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Tramadol Misuse & Addiction

Tramadol is an opioid medication that is prescribed for the management of moderate to moderately severe pain in adults.1 Although it does have beneficial pain-relieving effects for the appropriate patient when prescribed by a physician, it can come with side effects such as abdominal pain, flatulence, and headache.1

Since tramadol is an opioid, there is potential for misuse due to its euphoric and pain-relieving effects and as a result it can pose dangers such as addiction and overdose.1

If you or someone you care about uses tramadol, you should be aware of the potential risks and know how to find treatment for tramadol addiction if necessary. Opioid addiction can be challenging to overcome, but it is a treatable condition, and people can recover with proper help, which can include medication, counseling, and behavioral therapy.2

What Is Tramadol?

Tramadol is a prescription opioid that is approved by the U.S. Food & Drug Administration (FDA) for the treatment of moderate to moderately severe pain in adults.1,3 Other opioids include prescription and illicit drugs like hydrocodone, oxycodone, fentanyl, codeine, morphine, heroin, and methadone.2

This prescription medication is typically misused and diverted by people who want to experience a tramadol high or tramadol euphoria. According to the U.S. Drug Enforcement Administration (DEA), it is the most commonly misused prescription opioid among people struggling with opioid addiction, healthcare professionals, and people with chronic pain.4

Tramadol is listed as a Schedule IV substance under the Controlled Substances Act (CSA). This means that tramadol has a somewhat lower potential for misuse than methadone, codeine, hydromorphone, and morphine, which are all Schedule II substances that pose a higher risk for misuse and dependence.4,5

Different Types of Tramadol

Tramadol is available in generic forms and is also known by the brand names Ultram, Ultram ER, and Conzip, as well as Ultracet when combined with acetaminophen.3 It is available as capsules that come in immediate- or extended-release form.6

Side Effects of Tramadol

Tramadol side effects can vary from person to person. Some side effects of tramadol are mild and more common, while others can be serious and potentially life-threatening.6

Common side effects of tramadol usually include:6

  • Constipation.
  • Dizziness.
  • Headache.
  • Nausea.
  • Vomiting.
  • Sleepiness.

Side effects mostly occur during initial treatment rather than during maintenance doses that are used for ongoing pain management.6

Long-Term Effects of Tramadol

Tramadol most commonly impacts the central nervous system (CNS) and the neuromuscular and gastrointestinal systems, but it can also impact the endocrine, immune, and cardiovascular systems.6,7 This can result in immediate effects as well as tramadol long-term side effects. This includes:7

  • CNS issues, such as small or pinpoint pupils and respiratory depression.
  • Gastrointestinal issues, like slowed digestive and constipation.
  • Cardiovascular issues, such as low blood pressure upon standing up.
  • Endocrine issues, like androgen deficiency, which can manifest as low libido, impotence, erectile dysfunction, amenorrhea, or infertility.
  • Immune or immunosuppressive effects.

Long-term administration of tramadol can cause dependence and increase the risk of addiction, which is diagnosed as opioid use disorder (OUD).1

Signs of Tramadol Addiction

If you’re struggling with prescription opioid addiction, you’re not alone. According to the 2021 National Survey on Drug Use and Health, 8.7 million people age 12 and older had misused prescription opioids during the past year.8 One of the dangers of prescription opioid misuse is that it can be a gateway to heroin use; the National Institute on Drug Abuse explains that 4% to 6% of those who misuse prescription opioids switch to heroin and around 80% of those who use heroin first misused prescription opioids.2

Addiction is a treatable, chronic medical disease that involves complex interactions between the brain’s circuits, genetics, the environment, and an individual’s life experiences.9 Someone who is addicted to tramadol continues to use it, engaging in ongoing compulsive behaviors, despite the harmful consequences.9 Tramadol addiction signs, symptoms, and severity vary from person to person.10

Medical professionals use the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to guide their diagnoses. Only a professional can diagnose someone with OUD, but it can be helpful to know the diagnostic criteria, which includes:10

