Table of Contents
Tramadol Addiction, Abuse, and Symptoms


The Basics

This guide explains the effects, trends, and dangers of tramadol use and provides an unbiased analysis of the medicinal and behavioral treatment methods for tramadol addiction based on current research and publicly available statistics. In some cases, usage statistics are derived from general prescription opioid use, which includes hydrocodone, morphine, and hydromorphone.

Primary Tramadol Dangers

  • Addictiveness: In 2007, Nutt et al. published the results of their research into the addictiveness of several prescription medications and illicit drugs. After comparing the substances based on their potential for physical addiction and psychological addiction, Nutt and his colleagues determined that heroin — an opioid — has the highest addictive potential. Although tramadol has a lower addictive potential than heroin, its status as an opioid indicates that some users are likely to become addicted to it due to the pleasant sensations it produces.
  • Risk of overdose: From 1999 to 2017, approximately 399,000 people died as a result of an opioid overdose, according to the Centers for Disease Control and Prevention. CDC researchers attribute the increase in deaths to the rise in opioid prescribing that occurred in the 1990s. An overdose is more likely to occur when tramadol is combined with alcohol, other prescription medications, or illicit drugs.
  • Unintended side effects: Tramadol is not without side effects, especially in non-medical users who don’t use tramadol according to the prescription instructions. One of the most serious concerns associated with tramadol use is the increased risk of respiratory depression. Tramadol and other opioids slow down the central nervous system, which causes a corresponding reduction in an individual’s respiratory rate. In some users, slower breathing results in hypoxia, or a lack of oxygen in the blood. Other possible side effects include seizures, loss of consciousness, changes in heart rate, and sudden mood swings.
  • Legal risks: The United States Drug Enforcement Agency considers tramadol to be a Schedule IV substance. This classification is based on the fact that tramadol has a lower addictive potential than the prescription opioids included in Schedule II and Schedule III. Because tramadol is a controlled substance, possession without a valid prescription is a crime. A first offense is usually charged as a misdemeanor, with possible penalties ranging from fines to jail time.

Tramadol Background Information

Derived From Manufactured from precursor molecules in a laboratory setting
Ways Used Ingestion, crushing/snorting, injection, rectal insertion, infusion
Scientific Name Tramadol hydrochloride
Slang/Street Names for Tramadol Chill Pills, Trammies
How Long in Bodily System Half-life: 5.1 hours

Elimination usually occurs within one to four days but may take up to a week in long-term users or users with chronic health conditions that impair their ability to metabolize medications efficiently

Punitive Legal Measures: Using/Possession Tramadol is a controlled substance, making it a crime to possess it without a prescription. Penalties for conviction depend on a user’s criminal history and other factors; for a first-time offense, penalties may include fines, jail time, and participation in a court-ordered drug treatment program.
Punitive Legal Measures: Selling/Distributing Selling or distributing tramadol is a serious offense; as a result, it’s usually charged as a felony. Even for a first-time conviction, the penalties can be severe. In some states, this offense is punishable by 20 or more years in prison. If convicted, an individual may also have to pay a large fine and complete a rehabilitation program.
DEA Drug Rating Schedule IV

Signs of Abuse

Behavioral Symptoms of Tramadol Usage and Abuse

How tramadol affects the brain

Tramadol and other opioids affect the brain by changing the way it perceives pain signals. When the substance attaches to the brain’s opioid receptors, it slows down the central nervous system, producing an overall sense of calm; some users even experience a euphoric “high” when they take tramadol. The attachment of tramadol to the opioid receptors also floods the brain with dopamine, activating the reward circuit involved in helping humans survive. Eventually, the brain starts to associate tramadol with pleasant feelings; as a result, it urges the user to keep taking tramadol. This sequence is what causes some users to become tolerant to tramadol and other opioids.

