The opioid epidemic continues to rage on in the U.S., and a huge part of the epidemic stems from prescription drug abuse. One such prescription drug of abuse is tramadol. Tramadol is an opioid or narcotic pain reliever. For years tramadol was seen as less potent and less addictive than other opioids. The number of visits to emergency departments related to tramadol use and tramadol overdoses has been going up, leading many medical professionals to rethink tramadol addiction.
How Does Tramadol Addiction Occur?
What's In This Article?
Tramadol is a prescription opioid that is intended to relieve pain ranging from mild to moderate in severity. Tramadol is available under the brand name Ultram, primarily. Other tramadol brand names are ConZip, Ryzolt and Ultram ER. Tramadol immediate-release is given to patients to treat acute pain. Extended-release tramadol is for chronic, ongoing pain.
Tramadol is one of the least potent prescription opioid pain medications—for example, it’s much less potent than hydrocodone and oxycodone. Unfortunately, the reduced potency of tramadol can lead people to think it’s not dangerous or addictive—neither of which is true. Tramadol is highly addictive, particularly in certain situations.
When someone takes tramadol, whether as prescribed or otherwise, it crosses the blood-brain barrier, then, once this happens, the tramadol activates opioid receptor sites. This activation causes a slow-down of the central nervous system. Opioids like tramadol don’t treat pain—instead, the opioid site activation changes how a person senses pain.
Tramadol addiction may occur when a flood of feel-good neurotransmitters go into the brain, and this, in turn, causes the brain’s reward system to activate. Once the reward system activates, a person’s use of tramadol or another addictive substance becomes compulsive, meaning no longer in their control.
While tramadol addiction can occur when the medication is used exactly as prescribed, the risk is lower in this scenario. The risk of developing tramadol addiction is higher in someone who abuses the drug.
While the reward response in the brain is the primary reason tramadol addiction can occur, some people may be more at risk of developing an addiction than others. Factors that play a role in tramadol addiction and addiction to other substances are:
- Family History: Research indicates when someone has a close relative with an addiction disorder, they’re more likely to also develop an addiction as compared to someone without a family history.
- Other Genetic Factors: Other genetic factors that can play a role in tramadol addiction are things such as impulsivity or the desire to seek out new stimuli.
- Environment and Experiences: Some people with traumatic experiences or negative environments may be more likely to engage in drug abuse and become addicted. Substances are often used as a coping mechanism, and some people may look for relief from negative emotions or experiences by using substances.
Tramadol Is a Controlled Substance
Due to the reduced potency, some people wonder if tramadol is a controlled substance. The answer is yes; tramadol is a controlled substance. The Controlled Substances Act is a federal law, and it categorizes substances based on their medical use, and their potential to be addictive and habit forming.
Tramadol is schedule IV. This means that while there is a potential for dependence and addiction, that risk is lower than other opioids, which are typically schedule II. Schedule II substances have a high potential for abuse and to be habit-forming.
What Is Tramadol Abuse?
With prescription drugs, substance abuse is any situation where the medication is used without a prescription or outside of how it’s prescribed. Examples of abuse that can increase the risk of developing tramadol addiction include:
- Taking tramadol from a friend or family member
- Using tramadol for longer than a doctor instructs you to
- Taking higher doses than prescribed and instructed
- Crushing tramadol tablets to snort or inject them
- Combining tramadol with other substances to increase the effects—such as with alcohol or more potent opioids
- Using tramadol only for certain desirable effects such as feeling euphoria or relaxation
- Doctor shopping to get more prescriptions
In the short-term, some of the effects of tramadol abuse or the signs of tramadol abuse include:
- Deep relaxation
- Sense of well-being
- Loss of inhibition
- Changes in sleep patterns
- Panic attacks or anxiety
- Dry mouth
Signs of Tramadol Addiction
Addiction is a psychological disorder that affects a person’s physical and mental health. Addiction to any substance including tramadol indicates that the use of that substance is out of the person’s control. Addiction is considered a chronic disorder, and it typically requires treatment to manage addiction. Signs of tramadol addiction include:
- Using tramadol for longer than intended
- Regularly using more tramadol than intended
- Developing a tolerance and needing more tramadol to get desired effects
- Continuing to use the medication despite negative outcomes or consequences
- Unsuccessfully attempting to stop using tramadol or cut back
- Abandoning other activities and priorities to use or obtain tramadol
- Spending significant amounts of time trying to get more tramadol, using tramadol or recovering from its effects
Along with the concept of tramadol addiction and psychological dependence, there is something else to consider, which is physical dependence. When someone uses tramadol for a period of time, physical dependence is possible. Tramadol dependence doesn’t necessarily mean someone’s addicted. Physical dependence can occur even when tramadol use follows prescribing guidelines. It does mean that someone will experience withdrawal symptoms if they stop using tramadol suddenly.
