In terms of prescription medication, tramadol is not well known – but that does not mean that you do not need to know about tramadol and the possibility of addiction. While tramadol (sold as Ultram in the United States) is usually deemed safer and less addictive than other opioids, there are still risk factors with both its prescription and non-medical use. With this in mind, this post examines everything that you need to know about tramadol and addiction, including the correct and incorrect use of the prescription drug. Altogether, in this discussion we address all of the following questions:
- What is tramadol?
- How does tramadol work to reduce pain?
- What is the recommended dosage for tramadol?
- What purpose does tramadol serve?
- Is tramadol a narcotic?
- How should the prescription drug be used?
- What are the side effects of this prescription drug in particular?
- Is tramadol addictive?
- Can you get high off of tramadol (Ultram)?
- What can be done about addiction?
What is Tramadol and How Does it Work?
What is tramadol? Tramadol is most commonly sold under the brand name Ultram, and works as a narcotic-like pain reliever for patients experiencing mild to moderate chronic pain. The prescription medication is taken orally, and pain relief typically takes place within an hour of first taking the dose of tramadol. The medication works as a painkiller in two ways, from both opioids and from the inhibition of serotonin and norepinephrine. Because of this lowered impact of the opioid within the medication, it is generally considered a safer (or, rather, less addictive) option than other prescription opioids. “Tramadol is a prescription medication used to treat moderate to moderately severe pain. It is sold under the brand name Ultram in the United States, and as Ralivia, Dromodol and other names elsewhere. It is intended to work by changing the way the central nervous system responds to pain. Tramadol is effective on two fronts: about 20 percent of its painkilling effects come from opioids, and 80 percent from ingredients that inhibit the reuptake of serotonin and norepinephrine, two chemicals in the brain associated with mood and responsiveness to pain.” Despite this lower opioid content, tramadol is still associated with a certain level of risk. The prescription drug can still be abused, and it is possible for individuals to become addicted or overdose on the drug. These inherent risks are examined in more detail below. What is the recommended dosage for tramadol (Ultram)? In simple terms, the drug is used to treat mild to moderate chronic pain that does not require other, more intensified doses of analgesics. Tramadol is usually prescribed with an initial daily dose of 25mg. However, these doses can quickly be increased. For maintenance of the same level of pain relief, doctors will often increase the prescription over time to as much as 400mg per day. No matter the dosage, the medication should not be taken more often than every four to six hours. “The dosage is based on your medical condition and response to treatment. To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. The maximum recommended dose is 400 milligrams per day. If you are older than 75 years, the maximum recommended dose is 300 milligrams per day. Do not increase your dose, take the medication more frequently, or take it for a longer time than prescribed. Properly stop the medication when so directed.” Tramadol most commonly takes the form of a 50mg pill to be taken orally. By way of comparison, a dose of 50mg tramadol is roughly eight times less potent than its narcotic equivalents, such as oxycodone and codeine. Because of this, the drug is commonly used for less severe chronic pain and when the pain must be treated constantly. In a phrase, the drug is not as strong as other forms of prescription opioids. Tramadol can therefore be taken more often by patients without the negative side effects and a lowered risk of dependence. There is also a lowered likelihood of the onset of withdrawal symptoms associated with prescription opioids, described below. What purpose does tramadol have? There are two major purposes for tramadol. The first is to treat pain in patients as a result of cancer or surgery. It works much like any other prescription opioid, though is generally considered less addictive. Because of this consideration, the second major use of tramadol is to treat the withdrawal symptoms for patients addicted to other forms of opioids. The National Institute on Drug Abuse provides a more detailed description of the use of tramadol: “Opioid withdrawal symptoms are a major contributing factor for why opioid treatment programs often fail. Individuals with severe opioid withdrawal symptoms may experience shaking, muscle and bone pain, nausea, depression, anxiety, and drug craving. Tramadol is a medication that is currently used to treat moderate to severe pain individuals with cancer, joint pain, or pain resulting from surgery. Because of its pharmacological profile, tramadol may also be useful in treating opioid withdrawal. Further research is needed to confirm the benefits of tramadol for opioid addicts.” How should tramadol be used? Note: Tramadol should not be used in conjunction with alcohol, tranquilizers, sedatives or other forms of narcotic medications. If you have taken any other medication or drank alcohol in the past few hours, do not take tramadol. You should not take tramadol (or at the very least you should make your doctor aware of the preexisting condition) if you exhibit any of the following conditions:
