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Tramadol Abuse: 8 Vital Questions, Answered

By Manjari Bansal, Ashley Hinson
Tramadol is prescribed legally for mild to moderate pain, but there are certain risks associated with this opioid medication.

The World Health Organization (WHO) reports that tramadol, an opioid analgesic, carries less risk of abuse than stronger opioids like morphine. However, this doesn’t mean tramadol use is completely risk-free. If you're concerned that your own or a loved one's tramadol habit may be escalating, it's helpful to learn what to look for so that you know when to get help. Read on for the answers to eight vital questions about tramadol abuse.

1. Do People Abuse Tramadol?

“Absolutely- tramadol is basically an opioid similar to OxyContin,” Arthur Robin Williams, MD, MBE, Chief Medical Officer at Ophelia, tells WebMD Connect to Care. “However, it is a schedule IV controlled substance because it is not as reinforcing as Oxycontin so is less likely to be preferred by people looking to get high. Over the past decade, there had been a hope that because tramadol is less reinforcing than traditional Schedule II and III opioids patients prescribed tramadol would not go on to abuse it. However, it does happen, especially for people who can no longer access other, more potent opioids.”

According to the National Library of Medicine, Tramadol belongs to the category of opioid pain medications that acts on your brain to relieve the pain. It effectively helps treat moderate to moderately severe  pain conditions, when taken as prescribed by a doctor. However, if taken  more often than prescribed, or for a longer duration, it may lead to addiction.

“Providers think of tramadol as a pain medication that is ‘stronger’ than non-steroidal anti-inflammatory drugs (such as ibuprofen) but “safer” than opioids such as oxycodone,” Michael Fingerhood, MD, FACP, DFASAM, Associate Professor of Medicine and Public Health at Johns Hopkins University and Chief of the Division of Addiction Medicine at Johns Hopkins Bayview Medical Center, tells WebMD ConnectToCare. “When initially approved by the FDA, it was not a scheduled drug. However, abuse quickly became apparent and it was designated at Schedule 4, which allows refills.” 

“Studies have shown that approximately 4% of individuals prescribed tramadol, misuse the medication,” Aaron Sternlicht, LMHC, CASAC, a therapist and co-founder of Family Addiction Specialist in New York, tells WebMD Connect to Care. “While tramadol has the potential for abuse, prevalence of abuse is less than other commonly prescribed opioids such as hydrocodone, oxycodone, and morphine.”

Sternlicht tells WebMD Connect to Care that the symptoms of tramadol abuse may include:

  • Taking the medication more frequently or in a larger dose than prescribed.
  • Failure to fulfill obligations at school, work, or at home.
  • Being unable to cut down or stop using the medication.
  • Experiencing cravings to use the medication, or having a preoccupation with taking the next dosage.
  • Loss of interest in social or leisure activities at the expense of Tramadol use.
  • Developing a tolerance to the medication, or experiencing withdrawal symptoms when the effects of the medication wear off. 
  • Developing withdrawal symptoms such as nausea, headache, stomach aches, sweating, insomnia, aggression, anxiety, and depression.

2. How Does Tramadol Make You Feel?

“Tramadol is a prescription medication used to treat moderate to severe pain,” Clare Waismann, RAS, SUDCC, Founder and Director of Waismann Method® Opioid Treatment Center and Domus Retreat in California, tells WebMD Connect to Care. “When taken as directed, Tramadol works by binding to opioid receptors in the brain to change the way the brain perceives pain.”

“Tramadol is also a cousin to antidepressant medications in that it can boost serotonin and norepinephrine,” Williams says. “Over time, this can help decrease anxiety and depression for some patients. Given the opioid effects, some people will feel sedated when taking it. For some people at risk of abusing it, however, there may be a paradoxical stimulating effect which can make people feel really energized and euphoric.”

“Tramadol can be abused,” Mark Jaffe, MD, Psychiatrist at Westwind Recovery Los Angeles, tells WebMD Connect to Care. “When it is abused, people can feel euphoria and high and appear sedated without being fully aware that they appear high. When they abuse it, if they run out of tramadol they will feel ill, nauseous, sweaty, and unable to sleep.” 

3. What Happens When Someone Takes Too Much Tramadol?

“Tramadol is generally safe if taken as prescribed by a doctor,” Waismann says. “However, Tramadol can be dangerous if misused or taken in large doses. Taking too much Tramadol can lead to serious side effects, including shallow breathing, extreme drowsiness, fainting, or seizure. In some cases, taking too much Tramadol can even be fatal.”

According to the World Health Organization, worldwide more than 70% of deaths caused due to drug use are related to opioids and nearly 30% of those deaths are due to overdose. Opioid overdose causes death mainly due to its effect on the part of the brain which controls breathing. Opioid overdose can be identified by a combination of these 3 important signs and symptoms: 

  • Difficulty breathing
  • Loss of consciousness
  • Pinpoint pupils

Additionally, “some of the signs of Tramadol overdose may include decreased awareness or responsiveness, lack of muscle tone, lightheadedness, severe sleepiness, slow or irregular heartbeat, and unusual tiredness,” James Pratty, MD, a Psychiatrist and Medical Director at Behavioral Health for Brand New Day, tells WebMD Connect to Care. 

