Tramadol

Tramadol Overview

Tramadol is an addictive medicinal opiate with a distinct chemistry as an SNRI that allows it to be used for treatment of conditions such as restless leg syndrome and diabetic neuropathy as well as a weak painkiller. Prescription opiate abuse is a serious danger in the United States, with nearly 18,000 deaths being attributed to opioid painkiller abuse in 2015 alone.¹ Tramadol is so addictive due to its close interaction with dopamine production in the brain. Tramadol remains one of the most deadly recreational drugs found today due to its potency, its common use alongside substances that can produce deadly potentiation of the drug’s effects, negative physiological effects, and how easy it is to build a tolerance to it. Tramadol exhibits short-term effects similar to other painkillers including drowsiness, euphoria, pain reduction, and lethargy. Long term abuse of Tramadol can lead to a variety of physiological and mental ailments including infections, body deterioration, cardiovascular problems, and neurological decay. Recovery from Tramadol can be effective through the use of various medications and therapeutic treatments, and rehabilitation facilities offer extensive resources for recovering from Tramadol addiction in a safe, stable, and comfortable manner.

What is Tramadol?

Tramadol (brand name: Ultram) is an oral, synthetic opioid pain-relieving drug that is marketed under a variety of of trade names – with Ultram and Ultracet being the most widely prescribed and recognized. Tramadol is most often prescribed to treat moderate levels of pain including dental, osteoporosis, and neuropathy in both short term and long term settings. It is also approved for treating cancer pain in periods less than 3 months.

Tramadol is a relatively unique opioid pain medicine that has usage as an analgesic as well as a variety of uses in treatment of conditions like diabetic neuropathy and restless leg syndrome. Tramadol carries a reputation for its ability to be used recreationally, as well as an infamous reputation for its risk of serotonin syndrome, addictiveness, common overdoses, and difficult withdrawals when abused recreationally.

Opiates vs Opioids

Opiates are a class of drugs that include opium, heroin, and morphine, among many others. Opiates are differentiated from opioids by the manner in which they are created. Opiates are created from naturally occurring organic compounds called alkaloids that are found in poppies. Poppies are a type of flower common all over the world, but are grown in particular abundance throughout the Middle East and particularly in Afghanistan where they are grown, harvested, and sold in the opium trade. This differs from opioids, which are synthetically created in a lab and include common prescription painkillers such as Oxycodone, Hydrocodone, and Methadone. Tramadol comes from a long line of related opiates that have held historical significance in their prevalence and addictiveness. This lineage includes opium, which remained popular throughout the 19^th century, followed by morphine, and later heroin during the mid-20^th century. Both opiates and opioids are responsible for a deadly epidemic both in the United States and abroad. The National Institute of Drug Abuse estimates nearly 35,000 overdose deaths due to opioids and opiates in 2015, with numbers growing drastically every year.² Overdosing Tramadol is a risk factor and leads to death if not treated immediately. Those who survive Tramadol overdose are at risk of brain and neurological damage from cerebral hypoxia. Tramadol is classified as a Schedule II drug by the CSA, meaning that Tramadol has severely restricted medical usage and is not considered safe for use in personal settings due to its high potential for abuse.

Common synthetic and semi-synthetic opioids

Meperidine – Commonly known as by its brand name Demerol, meperidine is used to “relieve moderate to severe pain”

Fentanyl – Fentanyl is a particularly potent synthetic opioid that should only be used by those individuals who are already tolerant to narcotics.

Methadone – Methadone was produced in the 1930s by “a team of German scientists who were searching for a pain-killing drug (analgesic) that would not be as addictive as morphine”

Despite the fact that methadone is often used to treat opioid addiction, it can still be addictive itself when not used correctly which is why it is abused by many individuals.

Semi-synthetic opioids (Like Tramadol, or Ultram)

Buprenorphine – Buprenorphine is a semi-synthetic opioid. It is derived from thebaine, which is a natural opiate that occurs in the poppy plant.