- You have asthma or other breathing problems
- You have used a MAO inhibitor in the past two weeks
- You have a history of epilepsy, seizures, or head injury
- You have a history of alcohol or drug addiction
- You have a metabolic disorder
- You are also using antibiotics, heart medication, or medication to treat HIV/AIDS
- You have a liver or kidney disease, or stomach disorder
- You have a history of alcoholism, drug abuse, mental illness, or have attempt suicide in the past
More than anything, it is crucial that tramadol is used as prescribed and not used by anyone without a prescription. Because there are too many unknowns regarding how tramadol affects other physiological systems, it can be dangerous to use the drug outside of its prescribed method. “Tramadol may be habit forming and should be used only by the person it was prescribed for. Never share this medicine with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it. Selling or giving away tramadol to any other person is against the law. Take tramadol exactly as prescribed. Follow all directions on your prescription label. Tramadol can slow or stop your breathing, especially when you start using this medicine or whenever your dose is changed. Never take in larger amounts, or for longer than prescribed. Tell your doctor if the medicine seems to stop working as well in relieving your pain.” There are several types of other prescription drugs that will affect how tramadol interacts with your body. If you use any of the other types of medications described below, be sure to let your doctor know so that they can take it into account when prescribing tramadol. These other forms of drugs include:
- Narcotic Medications: This includes other opioid pain relievers and prescription cough medicine
- Drugs for Serotonin Levels: These include everything from medication to treat depression to migraine medicine
- Sedatives: These include sleeping pills, muscle relaxers, tranquilizers, and even anti-psychotic drugs
The Side Effects of Tramadol Use
Like any prescription medication, tramadol can result in both beneficial and detrimental effects for the patient who takes it. While they do not necessarily affect every patient, side effects of prescription medication should be taken very seriously and considered before the medication is taken. Tramadol is no exception to this generalized guideline. There are several side effects associated with tramadol use, which can occur either during the use of the medication or when you discontinue the use of Tramadol. Some of the side effects of using tramadol as a pain reliever include:
- Anxiety or agitation
- Abdominal pain
- Dry mouth
- Feeling cold or exhibiting a fever
- Sleeping problems
- Muscle soreness or pain
- Emotional shifts (i.e. feeling sad or despondent)
Because of these side effects and withdrawal symptoms, it is worth noting here that tramadol can form a habit – if not an addiction. In general, professionals do not consider tramadol to be addictive. However, this is not to say that addiction is entirely impossible. According to at least one source, tramadol can be habit-forming: “Tramadol is structurally related to the opioids like codeine and morphine and can lead to psychological and physical dependence, addiction and withdrawal. People with a history of drug-seeking behavior may be at greater risk of addiction, but illicit actions to obtain the drug can occur in people without a prior addiction, as well. Do not abruptly stop taking tramadol as withdrawal symptoms like nausea, diarrhea, anxiety, sweating, difficulty in sleep, shivering, pain, tremors, or rarely, hallucinations may occur. Consult with your doctor before discontinuing tramadol treatment; do not discontinue treatment on your own. Withdrawal symptoms may be relieved by reinitiation of opioid therapy followed by a slow dose reduction combined with symptomatic support, as directed by your doctor.” In other words, tramadol should be treated the same way as any other form of prescription medication or opioid. You should not attempt to self-medicate with tramadol, nor should you attempt to quit the medication altogether if you find yourself experiencing some of the side effects or withdrawal symptoms discussed above. Instead, you should consult with your doctor regarding your drug use, and consider seeking out medical help if you find that your dependency on tramadol has become too much to handle. In a phrase, it is possible to become dependent on the drug – but that does not mean that it is impossible to discontinue its use, either. Given the discussion above, there are two concerns when taking tramadol. First and foremost, the side effects associated with the use of tramadol should be taken seriously, and you should ask your doctor any questions that you may have about the drug before taking the dosage prescribed to you. The second, but equally important, concern is in regards to the use of tramadol to manage the withdrawal symptoms of other prescription opioids. While
