Tramadol is an opioid pain medication. Available in pill form, tramadol is a widely known painkiller. It is available by prescription as either a generic or marketed under several brand names, including:
- Ultram ER (extended release formulation).
- Conzip (extended release formulation).
- Ultracet (combination tramadol and acetaminophen).
Originally approved as a non-controlled medication in 1995, reports of tramadol abuse and diversion resulted in the FDA revising product labeling and issuing new warnings about its abuse potential. In 2014, the DEA began listing tramadol as a Schedule IV controlled substance.1 According to the 2013 National Survey on Drug Use and Health, more than 3.7 million people reported non-medical use of tramadol at least once in their lifetime.2 Even though it is one of the least potent opioids, tramadol is still abused for the feelings of well-being and sedation it produces. People may take it in higher than recommended or more frequent doses or mix it with other drugs and alcohol in order to achieve a high. It is commonly abused by chronic pain patients, narcotic addicts, and health professionals who have easy access to the medication.1 People with an opioid addiction are also more likely to have a co-occurring mental health condition, such as depression, antisocial personality disorder, or posttraumatic stress disorder (PTSD).11
Side Effects of Tramadol Abuse
While the drug is effective at temporarily relieving pain, there are many unwanted and potentially dangerous side effects that may occur even in the short-term. Common side effects that may occur include:1,10,11
- Slurred speech.
- Mood swings.
- Impaired judgment.
- Appetite loss.
- Muscle weakness or tightness.
- Sleep disturbances.
Serious and rare side effects can occur, especially when the drug is taken in a way other than prescribed. These side effects may include:1,10,11
- Swelling of the lips, tongue, and eyes.
- Difficulty breathing and/or swallowing.
Extremely high doses of tramadol, especially when combined with either selective serotonin reuptake inhibitor (SSRI) or monoamine oxidase inhibitor (MAOI) antidepressants, can cause serotonin syndrome, a dangerous condition characterized by very high body temperature, convulsions, and rigid muscles.1
Risks of Long-term Use
Long-term use of tramadol poses many serious potential consequences. The longer someone abuses the drug, the more likely it is that they will develop physical dependence, resulting in painful withdrawal symptoms when they try to quit using. Chronic misuse can lead to a tramadol addiction, in which it is difficult for the person to stop using despite adverse effects. Long-term abuse also increases the risks of the following harmful consequences:1,10,11
- Relationship problems
- Financial difficulties
- Poor work or academic performance
- Job loss
- Sexual dysfunction
- Irregular menses in women
- Severe constipation
- Exacerbation of physical or mental health problems
- Accidents and/or injuries due to violence associated with illegal buying and selling drugs
- Suicidal ideation or attempts
Effects and Symptoms of Tramadol Withdrawal
One of the most telling indicators of a drug’s addiction potential is what happens when use of the drug slows or ends altogether. While tramadol was originally thought to be a relatively less addictive painkiller alternative, it has been found to produce a number of withdrawal symptoms itself. Many of the symptoms to arise during acute tramadol withdrawal are typical of other opioid drugs, but some of them are unique to tramadol.
About 90% of people will experience a withdrawal syndrome similar to that associated with more typical opioids 1. It will resemble flu symptoms and include 4:
- Muscle pain.
- Enlarged pupils.
- Nausea and vomiting.
- Abdominal cramping.
The remaining 10% of people will experience atypical symptoms that result from the serotonin and norepinephrine changes in the brain 1. These include a range of mental health and physical health problems like 6:
- High anxiety with panic attacks.
- Delusional thinking with paranoia.
- Numbness and tingling.
- Visual and auditory hallucinations.
- Feeling disconnected from self and the world.
It appears that people who consume more than 400 mg of tramadol per day are at a greater risk of either set of withdrawal symptoms developing. Additionally, the risk increases for people that have used tramadol:
- For long periods.
- At high doses.
- At high frequency.
- In combination with other depressants like alcohol, sedatives, or other opioids.
People with a history of strong withdrawal symptoms in the past are at increased risk as well.
Withdrawal Length and Protocol
The tramadol detox timeline can be difficult to ascertain, as it will vary widely from person to person based on factors like:
- The typical dose.
- The frequency of use.
- The duration of use.
- Any concurrent substance abuse (e.g., tramadol and alcohol).
Luckily, tramadol is not a long-acting opioid, so most of the acute physical withdrawal symptoms should dissipate within a few days (up to 10 days, depending on the user, the severity of abuse, and the level of dependence 9). Certain psychological symptoms such as depression and dysphoria (a general feeling of unease), may persist over a longer period of time 9.
What Is Ultra-Rapid Detox for Tramadol?
Some programs offer rapid or ultra-rapid detox from opioids like tramadol. In this method, tramadol use is abruptly discontinued and the patient is given medications to speed up the process of withdrawal. The patient is often placed under general anesthesia during the acute portion of withdrawal, an appeal to many who don’t want to experience the uncomfortable symptoms.It’s important to note this method is not associated with better outcomes and may introduce unnecessary risk 7.
