Tramadol is one of many prescription painkillers approved by the U.S. Federal Food and Drug Administration (FDA) to treat moderate to moderately severe pain. It is marketed under the brand names Ultram, Ultram ER, and Conzip. It is also marketed in combination with acetaminophen, another pain-relieving medication, as Ultracet.

Due to the potency and possible side effects of Tramadol, The FDA restricts its pediatric use. Tramadol is approved only for adults as a single ingredient and combination medications. It is also recommended that Tramadol not be used by women who breastfeed due to possible harm to their infants.

It is an analgesic (painkiller) available only through prescription and controlled by federal law due to abuse and addiction risks. Physical and psychological dependence, as well as lethal overdose, are possible. For safety, prescribers are encouraged to access patients for substance problems prior to prescribing and to monitor their use closely throughout treatment because of its potential for misuse, abuse, and addiction.

Tramadol is an Opioid with Abuse and Addiction Potential 

Tramadol, like other prescription painkillers, belongs to the pharmacological class of substances known as opioids. Drugs in this class are related in chemical structure and effects to all other opioids including heroin, oxycodone (OxyContin), fentanyl and methadone among others. While medically beneficial to many for pain control and sedation, all opioids can trigger a Substance Use Disorder, or what is commonly known as substance abuse or addiction.

A Substance Use Disorder occurs with a range of severity. It can be mild, moderate or severe, but left untreated and with continuing use, such disorders progress in severity over time. Some of the symptoms of a Substance Use Disorder include:

• Cravings, or overwhelming urges to use the substance

• Using more than intended or over a longer period than intended

• Developing a physical tolerance for the drug that causes a need for increasing dosages over time to achieve the desired effect

• Having withdrawal symptoms when the usual dose is stopped or lowered that is relieved by using the substance again

• Giving up usual activities and responsibilities in the home, school, work, family or social realms due to using the substance

• Continuing to use despite a desire to stop or despite the knowledge that uses is doing physical or psychological harm

When one is misusing Tramadol or abusing it, a medical diagnosis based on these types of symptoms can be given. In the specific case of Tramadol issues, the exact diagnosis may be given to indicate the class of drug misused or the specific drug misused. For example, one may be diagnosed with an Opioid Use Disorder (class of drug designation), or with a Tramadol Use Disorder (specific drug designation).

The misuse of Tramadol can occur in several ways:

• One may use Tramadol by methods of administration not prescribed such as crushing the pills for intranasal use (‘snorting’) or injection

• One may use more than is prescribed as in larger doses or in greater frequency

• Tramadol may be obtained illegally without prescription and used without the medical need or supervision

• Tramadol may be used in combination with other mood-altering drugs

Risks, Dangers and Adverse Reactions to Tramadol Misuse 

Adverse reactions can occur whenever a substance is used without medical supervision or when prescribed Tramadol is misused. Along with the serious risk of developing a Tramadol abuse addiction, there are several other physical and psychological health risks, including some that are life-threatening. Some of these include:

• Respiratory Depression – Respiratory depression occurs when breathing is slowed or stopped. Tramadol has a sedating effect which is the result of induced brain changes that slow natural processes. Consequently, vital life functions such as respiration can be critically affected. Fatal Tramadol overdoses involve a respiratory arrest, and people are cautioned not to increase prescribed doses or to cut, break, crush, chew or dissolve extended release pills. Otherwise, the body can be exposed to rapid increases in the drug that will cause overdose and respiratory depression. Prescribers are even cautioned to watch for respiratory depression symptoms when initially giving Tramadol and when dosing is increased.

• Seizures – Seizures are always a possible side-effect even when use is monitored medically, but they are more likely when Tramadol is misused. Risks for seizures when taking Tramadol are increased for a variety of reasons. Among those vulnerable are people who already have a seizure disorder or who have had a seizure in the past. Others who are at risk for seizures when taking Tramadol are those who have had head injuries. Also, people who take certain anti-depressants and other opioids are at risk. There are other seizure-related risk factors when taking this drug and a prescriber can discuss those with you.

• Serotonin Syndrome – This syndrome occurs when the neurotransmitter serotonin increases to an unusually high level. Neurotransmitters are natural chemicals responsible for communication between nerve cells. They are essential in brain and nervous system functioning and consequently, functioning throughout the body. Symptoms can range from mild to life-endangering. When Tramadol misuse raises serotonin it can cause many symptoms:

  • Shivering

  • Agitation

  • Confusion

  • Rapid heart rate

  • High blood pressure

  • Dilated pupils

  • Loss of coordination

  • Muscle rigidity

  • Excessive sweating

  • Fever

  • Seizures

  • Unconsciousness

  • Death

• Risks for pregnant women – Pregnant women who use prescription painkillers such as Tramadol are at risk for delivering babies born with a life-threatening condition known as Neonatal Opioid Withdrawal Syndrome (NOWS). The mother’s use of causes the fetus to accommodate the presence of the addictive drug in its system. After delivery, the baby will have withdrawal symptoms requiring intensive medical care. NOWS can be fatal.

• Risks of polydrug use – Polydrug use is the combination of substances. There can be adverse, even lethal effects when prescription painkillers like Tramadol are used along with other substances. All substances used should be disclosed to a prescriber who recommends Tramadol. Among the substances that can cause serious problems in combination with Tramadol and other prescription painkillers are:

  • Alcohol

  • Benzodiazepines

  • Other opioids

  • Some over-the-counter medications and supplements

 If You or a Loved One Misuses Tramadol 

If there is Tramadol misuse in your life, it is important to know that effective help is available, and you are not alone. Countless people struggle with Tramadol misuse as well as the misuse of similar drugs. In fact, there has been a public health epidemic for many years in the U.S. involving such prescription painkillers. That is a testament to the powerful nature of the drugs and human vulnerability to addiction. It does not indicate low moral standards, but rather the facts of biology and the dangers of any addictive substance.

Contrary to common misperceptions, stereotyping and stigma, addiction is a medical condition, not a moral failing. People of all walks of life, from all different social, economic, religious and educational backgrounds are vulnerable to Tramadol abuse and addiction. Because Tramadol and related drugs are prescribed for pain, particularly those who have had a medical need for pain relief are at risk. Consequently, a Tramadol addiction can develop in the course of appropriate medical treatment, and all of us are vulnerable to events and illnesses that cause pain.

As people consider drug rehab, there are likely to be misgivings due to the mistaken beliefs about addiction and the people who have substance problems. Many are embarrassed and ashamed, not wanting to admit to anyone that they have a problem, even their medical providers. However, accepting the problem as a medical issue that requires treatment is a helpful perspective. Addiction, like many other illnesses, is a chronic, progressive and even fatal condition. It requires treatment.