Behavioral signs of tramadol usage and abuse

Several behavioral changes may indicate that an individual has become addicted to tramadol. In an attempt to hide their behavior from others, some users start spending more time alone. Adults may give up their hobbies to avoid having to socialize with others, and adolescents may quit their extracurricular activities or stop hanging out with friends on weekends. Mood swings and difficulty maintaining personal relationships are also potential signs of tramadol abuse.

Money problems can be a sign of tramadol abuse, especially in individuals who previously had good control over their finances. Individuals who misuse tramadol may max out their credit cards, take out payday loans, or borrow money from friends and family to fund their addiction. Some users may even engage in criminal behavior, such as writing bad checks or shoplifting items to sell for cash.

Tramadol abuse can interfere with an individual’s ability to engage in everyday activities. For example, adults may have difficulty keeping their jobs due to behavioral changes that occur with tramadol use. These changes may include showing up late, missing work frequently, and not performing up to expectations. For adolescents, tramadol abuse can make it difficult to concentrate in class, leading to lower grades. An adolescent tramadol user may also skip school, act out in class, or refuse to complete assignments.

Physical Symptoms of Tramadol Abuse

How tramadol affects the body

One of the main physical effects of tramadol is a decreased breathing rate. For many users, this reduced breathing rate does not cause any ill effects; however, some people metabolize tramadol quickly, causing their breathing to become much slower than expected. In users with chronic obstructive pulmonary disease (COPD), emphysema, and other lung problems, this rapid reduction in respiratory rate can cause serious consequences. For example, it’s possible to experience respiratory depression so severe that the individual must be placed on a ventilator until normal breathing can resume.

Early physical effects of tramadol

Due to its short half-life, tramadol starts working rather quickly. Some users experience its effects within as little as 30 minutes. Although tramadol is effective for relieving pain, some of these physical effects are unpleasant. In some users, they can even be dangerous.

This table illustrates the possible short-term physical effects associated with tramadol.
Short-Term Physical Symptoms
Initial (direct effects of drug, 30-60 min.) Sweating
Itchy skin
Reduced respiratory rate
Lingering (within an hour of taking the drug) Tremors
Post-Use (several hours to days after use) Constipation
Increased risk of dependence

Severe and long-term physical effects of tramadol

In chronic users, tramadol use can lead to loss of consciousness, especially when it’s taken more often or in larger doses than recommended. A loss of consciousness can be dangerous, especially if it occurs when the individual is driving or operating heavy machinery. If a loss of consciousness occurs during this type of activity, the individual may sustain broken bones, sprains, head trauma, and other injuries.

Tramadol can be dangerous when used by individuals with epilepsy or a history of seizures caused by other medical conditions. This is because tramadol has been known to cause seizures in some individuals. The risk of seizures increases when tramadol is combined with other medications; for example, mixing tramadol and alcohol can cause serious side effects.

Because tramadol slows down the central nervous system, it’s especially dangerous when combined with other CNS depressants. Therefore, tramadol should never be mixed with antidepressants, muscle relaxers, or other opioids. When tramadol is combined with these medications, the risk of overdose increases.

This table illustrates the possible long-term physical effects associated with tramadol.
Long-term Physical Symptoms
Casual Itchy skin
Chronic (Including all of the above effects for casual use) Respiratory problems
Reduced bone density
Intestinal blockages
Withdrawal Muscle aches
Runny nose/eyes
Abdominal cramps
Enlarged pupils
Goose bumps

Further Resources

Both the National Institute of Drug Abuse (NIDA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) offer in-depth information on both the symptoms and treatment of prescription opioid addiction.

Tramadol Usage

The global supply of tramadol has increased, causing concern about increased rates of tramadol use

According to the 2019 World Drug Report, tramadol usage has increased on almost every continent; the increase is attributed to a marked increase in the global supply of tramadol. In Africa, public health officials are especially concerned about tramadol use among individuals living in poverty. Although tramadol does have several legitimate uses, rates of non-medical use have increased drastically, especially in North Africa and Central Africa. The increase in tramadol usage is also a concern for Africa’s law-enforcement officials, as they’re tasked with responding to overdoses and seizing tramadol that has been trafficked in from other countries.

