Last Updated: October 25, 2022
Tramadol is a prescription painkiller. It is a synthetic opioid that activates the same brain receptors as oxycodone and hydrocodone, the mu-opioid receptors. While the potential for misuse and addiction is lower for tramadol than other opioids, it is still possible even when taken as prescribed.
What Is Tramadol?
Tramadol is a Schedule IV medication (as of 2014) under the Controlled Substances Act, meaning there is the potential for addiction and abuse. Tramadol was initially noncontrolled when released to the market in 1995. Shortly after, reports of diversion and misuse prompted its reclassification as a controlled medication. It is used to treat pain and is available under several different brand names as either immediate- or extended-release formulations.
Is Tramadol an Opioid?
Tramadol is an opioid. However, it is a prescription pain killer that is not an opium derivative (opiate), like oxycodone or hydrocodone. Instead, it is a fully synthetic opioid agonist and works on the same brain receptors as other opioids. As a result, it is less addictive than oxycodone or hydrocodone, though the potential for misuse and addiction remains.
What Is Tramadol Used For?
Tramadol is a prescription pain killer prescribed for acute or chronic pain. As with any pain medication, you should use the lowest dose for the shortest time possible. However, even when taken as prescribed, it is possible to develop a dependence on this medication.
How Does Tramadol Work?
Tramadol works by activating the same receptors in the brain as other opioids — mu-opioid receptors. By doing this, tramadol changes the body’s response to pain. Interestingly, tramadol also inhibits two neurotransmitters (norepinephrine and serotonin) responsible for signaling in the brain.
Is Tramadol Safe?
When taken as prescribed, tramadol is safe and effective. When taken differently than prescribed or at high doses, tramadol carries risks similar to other opioids, such as constipation, dry eyes and mouth, mood changes and respiratory depression. However, one important note is its effect on inhibiting norepinephrine and serotonin in the brain can lead to increased seizure risk.
Tramadol Side Effects
Taking tramadol can result in several different common side effects, which can include:
- Mood changes
- Dry mouth
- Runny nose
- Sleep disturbances
- Trouble concentrating
Other less common side effects of taking tramadol can include:
- Decreased appetite
- Night sweats
- Unusual dreams
- Weight changes
- Allergic reaction
How Long Do Side Effects of Tramadol Last?
While pain relief should start within an hour of taking a tramadol dose, its peak effect occurs after two to four hours, and most side effects appear during this time. Tramadol continues to provide pain relief for about three to six hours.
Long-Term Side Effects of Tramadol
Long-term tramadol use is associated with several neurological conditions thought to be related to how tramadol alters the neurotransmitters serotonin and norepinephrine. These include:
- Serotonin syndrome
- Alzheimer’s disease
- Parkinson’s disease
Tramadol can cause or contribute to overdose despite being a relatively weak opioid. While there is no specified lethal dose for this medication, the recommended maximum for the immediate-release formulation is 400 mg/day and 300 mg/day for the extended-release formulation.
Symptoms of a tramadol overdose may include:
- Change in consciousness
- Decreased awareness or responsiveness
- Breathing difficulty
- Lack of muscle tone
- Loss of consciousness
- Pinpointed pupils of the eyes
- Severe sleepiness
- Slow or irregular heartbeat
Is Tramadol Addictive?
Tramadol is addictive. Between 2015–2017, 1.6–1.8 million Americans reported tramadol misuse. Misuse can include taking more tramadol than prescribed or taking it differently than prescribed (by snorting, injecting, etc.). Like oxycodone and hydrocodone, tramadol activates mu-opioid receptors in the brain to change the body’s response to pain. However, this can also affect mood leading to activation of the brain’s reward response center. When this happens, addiction can develop and lead to compulsive tramadol use.
Often occurring with addiction is physical dependence. Physical dependence happens when the body compensates for consistently being exposed to tramadol and activating brain receptors. The body changes the number of receptors to adjust to the presence of tramadol — this is the process of developing tolerance. When you abruptly stop taking tramadol, the body does not have time to compensate, which can lead to opioid withdrawal. For this reason, tramadol is often slowly weaned until it is safe to quit taking. Always consult your health care provider if you are considering stopping tramadol.
