Not all medications are created equal, but weaker ones are no less dangerous than those that pack a punch. This realization has seemingly come to light about tramadol, a pain-relieving opioid medication that doctors have prescribed for human and animal patients.
Tramadol, sold under the brand names Ultram, Ultram ER, among others, has been viewed as a safer alternative to more potent opioid medications, such as oxycodone and hydrocodone. However, recent data indicate that perception could be changing.
A recently published Mayo Clinic study has concluded that patients who use only tramadol after surgery are at a somewhat higher risk of prolonged use than those who use longer-acting opioids.
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“We found that people who got tramadol were just as likely as people who got hydrocodone or oxycodone to continue using opioids past the point where their surgery pain would have been expected to be resolved,” said Molly Jeffery, Ph.D., the study’s senior author and scientific director of research for the Mayo Clinic Division of Emergency Medicine. “This doesn’t tie to the idea that tramadol is less habit-forming than other opioids.”
According to the report, researchers also concluded that the study’s findings suggest that the U.S. Drug Enforcement Administration (DEA) needs to take a closer look at tramadol treatment.
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What Is Tramadol?
Tramadol is an opioid medication that doctors prescribe to patients who manage moderate-to-severe pain. The synthetic opioid is structurally related to other opioid medications, specifically codeine and naturally occurring morphine, according to Drugs.com.
The U.S. Food and Drug Administration first approved it for use in 1995 under the brand name Ultram. Users can take the drug in two forms: extended-release and long-acting tablets, which help users manage their pain for longer periods. MedicineNet.com writes that researchers are not able to pinpoint exactly how the medication works. What’s known is that it is similar in structure to morphine.
As is the case with other opioids, tramadol affects the body’s central nervous system and binds to the brain’s opioid receptors after it is consumed. These receptors shape how the brain and body receive messages about pain.
In the past, tramadol was the preferred option over hydrocodone (Vicodin) and morphine. However, as Drugs.com reports, tramadol can be habit-forming among people who use it long-term and/or misuse it or abuse it. The body can get used to having tramadol in its system with regular use.
Tramadol is available internationally, and people all over the world misuse and abuse it for various reasons. Such abuse became more common in the mid-1990s when the drug was introduced in the U.S.
According to AZPulse.org, when the drug debuted in 1995, it was nonscheduled, meaning the U.S. government didn’t treat it as a controlled substance. It wasn’t on the radar because it was assumed that the risk of abuse was low, AZPulse writes. The drug became a Schedule IV substance in the U.S. in 2014.
Tramadol is among the drugs involved in the opioid epidemic that has the United States in its grip. According to data reported by the Drug Abuse Warning Network (DAWN) and highlighted by the U.S. Substance Abuse and Mental Health Services Administration, visits to the emergency department for tramadol-related misuse and abuse between 2005 and 2011 increased nearly 250 percent in those six years.
The report goes on to say that 20 percent of the visits involved tramadol and the use of one other drug; 26 percent of the visits involved tramadol and two other drugs; and 26 percent of the visit involved tramadol and three or more drugs. The other drugs were other prescription drugs, illegal drugs, and alcohol.
The longer one uses tramadol, the more the person will need to take it to get the initial effects. This means the body has gotten used to having the drug regularly. This is known as tolerance. Taking more than prescribed or more than the body can handle can lead to addiction. Some chronic or longtime tramadol users will decide to stop using the drug. Once they do, they likely will start to feel the effects of drug withdrawal.
What Is Tramadol Withdrawal?
Whether people use this drug under a doctor’s prescription or illegally, both groups of users are at risk of developing a tolerance for it and dependence on it. Chronic or longtime users who stop using tramadol risk throwing their system into shock. Once the dosage has decreased, and the user no longer takes the drug, the body will attempt to return to functioning as it once did before the drug was used. This adjustment will bring on uncomfortable symptoms.
Stopping the use of tramadol suddenly is not recommended. This practice, known as “going cold turkey,” can lead to more than just discomfort. Eventually, it can prompt users to pick up and use the drug again to manage hard-to-control urges. This practice can be dangerous and deadly.
Using the drug again after a break from it can lead to an overdose that can turn fatal, sometimes without warning. Overdose is a greater possibility at this stage because the body’s tolerance of the drug is lower. Initial doses that were once OK to take are now too much for the body to handle.
If you or someone you know is a longtime user of tramadol, and the goal is to get off the drug, tapering is the way to go. This procedure, which is carried out by a medical professional in a clinical setting, removes the substance from the body gradually. This keeps the user safe and medically stable. Detox also connects users with programs that can help them end their dependence on the drug.
What Are Tramadol Withdrawal Symptoms?
Tramadol withdrawal symptoms are typically similar to those of other opioid medications. Physical symptoms have been described as having the flu.