The extent of tramadol misuse is evident when examining drug-seizure data from 2017. According to the 2019 World Drug Report, officials seized nearly 70 tons of tramadol in 2017; this is approximately 140,000 pounds of tramadol. Due to the way trafficking networks are set up, most of the seizures (87%) occurred in Africa.

Tramadol use has also increased significantly in the Middle East, as traffickers have created drug routes to carry tramadol through Africa and into countries such as Israel and Iran. In many cases, this trafficked tramadol comes from illicit laboratories in Asia.

Prescription Opioid Use Throughout the World

Highest Second Third
Regions With Highest Quantities of Tramadol Seized North/Central Africa Middle East Eurasia
Regions With Highest Number of Opioid Users North America Oceania Europe

Tramadol Usage Demographics in the US

North America has the highest number of opioid users in the world; this includes tramadol

According to the Substance Abuse and Mental Health Services Administration, approximately 0.6% of the American population misused tramadol within the past 12 months in 2016. Medical professionals are concerned about increased rates of tramadol use, as tramadol can cause a serious condition known as serotonin syndrome, which causes agitation, sweating, high fever, and other symptoms. Misuse of tramadol and other opioids has increased patient loads in emergency rooms throughout the United States, taxing an already stressed health care system.

Although tramadol has narcotic properties, it’s not a true narcotic; therefore, it’s somewhat difficult to determine how many adolescents have misused tramadol within the past month or the past year; however, researchers have collected data related to the misuse of general prescription medications. According to the Monitoring the Future Study, nearly 15% of students admitted that they had misused a prescription drug at least once in their lives. Researchers also asked students if they had ever misused a prescription narcotic; 5.3% of the students surveyed admitted that they had misused a narcotic medication at least once.

Demographics of Prescription Usage
Past Year (2019) Lifetime
8th grade (14-15 yo) No data collected No data collected
10th grade (15-16 yo) No data collected No data collected
12th grade (17-18 yo) 14.6% 18.6%

How to Find Help

Tramadol relieves chronic pain and controls pain in individuals who have recently undergone some type of surgery. Although it’s effective when used according to the prescription instructions, tramadol affects the reward center of the brain, causing some users to develop a dependence on the drug. This dependence causes an addicted user to keep taking tramadol even when it causes unpleasant or dangerous side effects. If an individual stops taking tramadol suddenly, severe withdrawal symptoms can occur.

A multistep withdrawal process can reduce the severity of these symptoms and keep the user safe during the initial detoxification period. Medically supervised rehabilitation is especially helpful, as treatment staff may be able to provide supportive medications to control nausea, headaches, diarrhea, and other withdrawal symptoms. To learn more about the multistep rehabilitation process, read our tramadol rehabilitation guide.

Staging an Intervention

If you have a loved one who’s struggling with addiction, staging an intervention is often the first necessary step towards sobriety, but it’s important to be strategic and loving in your approach. Even the most well-meaning of interventions can have a negative effect if they aren’t handled correctly.

5 Tips for Staging an Intervention

1. Don’t Do It Alone. A professional interventionist is always the most qualified to guide a successful intervention. Also, rely on non-addict family and friends — especially those who have a close relationship with you or the addict.
2. Research Ahead of Time. It’s best to do plenty of research ahead of time to gather insight on the addiction and how it affects the addict. Also, be prepared with local resources for getting help.
3. Write Out Your Statement. During the actual intervention, emotions will likely be running high, so it’s best to have a statement of how the person’s addiction has impacted you and your relationship with him or her. These statements should be honest yet written from a place of love — no personal attacks.
4. Offer Help. It’s important for everyone attending the intervention to offer tangible help and support as the person works through detox and rehabilitation.
5. Set Boundaries. If the person refuses to seek help and take the next steps outlined, it’s important that they understand that everyone present will end codependent and enabling behaviors.