options are extremely limited. Opiates come in many forms, but all have the potential to cause physical dependence.
Over-the-counter medicines many not provide adequate pain relief if the individual is in moderate to severe pain. Alternatives to tramadol that are a safer option would include anti-inflammatory drugs such as Naproxen (brands like Aleve) and Ibuprofen.
Acetaminophen can be added to tramadol to make a lower dosage more effective. Ultracet combines both tramadol and acetaminophen. If you are combining tramadol with another analgesic exceptional caution should be applied. Taking too much acetaminophen can damage your liver and taking too much ibuprofen can cause intestinal problems.
Please discuss suitable alternatives to tramadol with your doctor. As everyone’s clinical requirements are different, a professional medical assessment is essential.
Like most pharmaceutical drugs the dosage of tramadol varies. The amount prescribed is very much specific to the level of pain relief required.
Tramadol can be administered orally, by intramuscular injection, by intravenous injection and by intravenous infusion. Tramadol has not been approved for use in children under the age of 18 years old.
Following titration (half dose), tramadol 50 to 100 mg can be administered as needed for pain relief every 4 to 6 hours, not to exceed 400 mg/day.
The maximum recommended daily dose for extended release tramadol is 300mg following titration. Always follow your doctor's instructions with regards to taking this drug.
Tramadol Side Effects
Tramadol side effects include but are not exclusive to:
- Difficulty urinating
- Drug addiction
- Dry mouth
- Hallucinations (auditory and visual)
- Heart palpitations and arrhythmia
- Opioid withdrawal syndrome
- Reduced appetite
- Respiratory repression
- Seizures (Rare)
- Serotonin syndrome (Rare)
- Skin reactions
How Long Does Tramadol Stay in Your System?
The length of time tramadol stays in your system varies from person to person and is dependent on several personal factors. Body fat percentage, metabolism and other medications can all affect the rate that your body dispels this drug.
Tramadol has a half-life of approximately 6 hours. The time the remaining half can be detected in your system falls within the following time frames, to be used as a broad guideline only:
- Urine: 2-4 days
- Saliva: 12 -24 hours
- Blood: 12 to 24 hours
- Sweat: 1 to 4 weeks
- Hair: 4 to 6 months