Tramadol: What Is It?

How Does Direct Tapering Help?Tramadol, or Ultram, is an opiate painkiller prescribed for the treatment of chronic moderate to severe pain. In both a short-acting and an extended-release formula, the drug works by binding to receptors in the central nervous system and diminishing the individual’s perception of pain.

Taken for an extended period or without a doctor’s supervision, tramadol, like other opioid analgesics, has the potential for abuse and addiction. It can also cause a number of side effects in users and increase the risk of acute medical emergencies and long-term health problems, which can be fatal.

For many, the use of tramadol is a positive way to manage the issues caused by chronic pain that would otherwise be intrusive in daily life. For others, however, even minimal use of the drug can trigger abuse of the medication, which in turn can create a landslide of negative physical, mental, and social consequences. The good news is that addiction to tramadol, like other opiate drugs, is highly treatable.

Who Abuses Tramadol?

Tramadol is not a common street drug, though people who struggle with opiate abuse and addiction may use the pills to avoid withdrawal symptoms if that is what is easily accessible to them. In most cases, when tramadol abuse issues develop, it stems from use of the drug via a doctor’s prescription; thus, patients who are living with chronic pain are at risk of developing a tramadol use disorder when they are prescribed the drug for treatment. It is also a common drug of abuse among health professionals.

How Does a Tramadol Use Disorder Develop?


Because patients who are prescribed the drug are at risk of developing a tramadol use disorder, the problem often develops slowly over time as tolerance develops or begins right away. For example, if the initial dose prescribed by the doctor is not effective in diminishing the experience of pain, the patient may take higher doses than prescribed or take the drug more frequently than recommended. Similarly, even if an initial dose is effective, over time, a tolerance will develop to the drug, requiring that the patient take a higher dose to experience the same level of pain relief. A patient may respond to this phenomenon by taking more of the drug on their own or otherwise attempting to increase the effect of the pills or get more pills, especially if the doctor is resistant to increasing the dose.

What Are the Risks of Abusing Tramadol?

There are a number of risks associated with the use and abuse of tramadol. A number of side effects have been reported with use of the drug, ranging from mild to severe, and patients who begin the medication are reminded to contact their doctors immediately if any symptoms occur.

Mild side effects can include:

  • Constipation
  • Drowsiness
  • Headache
  • Muscle tightness
  • Dry mouth
  • Nervousness
  • Shaking
  • Mood swings
  • Indigestion

Serious side effects can include:

  • Seizures
  • Allergic reactions (e.g., hives, pruritus, swelling, and others)
  • Respiratory depression
  • Negative interaction with other CNS depressants (e.g., sedatives, alcohol, etc.)
  • Increased intracranial pressure

Withdrawal Symptoms and Addiction

Withdrawal symptoms when stopping use of tramadol after long-term use are common. The drug is physically addictive, and most people will develop a physical dependence with ongoing use. These can include:

  • Nausea and vomiting
  • Sweating
  • Insomnia
  • Pain
  • Tremors
  • Diarrhea
  • Upper respiratory issues
  • Severe anxiety
  • Panic attacks

When addiction develops, both a physical dependence as well as a psychological dependence are in evidence. This means that when without the drug, an individual will not only experience some or all of the physical withdrawal symptoms listed but will also experience extreme cravings for more of the drug and feelings that it is impossible to function without it.

Additionally, in some cases, psychosis following tramadol withdrawal may be an issue for some, according to a study published in the journal Addiction & Health, but is atypical and may last only a few days.


Overdose is also a risk of tramadol abuse. Taking too much of the drug can intensify side effects, such as respiratory depression, in which the person’s breathing becomes shallow and/or slow. With too much of the drug in the system, the person may stop breathing entirely. If medical attention is not available to restart breathing or otherwise address the overdose of tramadol in the system, death will occur.

Risk Stats

The risks that come with heavy use of tramadol are real. The Drug Enforcement Administration (DEA) reports that:

  • In 2012, more than 13,000 tramadol exposures were called into the American Association of Poison Control Centers.
  • Of those tramadol calls in 2012, more than 6,500 reported single drug exposures, and nine deaths were associated with the calls.
  • In 2010, the Drug Abuse Warning Network (DAWN) reported more than 16,000 admissions to emergency rooms across the country for medical issues related to nonmedical use of tramadol. That number increased to about 20,000 the following year.
  • In 2012, an estimated 3.2 million people aged 12 and older used tramadol nonmedically, according to the National Survey on Drug Use and Health (NSDUH).