These flu-like symptoms, according to WebMD, include:
- Body aches, pains
- Runny nose
- Watering eyes
- Nausea, vomiting
- Muscle aches
- Excessive yawning
While tramadol withdrawal bears similarities with withdrawal of other opioids, there is an additional set of symptoms that present like those of antidepressant withdrawal, according to an article by Verywell Mind.
It explains that this happens because tramadol affects other neurotransmitters, or chemicals, in the brain that opioids typically do not. Among those is serotonin, a naturally occurring neurotransmitter that regulates several body functions, including mood and sense of well-being.
VeryWell Mind lists the following psychological withdrawal symptoms:
- Concentration difficulties
- Numb emotions
- Sudden behavioral changes
Tramadol withdrawal can also bring on atypical symptoms that usually do not occur in standard opioid withdrawal. These include:
- Increased paranoia
- Extreme anxiety
- Panic attacks
- Numbness, tingling sensation in the limbs, feet
- Depersonalization (feeling detached from one’s body and not in control of one’s actions, thoughts)
WebMD also mentions that withdrawal symptoms can include sudden behavior changes and mental/mood changes. These changes include trouble sleeping and thoughts of suicide.
If serious withdrawal symptoms are present, such as rapid breathing, dizziness, shortness of breath, or a rapid or irregular heartbeat, call 911 immediately or seek immediate medical attention. These symptoms are red flags that your situation is urgent, so you must seek help now.
Another condition tramadol users should be aware of is serotonin syndrome/toxicity. This happens when the body has too much serotonin as a result of taking medications that cause serotonin levels to spike and accumulate, as WebMD explains here. This commonly occurs with the intentional misuse and abuse of antidepressants. However, it can also happen when a person decides to abruptly stop taking tramadol.
Serotonin syndrome/toxicity can result in a range of symptoms, which include dizziness, vertigo, headaches, nausea, confusion, high blood pressure, muscle coordination loss, and twitching muscles, among others.
Mild symptoms may ease within 24 hours, but this condition can be severe, and WebMDcharacterizes it as very serious. Seek emergency treatment right away if any of these symptoms are present: high fever, seizures, irregular heartbeat, and unconsciousness.
What Are the Stages of Tramadol Withdrawal?
People who are in tramadol withdrawal usually want to know a reasonable timeline for it and what to expect. Each experience will be shaped by various factors unique to the person in recovery.
Age, weight, genetics, medical and mental health history, and past substance use all affect the timeline. But other factors concerning the actual use of tramadol can determine how long and severe withdrawal will be. Those include:
- How long tramadol has been used
- Size of the dose usually taken
- How the drug was taken (Was it in pill or powder form, or through intravenous injection?)
- If tramadol was used along with other drugs, such as alcohol and other opioids
- The last dose of tramadol
- Whether the drug was stopped gradually or abruptly
Users who quit cold turkey are likely to feel intense withdrawal symptoms rather quickly. People who used tramadol along with one or more substances could feel symptoms from those drugs along with symptoms of opioid withdrawal.
Symptoms could be very dangerous if alcohol or other drugs that depress the central nervous system were used along with tramadol. If this is the case with you or someone you know, seek medical attention as soon as possible. You do not have to quit first or wait for symptoms to appear before you get help.
Because tramadol is an opioid, withdrawal is similar to that of other opioid medications. It happens in two primary stages: early withdrawal and late withdrawal.
You are in early withdrawal if:
- You feel symptoms as soon as the drug leaves your bloodstream. In the case of opioids, this typically happens within 12 hours after the last dose is taken.
- You experience flu-like symptoms which begin within 24 to 48 hours.
- These symptoms run and peak within the next three to seven days.
- You notice psychological symptoms have started. They typically appear at this stage.
You are in late withdrawal when:
- Physical symptoms of tramadol withdrawal have eased up or stopped completely.
- Discomfort from psychological symptoms will peak.
- You are managing feelings of anxiety, depression, and other challenging mental symptoms. These could last for several weeks. In some cases, they may last for months. This is commonly known as Post-Acute Withdrawal Syndrome (PAWS).
A general Tramadol withdrawal timeline can look like this:
First 6-12 hours – Initial withdrawal symptoms will start. These will mirror the flu, as described above. Symptoms typically start gradually and increase in intensity.
24-36 hours – Expect discomfort to increase as symptoms peak. These symptoms include drug cravings, fever, nausea and vomiting, body aches, and more. Many people who are in this stage are at risk of relapsing. They pick the drug back up to stave off uncomfortable symptoms.
7 to 10 days – Withdrawal usually eases up during this stage, and the worst of the physical symptoms likely has passed. Now comes the part where you must contend with harrowing psychological symptoms.