  • Using opioids in larger amounts or over a longer period than was intended.
  • Being unable to control or cut opioid use.
  • Spending a lot of time in activities to obtain, use, or recover from opioids.
  • Craving opioid use.
  • Failing to fulfill major role obligations at work, school, or home due to opioid use.
  • Continuing to use opioids despite persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.
  • Giving up or reducing important social, occupational, or recreational activities because of opioid use.
  • Using opioids in physically hazardous situations (such as driving or operating machinery).
  • Continuing to use opioids despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
  • Needing increased amounts of opioids to achieve intoxication or the desired effect because due to opioid tolerance, lower doses don’t achieve this anymore.
  • Withdrawal when opioid use is cut back or stopped.

It’s not always easy to identify tramadol addiction in someone, but you might notice certain behaviors, such as:

  • Taking someone else’s prescription.2
  • Repeated loss of prescriptions.11
  • Doctor-shopping.11
  • Reporting increased pain although their condition is not worsening.11
  • Writing prescriptions for themselves (if they are healthcare professionals).10
  • Purchasing opioids online or through illegal sources.10

Tramadol Withdrawal

Tramadol withdrawal occurs when someone dependent on tramadol suddenly stops or cuts down their tramadol use.1 As mentioned earlier, dependence is a physical adaptation that occurs due to long-term, regular administration of a substance, which can include use as directed by a physician as well as misuse.1 The FDA labeling guide indicates that people may avoid withdrawal symptoms by following a proper tapering schedule under the guidance of a healthcare professional.1

Tramadol Withdrawal Symptoms

Common tramadol withdrawal symptoms can include:1

  • Anxiety.
  • Sweating.
  • Insomnia.
  • Shivers/feeling cold, followed by sweating.
  • Pain.
  • Nausea.
  • Tremors.
  • Diarrhea.

In rare cases, people can suffer from hallucinations, as well as panic attacks, severe anxiety, and paresthesias (pins and needles sensation).1 People typically report that opioid withdrawal feels like a very bad flu, and while it can feel unpleasant and uncomfortable, it is not usually life-threatening.12

Tramadol Withdrawal Timeline

The tramadol withdrawal timeline can vary in symptomatology and from person to person. Generally speaking, the tramadol detox timeline and withdrawal from long-acting opioids like tramadol begins around 12 to 48 hours after a person’s last use and lasts 10 to 20 days.12 Some people can develop less acute withdrawal symptoms, such as anxiety, feelings of unease, inability to experience pleasure, and insomnia, that persist for weeks or months.10

Dangers of Tramadol

In addition to the potential for dependence, withdrawal, and addiction, there are additional dangers of tramadol use and misuse.1 These can include:

  • Risk of overdose, which can cause symptoms such as respiratory depression, stupor or coma, skeletal muscle flaccidity, cold and clammy skin, constricted pupils, seizures, slow heart rate, low blood pressure, cardiac arrest, and death.1 An overdose is a life-threatening emergency. If you suspect someone is overdosing on opioids and you have naloxone (Narcan, RiVive, Kloxxado) on hand, you should administer it and call 911.1
  • Dangerous drug interactions, which can occur when combining tramadol with alcohol, opioids, anesthetic agents, narcotics, phenothiazines, tranquilizers, or sedative hypnotics, as well as with illicit drugs.1
  • Risk of suicide, especially in people who are depressed or suffer from more than one type of addiction.1

Tramadol Detox

Upon admission into a drug rehab program, treatment will generally involve:13

  • Medical detoxification.
  • Treatment (rehabilitation).
  • Aftercare.

Tramadol detox is typically the first step in the recovery process.13 It is designed to manage the onset of acute and general withdrawal symptoms through the use of medications, interventions, support, medical withdrawal management, and address complications that may arise.13

Detox involves 3 key elements:14

  1. Evaluation, which considers all your unique needs to determine the proper placement, test for substances, and formulate a post-detox treatment plan.
  2. Stabilization, which involves the actual withdrawal process, where you receive medication, support, and medical supervision to help you become medically stable and return to a substance-free state.
  3. Fostering a person’s readiness for and entry into treatment, which means you receive support and encouragement to follow through with the complete addiction treatment continuum of care.