Although buprenorphine is technically considered an opioid, it is only a partial opioid agonist, meaning that “its maximal effects are less than those of full agonists like heroin and methadone” This is why it is used to treat individuals who become addicted to opioids.

Hydromorphone – Hydromorphone is most commonly referred to as Dilaudid, one of its brand names. When abusers discuss it, it is often called dust or footballs. It is derived from morphine.

Oxymorphone – Sometimes octagonal in shape, this is where oxymorphone gets its most common street name.

Hydrocodone – Hydrocodone, prescribed most often as Vicodin (also containing acetaminophen), is the most “frequently prescribed opioid in the United States,” according to the DEA. It is also involved in more abuse and diversion than any other opioid drug, illicit or licit. It is synthesized from codeine which occurs in the poppy plant naturally like thebaine, morphine, and opium.

Oxycodone – Perhaps the most recognizable prescription opioid, oxycodone is manufactured by modifying thebaine. It is often called Oxycotton, oxy, or Perc (short for Percocet which contains oxycodone and acetaminophen).

Heroin – According to CESAR, “Heroin was synthesized from morphine in 1874 by the pharmaceutical company Bayer and was touted as a safer, non-addictive form of morphine.” Today, we know heroin to be one of the most addictive and dangerous illicit drugs in existence.

Tramadol is thought to be safe due to lower risk of tolerance, abuse, and dependence, but it has lower clinical value than other opiates. The drug has a lower pain reducing quality, only about one-tenth of morphine.

Tramadol is a fully synthetic drug, which means that it is man-made and does not occur in nature. This is in contrast to morphine and codeine – which are natural opiates derived from the opium poppy. It also differs from drugs like hydromorphone, hydrocodone, and oxycodone which, while also semi-synthetic and made in a laboratory, still retain some natural qualities.

Tramadol has an uncommon, dual-acting benefit. Tramadol works as an opiate in the expected way to manage the perception of pain, but beyond that, it allows increased availability of two other neurotransmitter chemicals in the brain called norepinephrine and serotonin. Norepinephrine is noted for its ability to improve concentration, and serotonin manages an array of functions including sleep and mood.

Although tramadol abuse is smaller in scope compared to other opiate painkillers, the number of people using this drug for nonmedical purposes and the consequences of that use are still significant. Some key tramadol statistics from the National Survey on Drug Use and Health and the Drug Abuse Warning Network include:

More than 7 million Americans over the age of 12 used tramadol for recreational purposes in 2013–an increase of more than 500,000 from 2012.

In 2013, the highest rate of tramadol abuse was found in young adults–with 2.8% of all people aged 18 to 25 taking it at some point for non-medical reasons.

Even though the drug is thought to be relatively safe due to its low potential for abuse, addiction to tramadol has been a growing problem in the US and around the world.

When the Tramadol is abused, it has desired effects similar to other opiates including:

• Feelings of euphoria.
• Feeling numb or detached from one’s body.
• Feeling lethargic and heavy.
• Feeling relaxed and calm.

• Though the effects are similar, rates of abuse are low based on information from the World Health Organization.

Consider the following:

• During the first years available in the U.S. (1995 – 1998), tramadol was only abused in between 1 and 3 cases per 100,000.
• During the period from 1999 – 2000, tramadol was only abused by 1 in 100,000.
• During 2004, the rate of tramadol abuse remained consistently low.

Tramadol for dogs

Humans are not the only ones prescribed to Tramadol and this makes the abuse aspect much easier for addicts to obtain. Veterinarians commonly prescribe dogs Tramadol to ease pain caused by Osteoarthritis, Cancer, Intervertebral disc diseases, Post-operative pain, and general pain from injuries or other conditions.

As Tramadol is a member of the opioid family, which means it alters the transmission and perception of pain in humans and animals. In addition, Tramadol inhibits the reuptake of norepinephrine and serotonin in the dog’s brain, which increases the level of these chemicals in the bloodstream, and creates that feeling of euphoria and well-being that human patients sometimes experience.