“Because it boosts serotonin levels, it can also contribute to serotonin syndrome wherein someone can become very uncomfortable and nauseous with a racing heart and muscle rigidity,” Williams says. 

“If you or someone you know has taken too much tramadol, it's essential to seek medical help immediately. Call 911 or visit the nearest emergency room. Symptoms of a tramadol overdose may not be immediately apparent, so it's important to get medical help immediately, even if the person seems fine. Early treatment can make a big difference in the outcome.” Waismann explains.

4. Can Tramadol Change Your Personality?

“In general, no,” Williams says. “But over time, someone struggling to control their use of tramadol, just like any addictive medication or substance, may start to change as a person in the context of prioritizing drug use over other obligations, commitments, and relationships in life.”

“Tramadol has been found to increase agitation and irritability in some people,” Michael Roeske, PsyD, Senior Director of Newport Healthcare’s Center for Research and Innovation, tells WebMD Connect to Care. “It may also cause some to have suicidal thoughts and tendencies or to become more depressed.”

“Taking too much tramadol can make people grumpy, depressed, anxious and some people, especially the elderly can experience hallucinations where they hear or see things that are not there,” Jaffe says.

5. Can Tramadol Cause Psychosis?

Psychosis happens when you are not able to differentiate between what is real and what is not. In this condition, your thoughts and perceptions are disrupted to an extent that you may see, hear, or believe in things that do not really exist, states the National Alliance on Mental Illness. 

According to the National Association of the State Mental Health Program Directors, the characteristic symptoms of psychosis include:

  • Hallucinations: seeing or hearing things that aren't there
  • Delusions: unusual beliefs or doubts
  • Confused thinking: trouble thinking clearly or concentrating 

“Psychosis resulting from tramadol use is not typical, but in rare instances can occur during withdrawal,” Sternlicht says. 

“It is uncommon, but in combination with other psychiatric substances such as antidepressants, there can be significant agitation and paranoia and even rarely perceptual disturbances such as auditory hallucinations and visual hallucinations,” Pratty adds.

6. Does Tramadol Make You Angry?

“Tramadol can also affect the brain's serotonin and norepinephrine systems, which are involved in regulating mood,” Waismann says. “Some people may experience mood changes when taking tramadol, such as feeling agitated or angry. These changes are more likely to occur at higher doses of tramadol or when the medication is used for long periods of time.”

“Not commonly does [tramadol] cause anger, but when someone has developed a use disorder and they are not getting the drug then they can become more irritable and agitated,” Pratty says. 

If you’re finding yourself becoming increasingly angry or irritable alongside your tramadol use, it may be time to re-evaluate your treatment plan. “If you experience mood changes while taking tramadol, please, talk to your doctor about whether the medication is right for you,” Waismann advises.

7. Does Tramadol Make You Hallucinate?

“While this medication is generally considered safe, some potential side effects are associated with its use,” Waismann says. “One of these is tramadol-associated hallucinations. Tramadol-associated hallucinations are typically visual or auditory in nature. Visual hallucinations may involve seeing things that are not actually present, while auditory hallucinations may involve hearing voices or other sounds that are not actually present.” 

“In most cases, tramadol-induced hallucinations are temporary and resolve once the drug is stopped. However, in some cases, they may persist for weeks or even months after stopping the drug.” Waismann adds.  

8. Is One Tramadol a Day Addictive?

“Although taking one tramadol a day seems to be safe, anything you do daily may become addictive,” Waismann says. 

“When something is done on a regular basis, the body and mind begin to expect it. If you skip a day, you may feel withdrawal symptoms, such as anxiety, sweating, shaking, and difficulty sleeping. This is because your body has become used to tramadol and needs it to function normally. Over time, you may need to take higher doses of Tramadol to get the same effect, leading to dependence and addiction,” Waismann explains. 

“Taking medications as prescribed lower the risk of developing an addiction,” Rahul Gupta, MD, Double Board-Certified Medical Director at Buckhead Behavioral Health and Tampa Recovery, tells WebMD Connect to Care. “However, some individuals are more susceptible to addiction than others. If you experience any symptoms of abuse as described above even when you believe you are taking medications as prescribed, please contact your prescriber immediately even if it's after just one tramadol.”

“Opioid medications like tramadol are generally not meant to be taken daily for more than several months,” Jaffe says. “When someone takes opioid medications too long, even just one a day, people can become psychologically and physically dependent on the pill; they feel like they need the pill to function and feel physically ill without it; it can also actually make the pain more intense rather than lessening it.” 

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