When used as directed, tramadol can be a safe and effective medication for people suffering from moderate levels of pain. However, misuse of the drug increases the risk of dependence and addiction.
Recreational tramadol use is risky and can lead to overdose. Luckily, there are many treatment programs available to guide those in need through the addiction recovery process.
Tramadol is a prescription opioid medication that is sold under the brand names Ultram, ConZip (an extended-release product), and Ultracet (a combination product with acetaminophen). It is prescribed for the treatment of moderate to moderately severe pain. Over 43 million prescriptions were written for tramadol in the United States in 2016 and 41 million were written in 2017.1
In a similar manner to other prescription painkillers, tramadol works by binding to and activating opioid receptors in the brain, spinal cord, and other organs in the body. When tramadol attaches to a certain subset of these receptors, several neurochemical events unfold, culminating in decreased perception of pain signaling as well as a subsequent increase in dopamine release, which creates a sense of reward and pleasure that can reinforce drug-taking.2
However, tramadol is also a monoamine reuptake inhibitor, which means that, like certain antidepressant medications, it inhibits the reuptake of norepinephrine and serotonin into nerve terminals. This monoamine reuptake inhibition is believed to contribute to its effectiveness as a painkiller.1
The effects of immediate-release tramadol will be felt for about 4–6 hours, while the extended-release version provides effects for about 12-24 hours.3
Whether for medical or recreational use, common side effects of tramadol use include:4
The elimination of tramadol begins in the liver where, as a result of specific enzymatic processes, at least 23 metabolites are created. The main metabolites are O-desmethyl-tramadol, which is pharmacologically active, and N-desmethyl-tramadol. The metabolites are mainly excreted through the kidneys.5
Tramadol has a half-life of 5-6 hours, and O-desmethyl-tramadol has a slightly longer half-life of 8 hours. A drug’s half-life indicates the amount of time it takes for a person’s system to eliminate half of the serum concentration of the ingested substance.5
While tramadol is not detected on all standard drug tests, it can be detected on some advanced screening panels. Urine tests, hair tests, saliva tests, and blood tests are the most common forms of drug tests.
Individual factors, such as age, weight, metabolism, and hydration all impact the results of a drug test. Additionally, the dose taken and the length of time taking tramadol will impact how long traces of the drug can be detected in the body.
When used responsibly and as directed by a doctor, tramadol is considered to be a relatively safe pain medication, according to the World Health Organization.3
In 2017, about 1.7 million people age 12 and older had abused tramadol in the past year.
However, tramadol may be abused or diverted from medical use. The FDA labeling on the drug has been changed to include information about its abuse potential. The label states that use of the drug can result in psychological and physical dependence; though this may impact both those with and without histories of opioid dependence, there is a higher risk in people with histories of substance abuse. People most likely to abuse it are people with opioid addiction, chronic pain patients, and health professionals.1
In 2017, about 1.7 million people age 12 and older had abused tramadol in the past year, which is about 0.6% of that population.9
One of the major risks of abuse is overdose, which can be fatal. Symptoms of a tramadol overdose include:10
The risk of a fatal overdose is increased if tramadol is abused with other drugs that depress the central nervous system, such as alcohol, benzodiazepines, or other opioids.10
An overdose requires immediate medical attention. If you notice the signs of an overdose in someone, call 911 without delay.
Withdrawal symptoms will usually be felt beginning about 12 hours after last use. In general, withdrawal symptoms will peak in severity within 1-3 days after last use then subside over the course of another week or so.11
When detoxing from tramadol, a myriad of withdrawal symptoms may be experienced, including:11
A supervised medical detox may be helpful for those with significant tramadol dependence. In such a setting, the person going through withdrawal is monitored for any health complications and given medications, if needed.
The FDA has approved 2 different drugs (methadone and buprenorphine) that can manage opioid withdrawal symptoms. Methadone and buprenorphine act similarly to tramadol on opioid receptors to help ease withdrawal symptoms and suppress cravings.12
Treatment normally consists of counseling and therapy but may also include medications. Behavioral therapies have found to be among the most effective treatments for drug addiction and include:12
After an initial stabilization period, some people may continue to take methadone or buprenorphine beyond the detox phase to help them maintain a baseline level of craving control and withdrawal prevention so that they are better able to return to their daily lives and continue focusing on their recovery in the long-term. In those who taper off of opioid medications altogether, the opioid receptor antagonist naltrexone may be used to block the effects of tramadol and other opioids to discourage relapse and promote long-term abstinence.12
Co-occurring conditions, such as mental health disorders or chronic pain, should also be addressed in treatment to decrease the likelihood of relapse.12
Many different types of drug rehabilitation programs are available across the country. If you or someone you know is ready to start the recovery process, explore your options today.
. Drug Enforcement Administration. (2018). Tramadol.
. National Institute on Drug Abuse. (2018). Prescription Opioids.
. World Health Organization. (2014). Tramadol: Update Review Report.
. University of Wisconsin Health. (2017). Tramadol.
. DrugBank. Tramadol.
. Arup Laboratories. (2019). Drug Plasma Half-Life and Urine Detection Window.
. U.S. Department of Health and Human Services. (2010). Drug Testing in Child Welfare: Practice and Policy Considerations.
. Hadidi, K., Almasad, J., Al-Nsour, T., Abu-Ragheib, S. (2003). Determination of tramadol in hair using solid phase extraction and GC-MS. Forensic Science International, 135, 129-136.
. Substance Abuse and Mental Health Services Administration. (2018). Key Substance Abuse and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health.
. Food and Drug Administration. (2009). Ultram.
. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
. National Institute on Drug Abuse. (2019). Treatment Approaches for Drug Addiction.