Beyond 10 days – Lingering post-acute withdrawal symptoms may continue into the coming weeks and months. It’s possible that they can drag on for years. These are psychological in nature and can include symptoms such as brain fog, insomnia, changes in appetite, and more. Joining a recovery program that offers post-treatment care with a focus on health and wellness can help recovering tramadol users manage this period.
Why Should I Detox?
Battling withdrawal symptoms on your own outside of a treatment facility are challenging if not difficult. Without professional help, many people don’t make it through. In many cases, they return to using so that they can manage their discomfort. The cycle of stopping and starting again is not only dangerous but deadly. As previously mentioned, all it takes is one dose that’s too much for the body to handle, and a person can die or sustain permanent injury as a result.
Detox is a safe route to recovery from substance abuse. It helps ensure that you stick to your plan of stopping tramadol use and learning how to manage your life without substance use. You’ll rest easier knowing that medical professionals who know what to expect and what to do can get you through this tough period.
Upon entering a treatment facility, you can expect 24-hour monitoring as you undergo a process that removes the substance from your system gradually. This is called tapering, and it usually is done via intravenous (IV) therapy under the supervision of a medical professional.
You also may be given medications to address other ailments you have. Tell your physician about any other drugs you may have used with tramadol. This will help the professional address your detox needs and ensure you get the best care for your situation.
It is standard to undergo a medical assessment of your physical and mental health needs. This must be done to find the best treatment program for you to attend after detox. If a mental health disorder is detected, such as depression, post-traumatic stress disorder, or anxiety, a program will be chosen that includes treatment for co-occurring disorders.
What Is the Next Treatment Step?
When detox wraps up, the next recommended step is to find the best place for you to begin your recovery. Skipping this step is taking a huge risk with your sobriety and possibly your life. Those who complete detox only before rejoining the real world raise the stakes for a relapse.
This possibility is already high for people in recovery from addiction, according to the National Institute on Drug Abuse. The agency reports that the relapse rate of people in active addiction is anywhere from 40 to 60 percent after leaving rehab. These rates are on par with those of other chronic illnesses, such as asthma, diabetes type I, and hypertension.
There are various treatment settings that recovering users can enter. In most cases, either an inpatient residential or outpatient setting in which to complete their treatment. If the situation is severe or requires more time to address, a residential or partial hospitalization setting may be recommended.
People who enter an inpatient or residential treatment program stay at a facility on-site 24 hours a day so they can focus on their recovery without distractions, outside influences, and triggering environments, people, and situations. This period can last anywhere from 30 to 90 days. This environment is monitored, and medical staff is on site daily. Various therapies are utilized to help people gain the tools and guidance they need strategies to address their situation effectively.
Partial hospitalization (PHP) is for people who are ready to move on from residential treatment but need more time before receiving outpatient services. These programs, also known as partial-day treatment programs, allow people to receive therapy and other services in a structured environment for a specific number of hours weekly.
There is more flexibility as clients do not need 24-hour supervision. They also do not have access to medical professionals throughout the day. Before someone is placed in PHP, they must demonstrate that they do not need 24-hour care and that they can take their medications and commit to completing their weekly therapy hours on their own.
Placement in a PHP can suit the needs of people who are dually diagnosed with a substance use disorder and a mental health disorder as well as those who are eligible to transition from detox into a PHP program. It also can help people who live either at home or in a sober living residence who need more time before returning to society full-time.
Outpatient treatment is the least intensive of the treatments listed above. People who are in the early stages of tramadol dependence, or may feel like they need ongoing support after a treatment program, may find outpatient programs helpful. These programs can help people avoid relapse.
They are also more affordable because there’s no room-and-board component, and they allow people to come and go as they need to while working treatment into their schedules.
Outpatient clients are still accountable for attending therapy sessions. They also must maintain their living environment and keep it conducive to their recovery and goals of living substance-free.
Successful recovery from addiction increases when users complete more steps in the continuum of care, a treatment system established by the American Society of Addiction Medicine (ASAM) that allows people to find the level of care they need to address their substance use disorders. There are placements along the continuum for more intense or less intense care.
Programs that offer the most are usually at facilities that design each client’s treatment plans according to their specific needs and situation.
Start Your Journey to Recovery Today
If you or someone you know is struggling with tramadol dependence, now is the time to get professional help that can help you weather the worst of withdrawal from this drug and avoid relapse. Call us today or reach out to us online so we can guide you toward treatment options that meet your needs.
We’ll help you understand the process and figure out if partial hospitalization services or another arrangement is better for you or your loved one. Get in touch with us now. We are available 24 hours a day, seven days a week.
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(January 31, 2019). Osborn, Corinne O’Keefe. “How Long Does Withdrawal From Tramadol Last?” Verywell Mind. Retrieved from https://www.verywellmind.com/tramadol-withdrawal-4177612
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