Table of Contents
Ultram Addiction, Abuse, and Symptoms


The Basics

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

Primary Ultram Dangers

  • Addictiveness: A 2007 study by Nutt et al. highlights the significant addictive potential of opioids like Ultram. Nutt and his colleagues assessed 20 substances to determine their addictive potential, including cannabis, cocaine, and heroin. Nutt et al. determined that the substance with the highest addictive potential is heroin. Since heroin and Ultram are both opioids, the results of the study indicate that medical professionals and consumers should be concerned about the risk of developing a tolerance for or an addiction to Ultram.
  • Risk of overdose: According to the Centers for Disease Control and Prevention, just under 400,000 Americans died between 1999 and 2017 as a result of opioid overdoses. The CDC data includes deaths related to Ultram and other prescription opioids as well as deaths linked with heroin use. Furthermore, Zeng et al. determined that patients taking tramadol have a higher risk of death than patients taking nonsteroidal anti-inflammatory drugs like naproxen. Dr. Robert H. Shmerling stated that it’s possible that the tramadol users had underlying medical conditions or risk factors that made them more likely to die than users of other pain medications, however, the study still highlights the risk of overdosing on tramadol.
  • Unintended side effects: Ultram is an effective pain reliever, but it can cause some unpleasant side effects, especially in users who take it more often than prescribed or use higher doses than recommended. In addition to the potential for fatal respiratory depression, Ultram can also cause uncontrollable shaking, seizures, severe mood changes, difficulty breathing, changes in heartbeat, or loss of consciousness.
  • Legal risks: Ultram and other forms of tramadol hydrochloride are listed as Schedule IV drugs by the United States Drug Enforcement Agency. Although Schedule IV drugs have a lower risk of overdose and addiction than drugs on Schedules I, II, and III, they do have some addictive potential. Due to its classification as a controlled substance, possession of Ultram without a prescription may result in criminal charges. This offense is usually charged as a misdemeanor, and the penalties for a first-time conviction often include fines of up to $1,000 and up to one year in jail.

Ultram Background Information

Derived From Synthetic manufacturing
Ways Used Ingestion, snorting, rectal use, injection, infusion
Scientific Name Tramadol hydrochloride
Slang/Street Names for Ultram Ultras, Trammies, Chill pills
How Long in Bodily System Half-life: 5.1 hours

Ultram typically leaves the body in 1-4 days, but it may remain in the user’s system for up to a week in chronic users.

Punitive Legal Measures: Using/Possession In the United States, possessing Ultram without a prescription is a crime. If it’s the user’s first offense, the prosecutor may charge it as a misdemeanor, resulting in a fine of $1,000 and/or up to one year in jail. If it’s not the user’s first offense, the penalties are likely to be harsher.
Punitive Legal Measures: Selling/Distributing Selling or distributing Ultram is a much more serious offense than merely possessing it. Depending on the state, it may be charged as a misdemeanor or a felony. An individual convicted of selling or distributing Ultram can expect a fine of as much as $100,000. Under certain circumstances, an individual convicted of this offense may be sentenced to 20 years in jail.
DEA Drug Rating Schedule IV

Signs of Abuse

Behavioral Signs of Ultram Usage and Abuse

How Ultram affects the brain

Like other opioids, Ultram changes the way the brain and nerves interpret pain signals. Not only does Ultram relieve pain, but it also slows down the user’s respiratory rate and creates a sense of calmness. When Ultram attaches to opioid receptors, it also increases the amount of dopamine in the brain, activating a circuit involved in reinforcing behavior. The brain views the pleasurable feelings created by Ultram as a “reward,” prompting the user to seek out opportunities to enjoy this reward again and again. Over time, the individual develops a tolerance for Ultram, which means they have to take higher doses to experience the same pleasurable sensations.

Behavioral signs of Ultram usage and abuse

Ultram usage and abuse may not have any obvious signs at first. Once an individual develops an addiction or dependence on Ultram, however, several behavioral signs may appear. Mood swings, a loss of interest in pleasurable activities, problems maintaining relationships with friends and family members, and spending more time alone than usual are all signs that someone may be abusing Ultram. For working adults, Ultram abuse may make it more difficult to manage work-related obligations and family responsibilities. The individual may miss more days of work than usual, show up late for work on many occasions, or start behaving unprofessionally in front of colleagues and clients.

Behavioral signs of Ultram abuse are almost the same in adolescents as they are in adults. Any sudden change in behavior is cause for concern, especially if an adolescent suddenly wants to spend more time alone, breaks curfew, or starts behaving in a secretive manner. An adolescent’s grades may suffer due to missed homework assignments, poor grades on tests and quizzes, skipping school, or a lack of class participation. Adolescents who abuse Ultram may also end long-term friendships and start hanging out with new friends.

Physical Symptoms of Ultram Abuse

How Ultram affects the body

Once Ultram enters the bloodstream, it is metabolized into O-desmethyltramadol, a substance that affects an individual’s rate of breathing. Some people metabolize Ultram much faster than others, leading to a more significant effect on respiratory rates. The respiratory effects of Ultram can be dangerous for anyone who already has reduced lung function. For example, Tantry et al. published a case report on a patient who suffered severe respiratory depression when he was given tramadol to relieve pain following a surgical procedure. The man had to be intubated for about 10 hours before he could breathe on his own again.

