Tramadol Withdrawal

What is Tramadol?

Tramadol is an opioid painkiller. Brand names formulations include Ultram, Ultracet, and Conzip.¹  Tramadol is used in the management of moderate to moderately severe pain and, in extended-release form, for the management of chronic pain.²

The Drug Enforcement Administration (DEA) lists tramadol as a Schedule IV medication, unlike other opioid drugs, like oxycodone and hydrocodone, which are considered to have a higher potential for abuse and are classified as Schedule II substances.³ 

The World Health Organization (WHO) notes, however, that while tramadol’s abuse potential is lower than morphine, it is still abused and dependence may develop in a matter of weeks, especially among people taking more than the prescribed dose. People who develop tramadol dependence often have a history of drug abuse.⁴

How Common is Tramadol Abuse?

• Tramadol was approved in 1995, and it wasn’t long until reports of abuse and diversion were made. Though it is touted as having a lower abuse potential than other opioid painkillers, it is abused for its high that it is similar to that of other opioids.⁵
• According to the DEA, tramadol is most often abused by patients with chronic pain, medical professionals with access to the drug, and those with a history of abusing narcotics.⁵

Tramadol Dependence and Withdrawal

Tramadol dependence may develop in a matter of weeks to months. When someone is physically dependent on this medication, they need it to feel normal. When the dose is lowered or they discontinue their use, they may experience typical opioid withdrawal symptoms such as:^5,6

• Insomnia.
• Large pupils.
• Restlessness.
• Anxiety.
• Excessive yawning.
• Watery eyes.
• Runny nose.
• Sweating.
• Goosebumps.
• Muscle aches.
• Abdominal pain.
• Diarrhea.

Tramadol is a unique opioid medication in that, in addition to its effects as an opioid agonist, it also has some activity as a serotonin and norepinephrine reuptake inhibitor. As such, upon abrupt discontinuation, it has some withdrawal symptoms atypical of other opioid drugs. The DEA notes that about 10% of people who quit will experience a withdrawal syndrome unlike that of other opioids that may include symptoms such as:⁵

• Confusion.
• Severe anxiety.
• Panic.
• Paranoia.
• Hallucinations.
• Numbness and/or tingling in the arms and legs.

Medical Detox for Tramadol Addiction

• Tramadol withdrawal is rarely dangerous; however, it can be difficult to get through. It may bring on intense flu-like symptoms including those listed above. Nausea and vomiting may also lead to severe dehydration or an imbalance of electrolytes that requires medical intervention.⁷
• While inpatient detox may not be a medical necessity since uncomplicated opioid withdrawal is rarely life-threatening, some form of medical supervision may take a great deal of pain out of the detox process. The drug may be tapered slowly to avoid an abrupt and severe dose reduction that induces significantly painful symptoms of withdrawal.⁷ In addition, for the small percentage of people who experience an atypical withdrawal syndrome from tramadol, which may include symptoms of psychosis, medical detox may be a preferred way to keep them safe during the acute period of withdrawal.
• During inpatient or outpatient medical detox, staff may provide medications such as methadone or buprenorphine to stabilize the patient and ease opioid withdrawal symptoms.⁷ These medications might be continued post-detox as part of a medication-assisted treatment (MAT) approach (the use of medications in combination with therapy to address addiction).
• Other medications (both prescription and over-the-counter) may also be provided to mitigate certain symptoms. For example, Benadryl or trazodone may be used to manage insomnia. Over-the-counter analgesics and other supportive medications may be used for headaches, muscle aches, bone pain, diarrhea, or other relatively mild symptoms. Tylenol, Motrin or other over-the-counter medicines may be used for headaches, muscle aches, and bone pain. In the case of abdominal cramps, dicyclomine may be used.⁷ 
• While you may be able to tough out the acute phase of tramadol withdrawal alone, getting professional detox help may alleviate your discomfort significantly and help you stay motivated to continue treatment post-detox. In fact, the Substance Abuse and Mental Health Services Administration (SAMHSA) advises some form of inpatient medical detox for opioid withdrawal in order to prevent needless suffering on the part of the patient.⁷ 

Get Help Overcoming Tramadol Addiction

• Detox is only the first step in overcoming tramadol addiction. After detox, someone who is struggling with opioid abuse should continue receiving treatment in some form, such as an inpatient rehab or outpatient treatment program like an IOP (intensive outpatient program) in order to work with a team to uncover and address the issues that led to and perpetuated their tramadol abuse.
• Individual, group, and family therapy are all important aspects of treatment. These help the person understand what triggered their addiction, how stress or mental health issues tie into their substance abuse, and mend family ties so they get better social support for their recovery going forward. The more social support from family, friends, and support groups a person has on a long-term basis, the better able they are to remain sober and healthy.

Are you ready to reach out for help and start the addiction treatment process? If you or someone you love is struggling with addiction and are ready to take the first steps towards recovery, call us today at . Greenhouse Treatment Center, American Addiction Centers’ Texas addiction recovery center, is ready to help you get the treatment you need today.

References:

1. U.S. Food & Drug Administration. (2019). Search Results for “tramadol”.
2. U.S. National Library of Medicine. (2019). Tramadol.
3. United States Drug Enforcement Administration. Drug Scheduling.
4. World Health Organization. (2014). Tramadol: Update Review Report.
5. U.S. Drug Enforcement Administration. (2018). Tramadol.
6. U.S. National Library of Medicine. (2018). Opiate and opioid withdrawal.
7. Center for Substance Abuse Treatment. Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131. Rockville, MD: Center for Substance Abuse Treatment, 2006.
8. http://www.everydayhealth.com/drugs/tramadol
9. https://www.dea.gov/druginfo/ds.shtml
10. http://www.who.int/medicines/areas/quality_safety/6_1_Update.pdf