Tramadol does not have the anti-inflammatory properties associated with nonsteroidal anti-inflammatory drugs (NSAIDs). Tramadol does not treat the underlying cause of the pain and instead, it alters the way the body perceives pain, giving the patient some relief. As a result, it is often used in conjunction with another drug, such as the NSAID carprofen (Rimadyl), or as an additional pain management strategy for chronic conditions. It is not a drug prescribe to cure but to comfort.

Addiction is not as common for dogs because it is a semi-synthetic opioid and Veterinarians urge dog owners to only give their pet what is prescribed. An excess of tramadol can lead to liver damage, overdose and death. Dogs are also prone to withdrawal symptoms if the medicine is removed too abruptly. Veterinarians encourage gradually tapering dogs off of tramadol as a safety precaution.

Tramadol, a narcotic-like pain reliever, it is used to treat moderate to severe pain.  It’s in a class of pain drugs called opiate narcotic analgesics, which work by changing the way your brain responds to pain.

The extended-release form of tramadol is for around-the-clock treatment of pain. This form of tramadol is not for use on an as-needed basis for pain.

Commonly asked questions regarding Tramadol

How long does tramadol stay in your system after you stop taking it?

For normal users, Tramadol shows up in urine screens from 2 to 4 days after usage. However Tramadol could show up for a few days after the last dose with heavy use or abuse. In most cases, if someone hasn’t taken the drug within 48 hours, the levels are undetectable.

What does Tramadol show up as on a drug test?

On a standard drug test, a test a new employer would ask you to take for example, Tramadol will not show up. It will however show on a toxicology screening specified for prescription drug detection.

How long does Tramadol HCL 50 mg last?

Tramadol’s half-life is 6 hours. Immediate release tablets are suggested to be taken ever 4-6 hours for continuous pain relief. Extended release tramadol tablet, used to treat chronic pain, the tablet lasts 24 hours and is to be taken once a day.

How long does it take for a tramadol to kick in?

Tramadol levels in the blood, peaking two hours after a 100 mg dose taken orally. In studies, the origin of pain relief came faster with a combination of tramadol (hydrochloride) and acetaminophen (Ultracet) than Tramadol alone. Pain relief kicked in in less than one hour.

How long can tramadol be detected in a urine test?

Current research suggests 60% of Tramadol doses appear as metabolites within urine, while 30% appears as unmetabolized Tramadol. It’s half life of 6.3 hours, and it’s primary “M1” Metabolite (O-desmethyltramadol) of 7.4 hours, both should be completely eliminated within 2 days of absorption.

Treatment for Tramadol overdose

Tramadol overdose is a severe medical emergency that requires immediate medical relief. Naloxone is a medication that is used to block some of the effects of Tramadol on the body, and potentially save a life in the event of an overdose.

How much does it take to overdose on Tramadol?

After 500 mg of Tramadol, you can begin to experience severe side effects like seizures. An actual overdose doesn’t occur unless you take between 2.65 & 8.2 grams of Tramadol, which is about 5 – 18 times the recommended daily dose.

Is Tramadol dangerous?

The effects of Tramadol on various neurotransmitter systems in the body are thought to cause seizures. This pro-epileptic property is especially dangerous for abusers with the probability to cause convulsions or seizures increases at high doses. The use of tramadol with serotonergic medicines can increase the risk of serotonin syndrome.

Is Tramadol an anti-depressant?

Tramadol (Ultram, Ultracet) is a centrally acting synthetic opioid with analgesic efficacy comparable to codeine. … These medications are proven effective antidepressants and this shared monoaminergic action resulted in the research of tramadol as a potential treatment for depression.

Is the medicine Tramadol a narcotic?

Both Yes and No. No, Tramadol is not officially classed as a federal narcotic by either the DEA or the FDA.  Instead, it is in a class of medications called opiate agonists. However, Tramadol is classified as a narcotic in some states such as Virginia and Kentucky.

What is Tramacet used for?

Tramacet is an international brand name for the combination of acetaminophen and tramadol, an opioid analgesic. It used for short term management of acute pain.

