Personalised Treatment for Tramadol Addiction
Table of Contents
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Key Takeaways
- Tramadol is a prescription medication used for the management of moderate to severe pain
- Tramadol belongs to a class of drugs called opioids. These drugs have misuse and addiction potential, particularly when they are used for prolonged periods (i.e., longer than three months)
- Tramadol has various brand names, including Conzip, Maxitram and Ultram. It can be swallowed in pill or liquid form or delivered by injection or infusion
- Tramadol can be misused for its psychoactive effects (i.e., ability to elicit feelings of happiness, relaxation and calmness)
- People misuse tramadol by taking it not as prescribed or by using it recreationally by crushing and snorting tablets
- People taking tramadol can experience significant side effects that require medical intervention, including confusion, hallucinations and inability to urinate
- Use of tramadol alongside other central nervous system depressants, like alcohol or benzodiazepines, increases the risk of overdose. Overdoses are medical emergencies that can be life-threatening
- Doses of tramadol should be slowly tapered to help mitigate uncomfortable withdrawal effects, like anxiety and sleep disturbances
- Treatment for tramadol addiction typically starts with detoxification and should feature long-term approaches, such as medications, psychological therapies and support groups, to treat the underlying addiction and support lasting recovery
What Is Tramadol?
Tramadol is a medication that can be prescribed to help manage moderate to severe pain. It belongs to a class of drugs known as opioids.
Tramadol works by acting on receptors in the central nervous system and brain to block pain signals. It can be swallowed in pill or liquid form or delivered by injection or infusion. Immediate-release and modified, or longer-acting, forms are available for pain relief.1,2
Tramadol has various brand names, such as Conzip, Maxitram, Tramulief, Ultram, Zamadol and Zydol.2,3
As an opioid drug, tramadol carries risks of dependence and addiction, particularly when it is used for extended periods of time (i.e., longer than three months).
Patients prescribed tramadol should be advised of these risks and educated about overdose and withdrawal effects. Treatment should be carefully planned and monitored and doses of tramadol should be slowly reduced to help ease potential withdrawal symptoms.1
In the UK, tramadol is classified as a Class C drug, under the Misuse of Drugs Act, 1971. This means that it is illegal to possess, manufacture or supply tramadol, unless it has been prescribed for medical use.4,5
People who misuse tramadol, by taking it not as prescribed or by taking street drugs, may take it by crushing and snorting tablets.6 Street names for tramadol include trams or trammys.7
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The Effects of Tramadol
When prescribed in the management of pain, tramadol can alleviate acute or chronic pain. Standard forms of tramadol typically work within 30–60 minutes, with effects wearing off after 4–6 hours. Longer-acting forms last for longer but can take up to two days to take effect.1,2
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Tramadol Side Effects
Serious Side Effects
Some side effects of tramadol can be serious and warrant medical intervention. It is recommended that patients contact their doctor if experienced:2
- Confusion
- Hallucinations (e.g., hearing or seeing things that aren’t there)
- Signs of low blood pressure (e.g., extreme tiredness, dizziness and low energy)
- Extreme sleepiness
- Difficulty urinating
- Inability to urinate
Tramadol can also cause breathing difficulties, seizures or allergic reactions, in rare cases. These are medical emergencies and patients should call 999 or go to A&E for immediate intervention.
Long-Term Effects
In some cases, patients may require long-term pain relief. Taking tramadol for extended periods of time increases the risk of developing tolerance (where higher doses are needed to relieve pain), dependence and addiction, even at treatment doses.1,2
Some people who are prescribed tramadol for long-term pain relief can become more sensitive to pain. This is known as hyperalgesia, a condition that can be managed by gradually reducing the dose of tramadol.
People who are prescribed tramadol long-term, for example to manage cancer pain, should be carefully monitored during treatment. This can help to ensure that any side effects are recognised and managed appropriately.2
Medical supervision is especially important in patients who are at increased risk of dependence and addiction, including those with a previous or current substance use disorder and patients with mental health condition(s).1
Tramadol Overdose
In some cases, use of tramadol can lead to overdose. Signs and symptoms of a tramadol overdose include:
- Breathing difficulties
- Extreme drowsiness
- Loss of consciousness
- Reduced pupil size
- Muscle weakness
- Reduced heart rate
- Clammy, cold skin
The risk of tramadol overdose is increased by using very high doses and using tramadol alongside other central nervous system depressants, like alcohol, benzodiazepines and other opioids.8,9
Tragically, tramadol can be used in intentional overdoses or suicide attempts.8
Overdoses are medical emergencies that can have fatal outcomes. If you recognise any of these signs or symptoms, it is crucial to seek help immediately by calling 999. If you have access to naloxone, you should deliver a first dose as soon as you recognise the signs of overdose, so that this can begin working.
This medication can help reverse the effects of opioid overdoses, so can be life-saving. Repeated doses of naloxone can be given every 2–3 minutes, if symptoms recur before medical help arrives.3
More on tramadol overdose.
Tramadol Addiction
Tramadol can be misused for its psychoactive effects.8 Psychoactive substances, like tramadol, impact brain functioning and generate changes in thinking, awareness, emotions, mood and/or behaviour.10
Psychoactive effects of tramadol include feelings of euphoria (i.e., intense happiness), reduced anxiety, calmness and relaxation.6,8
People who misuse tramadol by taking it not as prescribed or by using street forms of the drug may be seeking these pleasurable effects. Misuse can precipitate dependence and addiction as people develop strong desires to keep using the drug and can experience cravings or uncomfortable withdrawal effects that are alleviated by further tramadol use.6
It is important to remember that anyone can develop addiction to tramadol, even if it has been prescribed and they have no history of substance misuse.1,9
Diagnosing Tramadol Addiction
At Castle Craig, we recognise addiction as a chronic brain disease.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is a text that helps medical professionals to recognise and diagnose conditions like tramadol addiction. Also known as substance use disorders (SUDs), addictions can be characterised by criteria that portray the loss of control, physical dependence, risky use and social issues arising from the condition.