What Can I Expect in Tramadol Detox?
There are two general types of detoxification programs that aim to free the body from addiction and dependence to tramadol: social detox and medically assisted detox.
In social detox, the recovering user receives minimal amounts of professional treatment that mostly focuses on encouragement and support during periods of high withdrawal symptoms.
Medically assisted detox enlists a medically trained staff to evaluate, stabilize, and treat withdrawal symptoms with medications to promote comfort and safety of the patient. Increased comfort during detox reduces the chances of relapse, a common occurrence among those trying to detox without help.
In the case of detox from tramadol, the Substance Abuse and Mental Health Services Administration recommends medically assisted detox because 2:
- The person may need inpatient, 24-hour observation.
- The medical staff can monitor the physical effects of withdrawal and address any emergent concerns.
- The staff can prevent and treat the mental health risks of anxiety, panic, and psychosis.
Medically assisted detox enlists a medically trained staff to evaluate, stabilize, and treat withdrawal symptoms with medications to promote comfort and safety of the patient.
Detox should include an individualized treatment plan based on the patient’s unique needs. An effective treatment plan will be based on:
- The needs of the patient.
- Current levels of tramadol consumed.
- Abuse of additional substances.
- Available support systems in place.
- Previous attempts to quit substance use.
Commonly, medical detox employs a tapering program where the medical staff will assess current usage and begin reducing the dose over the course of days or weeks 8. By slowly weaning the patient off tramadol, the withdrawal symptoms will be more dispersed and less intense, which increases compliance for the patient.
Medications to offset withdrawal symptoms during detox include 2:
- Clonidine – A blood pressure medication used to reduce withdrawal symptoms.
- Pain medications like acetaminophen and ibuprofen.
- Medications to alleviate insomnia, such as trazodone or Benadryl.
- A number of over-the-counter medications to aid with GI upset, nausea, and diarrhea like Maalox and Pepto-Bismol.
The program may also employ medication-assisted treatment (MAT) with a substance like methadone or buprenorphine 2,3. These substances help to reduce addictive behaviors and decrease cravings 5.
Do I Need a Detox Program?
Tramadol has maintained a reputation as a low-risk substance for some time, but that status may not be warranted. Taking it, even at the recommended dose and interval, can lead to a number of issues like:
- Dependence – The physical state where the drug must be present in the system in order for the user to feel and function at expected levels.
- Tolerance – The state in which the body requires increasing levels of tramadol to achieve the desired effect.
- Addiction – The compulsive use of the substance despite the high probability of unwanted results. Many addicted to tramadol will sacrifice that which is most important to them for the substance including:
- Mental health.
- Physical health.
The development of tolerance and dependence are two of the major symptoms of tramadol abuse and addiction. If your body has become dependent on tramadol and you are continuing to use it compulsively without regard to the negative effects, you may need to seek out a tramadol detox program. Formal treatment programs have staff that know how to detox you off tramadol in the safest and most comfortable manner possible.
How Does Supervised Detox Help?
It is possible to detox from tramadol at home, but doing so can be so uncomfortable that you may relapse despite your best intentions to see detox through.
Supervised detox programs help you complete detox with the support of trained staff and will usher you into the next phase of your recovery.
Many detox programs will either help you make a plan for ongoing addiction treatment or exist as part of a more robust inpatient program. Remember, detox from tramadol should not be the end point of your care. Without therapy, counseling, and additional skills training to maintain sobriety, you are more susceptible to relapse.
Finding an Addiction Treatment Program
An important aspect of supervised detox is the program’s ability to connect the patient to an appropriate form of ongoing treatment when detox is completed. Available options include:
- Residential rehab.
- Transitional housing options like sober living or a halfway house.
- Outpatient therapy for mental health and/ or addiction treatment.
Finding treatment doesn’t have to be complicated. Consider calling
to speak with someone able to recommend care based on your needs. If you wish to stop the progress of tramadol in your life or in the life of a loved one, this call can be the first step.
- U.S. National Library of Medicine. (2016). Tramadol.
- Center for Substance Abuse Treatment. Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131. Rockville, MD: Center for Substance Abuse Treatment, 2006.
- Substance Abuse and Mental Health Services Administration. (2009). Medication-Assisted Treatment for Opioid Addiction.
- U.S. National Library of Medicine. (2017). Opiate and opioid withdrawal.
- National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).
- Rajabizadeh, G., Kheradmand, A., & Nasirian, M. (2009). Psychosis following Tramadol Withdrawal. Addiction & Health, 1(1), 58-61.
- National Institute on Drug Abuse. (2006). Study Finds Withdrawal No Easier With Ultrarapid Opiate Detox.
- U.S. Department of Veterans Affairs. (2013). Tapering and Discontinuing Opioids.
- Substance Abuse and Mental Health Services Administration. (2010). Protracted Withdrawal.
- U.S. National Library of Medicine. (2016). Tramadol.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.