Tramadol Abuse and Addiction

What is Tramadol?

Tramadol is an opioid that’s most often prescribed to treat pain. Available in immediate- and extended-release formulations, tramadol is also offered in combination with acetaminophen.^1,2 Tramadol hydrocholoride and tramadol hydrochloride/acetaminophen combinations are sold as a generics, but other names for tramadol include the following brands: ConZip, Qdolo, and Seglentis.²

Does tramadol get you high, and can tramadol be addictive?

Although it has valid therapeutic effects, tramadol is sometimes misused for its rewarding opioid effects, which can include euphoria and feelings of relaxation (aka a tramadol high).³ And while tramadol is classified as a Schedule IV drug with low potential for misuse and risk of dependence, its drug label warns that use exposes people to the risks of misuse and addiction.^1,4

Data from the 2022 National Survey on Drug Use and Health shows that of the 14.6 million people aged 12 and older who used tramadol products in the past year, 9.4% of these individuals misused the drug.⁵ An estimated 6.1 million people in that same age group had an opioid use disorder in the past year.⁶

How Tramadol Affects the Brain

Like other opioids, tramadol modifies pain signals by attaching to and activating opioid receptors throughout the brain. This activation is associated with an increase in dopamine activity in key regions of the brain, which can significantly reinforce the act of taking drugs such as tramadol and ultimately prompt people to repeat the experience.³

Tramadol Side Effects and Adverse Events Associated with Misuse

While tramadol is an effective pain reliever, it has several potential side effects including:¹

• Constipation.
• Nausea, vomiting.
• Sleepiness.
• Headache.
• Dizziness.
• Abdominal pain.
• Respiratory depression.
• Seizures.

Tramadol appears to have less potential for respiratory depression than other opioids, which can sometimes create the misconception of safety.⁷ However, when it occurs, respiratory depression can be life-threatening, particularly in the case of overdose.³

While drug manufacturers warn of several adverse but relatively rare conditions associated with tramadol, two worth noting include:

• Acute liver failure. Overdose involving tramadol and acetaminophen combinations have been linked to acute liver failure, likely due to the toxic effects of high doses of acetaminophen.⁸
• Serotonin syndrome. Tramadol has also been associated with serotonin syndrome, particularly in relation to overdose. However, it has also been identified as a potential single agency cause for the condition.⁷

Recognizing Tramadol Addiction and Misuse

Tramadol addiction, also known as opioid use disorder (OUD), is the continued use of tramadol despite harmful consequences.¹⁰

You might be asking yourself: How do I know if I or someone I know is addicted to tramadol?

The technical answer is that you don’t. That is, only addiction and health professionals can diagnose opioid use disorder. However, as you assess tramadol use, it may help to better understand the criteria used in diagnosis. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), criteria used to diagnose opioid use disorders include:¹⁰

• Taking opioids for longer periods of time or in larger amounts than intended.
• Being unable to cut down or stop substance use.
• Spending a lot of time obtaining, using, and recovering from the effects of the substance.
• Experiencing cravings, or intense desires or urges for the substance.
• Failing to fulfill obligations at home, work, or school due to substance use.
• Continuing substance use despite having interpersonal or social problems that are caused or worsened by substance use.
• Giving up social, recreational, or occupational activities due to substance use.
• Using the substance in risky or dangerous situations.
• Continuing substance use despite having a physical or mental health problem that is tightly linked to substance use.
• Developing tolerance or needing more of the substance to achieve previous effects.*
• Suffering from withdrawal, meaning that unpleasant symptoms occur when you stop using or cut back on your substance of choice.*

*These are not criteria for those solely taking tramadol therapeutically under appropriate medical supervision.

Tramadol Overdose Risks and Symptoms

An overdose of tramadol occurs when there is more tramadol in the body than it can handle, resulting in potentially fatal symptoms.³ As such, an opioid overdose is a medical emergency. Symptoms of a tramadol overdose include:¹

• Drowsiness progressing to stupor or coma.
• Constricted pupils.
• Respiratory depression.
• Cold, clammy skin.
• Limp skeletal muscles.

Complications associated with tramadol overdose include:¹

• Atypical snoring.
• Seizures.
• Partial or complete airway obstruction.
• Fluid in the lungs (i.e., pulmonary edema).
• Slowed heart rate (i.e., bradycardia).
• Decreased blood pressure (hypotension).
• Death.