The Possibility of Tramadol Addiction
The list of side effects and withdrawal symptoms provided above make it clear that it is possible to become dependent on tramadol – not only as a pain reliever, but also as an opioid. Although tramadol is not considered a scheduled drug, and is considered to have a low risk of abuse or dependence, there are cases of tramadol addiction and dependence. Outside of the prescribed use of tramadol, the drug can be used to get high. It is an opioid, after all, and when taken in large enough doses individuals can get high from the drug. However, getting a tramadol high usually requires going well above the prescribed dosage, which can be extremely dangerous given the risk of overdose and seizures. Getting high off of prescription tramadol (most commonly in the form of Ultram 50mg) only works to increase the possibility of addiction to the prescription drug. While only a small percentage of tramadol users are likely to get addicted to the drug, the risk of addiction is nevertheless present.
Case Study: Tramadol Addiction in a Healthy 39-year-old Male
One academic journal article describes a particular case study of addiction to tramadol. While the jargon may appear a little technical, the case study is worth quoting at length in order to provide a holistic understanding of what tramadol addiction can look like: Mr A, a 39-year-old man, presented to the emergency department in 2007 to get help with tramadol addiction. He was a college-educated active duty military officer and had been in the Air Force for 17 years. He was married and had 4 children. Mr A had no previous history of illicit drug use, did not smoke cigarettes or use any other tobacco product, and drank alcohol only socially, consuming a total of about 5 or 6 drinks in a year. He did, however, have a family history of alcoholism: his sister had died of liver cirrhosis from alcohol abuse. Mr A was started on tramadol treatment about 2 years earlier for pelvic pain. Initially, he was on treatment with hydrocodone and acetaminophen for about 2 months and was later switched to tramadol. He did have better pain control with tramadol, but he gradually started taking more and more. Ultimately, his pain resolved but he was unable to stop taking tramadol: he was taking up to 600 mg/d of tramadol and had made multiple efforts to stop. When he stopped taking tramadol, he had dysphoria, muscle cramps, anxiousness, restlessness, and a sensation of insects crawling all over his body. His withdrawal symptoms were severe enough to interfere with his work and family life. He was feeling very guilty about his addiction. He denied diarrhea, piloerection, or rhinorrhea. He did not have any other significant past medical history except for the episode of pelvic pain, which was diagnosed as osteitis pubis and was believed to be secondary to muscle overuse from jogging. Mr A was admitted for inpatient detoxification and was started on tapering doses of tramadol. His withdrawal symptoms were well controlled with lorazepam and clonidine. After 4 days of inpatient treatment, he did not require any more tramadol and was sent home with a week’s supply of lorazepam and clonidine. This case study makes at least one thing clear: addiction to and dependence on tramadol is certainly possible, even in a relatively young and relatively healthy patient. With this case study and the withdrawal symptoms described above in mind, you should be careful in your approach to tramadol, even after it has been prescribed by a doctor. This post has given you everything that you need to know about the prescription drug known as tramadol, including both how and why it is used and how it can lead to addiction in some cases. It is not the idea of this post to say that tramadol should not be used at all; instead, we are looking to simply provide you with all of the knowledge that you need to make an informed decision about its use, particularly if you have a history of addiction or drug abuse. If you still have questions about tramadol or think you may be addicted to the prescription drug, feel free to contact us today to receive the help that you need.
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