Is Tramadol is an opiate?

Again, Yes and no, Tramadol (sold under the brand name Ultram) among others, is an opioid pain medication used to treat moderate to moderately severe pain. Depending upon classification system used, synthetic substances such as Tramadol that are directly derived from the opium poppy are considered to be opiates as well. But for simplicity’s sake, we will refer to Tramadol as a semi-synthetic opioid.

Is there a stimulant in Tramadol?

Tramadol can suppress opioid withdrawal, and chronic administration can produce opioid physical dependence; however, diversion and abuse of tramadol is low. The highest dose of tramadol did increase ratings on the stimulant scale, but was not identified as methylphenidate-like.

Can you take Tramadol for back pain?

Yes, Tramadol (Ultram) Pain Reliever has been used for back pain. Tramadol is a type of narcotic pain reliever often prescribed for moderate or moderately severe pain in adults. It is a synthetic analog of codeine with supposedly less potential for abuse than other opioid agonists, and works in the brain to alter the body’s response to pain.

Why is Tramadol a controlled substance?

DEA reclassifies painkiller tramadol as a controlled substance. The U.S. Drug Enforcement Administration began labeling tramadol, an opioid pain medication, as a Schedule IV controlled substance

What drugs help with Tramadol withdrawal?

Tramadol Detox

• Metocloperimide for nausea and vomiting.
• Loperimide for diarrhea.
• Ibuprofen or acetaminophen for muscle aches.
• Clonidine for anxiety and sweating.
• Valium for anxiety and insomnia.

How long does it take to get off Tramadol?

After 24-72 hours, the body begins tramadol withdrawal – with the onset of symptoms manifesting shortly after the drug has worn off and lingers for up to a few months after the medication is totally out of the system. Following the absence of the drug, nervousness, anxiety, feeling of pins and needles, sweating, palpitations are the first signs of withdrawal

What are the symptoms of withdrawal from Tramadol?

Common Tramadol withdrawal symptoms include:

• Agitation
• Anxiety
• Depression
• Cravings
• Nausea and vomiting
• Headaches
• Confusion

How Does Tramadol Addiction Work?

Tramadol’s deadly addictiveness can be attributed primarily to its effectiveness at mimicking the brain’s natural opiates, which work to allow dopamine to be released. Dopamine is a neurotransmitter that is colloquially known as the ‘happiness drug’ due to its purpose in producing feelings of well-being and pleasure when released into the brain. When the body is hurt, the brain produces natural opiates that allow dopamine to be released in the areas of the brain commonly responsible for feelings of pain and stress, which works to reduce overall feelings of pain. Tramadol mimics this process in the brain, allowing dopamine to constantly be produced and released, over-stimulating the brain and associating Tramadol with the pleasure and happiness that comes from dopamine release. Because the brain isn’t capable of handling such intense rushes of dopamine, dopamine receptors become damaged and make it more difficult to feel pleasure, leading users to use more and more Tramadol to chase the fleeting euphoria it once offered them. These numerous issues compound to create a strong addiction potential for Tramadol, which becomes more and more difficult to feed the more it is abused. This deadly selffeeding cycle of addiction is at the root of Tramadol’s effectiveness at becoming addictive.

What are Tramadol side effects?

Common tramadol side effects may include:

• feeling nervous or anxious
• itching, sweating, flushing (warmth, redness, or tingly feeling).
• headache, dizziness, drowsiness, tired feeling;
• constipation, diarrhea, nausea, vomiting, stomach pain;

Short and Long Term Effects

Tramadol can be taken orally through compressed tablet or syrup form. Onset of effects varies with the method used to take it, but generally takes around 40 minutes. Effects can last up to 6 hours.

