Cirque Lodge > Blog > Addiction > Tramadol Addiction and Abuse

The commonly prescribed medication, Tramadol, is one of the least potent painkillers available. But does that mean that it is risk-free, or is tramadol addictive?

Tramadol can cause a series of health risks, especially when taken for a long time or abused, and tramadol addiction can develop.

What Is Tramadol?

Tramadol is a painkiller prescribed by healthcare providers to treat moderately severe pain and in some cases, chronic pain.

Belonging to the group of medicines called opioid analgesics, Tramadol works in part by inhibiting the reuptake of serotonin and norepinephrine.

The drug works much in the same way as other synthetic opioids; Tramadol relieves pain by acting on the central nervous system. As a central nervous system depressant, Tramadol interferes with pain messages between the brain and the body. It attaches to opioid receptors and blocks impulses going through the brain that cause a headache, for example.

Tramadol is commonly sold under brand names Ultram, ConZip, or Ryzolt, and has street names Trammies, Ultras, and Chill Pills. It is commonly prescribed to treat neuropathic pain resulting from injuries, diabetes, or stroke, and is also used as a way to help manage pain associated with the back, osteoarthritis, and fibromyalgia.

Because of its manufacturing, Tramadol's addictive properties are not as strong as other opioids like Hydrocodone or Oxycodone, but they are still there.

In 2014, Tramadol became a Schedule IV controlled substance as its use can lead to abuse or a substance use disorder. Apart from the danger of addiction or dependence, Tramadol can also cause several adverse effects, especially when abused.

The Effects of Tramadol

The Effects of Tramadol

Tramadol is considered a safer alternative to other prescription opioids designed to manage moderate to severe pain, but tramadol addiction and abuse are still an issue. The assumption that it is safer is particularly false in cases where a person has a personal or family history of drug abuse, particularly opioid abuse, and/or mental illness. The effects of Tramadol have the potential to initiate the same substance-seeking behaviors as other drugs, in particular other opioids.

Serotonin Syndrome

Tramadol not only works by blocking pain receptors in the brain. It also works by inhibiting serotonin and norepinephrine uptake, and by including Selective Serotonin Reuptake Inhibitors (SSRIs), tramadol use may lead to a condition called serotonin syndrome. This is when there are abnormally high levels of serotonin in the body.

The syndrome can be experienced as mild and may dissipate after a few days, but if serotonin syndrome is left untreated, it can be life-threatening. It may occur when a person starts increasing their dose or when they start using other substances or medication at the same time.

Symptoms of serotonin syndrome include:

  • Headache
  • Confusion
  • Dilated pupils
  • Lack of coordination
  • Shivering and goosebumps
  • Agitation
  • Jerky or rigid muscles
  • Tremors
  • Seizures
  • Coma

The Effects of Substance Abuse

The Effects of Substance Abuse

According to the Substance Abuse and Mental Health Services Administration (SAMHSA)around 9.3 million people in the United States misused prescription pain relievers in 2020.

While most people reported that misusing these medications was to relieve pain, other common reasons included feeling good or getting high, relieving tension, or relaxing. Others misuse painkillers to help with coping with feelings or emotions, or to help with sleep. Some people abuse these drugs to increase or decrease the effects of other substances, while others abuse them because they are 'hooked' to it, or need to have it.

Those who abuse tramadol may initially feel relaxed and euphoric, but there are also adverse reactions that come about.

Tramadol effects vary according to how much of the substance is abused and whether it is combined with other substances; more severe symptoms of Tramadol abuse, like seizures or central nervous system depression, typically occur with higher doses.

Other side effects of Tramadol abuse include:

  • Changes in appetite
  • Nausea and vomiting
  • Slurred speech
  • Pinpoint pupils
  • Drowsiness
  • Impaired coordination
  • Muscle aches
  • Constipation
  • Fever
  • Depression

Frequent Tramadol abusers may become addicted to the drug and with time transition to taking harder painkillers or illicit drugs to satisfy their cravings. Those who misuse or abuse Tramadol may need intensive treatment to end the abuse, especially when abusing it along with other, more potent substances.


As with other drug abuse, very large doses of Tramadol - much higher doses than prescribed by a doctor - may experience a fatal overdose. As a central nervous system depressant, too much tramadol can stop breathing completely and lead to a Tramadol overdose.

Symptoms of a Tramadol overdose include:

  • Abnormally low blood pressure
  • Slow heart rate
  • Weak muscles
  • Sweaty or clammy skin
  • Respiratory depression
  • Sleepiness
  • Unconsciousness
  • Coma

Polydrug use, which means taking Tramadol in combination with other drugs, increases the risk of severe health risks. Mixing Tramadol with other opioids or some types of illicit drugs, or other central nervous system depressants such as anti-anxiety medications, (e.g. benzodiazepines) or alcohol, increases the risk of oversedation, respiratory depression, coma, and death.

Between 2005 and 2011the number of emergency department visits involving Tramadol abuse or misuse increased by approximately 250%, and nearly half of these visits involved tramadol combined with other pharmaceuticals.

Tramadol Dependence and Addiction

Tramadol Dependence and Addiction

While the drug is considered less habit-forming or with a low addiction potential compared to other prescription opioids, tramadol dependence and addiction can happen, even in a person without a history of substance abuse and addiction. Tolerance to, and withdrawal from Tramadol are signs of Tramadol dependence.

People may develop a mental dependence on Tramadol, in which they experience cravings to use the drug. They can also develop a physical dependence in which any attempt to stop or reduce the medication leads them to experience withdrawal symptoms.

Those who have a tendency toward opioid addiction very easily become dependent on it and can have the same symptoms that develop with stronger opioid medications.