Early physical effects of Ultram

Ultram starts working quickly, within 30 to 60 minutes of administration, producing a wide range of effects. Some of these effects are considered undesirable, while others put the user at risk for overdose.

This table illustrates the possible short-term physical effects associated with Ultram.
Short-term Physical Symptoms
Initial (direct effects of drug, 30 – 60 min.) Drowsiness
Slowed breathing
Lingering (within an hour of taking the drug) Itchy skin
Post-Use (several hours to days after use) Constipation
Dependence (more likely with long-term use or at higher doses)

Severe and long-term physical effects of Ultram

Ultram can cause dangerous side effects if mixed with alcohol or other medications. The American College of Cardiology warns that Ultram should never be mixed with alcohol, sedatives, narcotics, tranquilizers, antidepressants, medications used to treat anxiety, or medicines used to treat any mental health disorder.

Some users experience seizures while using Ultram, especially when taking higher doses than prescribed. Seizures are more likely to occur in people who have metabolic disorders, a history of head trauma, or a history of seizures. The chance of seizures also increases when Ultram is combined with muscle relaxants, narcotics, antidepressants, or medications used to relieve nausea and vomiting.

In some users, the chronic use of Ultram can lead to loss of consciousness. This loss of consciousness may be preceded by a seizure, resulting in the hospitalization of the user until he or she can be stabilized. Loss of consciousness increases the risk of injury in people who use or abuse Ultram. For example, someone who loses consciousness may break a bone or sustain a head injury.

This table illustrates the possible long-term physical effects associated with Ultram.
Long-term Physical Symptoms
Casual Drowsiness
Itchy skin

Including all of the above effects for casual use

Breathing problems
Intestinal blockages
Increased sensitivity to pain
Withdrawal Muscle aches
Increased tear production
Runny nose
Frequent yawning
Abdominal cramps
Dilated 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.

Ultram Usage

Ultram is no longer considered a "safe" opioid, making public health officials concerned about increasing rates of use

According to the 2018 World Drug Report issued by the United Nations Office on Drugs and Crime, healthcare providers and law-enforcement professionals must “raise the alarm” about the dangers of tramadol addiction. Tramadol use is increasing all over the world, but the problem is especially pronounced in Africa. Tramadol addiction is now a crisis that affects many of Africa’s most vulnerable citizens, making it critically important for officials to find ways to divert this substance from non-medical users, while also ensuring that people with a legitimate need for pain relief have access to tramadol and other opioids.

Tramadol use is also increasing in the Middle East, partially due to increased rates of tramadol use in Africa. Drug traffickers smuggle tramadol to markets in various parts of Africa; from those markets, some of the supply is trafficked to Iran, Israel, and other countries in the Middle East. Much of this trafficked tramadol comes from Asian laboratories, although some of it is diverted from legitimate sources.

Law-enforcement officials frequently seize tramadol from drug traffickers, but the large supply of tramadol available has made it difficult to stop illicit tramadol sales. As a result, 68 tons of tramadol were seized in 2016. The amount of tramadol seized in African countries accounts for 87% of the total seized worldwide.

Prescription Opioid Use Throughout the World
Highest Second Third
Regions with the Largest Quantities of Tramadol Seized in 2016 North, West, and Central Africa Middle East Eurasia
Regions with the Highest Number of Prescription Opioid Users North America Australia and New Zealand Europe

*This table includes data from users of both tramadol and general prescription opioids like hydrocodone, morphine, and codeine.
Sources: 2018 World Drug Report

Ultram Usage Demographics in the U.S.

Ultram misuse is also a growing problem in the United States

According to the 2016 World Drug Report, approximately 1.6 million individuals aged 12 and older admitted that they had misused tramadol within the past 12 months. This represents approximately 0.6% of the U.S. population.

Parents, educators, and public health officials are concerned about increased rates of prescription misuse among adolescents in the United States. The Monitoring the Future Study collected data by surveying students in the eighth, tenth, and twelfth grades. Students were asked if they had misused each drug or type of drug within the past year or at any point in their lives. In 2019, 14.6% of the students surveyed reported that they had misused some type of prescription drug at some point in their lives. When asked if they had misused narcotics other than heroin, 5.3% of the students stated that they had misused a prescription narcotic at least once. Tramadol is a narcotic-like substance, not a true narcotic, but the results of the study still demonstrate how important it is to talk with adolescents about prescription misuse.

Demographics of Prescription Usage
Past Year (2018) 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

Although Ultram is an effective medication, it has several side effects that are unpleasant or downright dangerous. The risk of complications increases once a user has developed a dependence on Ultram and must take higher and higher doses to achieve the same “high” that used to come from taking a regular dose. Users who are addicted to Ultram have an increased risk of overdose and sudden death, as Ultram depresses respiratory function and may cause seizures, especially in people who have a history of epilepsy and other chronic medical conditions.

To reduce the risk of withdrawal complications, the Ultram rehabilitation process aims to help the individual taper off Ultram, instead of stopping it suddenly. With medical supervision, individuals have a better chance of avoiding severe complications and staying sober. To learn more about this multi-step process, read our Ultram 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 codependence and enabling behaviors.