The short term effects of Tramadol are similar to the effects of dopamine in general – only amplified. Users report short-term mental effects such as feelings of:

• Pain reduction
• Intense pleasure
• Relaxation
• Contentment
• Confusion

And physical effects such as:

• Heaviness of limbs
• Itchiness
• Nausea
• Drowsiness
• Slowed breathing
• Lethargy
• Elevated body temperature

Repeated long-term use of Tramadol leads to physical side effects such as:

Neurological damage – Frequent abuse of opioid receptors through Tramadol can lead to both physical and chemical damage, and has shown to diminish the presence of white matter in the brain, which reduces important neural activity such as decision making and judgment skills.

Diminished digestive health – Digestive health is severely diminished in the body of a frequent Tramadol user due to a reduction in digestive activity. This can lead to weakened gut fauna, cramping, nausea, constipation, and diarrhea.

Liver and kidney damage – Frequent use of Tramadol has shown a correlation with an increased risk of both kidney and liver disease as the body is not capable of healthily processing Tramadol. The use of additives in Tramadol such as Acetaminophen also poses a particular threat to the liver and kidneys, as many additives are not meant to be ingested in such great quantities..

Increased risk of bacterial infection – Tramadol has shown to significantly increase the risk of bacterial infections both externally and internally due to a diminished immune response.

Insomnia – Due to a general decay in personal health as well as frequent interruptions in ordinary circadian activity, Tramadol users often experience worsening sleeping problems that can develop into insomnia.

Long-term use of Tramadol also carries several mental side effects including:

Serotonin Syndrome – Serotonin Syndrome is a serious concern for those who repeatedly take Tramadol. Short term effects include agitation, diarrhea, shivering, muscle tension and twitching, and fever. Long-term this can result in SSRI-Induced Indifference resulting from an imbalance in serotonin.

Severe addiction – Because of Tramadol’s addictiveness, both mental and physical addiction are developed very quickly, leading to a complete dependency on the drug.

Depression – Due to overstimulation of dopamine receptors, Tramadol frequently leads to depression due to the brain’s inability to properly manage its circadian rhythm and dopamine production.

Anxiety – Anxiety is a frequent symptom of drug abuse in general, and is common in Tramadol abuse due to internal factors from the psychological and physical effect of the drug itself, as well as external factors such as pressure family, friends, and work that may all be affected by addiction. This can compound and develop into chronic paranoia.

Other risks posed by Tramadol abuse include:

Risk of Tramadol overdose – Tramadol holds a reputation for how easy it is to overdose on for a good reason. Because Tramadol and Tramadol tolerance are so volatile, it is very easy to misjudge the amount you can handle and overdose. Death by respiratory failure is common, and survivors are at risk of permanent neurological damage.

Additives – Tramadol almost always comes with a variety of other chemicals such as paracetemol which has beneficial effects when taken at the recommended dosage. However, these chemicals have a much higher capacity for overdose and organ damage, and when taken at psychoactive doses these chemicals frequently lead to death. Death can come as a result of liver failure, respiratory failure, or cardiac damage.

Allergic reaction – Allergic reactions to Tramadol are not uncommon, and can often be fatal. Common symptoms of allergic reactions to Tramadol include skin rashes, difficulty breathing, and swelling of the throat. Action should be taken immediately when an allergic reaction occurs to avoid suffocation.

Pregnancy – While Tramadol has not been linked directly to birth defects, evidence has been found that Tramadol increases risk of miscarriage in mothers who took Tramadol while pregnant.

Tramadol withdrawal symptoms are notoriously difficult process to go through, and includes withdrawal symptoms such as:

• Cold sweats
• Uncontrollable shaking and shivering
• Diarrhea
• Nausea and vomiting
• Elevated heart rate
• Muscle aches and cramps
• Insomnia

Treatment for Tramadol addiction

Primarily, medications for tramadol addiction treatment addresses the chemistry of the nervous system. Medicines such as clonidine or benzodiazepines might be used during acute withdrawal from tramadol. OTC medications such as NSAIDs can help with acute withdrawal symptoms.

The first step in treatment for a Tramadol addiction is detoxification. This is the process of allowing the drug to exit the body. Withdrawal symptoms are common during this period, and they can be very uncomfortable, or even deadly. It is highly recommended that withdrawal symptoms be closely monitored by a medical professional to ensure fatal reactions don’t occur, and so symptoms can be safely managed without relapse into drug use.

