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Tramadol Addiction Treatment

In the 1960s, the German pharmaceutical company Grunenthal developed this drug and brought it to market in West Germany in 1977 under the trade name Tramal. About 20 years later, tramadol was introduced in the U.S. for the treatment of cancer and non-cancer pain. Tramadol has unique pharmacology and toxicology characteristics, both similar and different than other narcotic painkillers such as oxycodone or hydrocodone. Like those drugs, it binds to opioid receptors in the brain, although it also has antidepressant properties due to its prolonged effects on norepinephrine and serotonin.1,2

Tramadol causes adverse effects related to elevated brain serotonin levels (serotonin syndrome) especially when co-administered with selective serotonin reuptake inhibitors (SSRIs). A 2006 study found the abuse potential of tramadol was significantly lower than that of codeine. Serious side effects such as seizures have been reported in multiple studies.1,2

Brand names for tramadol in the U.S. include ConZip, Rybix ODT and Ultram. The drug Ultracet is a combination of tramadol and acetaminophen. Tramadol tablets are available in 50 and 100 mg strengths and are usually taken several times a day. Extended-release tablets are available in 100, 150, 200 and 300 mg strengths. Tramadol is also available in oral drops and administered intravenously.1

Tramadol Abuse

Although tramadol was originally considered a safer alternative to other narcotic analgesics like hydrocodone and methadone, mounting evidence of abuse and withdrawal symptoms raised concerns. In 2014, the U.S. Drug Enforcement Administration (DEA) published revised rules making tramadol a federally controlled Schedule IV drug. Taken orally at high doses, tramadol can produce similar euphoric effects as the commonly abused opiate medication oxycodone (OxyContin). Effective Aug. 18, 2014, the DEA ruling mandates tramadol prescriptions can only be refilled up to five times within six months of the original prescription date. After five refills or after six months, whichever occurs first, a new prescription is required. This rule applies to all controlled Schedule III and IV substances.3,4

Extreme Cases of Tramadol Addiction

Highly disturbing media reports have been published of people intentionally abusing their pets to obtain tramadol in the U.S. In one case, a woman took her injured 4-year-old dog to an animal hospital near Louisville, Kentucky. After the veterinarian sewed up the wound, the woman requested tramadol, which is also used in animals to control pain. Three days later, she returned with the excuse that her child had flushed the pills down the toilet, so the vet gave her more. The vet became suspicious on the third visit when the dog had a new, clean cut in addition to the partially healed old wound. It was discovered that the woman was intentionally wounding her dog and “vet-shopping.” She visited multiple vets to obtain prescription medication for her dog and then took it herself to satisfy her addiction. The woman ultimately admitted she had no child and cut her dog with her husband’s disposable razor blade three different times to obtain the tramadol.5

Stats and Facts

  • In 2013, more than 43 million tramadol prescriptions were written in the U.S.4
  • Emergency room (ER) visits related to adverse reactions to tramadol increased by 145% from 10,000 in 2005 to nearly 27,500 in 2011.6
  • The greatest increase in tramadol-related ER visits occurred among individuals ages 55 and older, with a 481% increase — from 892 visits in 2005 to 5,181 visits in 2011.6
  • According to the World Anti-Doping Agency, 71% to 82% of tramadol use between 2012 and 2015 in globally monitored sports occurred in cycling.7
  • About 95% of people who abuse tramadol have a prior history of other substance abuse.8

Relapse Prevention

Tramadol is used in detox tapering for other opioid abuse due to its weaker binding to opioid receptors. Nevertheless, people addicted to tramadol need pharmacological and behavioral interventions to treat its abuse and prevent relapse. Support groups and 12-step programs can help prevent relapse after detox and rehab.

  1. Tramadol and Hydrocodone. Healthline website. http://www.healthline.com/health/pain-relief/tramadol-vs-hydrocodone?m=0&rw1#Comparison2 Published March 31, 2015. Accessed February 20, 2017.
  2. Sweileh WM, Shraim NY, Zyoud SH, Al-Jabi SW. Worldwide research productivity on tramadol: a bibliometric analysis. Springerplus. 2016;5(1):1108. doi:10.1186/s40064-016-2801-5.
  3. Tramadol Abuse. Drug Abuse website. http://drugabuse.com/library/tramadol-abuse/ Accessed February 20, 2017.
  4. Tramadol – Top 8 Things You Need to Know. Drugs website. https://www.drugs.com/article/tramadol-need-to-know.html Accessed February 20, 2017.
  5. Lindsey Bever. The horrifying way some drug addicts are now getting their fix. The Washington Post. January 23, 2017. https://www.washingtonpost.com/news/to-your-health/wp/2017/01/23/some-addicts-are-so-desperate-for-drugs-that-theyre-now-taking-medication-prescribed-to-pets/?utm_term=.e813e4ee3eab Accessed February 20, 2017.
  6. SAMHSA reports highlight rise in tramadol-related hospital emergency department visits. Substance Abuse and Mental Health Services Administration website. https://www.samhsa.gov/newsroom/press-announcements/201505141130 Published May 14, 2015. Accessed February 20, 2017.
  7. Tramadol: Why Some Athletes and Experts Want it Banned. Cycling Tips website. https://cyclingtips.com/news/kristoff-wins-tour-of-oman-opener/ Published February 15, 2017. Accessed February 20, 2017.
  8. Tramadol History and Statistics. Drug Abuse website. http://drugabuse.com/library/tramadol-history-and-statistics/ Accessed February 20, 2017.
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