To avoid withdrawal, most health care providers will advise patients to slowly reduce how much tramadol they take, or taper down. Tapering down can minimize or eliminate symptoms of opioid withdrawal.
Possible symptoms or tramadol withdrawal are:
- Physical and psychological cravings
- Abdominal pain
- Cold sweats
- Problems sleeping
- Bone pain
- Muscle tension
- Large pupils
One of the biggest risks of tramadol addiction or addiction to any kind of opioid is the potential for an overdose to occur. Opioid overdoses are extremely deadly and kill tens of thousands of people—most unintentionally—in the U.S. every year.
Opioids like tramadol are central nervous system depressants. They slow down the central nervous system. The CNS controls some of our most vital functions. For example, the CNS controls breathing, respiration and heart rate.
If someone takes too high of a dose of tramadol or any opioid, their central nervous system might slow down so much that their breathing and heart rate reach dangerously low levels or stop altogether.
Along with the risk of overdosing on tramadol when it’s used on its own, it’s also possible to overdose on tramadol when it’s combined with other central nervous system depressants. Other CNS depressants include:
- All opioids
- Benzodiazepines such as Xanax
- Prescription sleep aids like Ambien
Synthetic opioids like tramadol have shown the highest increases in overdose deaths in recent years compared to other opioids.
The potential for a tramadol overdose increases if:
- You have chronic pain, and you take higher doses to try and find relief
- You’ve developed a tolerance to the drug
- You combine tramadol with other substances
- You use tramadol in ways other than what’s intended, such as snorting it
- You’ve stopped using tramadol for some time and then you relapse and use again. In this situation, your tolerance may have gone down, and you don’t realize it, so you use the same amount of tramadol you were previously.
Symptoms of a Tramadol Overdose
A tramadol overdose is a medical emergency and requires immediate help. Signs and side effects of a tramadol overdose are:
- Extreme nausea and vomiting
- Extreme drowsiness or lethargy
- Blurred vision
- Odd changes in behavior
- Irregular breathing, slow breathing or stopped breathing
- Fingernails or lips get a bluish tint
- Cold or clammy skin
- Tiny pinpoint pupils
Long-Term Effects of Tramadol Addiction
For someone struggling with tramadol addiction, not only are the short-term effects scary but so are the long-term effects.
Dependence and addiction are considered two of the most serious long-term effects of tramadol addiction, but there are others.
Long term effects of tramadol addiction can include:
- Sexual dysfunction
- Changes in hormone levels including testosterone levels
- Extreme constipation leading to medical complications
- Abdominal bloating and distention
- Liver damage
- Brain damage because of continuing respiratory depression
- The development of psychological disorders such as depression
- Cardiac arrest
- Heart failure
- Organ damage
With tramadol addiction, people who use it for extended periods often start to lose the natural ability to cope with pain, without the use of opioids. Long-term opioid use almost always causes significant decreases in pain tolerance. People who abuse opioids also experience more intense and severe levels of pain than people who don’t use opioids.
Long-term opioid use can cause problems with a person’s immune system, also.
How Is Tramadol Addiction Treated?
There are different options for how a tramadol addiction can be treated. First, visiting a health care professional is important, to diagnose you with an addiction. There are specific criteria used to make an opioid addiction diagnosis. The number of criteria that a person shows signs for will determine not only if they have an addiction disorder, but also how severe it is.
Once someone receives an opioid addiction diagnosis, treatment options include:
- Medical Detox: Since physical dependent on tramadol can form, some people may require a medical detox. During a medical detox, a patient is monitored and provided with the necessary medications and treatments to keep them safe.
- Inpatient Rehab: An inpatient rehab program is also called residential rehab. This is best suited for people with severe and long-term addictions. During inpatient rehab, patients check into a facility where they receive holistic care.
- Outpatient Rehab: Outpatient rehab is an option for milder addictions and also for people who have already completed an inpatient program.
- 12-Step and Support Groups: Some people may go to a support group like Narcotics Anonymous (NA) if they’re struggling with a tramadol addiction.
- Individual therapy: Individual therapy can be a way to treat tramadol addiction, either on its own or along with a formal rehab program.
Summing Up: What to Know About Tramadol Addiction
Tramadol addiction is becoming a growing problem. Specific issues related to tramadol addiction include polysubstance abuse where people are developing addictions to multiple drugs and the increased risk of overdose. Tramadol addiction is possible, despite the decreased potency of this drug and if you have concerns about yourself or a loved one, you should contact a health care professional. You may require care at an addiction center or treatment facility if your substance use disorder is severe enough.
IBM Micromedex. “Tramadol (Oral Route).” The Mayo Clinic. Accessed March 17, 2019.
Addiction Center. “Tramadol Addiction and Abuse.” Accessed March 17, 2019.
Family Doctor Editorial Staff. “Opioid Addiction.” American Academy of Family Physicians. February 26, 2019. Accessed March 17, 2019.