This is best achieved in an inpatient drug rehabilitation facility with trained addiction experts.

Once detox is complete, ongoing counseling and support is required. Counselors can give advice on dealing with cravings, managing pain symptoms without drug use, and dealing with underlying issues which may have contributed to the drug abuse.

Counseling in an outpatient capacity is often continued for months, or years, after the initial rehabilitation is complete in order to provide encouragement and to keep patients on track.

Methods of Treatment

Pharmacological:

Treatment for Tramadol addiction via medication is one of the most common and effective forms of treatment available. Due to the strength of Tramadol’s addictive potential and the severity of withdrawal symptoms, treatment through medication aims at minimizing as many adverse reactions to withdrawal as possible. Treatment through medication begins with a detoxification process in which the body is given time to expel Tramadol from the body, which is often accompanied by common withdrawal symptoms such as diarrhea and vomiting. Once the user has gone through detox, they begin treatment with certain opioid substitutes. These drugs function similarly to Tramadol in their reaction with dopamine, but to a lesser degree, and through significantly safer and less addictive chemicals. This allows a gradual transition from addiction to sobriety while minimalizing unpleasant side effects of withdrawal that are likely to lead to relapse. Buprenorphine is a common medication used in Tramadol treatment. Buprenorphine is particularly effective due to its ability to satiate opiate cravings without producing any high, which is due to it being a partial opioid agonist. This means that when

Buprenorphine is ingested, it will only activate opioid receptors in the brain to the point where cravings are satiated, but without producing a high. Other medications include Methadone, one of the earliest medications used in Tramadol treatment that works as a full opioid agonist, and Naltrexone, an opioid antagonist which completely blocks the functioning of opioids when ingested. Each of these medications functions differently and is prescribed on a case-to-case basis to best fit the needs of the individual undergoing treatment.

Therapeutic:

Other forms of treatment for Tramadol addiction come in the form of psychological and behavioral therapies. These treatments focus on the behaviors and habits that led to addiction in the first place in an attempt to remove the root of addiction. Amongst these forms of treatment, Cognitive Behavioral Therapy (CBT) is one of the most common, and is growing in support from the scientific and clinical communities all the time. Cognitive Behavioral Therapy sees substance abuse such as Tramadol addict as a symptom of a greater psychological issue, and not a cause in and of itself. By utilizing reflective and analytic techniques, an addict is better able to understand what led them to addiction in the first place, change bad habits, and avoid behaviors that may trigger cravings.

Rehabilitation

There are two main types of rehabilitation: inpatient and outpatient. Inpatient rehabilitation refers to programs that require patients to check themselves into a facility where they will undergo all rehabilitation treatment. Although inpatient rehabilitation requires a greater level of commitment, the facilities, environment, and support offered by these facilities are conducive to a stable and effective recovery. Inpatient facilities generally offer services such as psychiatrists, counselors, group therapy, and all of the living facilities necessary for a comfortable stay. The extensive support offered by these facilities, combined with an environment that is focused on self-improvement and wellness is a great combination for providing the motivation to push through the difficulties of withdrawal and to establish good healthy habits to prevent relapsing once you leave. This form of rehabilitation is effective for those who would benefit from a stricter more scheduled recovery in which the outside distractions and temptations of life won’t get in the way of focusing on recovery.

Outpatient rehabilitation is based on the principle of spending only part of your time in recovery programs while offering you the freedom to continue daily living on your own. Generally these programs will require ten to twelve hours of commitment per week spent in a treatment facility participating in similar activities to those done in an inpatient facility such as group therapy, counseling, and even detox. While this does offer easier access to drugs, some may find being able to maintain their normal daily schedule more beneficial. This form of rehabilitation is effective for those who require more freedom and contact with friends and family.

Both forms of rehabilitation are effective solutions at combatting Tramadol addiction, and there is a variety of different types of both inpatient and outpatient rehabilitation to suit the personal needs of each individual.