Tramadol addiction is an opioid use disorder. Although it is a controlled, narcotic painkiller, tramadol has a lower potential for abuse and addiction than other opioids. There is still a significant risk, though, and misusing the drug can lead to addiction and put an individual at risk for an overdose. Recognizing the signs of out-of-control use of tramadol is important, as is seeking professional treatment for recovery. With commitment to long-term treatment with therapy and appropriate medications, it is possible to overcome tramadol addiction.
What Is Tramadol Addiction?
Tramadol is a prescription narcotic used to manage moderate to severe pain. It is an opioid painkiller that belongs to the same class of drugs as morphine, oxycodone, fentanyl, and other painkillers. Tramadol can be prescribed as a generic drug or under the brand names Ultram and ConZip. Like other opioids, tramadol decreases pain but also produces a sense of euphoria and has a potential for abuse.
Addiction to tramadol is an opioid use disorder. It occurs in some people who misuse the drug, which can include taking more than prescribed, taking it for longer than prescribed, and taking the drug without having a prescription. Addiction to this drug is dangerous and can lead to overdoses that may be fatal. Tramadol addiction is characterized by being unable to stop using the drug, impairment in other areas of life because of drug use, cravings, tolerance, and withdrawal. The best way to recover from tramadol addiction is to get professional treatment.
Facts and Statistics
Addiction to tramadol falls under the category of an opioid use disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). While it has long been considered to be a safer opioid painkiller, newer evidence suggest tramadol may be just as harmful as oxycodone, hydromorphone, and others.
- Tramadol is a schedule IV controlled substance, while other opioid painkillers have been placed in schedule II. Schedule IV drugs have a lower potential for abuse.
- Abuse of tramadol has been a growing problem in India, and in some Middle Eastern and African countries, according to the World Health Organization.
- Emergency room visits related to tramadol have been increasing in the U.S. More than half of the admissions involved tramadol combined with one or more other drugs.
- From 2008 to 2013, prescriptions for tramadol in the U.S. increased by 88 percent, from 23.3 million to 43.8 million.
Symptoms and Diagnosis of Tramadol Addiction
While tramadol is less habit forming than some other opioids, and safer in terms of the risk of overdose, this is still a risky drug that is susceptible to abuse and that can lead to addiction and overdose. The high that someone experiences with tramadol is less intense than with other opioids, but the effects are otherwise similar. A person intoxicated by tramadol will be euphoric, confused, and uncoordinated, with slurred speech, difficulty concentrating, lack of awareness, and drowsiness.
Opioid use disorder, or addiction to any opioid, including tramadol, causes certain characteristic symptoms. An addiction specialist uses the criteria set by the DSM-5 to determine if someone misusing tramadol has a mild, moderate, or severe use disorder. The more of these criteria they meet, the more severe the addiction:
- Being unable to cut back on drug use
- Consistently taking more than intended
- Craving tramadol when not using it
- Spending a significant amount of time acquiring or using tramadol
- Failing to meet responsibilities because of drug use
- No longer engaging in normal activities to have more time for drug use
- Persisting with tramadol use in spite of issues in relationships caused by it
- Using tramadol in dangerous situations
- Continuing to use the drug even when it causes or worsens health problems
- Developing a tolerance to tramadol
- Having withdrawal when not using it
A big risk of misusing any opioid drug is the potential for overdose. Opioids are central nervous system depressants, and they can cause breathing and heart rate to slow down so much that it leads to death. The risk of overdose is greater when tramadol is combined with other opioids, with alcohol, or with other similar substances. Signs of an opioid overdose include:
- Very small pupils
- Loss of consciousness or being unable to wake someone
- Very slow or shallow breathing
- Limpness and unresponsiveness
- Pale, cold, or bluish skin
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Causes and Risk Factors
Causes of any kind of addiction are impossible to pinpoint. Substance use disorders are complex brain and behavioral conditions with many contributing factors. Of course, ultimately the cause is misuse of the drug. Anyone who misuses tramadol is at risk of developing an addiction, although most people will not.
There are several risk factors associated with any type of opioid use disorder, including those involving tramadol. One important risk factor is access. Access to prescription drugs is often easy, and being around these drugs or people who use them increases the risk of abuse and dependence.
Other risk factors for tramadol addiction include family history or personal history of substance abuse and addiction, having a mental illness, particularly one that is undiagnosed and untreated, abusing drugs at a young age, having experienced trauma or very stressful situations and having a troubled childhood or home life. The more addictive a drug is, the higher the risk of developing a use disorder, so the risks are generally lower with tramadol than with other opioids.
Withdrawal and Detox
Withdrawal refers to the symptoms experienced when detoxing from a drug, as the brain and body adjust to not having it in the system anymore. Opioid withdrawal can be painful, uncomfortable, and even unbearable. It is a very common reason that people relapse when trying to stop using any opioid, including tramadol. Opioid withdrawal can cause:
- Anxiety and agitation
- Muscle pain
- Tearing in the eyes
- Excessive sweating
- Runny nose
- Excessive yawning
As withdrawal progresses, more symptoms emerge that are even more uncomfortable: cramps, diarrhea, vomiting, nausea, goosebumps, and chills. Withdrawal can last for a few days, and without supervision it is very easy to relapse during this period. Professional support during detox helps manage symptoms, provide relief, and prevent relapse so that ongoing treatment can begin shortly after this.
Abuse of tramadol and addiction to this drug is often accompanied by other co-occurring disorders, including abuse of other substances and mental illnesses. Someone who abuses tramadol may also be misusing alcohol, cannabis, stimulants, or benzodiazepines. Taking other substances is often done to enhance the effects or in an attempt to manage withdrawal symptoms.
Mental illnesses that are most common with opioid use disorders are major depression, dysthymia, post-traumatic stress disorder, and personality disorders. It is common for mental illnesses to co-occur with substance use disorders, because one can exacerbate or trigger the other but also because they have similar risk factors. Treating both tramadol addiction and any existing mental illnesses is important, because if only one is addressed that treatment will have limited effectiveness.
Treatment and Prognosis
Treatment for tramadol addiction should be guided by mental health and addiction professionals, but it can be done in either an outpatient or residential setting. A treatment plan should begin with detox but continue with ongoing therapy, medical treatment, and other types of therapy and management strategies, including relapse prevention.
Medical care is especially important with any opioid use disorder, because there are approved medications that can actually help patients see better outcomes when combined with therapy. Buprenorphine, for instance, can reduce withdrawal symptoms and cravings, while naltrexone blocks the action of opioids rendering use of tramadol pointless and reducing relapse rates.
Therapies used to help manage tramadol addiction are largely behavioral in nature. Cognitive behavioral therapy, for instance, uses mindfulness, coping strategies, and goal-setting to recognize negative patterns in thoughts and behaviors and to make productive changes. Relapse prevention is an important part of this therapy and involves identifying triggers and learning how to avoid them, finding substitutes for drug use, developing stronger social bonds, and practicing healthy stress management strategies.
Treatment facilities also offer tramadol addiction patients a variety of other services and activities designed to improve quality of life and reduce relapses. These include life and job skills training, nutrition and exercise, mindfulness practices, creative therapies, group support, and family therapy and education.
The outlook is good for anyone who struggles with tramadol addiction but seeks professional treatment. With a combination of medical treatment and therapy, it is possible to stop using tramadol and to learn how to avoid relapsing once out of treatment. It is important to recognize addiction as a chronic illness, though, and not to assume one is cured after treatment. Those with the best prognoses are patients who commit to ongoing treatment over the long-term, not quick fixes.