All medications pose a risk of addiction. When it comes to opioids, the risk is even greater. Tramadol is no exception.
Tramadol was the 25th most prescribed medication in the US in 2020, with more than 24 million prescriptions.1
Although not as potent as other opioids such as heroin and oxycodone, ongoing use and heavy doses can lead to addiction.
Let’s review the research-based information on the signs of tramadol addiction, withdrawal, and overdose, as well as the recommended treatment.
Tramadol is available only as a prescription. It comes as tablets, capsules, and liquid drops. It also comes in the form of an injection typically administered in controlled environments such as hospitals.
Generally, the recommended dose is 400 milligrams per day, or 300 milligrams when you are older than 75.
The biggest misconceptions about tramadol are that it is not opioid or addictive. However, tramadol can be very addictive.
Tramadol is a mix of synthetic opioid medication and monoamine reuptake inhibitors (MRI). Once it enters the body, the synthetic drug is metabolized into an opioid and acts on the opioid centers of the brain to stop pain signals.
Although it’s considered a substance with a low potential for dependence relative to morphine, tramadol dependence can occur. Dependence can develop if the drug is used for a prolonged time and taken in higher doses than recommended. Physical and mental dependence can lead to addiction.
It’s common for tramadol dependence to occur in people with a history of substance abuse.3
Like many antidepressant medications, tramadol works to increase serotonin and norepinephrine levels in the brain.
Due to how it can alter brain chemistry, tramadol can also lead to relaxation and calm.
Taking tramadol for an extended time and in higher doses can lead to the body developing tolerance to the drug. As the body adapts to the presence of the medication, higher doses of the drug must be taken to experience the same “high.”
It’s more likely that dependence will form if the drug is used for a prolonged time and taken in higher doses than recommended. If drug use suddenly stops, a range of withdrawal symptoms will begin.
The side effects of tolerance and dependence may ultimately lead to an addiction. Addiction is when there is a change in behavior due to biochemical changes in the brain after extended substance abuse.
Low levels of serotonin can lead to feelings of depression. High serotonin levels can lead to mild physical signs and symptoms such as diarrhea and shivering, and severe signs and symptoms that include muscle rigidity, fever, and seizures. In the most severe cases, serotonin syndrome can lead to death if left untreated.
According to research, tramadol can induce Serotonin syndrome when used in combination with selective serotonin reuptake inhibitors (SSRIs) and atypical antipsychotics or when taken in high doses.5
The most common withdrawal symptoms include:
According to the Centers for Disease Control and Prevention, overdose deaths involving synthetic opioids, such as tramadol, have increased.6
There is always an increased risk of overdose on tramadol when taken in larger doses than prescribed/recommended or combined with other substances.
Taking tramadol with other substances such as analgesics, muscle relaxants, and CNS depressants can lead to overdose and potentially death.7
The most common causes of death due to tramadol overdose include cardio-respiratory depression, resistant shock, asystole, and liver failure.
Overdosing on tramadol may include the following signs:
Detoxification, the process of getting the body rid of all toxins, is the first step in many tramadol addiction treatment programs. A medically-supervised detoxification process can gradually wean tramadol down to avoid the risk of potentially life-threatening complications.
Once the substance is gone, the second step in the treatment program includes inpatient or outpatient care.
Inpatient care is for addressing severe cases of tramadol addiction. During inpatient treatment, 24/7 on-site support and a very structured plan that creates a healing environment. It typically involves group sessions, 1-on-1 therapy, holistic therapy, 12-step program, and more. The recommended length of inpatient treatment is 28 days, although some choose to extend their stay to 90 days.
The most common activities of an inpatient treatment program include:
The alternative to inpatient treatment is outpatient rehab. This type of treatment is suitable for mild tramadol addiction or for anyone who cannot commit to living on-site. Outpatient treatment also includes group and 1-on-1 therapy sessions on-site a few times per week. It is also a less expensive option.