While anyone who uses opioids can overdose on them, the Centers for Disease Control and Prevention has identified several risk factors for overdose related to tramadol and other opioids. They include:¹¹

• Taking high daily doses of prescription opioids.
• Combining opioids with alcohol and other depressants.
• Taking more opioids than prescribed.
• Taking illicit or illegal opioids (e.g., heroin or illicitly manufactured fentanyl, which can contain harmful or unknown substances).
• Medical conditions such as sleep apnea and reduced liver or kidney function.
• Being older than 65 years of age.

Tramadol Withdrawal

Tramadol withdrawal occurs when someone who is physically dependent on the drug suddenly stops use or significantly reduces the amount they use.  This is because the body has adapted to the presence of the drug, so when it is discontinued, the body struggles to function, causing uncomfortable withdrawal symptoms.¹³

Common symptoms of tramadol withdrawal can include:¹³

• Bone and muscle aches, enhanced pain sensitivity.
• Chills, goosebumps, teeth chattering, changes in body temperature.
• Insomnia.
• Stomach cramps, vomiting, nausea, diarrhea.
• Weakness.
• Anxiety and emotional pain.
• Irritability and stress.
• Malaise, unease, and lack of motivation.

So can you just stop taking tramadol if you think you’re addicted?

Because quitting tramadol cold turkey can be very uncomfortable (but is not life threatening), medically assisted detox (perhaps including various medications) is often recommended. It can keep people as safe and as comfortable as possible during this challenging period of early recovery.¹³

Tramadol Detox and Treatment

So how is tramadol addiction treated? The setting and type of treatment for tramadol addiction varies by individual and often depends on a person’s level of addiction, needs, individual characteristics, and recovery goals.¹⁴ However, common levels of care for tramadol addiction include:¹⁴

• Detox. Medically supervised opioid detox can take place in both outpatient and inpatient settings. While often the first step of recovery, it’s not the only step in the process.
• Inpatient treatment. Inpatient care involves 24/7 treatment and monitoring in a residential setting.
• Outpatient treatment. Varying in intensity, outpatient programs include traditional outpatient rehab as well as partial hospitalization programs (PHPs), intensive outpatient programs (IOPs), and telehealth services.
• Aftercare programs. Aftercare programs include ongoing therapy, 12-Step programs, sober living facilities, and more.

Providing all levels of care, American Addiction Centers is equipped to treat a host of substance use disorders including those involving opioids such as tramadol. Plus, AAC has facilities scattered across the country, each of which is staffed by highly trained professionals who provide evidence-based treatment interventions.

Co-occurring Disorder and Tramadol Addiction

Tramadol addiction and other opioid use disorders often occur alongside mental health conditions, such as generalized anxiety disorder, post-traumatic stress disorder (PTSD), depression, bipolar disorder, attention-deficit hyperactivity disorder (ADHD), psychotic illness, and more.¹⁵ The term for this phenomenon is co-occurring disorder (aka dual diagnosis).

Substance use disorders don’t always cause mental health conditions and vice versa. However, according to the National Alliance on Mental Illness (NAMI) substance misuse is twice as prevalent among adults with mental illness, perhaps because of a desire to self-medicate symptoms.¹⁶

In terms of treatment, the National Institute on Drug Abuse indicates that addressing both conditions at the same time is more effective than treatment for each disorder individually.¹⁷

Prevention, Education, Support Systems, and Resources

A host of education, support, and resources can help prevent tramadol misuse and promote recovery. The Substance Abuse and Mental health Services Administration offers several campaigns related to SUD prevention such as: “Talk. They Hear You.” (aimed at parents, caregivers, and educators); National Prevention Week (a public education platform); and Communities Talk (a national initiative to raise awareness and educate the public about substance misuse). Myriad SAMHSA educational resources are also available.

Where can you find support for tramadol addiction?

If you are concerned about a loved one’s use of tramadol or other substances and want to support them in seeking help, American Addiction Centers offers several helpful articles, such as:

• Loving Someone with an Addiction: What You Can Do to Help
• How to Choose a Rehab Facility
• How to Encourage Someone to Go to Rehab

If you or a loved one is ready to enter treatment or you simply want to learn more about the process, contact an American Addiction Centers admissions navigator at . Available 24/7 for a free and confidential conversation, staff can listen to your story, answer your questions, and discuss treatment options.

Plus, for those with insurance, staff can verify your insurance benefits for admission to one of AAC’s many treatment centers, or you can verify your benefits online. If you don’t have insurance, finances don’t have to be a barrier to treatment, as staff can also discuss other payment options.

The best day to enter treatment is always today. Reach out to take your first steps toward recovery now.