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Tramadol Addiction and Abuse

What Is Tramadol and How Is it Used?

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.

What Does Tramadol Treat?

Tramadol is a pain reliever prescribed to treat symptoms of moderate to severe chronic pain. It is one of the most potent pain killers on the market that binds to pain receptors, stopping pain signals. Doctors commonly prescribe it for the treatment of osteoarthritis and other painful conditions.


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.

The dosage of this medication is different for every person. The dosage, the form of the drug, and how often it should be taken depends on:
  • Age
  • Medical condition
  • The severity of their condition
  • Other medical conditions they may have
  • Response to treatment
To reduce the risk of side effects, doctors can prescribe a lower dose of the medication and gradually increase it.

Generally, the recommended dose is 400 milligrams per day, or 300 milligrams when you are older than 75.

History of Tramadol

Tramadol was first developed in the early 1960s by a German scientist called Kurt Flick, who worked at the German pharmaceutical company Grünenthal GmbH. The drug was patented in 1963 and was launched to market 14 years later, in 1977, by another Grünenthal chemist, Ernst-Gunther Schenck. Ernst-Gunther Schenck believed that tramadol was a less addictive substitute for more potent traditional opioids.
It was approved in the US and UK in the mid-1990s. Since then, it has been marketed under many brand names worldwide.
In 2013, the DEA classified tramadol as a Schedule IV drug with a low potential for abuse. A schedule IV classification means the medication has a lower likelihood of abuse and some medical purpose.

Between 2012 and 2015, tramadol prescriptions increased by 22.8%.2


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

Effects of Tramadol


Lack of Pain

Tramadol binds to receptors in the central nervous system and reduces feelings of pain by blocking pain signals between the brain and the body.4

Elated Mood

Like many antidepressant medications, tramadol works to increase serotonin and norepinephrine levels in the brain.

Anxiety Reduction

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.”

Physical Dependence

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.

Serotonin Syndrome

Serotonin is a chemical that the body produces that enables brain cells and other nervous system cells to communicate. Serotonin syndrome happens when high levels of serotonin are accumulated due to drug use.

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.

Serotonin syndrome can occur when a person takes a new medication that affects serotonin levels or raises their current drug dose.

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

Signs of Tramadol Addiction

Physical Signs

The following physical signs are commonly associated with tramadol addiction:
  • Nausea
  • Vomiting
  • Sweating
  • Constipation
  • Fever
  • Sleep problems
  • Dizziness
  • Appetite loss
  • Trouble concentrating
  • Muscle aches
  • Depression

Behavioral Signs

Some of the most common behavioral signs of tramadol addiction include:
  • Compulsive drug-seeking behavior
  • An inability to stop using the drug
  • Difficulty functioning in life without the drug
  • A loss of interest in hobbies or activities that were once important
  • Neglecting relationships
  • Missing important obligations such as work and school
  • Risk-taking tendencies, especially when it comes to getting drugs
  • Lying about drug use

Withdrawal and Overdose

Withdrawal Symptoms

As tramadol acts like an opioid, many of its withdrawal symptoms are similar to other opioid withdrawal symptoms. However, the withdrawal symptoms are frequently less intense than those that occur with heroin or oxycodone withdrawal.

The most common withdrawal symptoms include:

  • Tremors
  • Insomnia
  • Anxiety
  • Depression
  • Hallucinations
  • Shivering
  • Flu-like symptoms

Overdosing on Tramadol

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:

  • Contracted pupils
  • Changes in appetite
  • Vomiting
  • Slurred speech
  • Drowsiness
  • Impaired coordination
  • Seizure

Tramadol Addiction Treatment

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:

  • Cognitive-Behavioral Therapy (CBT)
  • Biofeedback therapy
  • Group therapy
  • One-on-one counseling
  • Motivational Enhancement Therapy (MET)
  • Dialectical Behavior Therapy (DBT)
  • Holistic therapy
  • Art therapy
  • Yoga therapy
  • Equine and pet therapy
  • 12-step programs
  • Support groups

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.

Addiction treatment does not end with an inpatient or outpatient program. The road to recovery continues with an aftercare program, and in some cases, well beyond. Aftercare programs are a continued treatment that aims to help maintain recovery from substance abuse and prevent relapse.
This information should not replace a visit to a doctor or treatment center. If you are concerned that you or a loved one might be suffering from tramadol addiction, ask for professional help today.


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