Any medication has risk factors involved with taking it. Whether we are talking about minor side effects or life threatening allergic reactions, advice should be sought either from the packaging or from your doctor or pharmacist. Medication should only then be taken if the benefits outweigh the expected risks. Today however, as we are well aware from the opioid epidemic that has taken the world by storm, many of the risks of certain opiates, including Tramadol, are not being considered by those who take them.

What is Tramadol?

Tramadol is a centrally acting, oral pain medication. When it was first approved in 1995, it was considered a pain medication that didn’t need to be controlled, even though it acted in similar ways to other opiates like morphine or codeine. However due to reports of abuse, misuse and trafficking, Tramadol has been a controlled substance since 2014. When something becomes a controlled substance it means that, although it may be used for medical purposes, it has the potential for abuse and needs to be more tightly regulated. Despite the need for tighter regulation, Tramadol is still regularly dispensed as a pain relief medication.

Tramadol is a “safer” alternative to opioids.

In the years between 1995 and 2014, when Tramadol was considered a non controlled substance, many people believed it offered a safer alternative to other pain relief medication because it had less potential for abuse. Because of this, for many years Tramadol was widely prescribed by doctors around the world. We live in a world where millions of people ‘experience pain that can affect performance on daily tasks, quality of life, and productivity in the workplace,[1]’ not to mention that studies[2] have also shown that pain medication offers us relief not only from physical pain, but also from emotional distress. So it goes without saying that when a drug purports to offer pain relief without much chance of a physical or emotional dependency, many resort to using it.

Despite concerns during its years as a non controlled substance, it took almost 20 years to decide to control the use of Tramadol. This is one of the main reasons that it is so dangerous. It had long-standing reputation for being “safe” and was much more widely prescribed than anything else and was therefore easy to obtain for years.

Over its years as a non controlled substance, discrepancies began to emerge between the results of the clinical trials, which asserted that it was non-dependance forming and there were few side affects associated with the drug, and what was actually being seen in emergency departments. In the US between 2005 and 2011 ‘Tramadol-related ED visits involving adverse reactions […] rose overall by 226 percent for males […] and by 154 percent for females.[3]

 

Tramadol Addiction

It is now known that, like other narcotics, one of the serious dangers surrounding Tramadol is its habit forming potential. When Tramadol is ingested, the brain no longer registers pain in the same way – it offers immediate pain relief. As well as working at the opioid pain receptor, Tramadol also inhibits uptake of two neurotransmitters, norepinephrine and serotonin, so like SSRI’s which block serotonin uptake, Tramadol will also work as an antidepressant. When taken in large quantities, serotonin will flood the brain causing feelings of euphoria and extreme pleasure.

When taken over a consistent period of time, the brain becomes dependant on receiving these chemicals unnaturally and will carve out new pathways for the neurotransmitters. If you try to stop using Tramadol, your brain will suddenly be depleted of these feel good chemicals causing intense feelings of low mood and depression. Furthermore, a significant proportion of these patients with chronic pain will have been prescribed opioids: drugs that we now know, when used long term, to be generally ineffective, harmful, addictive and difficult to stop.

Patients with mood disorders, depression in particular, are more likely to use long term opioids, such as Tramadol for pain[4], despite being most at risk of dependence[5].  This “adverse selection” reflects that patients with depression are twice as likely to transition from short to long-term Tramadol use compared to those without a mood disorder. Depressed patients may be using Tramadol to manage symptoms accompanying pain, such as insomnia or stress, rather than the pain itself[6].  It is this psychological pain, rather than physical pain, that will need to be addressed when supporting patients during Tramadol reduction.

 

Because Tramadol has been so over prescribed the world over, many people today are suffering with addiction to it. Along with addiction, we are also seeing an increase of overdoses caused by Tramadol. ’Harmful consequences, including seizures and a potentially fatal drug reaction known as serotonin syndrome, can occur even when Tramadol is taken as prescribed by a physician. Additionally, when Tramadol is combined with other drugs that depress the central nervous system—such as anti-anxiety medications (e.g., benzodiazepines), narcotic pain relievers, or alcohol—the sedative effects of tramadol can be enhanced.[7]

When attempting to manage an addiction to a drug like Tramadol, it is important to seek the advice of professionals, rather than try to stop alone. Working with a proper treatment centre like Addcounsel will allow you to get the necessary treatment, personalised to you and the severity of your addiction. Working with our discrete team of medical professionals will allow you to access the best treatment plan for your own individual needs.

At Addcounsel, we understand that addiction is influenced and impacted by each individual’s personal life circumstances. Your biology, social and environmental factors, as well as your genes, will all be contributing factors and we will access them all in order to achieve the best possible service. Our treatment centre is private and exclusive and you can come assured of total confidentiality. You are our priority and we are expertly placed to assess and treat the root causes of your addiction to Tramadol.


[1] Bush, Donna. EMERGENCY DEPARTMENT VISITS FOR ADVERSE REACTIONS INVOLVING THE PAIN MEDICATION TRAMADOL

[2] Dermendzhiyska, A. Rejection kills. https://aeon.co/essays/health-warning-social-rejection-doesnt-only-hurt-it-kills (accessed 22 July 2019)

[3] Bush, Donna. EMERGENCY DEPARTMENT VISITS FOR ADVERSE REACTIONS INVOLVING THE PAIN MEDICATION TRAMADOL

[4] Halbert B, Davis R, Wee CC. Disproportionate longer-term opioid use among US adults with mood disorders. Pain 2016;157:2452–7.

[5] Grattan A, Sullivan MD, Saunders KW, Campbell CI, Von Korff MR. Depression and prescription opioid misuse among chronic opioid therapy recipients with no history of substance abuse.  Ann Fam Med. 2012 Jul-Aug;10(4):304-11

[6] Sullivan MD. Why does depression promote long term opioid use? Pain 2016:157:2395–2396

[7] Bush, Donna. EMERGENCY DEPARTMENT VISITS FOR ADVERSE REACTIONS INVOLVING THE PAIN MEDICATION TRAMADOL