People who have chronic pain conditions are exposed to extended use and may develop dependence despite not abusing Tramadol. They may also show signs of a Tramadol addiction or develop a substance use disorder, which is influenced by many genetic, environmental, and psychosocial factors.

Eleven criteria characterize addiction, according to the Diagnostic and Statistical Manual of Mental Disorders. A person can have a mild, moderate, or severe substance use disorder according to how many of the criteria apply.

Signs and Symptoms of Tramadol Addiction

A person suffering from tramadol addiction may experience excessive drowsiness, apathy, and mood swings. They may vomit in large doses or experience impaired coordination. Other signs of a Tramadol addiction include:

  • Leaving around, or hiding, prescription bottles
  • Spending large amounts of money on Tramadol
  • Spending a lot of time trying to obtain, use or recover from Tramadol
  • Increased risk-taking behaviors and lowered inhibitions
  • Compulsive use of Tramadol
  • Experiencing withdrawal symptoms when attempting to cease use
  • Neglecting personal, home, work, or school responsibilities
  • Social or interpersonal problems related to Tramadol use
  • Doctor shopping (visiting multiple doctors to obtain many prescriptions for more Tramadol
  • Continuing Tramadol use despite negative consequences

Withdrawal Symptoms

Withdrawal symptoms vary according to the amount used, the frequency of use, and whether it was combined with other substances. The more Tramadol a person takes on a regular basis, the more severe their withdrawal symptoms will be, and the more time it will take for them to end use or abuse.

As the drug is in the family of opioid medications, Tramadol withdrawal symptoms closely mimic symptoms of opioids like hydrocodone or oxycodone.

The symptoms of opioid withdrawal can be extremely uncomfortable and disturbing, and include:

  • Nausea and vomiting
  • Headaches
  • Confusion
  • Poor appetite
  • Muscle pain
  • Blurred vision
  • Restless legs
  • Agitation and aggression
  • Mood swings
  • Tingling
  • Hallucinations
  • Tremors
  • Insomnia

In some cases, secondary tramadol withdrawal symptoms can occur. These can persist for months and include sleep disturbance, restlessness, and dysphoria ( a state of unease or dissatisfaction, typically presenting with anxiety, agitation, or depression).

Treatment for Tramadol Addiction and Abuse

Treatment for Tramadol Addiction and Abuse

A treatment center can evaluate a person's physical, mental and emotional health, as well as their family, medical and substance use history before designing a treatment plan so that the person receives the best treatment according to their needs.

There are outpatient settings, whereby a person attends specific therapies at the treatment center, or inpatient treatment, whereby a person resides at the center for the duration of their recovery.

In 2017, an estimated 18.7% of people with mental health disorders were using prescription opioids. Mental disorders often co-occur with substance use, and a treatment program addresses both mental health and substance addiction. In this way, possible causes or contributing factors to substance abuse are addressed, giving a person a better chance for long-term recovery.

As the withdrawal symptoms listed above will occur, could last about one week, and could be severe, quitting Tramadol 'cold turkey' is not advised. A person may require immediate medical care, and withdrawal management in a treatment center is both safer and decreases the chances of relapsing in order to cope with symptoms.

How Does Treatment for Tramadol Abuse Look?

The first phase of Tramadol treatment programs gradually tapers off Tramadol from a person's body through detox. In the case that the drug was taken for pain control or pain relief under a physician's supervision and with no other substances, this should be sufficient to end Tramadol misuse. However, in cases of abuse or combination with other opioids or drugs, a medical detox is required.

Here, any potentially life-threatening complications can be managed and a person is under supervision throughout the detox process. Medical detox may include the slow tapering of tramadol with the addition of clonidine or lorazepam to treat anxiety or restlessness. In other cases, the partial opioid agonist buprenorphine can help to reduce cravings and help to manage opioid withdrawal symptoms. This is a synthetic medication that blocks Tramadol from binding to opioid receptors of the brain by acting on them.

Another medication that may be used in tramadol withdrawal management and to counteract overdose symptoms is Naloxone, an opioid antagonist. Yet another opioid antagonist, Methadone, binds to opioid receptors for a longer time and at a lower intensity to help reduce withdrawal symptoms.

Seeking Help

Seeking help from a treatment center has a big advantage as a comprehensive rehabilitation program offers the next stage involved in tramadol recovery. This stage includes therapies and other support that can help a person identify underlying causes of addiction or abuse, and triggers for cravings that may cause them to use again. In this way, with the help of mental health professionals, a person who has abused tramadol can develop more healthy behaviors or responses.

Addiction treatment for substance use disorders typically includes cognitive behavioral therapy, motivational therapy, family therapy, peer support and group therapy, and in some cases experiential therapy to manage mental conditions that may contribute to addiction.

Where Can I Find a Treatment Centre?

If you or a loved one is battling Tramadol addiction and abuse, Cirque Lodge can help.

We understand that suffering from an addiction to painkillers is complicated and can have many causes. That is why we approach the healing process in a variety of ways, helping you to understand these causes and supporting you to overcome them.

Our state-of-the-art facilities offer the latest therapeutic techniques and invigorating outdoor activities so that you can reconnect with your true self.

Cirque Lodge provides an individualized treatment plan for each person. Our substance abuse or addiction treatment program includes detoxification, and a combination of the traditional 12-step model with cognitive-behavioral therapy (CBT), group therapy, and experiential therapies. As underlying or co-occurring mental disorders can many times be the driving force behind addiction, we offer integrated, dual diagnosis programs that treat both mental health conditions and substance use disorders.

Our experiential therapies incorporate the use of physical activities to boost your mental and physical well-being and allows you to explore and reinforce the skills you learn through exhilarating activities such as mountain hikes or flyfishing, mindful meditation, or equine therapy.

Cirque Lodge's holistic approach can help you heal from addiction and guide you to personal growth and long-term success in your recovery.

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