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What is Tramadol?

Tramadol is a drug prescribed to treat moderate-to-severe pain. It is an opioid. Therefore, it is in the same family of drugs such as Oxycodone, Morphine, Fentanyl, and heroin, derived from the opium poppy plant. Opioids attach to opioid receptors in the brain, suppressing the central nervous system (CNS) to block pain signals.

This drug is versatile in that it is prescribed as either immediate-release or extended-release tablets, which control the speed in which the drug is released into the body. The type of tablet prescribed is dependent on a patient's specific needs.

In 2014, the U.S. Drug Enforcement Administration listed Tramadol as a schedule IV controlled substance due to the risk of addiction and overdose.

tramadol pills

Tramadol is a popular medication because it is less powerful than many other drugs within the opioid category. To put it in perspective, it has about one-tenth of the potency of Morphine. However, it still has the same risks as other opioids, including:

  • Addiction
  • Tolerance
  • Dependency
  • Withdrawal symptoms
  • Overdose
  • Death

Tramadol Side Effects

  • mild-to-moderate headache
  • dizziness
  • drowsiness
  • lethargy, or reduced energy
  • nausea and vomiting
  • constipation or diarrhea
  • dry mouth
  • profuse sweating

A small percentage of patients experience more severe side effects. If any of the following symptoms develop, speak with your doctor immediately:

  • Slowed breathing
  • Rapid or irregular heartbeat
  • Serotonin Syndrome — a combination of elevated body temperature, agitation, profuse sweating, tremors, dilated pupils, and diarrhea, and can result in coma or even death

Immediate-release vs. extended-release tablet form

Immediate-release (IR) provides fast-acting pain relief for people with short-term pain issues. These pills come in 50 mg doses. Patients with long-term and chronic pain issues benefit from extended-release (XR), which releases gradually, providing long-lasting pain relief. XR prescriptions come in 200 mg, 300 mg, and 400 mg doses.

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Tramadol Risks

Tramadol is warned against use in combination with alcohol or several other prescription or illegal drugs. Additionally, doctors strongly advise women against breastfeeding, as the drug passes through breast milk. Tramadol also has several risks associated with misuse, such as:

Dependence

Tramadol use can cause a build-up of tolerance, particularly with extended or overuse. Tolerance is when more of a drug is needed to relieve pain than previously used. The speed and strength of drug tolerance depend on the amount taken, duration used, and genetics.

Abuse or misuse of the drug will occur when:

  • A patient takes more of the drug than prescribed
  • A patient takes the drug without a prescription altogether
  • When used in any way other than intended

Once dependent, a person will experience symptoms of withdrawal if they abruptly stop taking the drug. Though Tramadol is less potent than many other opioids, there is still a risk of withdrawal symptoms, including:

  • An intense craving for the drug
  • Profuse sweating and clamminess
  • Runny nose
  • Chills and goosebumps
  • Muscle spasms
  • Stomach cramps
  • Nausea and vomiting
  • Psychosis
  • Agitation and irritability
  • Hallucinations
  • Homicidal or suicidal thoughts
  • Insomnia
  • Depression

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Tramadol Addiction

Because pain is a legitimate concern for people with an Oxycodone prescription, it may be challenging to identify someone as addicted. The drug is legal, so the symptoms of addiction may be subtle and difficult to identify in others. A patient taking the medication can even fall into addiction when using it as prescribed. The symptoms of addiction can include:

  • Depression
  • Neglect of personal relationships and isolation
  • A decline in fulfilling responsibilities at work and home
  • Visible fatigue and drifting off
  • Strong desire to use the drug, particularly with frequent visits to the ER to coax doctors into writing them a prescription
  • Seemingly distant or "out of it."
  • Mood swings
  • Apathy
  • Lapses in memory
  • Decreased appetite and weight loss
  • Financial or legal problems
  • Visiting different physicians to obtain codeine prescriptions, also known as doctor shopping

Tramadol Overdose

A Tramadol overdose can cause severe symptoms and even death. It is a central nervous system (CNS) suppressant. Therefore, large quantities become toxic, drastically affecting vital systems in the body, especially breathing. Initial symptoms of overdose include:

  • Vomiting and stomach cramps
  • Slurred speech and loss of basic motor functions
  • Slow pulse and low blood pressure
  • Pin-point-shaped pupils
  • Blue lips and fingertips
  • Cold to the touch
  • Clammy skin
  • Seizure

A person's breathing slows to a dangerously low pace. As a result, this causes a lack of oxygen to the brain and other vital organs. In many cases, breathing stops altogether, resulting in permanent, irreversible damage to the brain and other organs, coma, and even death. Immediate medical attention is required.

The drug Naloxone, an opioid agonist, is often used to remove Oxycodone from the brain's receptors and counteract its effects.

Treatment Options for Opioid Abuse & Addiction

Opioid use disorder is difficult to overcome. Fortunately, there are several options for help. These include:

  • Medication-Assisted Therapy (MAT) When it comes to medication-assisted therapy for opioid use disorder, there are three types approved: buprenorphine, methadone, and naltrexone. Buprenorphine and methadone help manage withdrawal symptoms as you detox. Naltrexone blocks the receptors that opioids bind to, making it impossible to get high from them. Medication-assisted therapy is most effective when combined with other therapies.
  • Inpatient Programs — Inpatient programs are the most intensive addiction treatment options. These programs guide you through medical supervised detoxification, behavioral therapy and other services such as medication-assisted therapy. They typically last 30, 60 or 90 days, but may be longer if necessary.
  • Partial Hospitalization Programs (PHPs) Intensive outpatient programs are the next level of addiction treatment, providing similar services to inpatient programs such as detoxification and behavioral therapy. The difference is that the patient will return home to sleep, and some programs will include transportation and meals. PHPs are ideal for both new patients as well as those who have completed inpatient treatment but still need intensive care.
  • Outpatient Programs Outpatient programs provide a well-rounded treatment program for people with a high motivation to recover. These programs are flexible and can be made around for your schedule, and can be customized to work best for you. These programs work for new patients as well as those that complete an inpatient or partial hospitalization program.

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Resources

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Shmerling, Robert. “Is Tramadol a Risky Pain Medication? - Harvard Health Blog.” Harvard Health Blog, 14 June 2019, https://www.health.harvard.edu/blog/is-tramadol-a-risky-pain-medication-2019061416844.

“Tramadol (Oral Route) Description and Brand Names - Mayo Clinic.” Mayo Clinic, https://www.mayoclinic.org/drugs-supplements/tramadol-oral-route/description/drg-20068050

“Tramadol Hydrochloride 50 Mg Capsules - Summary of Product Characteristics (SmPC) - (Emc).” Logo for Datapharm, 26 June 2019, https://www.medicines.org.uk/emc/product/6116/smpc.

“Tramadol - DrugBank.” DrugBank, https://www.drugbank.ca/drugs/DB00193

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