What Are the Signs of Tramadol Abuse?

There are a number of different red flag behaviors and changes that can indicate that someone’s use of tramadol has crossed the line from safe use to abuse. They include:

  • Taking pills in any way that is not prescribed (that is, crushing pills that were designed to be swallowed whole before use, taking more than prescribed, or taking the drug more frequently than prescribed)
  • Taking tramadol without a prescription
  • Experiencing negative consequences (e.g., mental health issues, physical health problems, difficulty maintaining friendships or commitments at work, etc.) due to use of tramadol
  • Drinking alcohol or using other substances in combination with tramadol to increase potency
  • Craving the drug when without it and/or constantly obsessing over how to get more
  • Attempting to get multiple scripts for tramadol or other opiate drugs from multiple doctors or filling a single prescription at multiple pharmacies
  • Lying about losing pills or otherwise attempting to justify drug-seeking behaviors

When an individual not only exhibits some or all of the behaviors listed but also continually requires higher doses of tramadol to avoid withdrawal symptoms and is unable to moderate their use of the drug despite all the problems they experience as a result, tramadol addiction is in evidence and professional treatment is recommended.

How Are Tramadol Use Disorders Treated?

In most reputable treatment centers, each client will receive a unique set of therapies and treatments chosen to meet personal needs and address individual experiences before and during addiction with an eye toward accomplishing personal recovery goals. However, because tramadol is an opiate drug, there are some treatments and therapies that may generally play a role in the plan to address a substance use disorder.

Medical Detox

Stabilizing physically and mentally in recovery is the first order of business, and because most people living with a tramadol use disorder will experience withdrawal symptoms when they stop taking the drug, medical detox is a necessary first step. This period can last anywhere from a few days to a few weeks depending on the dose of the drug taken, and may include medicated detox options and/or the use of nonaddictive medications to help diminish the experience of specific withdrawal symptoms. As symptoms fade and the individual is ready, the attention turns to positive choices that continually improve physical health and mental health treatment with a focus on relapse prevention.

Therapeutic Treatment

A unique combination of therapies can help clients to begin to look at the issues that may have driven the development of addictive use of drugs as well as the co-occurring mental health disorders and medical ailments that may have triggered use of tramadol specifically. With an increased understanding of how addiction works and develops, clients will begin to learn new and healthier tools to address those issues in the future without turning to substance use and abuse. This often includes:

  • Personal therapy and treatment plan/goal management
  • Cognitive Behavioral Therapy to address perspectives and choices that may be contributing to cravings for drugs and alcohol
  • Group therapy to increase peer support and positive social interactions
  • Family therapy to rebuild bonds broken during addiction
  • Experiential therapies to explore trauma and other issues non verbally
  • Holistic treatments to heal the mind and body

Treatment for Co-occurring Disorders

For most people who develop a tramadol use disorder, chronic pain is a co-occurring issue. Learning how to manage chronic pain without use of tramadol often plays a major part in recovery, and patients are encouraged to do everything possible to find relief through holistic treatment and positive lifestyle changes. For many, this means:

  • Nutritional therapy designed to increase intake of nutrients that can help the body heal and maintain positive weight management to decrease stress on joints and improve sleep
  • Positive sleep hygiene choices that promote rejuvenating sleep patterns
  • Body work and massage to decrease muscle pain
  • Occupational therapy to strengthen muscles and increase mobility

Additionally, co-occurring mental health disorders must be treated during addiction treatment as well. Depression due to pain as well as anxiety and other mood disorders are common among those who struggle with addiction, and getting treatment for these issues can decrease cravings for drugs and alcohol.

Aftercare Support

Especially for clients who struggle with chronic pain, continued connection with treatment and therapy is essential during the transition into independent living in recovery. Building a strong support system and continuing to see therapists and doctors who were helpful during treatment mean continued growth in recovery for all issues: mental wellness, physical health, chronic pain management, and relapse prevention. The longer that a client continues to actively engage with treatment, the more sustainable their recovery will be.

Connecting with Treatment for Tramadol Abuse and Addiction

Tramadol abuse and addiction is a treatable disorder. The sooner that one connects with a treatment program that has the capability to fully address all issues faced on the road to recovery, the better. Often, family members play a significant role in helping the individual to recognize the need for treatment and to begin the process of enrollment, and are encouraged to take part in the recovery process, helping themselves as well as the person in treatment to make positive progress forward.

Connecting with Treatment