Tramadol is a prescription painkiller used to treat moderate to severe pain.

While this medication has some opioids in it, it is not considered as addictive as other narcotic drugs like hydrocodone or oxycodone, because the amount of opiate in the medication is so small.

Only about 20 percent of tramadol is opioid-based, while the remaining 80 percent of ingredients inhibit the reuptake of serotonin and norepinephrine, which also help elevate mood and reduce pain. The Drug Enforcement Administration lists tramadol as a Schedule IV drug, because of its alleged low risk of abuse, while other opioid painkillers are Schedule II in order to restrict and monitor their use.

Because this drug is being prescribed more widely as other painkillers lose favor, abuse and overdose reports are on the rise. According to the Substance Abuse and Mental Health Administration (SAMHSA), prescriptions for tramadol increased 88 percent between 2008 and 2013. Emergency room visits related to tramadol increased during that period as well; between 2005 and 2011, ED visits due to tramadol misuse or abuse increased 250 percent.

What Are the Risks for Tramadol Addiction, and Who Abuses the Drug?

signs of abuse
SAMHSA found that the greatest increase in emergency department visits due to tramadol misuse or abuse was among people ages 55 and older. This could, in part, be due to prescribing practices related to painkillers for chronic pain or age-related health problems. Meanwhile, people ages 18-24 maintained a consistent level of tramadol-related ER visits, and there was not a statistically significant number of reports related to ages 12-17. Both men and women abused more tramadol in the period between 2005 and 2011, although slightly more men were hospitalized due to tramadol misuse.

According to a study reported on by the World Health Organization, 95 percent of tramadol addiction or abuse cases in the US involve people who have a previous history of substance abuse. This number suggests that tramadol is, for many people who become addicted to painkillers, an alternative opioid-like medication. It is often easier for individuals to doctor shop and get another prescription for this drug than other opioids. People who use tramadol and other analgesics as prescribed, with medical oversight, do not struggle as often with addiction or abuse.

Signs of Tramadol Addiction

Symptoms of prescription drug addiction, including opioid addiction, can look like:

  • Excessively thinking about the drug, or feeling anxious about the next dose
  • Taking more than prescribed
  • Attempting to get more prescriptions by “doctor shopping,” especially for a less regulated substance like tramadol
  • Stealing painkillers from others, or purchasing them illegally
  • Inability to stop taking painkillers, even when pain should have ceased or a prescription has run out
  • Defensiveness or anger when friends or family ask questions about drug use
  • Needing the next dose to feel normal
  • Avoiding responsibilities, work, school, or social obligations to use the drug

Tramadol can cause some side effects, including:

  • Sleepiness
  • Nausea
  • Vomiting
  • Itchiness
  • Sweating
  • Tremors
  • Appetite loss
  • Dry mouth
  • Swift heartbeat
  • Slowed breathing
  • Fainting
  • Hallucinations
  • Seizures

How to Treat Tramadol Addiction

Because tramadol has an opioid component, withdrawal symptoms will be similar to other opioid medications, such as hydrocodone or oxycodone. Tramadol withdrawal symptoms can include:

  • Abdominal cramps
  • Anxiety, petulance, and agitation
  • Bone pain
  • Goosebumps
  • Insomnia
  • Watery eyes
  • Runny nose
  • Sweating
  • Depression
  • Panic attacks
  • Confusion
  • Depersonalization
  • Paranoia

When a person struggles with an addiction to tramadol, it is important for them to get help as soon as possible. Contacting a doctor can get the person medical oversight that can ease withdrawal symptoms, allowing them to safely detox from the drug. Because tramadol has an opioid component, some opioid withdrawal medications have been used successfully to treat addiction to tramadol.

Medication-Assisted Therapy

Medications that can help people overcome their addiction to opioid painkillers, including tramadol, include:

  • Buprenorphine: This medication is a partial opioid agonist, with fewer side effects than methadone. It does not require as much oversight as methadone, which is often dispensed at clinics on a daily basis. Buprenorphine can be safely prescribed for outpatient use, as long as a doctor oversees the individual’s dosing schedule. The drug binds to opioid receptors and eases withdrawal symptoms, helping to smooth the physical transition into a drug-free life.
  • Naltrexone: This opioid antagonist blocks the high that a person receives from ingesting an opioid medication. It is only used to support the ongoing recovery process after a person has been weaned off opiates by using buprenorphine or another detox process.

One medication, Suboxone, is less effective in treating tramadol abuse than it is in addressing other opiate abuse. This medication is a combination of buprenorphine and naloxone. When taken as prescribed, buprenorphine works as the main ingredient to ease withdrawal and cravings, but if the person attempts to abuse Suboxone to get high, naloxone will prevent buprenorphine from binding to opioid receptors in the brain, sending the individual into withdrawal. However, naloxone is less effective with tramadol addiction due to tramadol’s low opioid content and high content of other substances. Overdoses cannot be reversed as effectively, and naloxone can increase the risk of seizures during a tramadol overdose.

Tapering with buprenorphine appears to be a very effective method of detoxing from tramadol. While medications can aid the withdrawal and recovery process, they do not constitute addiction treatment on their own. They must be used in conjunction with comprehensive addiction therapy to ensure issues related to substance abuse are effectively addressed.

Tramadol and Co-Occurring Disorders

According to SAMHSA, in 2011, 20 percent of emergency room visits involving tramadol were found to involve a second drug; 26 percent involved a combination of tramadol and two other drugs; and 26 percent involved tramadol in combination with three other drugs. This suggests that substance abuse is, for these individuals, part of a larger pattern of self-medication or recreational use, which could be related to a co-occurring disorder.

Co-occurring disorders involve a coexisting substance use disorder and another mental health issue. SAMHSA data from 2014 shows that nearly 8 million American adults struggle with co-occurring mental health and substance use disorders. Because both addiction and other mental health issues are diseases of the brain, one can trigger the other; a mental health issue can lead to self-medication through drug abuse, while drug abuse can change the chemistry of the brain and lead to a mental health condition like depression or even psychosis.

It is very important for people who struggle with co-occurring substance abuse and mental illness to get appropriate help. Until recently, very little was understood about how these two conditions affected each other, and treatment tended to focus on one condition without addressing the other. For successful recovery, however, integrated therapy, which addresses both conditions simultaneously, works best. More rehabilitation programs are offering integrated therapy to help people who have co-occurring disorders.

Comprehensive Help

Although tramadol is largely considered a safe prescription painkiller, the opioid component in the medication can still lead some people to become addicted to this drug. Statistics show that, as more people receive tramadol prescriptions, more people become addicted to the drug, overdose, and end up in the emergency room.

It is important for people who abuse tramadol to get help. Finding a rehabilitation program that offers medical oversight along with group and individual therapy can be essential in overcoming tramadol addiction. Thankfully, thousands of addiction treatment facilities are equipped to provide that help. Reach out for assistance today, and get on the path to a better life.
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