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.
|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|
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.
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.
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.
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.
|Short-Term Physical Symptoms|
|Initial (direct effects of drug, 30-60 min.)||Sweating
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
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.
|Long-term Physical Symptoms|
|Chronic (Including all of the above effects for casual use)||Respiratory problems
Reduced bone density
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.
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.
|Regions With Highest Quantities of Tramadol Seized||North/Central Africa||Middle East||Eurasia|
|Regions With Highest Number of Opioid Users||North America||Oceania||Europe|
Source: 2019 World Drug Report
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.
|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%|
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.
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.
|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.|