Tramadol Use and Abuse
Tramadol (Ultram, ConZip) is an opioid medication prescribed for the treatment of moderate to moderately severe acute or chronic pain in adults. Although it can help treat pain, it has a relatively high potential for abuse and addiction in some people.1
What Is Tramadol?
Tramadol is prescribed for moderate to moderately severe pain. Because it is one of the least potent drugs in the opioid class, many people underestimate its potential for abuse and addiction, which can be crippling to those who suffer from it.
Referred to on the street as “chill pills,” “trammies,” or “ultras,” tramadol is often sold illegally as a lighter version of OxyContin or heroin. The drug is typically abused for the feelings of well-being and sedation it produces, particularly in higher doses.
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Classification as a Schedule IV Drug
Despite many reports of its abuse, authorities hesitated to make tramadol a controlled substance, fearing that physicians would be less likely to prescribe it for chronic pain. However, in July 2014, the Drug Enforcement Administration (DEA) listed tramadol as a Schedule IV drug under the Controlled Substances Act after a significant increase in emergency room visits related to nonmedical use of tramadol. Schedule IV drugs have some potential for abuse, though their abuse potential is lower than drugs scheduled as I, II, or III. 1,2,3
Methods of Use
Tramadol is an oral medication, but it may be abused in a variety of ways, including:
- Crushing and snorting the tablets.
- Chewing the tablets.
- Dissolving the tablets in solution for injection.
Users may also take tramadol more often than prescribed, take it in higher doses than prescribed, or mix it with alcohol and/or other prescription or nonprescription drugs.
Short-term effects include reduced perception of pain, euphoria, relaxation, and drowsiness.
Tramadol is a synthetic opioid analgesic that works by changing the brain’s perception of pain. Because the drug works on the brain’s opioid receptors, it can also cause feelings of pleasure and euphoria, particularly when taken in higher, nonmedical doses.Tramadol is unique among opioids in that, in addition to its painkilling effects, it possesses some antidepressant properties due to an increase in the level of certain neurotransmitters (serotonin and norepinephrine) in the brain when taken. 2
Even though tramadol is a less potent opioid, it still has a potential for abuse due to its pleasant sedating effects and its influence on brain reward mechanisms.
Common short-term physical and mental effects of tramadol include:
- Reduced perception or absence of pain. 1
- Uplifted mood.
- Feelings of euphoria.
- Feelings of relaxation.
- Reduced anxiety.
- Drowsiness. 2
- Loss of appetite. 1
Tramadol has many potential side effects even for those who take their dose as prescribed by a physician. Some common side effects are: 1,2,3
- Mood changes.
- Muscle weakness.
- Muscle tightness.
- Uncontrollable shaking/tremors in certain parts of the body.
- Sleep problems (difficulty falling asleep or staying asleep).
- Anxiety and nervousness.
- Dry mouth.
- Appetite loss.
- Rash, hives, or blisters.
- Rapid pulse.
- Swelling of the eyes, lips, face, tongue, etc.
- Difficulty breathing.
- Difficulty swallowing.
- Coordination problems.
- Loss of consciousness.
Long-term use of tramadol also poses many significant risks for users. High doses of tramadol, especially when combined with selective serotonin reuptake inhibitors or monoamine oxidase inhibitors, can lead to serotonin syndrome, a potentially life-threatening result of specific drug interactions that produces symptoms such as muscle rigidity, pain, hyperthermia, and convulsions. 2
Other potentially serious risks and long-term effects of tramadol abuse include: 5,7
- Increased risk of infectious disease (if injected).
- Collapsed veins (if injected).
- Slowed reaction time.
- Memory problems.
- Increased suicide risk.
- Risk of automobile accident while driving under the influence.
- Marital and familial problems due to problematic drug use.
- Poor work or academic performance.
- Overall health decline as a result of drug addiction.
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Over time, the brain and the body can become accustomed to tramadol and may seem to function suboptimally without it. When taken on a long-term basis, tramadol leads to the development of physical dependence and will result in a myriad of withdrawal symptoms when use is abruptly stopped or lessened.
Common symptoms of tramadol withdrawal include: 1,2
- Muscle pain.
- Upper respiratory problems.
- Drug cravings.
- Extreme nervousness and anxiety.
- Panic attacks.
- Tingling and numbness in the extremities.
Signs and Symptoms of Addiction
It may be challenging for people abusing tramadol to realize that they have a problem. Many people begin taking the drug as prescribed by their doctor for acute or chronic pain and may not recognize that they have developed an addiction because they see the drug as medicine. For this reason, those who take the drug should be aware of the signs and symptoms of addiction so that they know when to seek help if their use becomes a problem.
Some common signs and symptoms of drug addiction or a substance use disorder include: 2,4,5
- Taking higher doses than prescribed.
- Running out of prescriptions and purchasing more on the streets.
- Taking the drug in a way other than prescribed.
- Drug-seeking behavior (doctor-shopping, forging prescriptions, repeated “loss” of prescriptions, etc.).
- Taking illicit actions to obtain tramadol.
- Lack of control over drug use.
- Compulsive drug use.