The DSM-5 presents these criteria to aid the diagnosis of SUDs, like opioid use disorder. Opioid use disorders arise as a result of misuse of opioids, like tramadol.
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Signs and Symptoms of a Tramadol Use Disorder
- Using higher doses of tramadol or taking it for longer than prescribed or intended
- Inability to reduce or stop tramadol use
- Experiencing cravings
- Development of tolerance, where higher doses of tramadol are needed to achieve desired effects
- Investing lots of time in obtaining, using or recovering from tramadol use
- Continued use of tramadol despite relationship issues
- Continued use despite health issues that may have been caused or worsened by tramadol use
- Continued use despite potential risks or dangers
- Inability to manage usual responsibilities at home, work or school due to tramadol use
- Withdrawing from significant work, social or hobby activities due to tramadol use
- Experiencing withdrawal symptoms that can be alleviated by further tramadol use
These 11 criteria describe the widespread impacts of SUDs, like tramadol addiction, on a person’s life. People experiencing two or three of these effects can be said to have a mild SUD, whereas those who have four or five, or six or more symptoms, are likely to be experiencing a moderate or severe SUD, respectively.11
Some people can be diagnosed with a SUD, like tramadol addiction, and a mental health condition. This is referred to as a co-occuring disorder, or dual diagnosis. A co-occuring disorder occurs in around 50% of cases, meaning that these conditions are closely linked.12
Learn more about co-occurring disorders on our dedicated web page, ‘Dual Diagnosis and Addiction’.
Safe Detox in Comfort
Tramadol Addiction Treatment
The first step in overcoming tramadol addiction is detoxification, or detox. This is the process by which tramadol is removed from the body. Detox can occur at home and/or under medical supervision. When overseen by medical professionals, this process is known as a medically managed withdrawal.
Following detox, it is important to treat the underlying addiction as relapse is common following withdrawal. Long-term treatment can aid recovery and promote lasting sobriety from tramadol.15
Long-term treatment for tramadol addiction can include:11,13,15
Medications
Three medications (buprenorphine, methadone and naltrexone) are FDA-approved for managing opioid use disorders, like tramadol addiction
- Buprenorphine and methadone are opioid drugs that can help alleviate cravings and withdrawal effects. In people with tramadol addiction who have developed tolerance to opioids, treatment doses of these drugs should not elicit euphoric effects
- Naltrexone, on the other hand, is not an opioid but works by preventing opioids from binding to receptors. This means that if someone takes an opioid, it will not produce desired effects
Counselling and Psychotherapy
Behavioural therapies, like cognitive behavioural therapy (CBT), can help people suffering from tramadol addiction to recognise negative thought patterns and establish more positive behaviours. Individual or family counselling can provide support to help people cope with the widespread effects of tramadol addiction
Support Groups
Groups like SMART Recovery and Narcotics Anonymous can provide encouragement and guidance during recovery from tramadol addiction. They are an invaluable source of social support, which helps in promoting successful recovery
Harm Reduction Education
Learning about safe use of injection equipment, the risks of using tramadol alongside other drugs and how to effectively use naloxone in overdoses can help to reduce harms associated with tramadol misuse and relapse. Patients, family members and friends can all be involved in harm reduction education. This can be particularly beneficial for patients who are unable to engage in formal treatment programmes
There is no one-size-fits-all approach to managing substance use disorders, like tramadol addiction.11 However, combination of multiple approaches, particularly medications and behavioural therapies, can be most effective in managing this chronic condition.15
Treatment for tramadol addiction can occur in outpatient or inpatient (also known as residential) settings. Outpatient treatment occurs when patients receive treatment at home or by visiting community-based facilities. Inpatient treatment, on the other hand, takes place in hospitals or specialist addiction treatment facilities.11,15
Residential Rehab for Tramadol Addiction
At Castle Craig, we recognise the challenges associated with tramadol addiction for those suffering from the disease and their loved ones. We provide a comprehensive tramadol addiction treatment programme:
Specialist detoxification unit
If you or someone you know is suffering from tramadol addiction, an important first step is reaching out for help. Our friendly and professional team are here to answer any questions you may have and provide guidance on available treatment options.
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References
- National Institute for Health and Care Excellence (NICE). Tramadol hydrochloride.
- National Health Service (NHS). Tramadol.
- MedlinePlus. Tramadol.
- National Institute for Health and Care Excellence (NICE). Controlled drugs and drug dependence.
- GOV.UK. Drugs penalties.
- Talk to Frank. Tramadol.
- Rapid Action Drug Alerts and Response (RADAR) Team, Public Health Scotland (PHS). RADAR A to Z: A guide to common drug names in Scotland (PDF).
- Roussin A, et al. Increase of high-risk tramadol use and harmful consequences in France from 2013 to 2018: Evidence from the triangulation of addictovigilance data.
- Dhesi M, et al. Tramadol. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.
- National Cancer Institute. Psychoactive substance.
- Hartney E, Gans S. DSM 5 Criteria for Substance Use Disorders: How substance use disorders are diagnosed.
- Gupta S, Umhau JC. What Is a Dual Diagnosis?
- O’Keefe Osborn C, Gans S. Coping With Tramadol Withdrawal Symptoms.
- Beakley BD, Kaye AM, Kaye AD. Tramadol, Pharmacology, Side Effects, and Serotonin Syndrome: A Review. Pain Physician. 2015;18(4): 395–400. PMID: 26218943.
- Yale Medicine. Opioid Use Disorder.