Although the detox and withdrawal management process is important (and potentially lifesaving in some instances), it is not a substitute for more comprehensive rehabilitation or treatment efforts.15 People are encouraged to continue ongoing treatment to solidify their recovery efforts, work on underlying issues, and lay the foundation for long-term abstinence.15

Rehab Treatment for Tramadol Addiction

There are various types of addiction treatment programs, including specialty programs, programs for co-occurring disorders, and inpatient and outpatient treatment. Different settings can be more appropriate for different people, so you will receive an evaluation and guidance from a rehab center to find the right placement for your needs.16 These addiction treatment programs can include:

Inpatient Treatment

An inpatient program involves living onsite for the duration of treatment and receiving around-the-clock care. It can be a short-term form of treatment that takes place in hospital-like settings, or longer-term residential treatment that occurs in licensed residential facilities.13 Inpatient treatment can vary in duration, with programs lasting a few months to more than a year, but the exact timeframe can depend on your unique needs.13 Inpatient treatment is typically recommended for those with severe OUD, co-occurring disorders, or those without supportive friends, families, or home environments.13

Outpatient Treatment

An outpatient program involves living at home for the duration of treatment and traveling to a rehab center to participate in treatment and receive care. It can vary widely in level of intensity and the type of care offered, and programs can last anywhere from 2 months to a year or longer.16 Outpatient rehab can be a good option for those with less severe problems, supportive friends or family members, a safe home environment, and access to reliable transportation.16

Medications for Addiction Treatment

Different medications are used to help people through withdrawal, and some are also used during the maintenance component of treatment to help decrease cravings and reestablish normal brain function.13 These FDA-approved medications can include lofexidine, a non-opioid medicine designed to reduce opioid withdrawal symptoms, as well as those used for treatment and maintenance, such as methadone, buprenorphine, and naltrexone.13,17

Behavioral Therapy

Treatment usually also involves different behavioral therapies, such as:

  • Contingency management (CM), which provides tangible rewards to reinforce positive behaviors and treatment outcomes, such as negative drug tests.15
  • Cognitive behavioral therapy (CBT), which helps people work on unhelpful behaviors and teaches improved coping skills.2
  • Family therapy, which can help repair and strengthen family relationships affected by addiction.2
  • 12-Step programs, which provide the support and fellowship of others in recovery.13

Aftercare

As recovery is a lifelong process, it can be important to participate in some form of aftercare upon completing a more intense addiction treatment program.13 Aftercare, also known as continuing care, can provide many benefits, such as monitoring ongoing recovery, a lower chance for relapse, and increased long-term recovery success.18 Aftercare can include different options, such as continued participation in support groups, individual counseling, informal check-ins with a counselor, or a sober living home.18

Insurance Coverage for Tramadol Addiction

Treatment for tramadol addiction can be managed in a variety of ways, such as using health insurance coverage, paying out-of-pocket, attending a facility with public funding, asking about sliding scale plans or payment plans, or asking relatives or friends to help out.

Health insurance plans can vary in coverage. Some plans may require you to use in-network providers, as with HMOs, or may require you to pay less if you use their providers, as with PPOs.19 You may be responsible for a co-pay, which is the small amount you pay upfront when you visit a provider, or a deductible, which is the yearly amount you’ll need to pay before your plan covers costs, but these amounts can vary widely.20

It’s important to verify your exact coverage with your carrier to determine your specific benefits and costs.

The Affordable Care Act (ACA) states that addiction treatment is an essential benefit, and healthcare plans must include care for substance use disorders.21

If you’re struggling, contact American Addiction Centers (AAC) at to find local rehab options or to learn more about treatment.

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