Tramadol is an opioid medication prescribed for pain relief, and is labeled a Schedule IV controlled substance. In 2013, there were approximately 44 million prescriptions given for tramadol products in the U.S.
When a person takes a tramadol product on a regular basis, the chemical makeup of the brain can be physically changed. Tramadol is designed to suppress pain and enhance feelings of relaxation by acting on opioid receptors in the brain. After prolonged use, the usual dose of tramadol will become less effective, and more of the drug will be needed to have the same effect. This is called drug tolerance. There are warning labels on products containing tramadol, that the drug has a potential to create a dependency in its users. Dependency can be created even if the person takes the drug as prescribed, but typically happens more quickly when the drug is abused. It is estimated that 3.2 million Americans have at some time used tramadol for nonmedical purposes. According to the World Health Organization (WHO), the potential for a dependency on tramadol is higher in individuals who are abusing the drug or if they have a history of addiction or substance abuse, although a dependence can also form when taken for an extended time with a prescription.
Tramadol Detox & Withdrawal Symptoms
Tramadol detox or withdrawal generally consist of 2 phases: early withdrawal and late withdrawal. Once the drug leaves the bloodstream, early tramadol detox & withdrawal are experienced. Late withdrawal occurs after the initial Tramadol detox. Symptoms will vary depending on what stage of withdrawal is a person is going through.
Early withdrawal symptoms:
- Muscle and body aches
- Tearing up
- Accelerated heart rate and breathing
- Runny nose
Late withdrawal symptoms:
- Stomach ache and cramps
- Chills and goosebumps
- Loss of appetite
- Pupil dilation
- Difficulty concentrating
Typically, symptoms of tramadol detox or withdrawal start within 12 hours of the last dose taken. As published by the DEA, approximately 90 percent of people will experience traditional withdrawal symptoms, while 10 percent may experience symptoms like anxiety, panic attacks, hallucinations, severe confusion, extreme paranoia and numbness or tingling of the extremities.
Tramadol detox or withdrawal symptoms may cause physical side effects that are similar to having the flu. These symptoms typically peak within a few days and then gradually taper off. Psychological withdrawal symptoms may last longer. Symptoms will vary with each individual, however, and other factors may influence how long symptoms will last and their severity.
A major contribution to the duration and severity of withdrawal is the level of dependency on tramadol, which directly correlates to the length of time and amount of the drug a person has been taking. A brain that is heavily dependent on tramadol may take longer to normalize its chemistry after long-term drug use.
Another factor is the way the drug is used. If taken as prescribed, it would cause less dependency as opposed to someone who may be injecting, smoking or snorting the drug. Using other drugs or drinking alcohol in addition to taking tramadol can also increase the level of dependency and severity of withdrawal symptoms.
Some people may become dependent more easily than others depending on their genetics, biology and personal physiology. Co-occurring mental health issues or underlying medical conditions can also have an effect on drug dependence. The NCADD (National Council on Alcoholism and Drug Dependence) reports that genetics are thought to be a factor about half the time when it comes to drug dependence.
Chronic stress, abuse, neglect and trauma also affect the onset of a drug addiction, as well as the age a person first uses drugs. As published by the journal of Clinical EEG Neuroscience, the brain is not fully formed in adolescents and the areas of the brain that control learning, decision making, memory and impulse control may be damaged by drug use during a person’s teenage years. In a publication by the U.S. Department of Health called National Survey on Drug Use and Health, it was reported that when people abuse drugs before the age of 14, they were more likely to suffer from addiction than those who used drugs after the age of 18.
As with most drug dependencies, tramadol detox and withdrawal is best managed through medical detox. It is not recommended to stop taking the drug suddenly and without the help of a medical professional. In a medical detox, an individual will have access to a high level of care and 24 hour monitoring. As withdrawal symptoms increase, the desire to keep taking the drug will intensify. Depression and cravings can be managed with the help of medication during detox.
There are three types of medication approved by the FDA for opioid withdrawal: methadone, buprenorphine, and naltrexone. These medications can help manage drug cravings and ease withdrawal symptoms. Each one has beneficial properties that are helpful during detox in different ways.
Methadone: This medication acts as a substitution for tramadol, keeping withdrawal symptoms from starting, as it is a longer acting medication. However, it should be used cautiously because it is still an opioid and has potential for dependency as well.
Buprenorphine: Like methadone, this medication also fills opioid receptors in the brain for a longer period of time, however, it doesn’t activate the receptors in the same manner. It can minimize withdrawal symptoms and at the same time not create a feeling of being high, like other drugs. Buprenorphine is also designed to plateau, so that if more than the recommended dose it taken, it will no longer produce any effect. This can help reduce the risk for abuse of this medication. There are four types of buprenorphine products approved by the FDA for opioid dependency treatment: Suboxone, Zubsolv, Bunavail and Subutex. These all contain buprenorphine and naloxone. If abused, withdrawal symptoms may be triggered by naloxone, thereby acting as a deterrent. These products containing naloxone are optimal when used after the initial stages of detox and may be helpful to prevent relapse.
Naltrexone: Once tramadol is fully removed from the body and during early withdrawal, naltrexone will block opioid receptors from being activated by opioid drugs. Naltrexone products are labelled as Depade, ReVia and Vivitrol.
A variety of these medications or supplements may be used during medical detox for specific withdrawal symptoms. It is common for mood-enhancing medications or antidepressants to be used during detox to help alleviate withdrawal symptoms. It is warned by the DEA that tramadol should not be combined with any selective serotonin reuptake inhibitors (SSRI’s) or monoamine oxidase (MAO) inhibitors. This can cause a risk of serotonin syndrome which can cause convulsions, muscle pain or rigidity and hyperthermia.
Medical management can be very helpful in easing the withdrawal symptoms of tramadol and create physical stability. Other therapeutic tools can help with stress, drug cravings and mood control also. A balanced combination of medications, therapeutic and support techniques are the best way to treat substance use disorders, dependence and addiction.