Like other opioids, tramadol activates the brain’s mu-opioid receptors, which can trigger the reward center in the brain. This change in the body’s response to pain can lead to feelings of euphoria, which can alter the brain’s chemistry and result in dependence. Despite causing similar effects to those of other opioids, tramadol generally results in weaker effects than others like hydrocodone and oxycodone.
Signs and Symptoms of Tramadol Addiction
There are many signs indicating tramadol addiction. Some include:
- Downplaying use or hiding use from friends and family
- Experiencing withdrawal when trying to stop or decrease the dose
- Taking tramadol at inappropriate times, like at school or work
- Using tramadol despite adverse consequences
How Long Does It Take to Get Addicted to Tramadol?
There isn’t one specific answer to the frequently asked question, “How long does it take to get addicted to tramadol?” Some people may get addicted after using it only a few times, while others may use it without ever becoming addicted.
Factors that play a role in whether someone becomes addicted to tramadol include:
- Having a personal or family history of substance abuse or addiction
- How often someone takes it: a person who takes tramadol more frequently is likely to develop an addiction faster than someone taking it only occasionally.
- Whether co-occurring disorders exist as mental health disorders, such as anxiety or depression, may increase the likelihood of an addiction-forming.
- If someone uses tramadol in ways other than intended, such as injecting or snorting it, they are more likely to become addicted rapidly.
- A person taking tramadol without a prescription or differently than prescribed is at an increased risk of developing an addiction than someone else.
Common Tramadol Drug Combinations
While you should not take tramadol in addition to other drugs or alcohol, some people combine it with other substances to increase the high. In 2011, 68% of emergency department visits related to tramadol use involved tramadol with another prescription drug. In 35% of cases, this was a pain reliever like hydrocodone or oxycodone, and 32% of patients included anti-anxiety medications like benzos or insomnia medications like zolpidem. In 14% of cases, tramadol was combined with alcohol; in 12% of cases, they also used illicit drugs, like heroin.
Combining tramadol with other substances, especially other depressants, can have an additive effect. This additive effect is risky as it can increase the likelihood of many side effects like respiratory depression.
When you stop taking tramadol abruptly or wean off too quickly, you may experience tramadol withdrawal. Withdrawal happens when the body does not have enough time to adjust to the absence of a substance.
Symptoms of tramadol withdrawal in about 90% of cases include:
- Rigors (shivering)
- Upper respiratory symptoms
- Piloerection (erection lasting longer than four hours)
- Hallucinations (rarely)
The remaining 10% of tramadol withdrawal cases are associated with:
- Extreme anxiety
- Panic attacks
- Numbness and tingling in the extremities
Tramadol Addiction Treatment Options in Ohio
If you or someone you care about is struggling with tramadol addiction, The Recovery Village Columbus can help. Our knowledgeable staff will support you in treating tramadol addiction at our Joint Commission-accredited facility. We offer a spectrum of care ranging from medical detox to inpatient and outpatient rehab and aftercare planning while providing state-of-the-art amenities like an art studio and fully equipped gyms.
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- Drug Enforcement Administration. “Tramadol (Trade Names: Ultram, Ultracet).” March 2020. Accessed August 5, 2022.
- Raj K; Chawla P; Singh S. “Neurobehavioral Consequences Associated […]hological Mechanisms.” CNS & Neurological Disorders – Drug Targets, November 2019. Accessed August 5, 2022.
- Reines SA, et al. “Misuse of Tramadol in the United States:[…]and Health 2002-2017.” Substance Abuse, June 3, 2020. Accessed August 5, 2022.
- Ohio State Health & Discovery. “How to spot signs of addiction.” January 6, 2022. Accessed August 5, 2022.
- SAMHSA. “Emergency Department Visits for Drug […]ication Tramadol.” The CBSHQ Report, May 14, 2015. Accessed August 5, 2022.
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