- Needing tramadol to function.
- Using the drug for nonmedical purposes.
- Making excuses to use drugs.
- Missing work, school, or other commitments and duties as a result of drug use.
- Neglecting to eat.
- Neglected personal appearance and hygiene.
- Secretive behavior surrounding drug use.
- Missing activities due to drug use.
- Social isolation due to drug use.
- Continued use despite any harm it may be causing.
- Physical tolerance resulting in withdrawal symptoms when use is abruptly stopped.
In some cases, other signs of drug use may be apparent, such as:
- Hostility when confronted about use.
- Mental confusion.
- Violent episodes.
Other signs of addiction specific to tramadol and other opioid drugs include: 7
- Pinpoint pupils
- Nodding in and out of consciousness
- Slurred speech
- Appetite/weight changes
- Coordination problems
Dependence vs. Addiction
It is important to understand the difference between dependence and addiction. The majority of people who use tramadol long-term will likely become dependent on it.
People can be develop physical dependence to a drug without being addicted to it. However, those who are addicted are typically dependent as well. Addiction is a chronic and crippling condition that results in compulsive behavior and an inability to control drug use despite obvious harm that it may be causing in one’s life.
Combining tramadol with other drugs increases the risk of overdose.
Perhaps the greatest risk of tramadol abuse is overdose, which can lead to accidental death. Tramadol overdose is not likely when taken as prescribed by a doctor, but it can occur in those who abuse it.
Higher doses can cause overdose, especially after a relapse. People may develop a high tolerance to the drug and need larger doses to achieve the initial effect or “high.” After quitting the drug for a period of time and relapsing, addicts may not realize their tolerance is lower and end up taking a dose that is too high, which can lead to an accidental overdose. 8
The risk of overdosing on tramadol is also significantly higher when it is taken in combination with other central nervous system depressants, such as alcohol, benzodiazepines, or other opioid pain relievers (oxycodone, hydrocodone, etc.). Those who are taking antidepressants, sedatives, muscle relaxants, opiates, or tranquilizers should take extra caution when using tramadol as the risk of overdose is significantly increased. 4
Symptoms of tramadol overdose may include: 1
- Extreme drowsiness
- Slowed heart rate
- Breathing problems
- Decreased pupil size (pinpoint pupils)
- Muscle weakness
- Cold, clammy skin
- Respiratory depression
- Loss of consciousness
- Overall rates of abuse: According to the 2013 National Survey on Drug Use and Health, 3.2 million people in the United States aged 12 and older reported using tramadol non-medically at least once in their lifetime, increasing from 2.7 million in 2012. 2,6
- Abuse rates by age: Of the 3.2 million people who reported non-medical use of tramadol, approximately 89,000 were between the ages of 12 to 17, 928,000 were 18 to 25, and 2.2 million were 26 years of age or older. 6
- Increase in prescriptions: From 2008 to 2013, prescriptions for tramadol increased 88%, from 23.3 million to 43.8 million. 3
- Emergency room visits: In 2011, the Drug Abuse Warning Network (DAWN) reported approximately 54,000 emergency room visits related to tramadol use, and at least 20,000 of those visits were due to non-medical use of tramadol. 2,3
- Increases in ER visits over time: Tramadol-related emergency room visits as a result of abuse or misuse increased by 250% between 2005 and 2011, with only 6,255 visits in 2005. Of these visits, the greatest increase occurred in patients 55 and older, increasing by 481% from 892 visits in 2005 to 5,181 in 2011. Women accounted for more visits in men, with 12,238 emergency room visits by females in 2011 and only 9,411 male emergency room visits. 3
- ER visits due to drug combinations: Of the total emergency room visits in 2011, 29% were for tramadol misuse only, 20% involved tramadol in combination with another drug, 26% involved tramadol combined with 2 other drugs, and another 26% combined tramadol with at least 3 other drugs. Of the drug combinations, 35% combined tramadol with other painkillers, 32% combined tramadol with anti-anxiety and insomnia medications, 14% combined it with alcohol, and 12% combined it with illegal drugs. 3
Find Treatment for Tramadol Addiction
Tramadol addiction can lead to physical and emotional challenges. Many recovery centers and rehabilitation programs are designed to help people detox under medical supervision and rebuild their lives, free from drug addiction and dependence.
. U.S. National Library of Medicine. (2016). MedlinePlus, Tramadol.
. Drug Enforcement Administration. (2014). TRAMADOL: (Trade Names: Ultram®, Ultracet®).
. D.M. Bush. (2015). The DAWN Report: Emergency Department Visits for Drug Misuse or Abuse Involving the Pain Medication Tramadol. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Rockville, M.D.
. Rosenthal, Norman. (2010). Federal and Drug Administration. Important Drug Warning.
. Berger, F. (2014). MedlinePlus, Substance Use Disorder. U.S. National Library of Medicine.
. Substance Abuse and Mental Health Services Administration (SAMHSA). (2013). Results from the 2013 National Survey on Drug Use and Health: Detailed Tables.
. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) Arlington, VA: American Psychiatric Publishing.
. National Library of Medicine. (2016). Opiate and opioid withdrawal.