Tramadol – abuse, addiction & recovery

According to the United States federal Controlled Substances Act, tramadol is classed as a Schedule IV substance, effective July 2, 2014.

By this classification, tramadol satisfies the following criteria: possessing a low potential for abuse, relative to the substances classed under Schedule III; currently accepted for medical use in the United States; and posing less of a risk for physical and/or psychological dependence than Schedule III substances.

Tramadol comes in various formations, viz., tablets, capsules, drops and injections. As a tablet or capsule, it takes the form of a white pill; round, elliptical or ovaloid in shape; and bearing the imprint of either 93/58, R 174, G/TL 50, cor/127, M/T7, 7171/M, 466/Watson, 377, E/311 or MP/717, among others.

The active substance is tramadol hydrochloride, an opioid analgesic. Other ingredients are cellulose, microcrystalline, silica colloidal anhydrous, sodium starch glycolate, magnesium stearate, gelatin, sodium lauryl sulphate, indigo carmine, iron oxide and titanium dioxide.

Similar to other prescription pain medications, such as codeine, hydrocodone and morphine, tramadol works by binding to opioid receptors in the brain in order to block pain signals. Tramadol also acts on two major neurotransmitters (chemical messengers) in the brain—serotonin and norepinephrine—both of which affect pain perception.

Its potential routes of administration are oral, rectal, intravenous or intramuscular. Typically taken by mouth, in tablet or capsule form, the analgesic effects of an immediate-release formulation take about one hour to activate, two to four hours to peak and a total duration of action of 6 hours on average for its painkilling effects.

In this dosage, tramadol is roughly one-tenth the potency of morphine and roughly equivalent to codeine at low doses and hydrocodone at high doses.

Empirical studies comparing the relative strength of tramadol and oxycodone have found that 20 mg of controlled-release oxycodone is clinically equivalent to 200 mg of controlled-release tramadol for post-operative analgesia for breast cancer patients.

In general, and like other opioids, tramadol is detectable in saliva and blood for up to 48 hours, detectable in urine for 24 to 72 hours and detectable in hair for 30 to 90 days after it is taken.

Various factors, however, control how long tramadol is present in your body, including dosage size, frequency of intake over time, the route of administration (with injections leaving the body sooner than oral consumption), the rate of your individual body’s metabolism, organ function (with compromised kidney or liver function increasing the time it takes your body to excrete the substance), and age (with individuals over 75 taking a greater length of time).

Similar to other opioids, common side effects include nausea, vomiting, constipation, itchiness, euphoria, indigestion, spasticity, weakness, lightheadedness, drowsiness, dizziness and headache. More serious side effects include seizure, serotonin syndrome, impaired alertness, depression, addiction and death.

For immediate release tablets, the recommended dose is 50-100mg, every 4-6 hours as needed, with the maximum daily dose being 400 mg.

To improve tolerance, patients may begin with a dose of 25 mg/day, increasing dosage by 25 to 50 mg every three days, as needed, up to 50 to 100 mg every 4 to 6 hours in a day.

Risk of side effects like nausea and dizziness attend tramadol use even when prescribed and consumed in the proper amount, and so should only be taken under a physician’s supervision.

Greater danger results from its abuse, altering its formation or exceeding the necessary dosage—inducing severe side effects, including the potential for overdose and death.

In its prescribed form tramadol use, as mentioned, should not exceed the range of 300 to 450 mg per day. Risk of fatal overdose comes when consumption ranges between 2 and 8 grams. But other harmful effects, including seizure, can result from dosages as low as 500 mg.

In general, the length varies, according to various factors, such as size and frequency of consumption, combination with other substances, age, gender, body size, family history and overall health.

However, the relatively mild potency of tramadol, when taken in its prescribed form as warranted, together with its Schedule IV classification, should not be used to discount the potential for abuse and addiction.

If pursued for the purpose of its euphoric effects, outside of its prescribed application, tramadol, like any other opioid painkiller, is liable for tolerance, dependence and withdrawal, especially for individuals with a history of opioid abuse.

Some common withdrawal effects are decreased appetite, headache, nausea, diarrhea, among other flu-like symptoms, as well as anxiety and depression.

Combining tramadol with other substances increases the dangers of side effects and the risks of withdrawal. For example, when high doses of tramadol are combined with anti-depressants, abuse of tramadol creates a threat of seizure upon withdrawal.

Another high risk of tramadol abuse is central nervous system depression, causing decreased heart rate and breathing, creating a greater risk of coma and death.

In consequence, emergency room visits related to adverse reactions to tramadol increased 145% between 2005 and 2009.

Tramadol detox varies according to the factors mentioned above, but should be done under a doctor’s supervision in any case. In the standard scenario, a tapering schedule administered over an interval of weeks would facilitate the withdrawal process.

To the extent that there are withdrawal symptoms during this period, they should be mild and last on average between 5 and 7 days.

Symptoms persisting longer than this are categorized as post-acute withdrawal symptoms (PAWS), which include insomnia, impaired appetite, poor concentration, mood swings, anxiety and depression.

While PAWS wanes over time, they could last as long as 18 to 24 months. In such a situation, a physician might recommend certain over-the-counter medications or prescribe others (medication-assisted-treatment, or MAT) to ease the withdrawal.

The world-class care delivered by RCA can provide for detox and MAT, as well as other inpatient  and outpatient treatment options, including telehealth.

So if you or a loved one are concerned about a potential problem with tramadol and would like support in stopping, call Recovery Centers of America (844-242-7956) now, where immediate, expert help is available 24 hours/day, 365 days/year.

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