Tramadol is an opioid analgesic medication that the Drug Enforcement Administration (DEA) permanently moved into Schedule IV of the Controlled Substances Act in 2014, in part due to its abuse and dependence potential. Tramadol, marketed under the brand names Ultram, ConZip, FusePaq, Rybix, Ryzolt, and Ultram ER, is prescribed to treat pain symptoms, Mayo Clinic publishes. As an opioid drug, it binds to opioid receptors in the brain and increases levels of dopamine, one of the brain’s chemical messengers that serve to regulate moods and emotions.
With regular use tramadol can be habit-forming, as the transmission, production, and reabsorption of the brain’s neurotransmitters are chronically disrupted. The brain then will attempt to regulate itself when tramadol is not active in the bloodstream and withdrawal symptoms can occur. Physical dependence on tramadol can build up even if a person is taking the drug for legitimate medical reasons with a prescription. Dependence may set in more quickly if the drug is abused, however.
Tramadol dependence is directly related to its withdrawal, meaning that the more dependent a person is on tramadol, the more intense and longer the withdrawal syndrome may be.
Several factors can influence the duration and significance of tramadol withdrawal side effects, including:
- Environmental factors, such as exposure to trauma or high levels of stress
- Genetic contributors, including a personal or family history of addiction, which may predispose someone to drug dependence and/or addiction
- Biological aspects, such as age, gender, ethnicity, etc., which can impact metabolism and level of dependence
- The amount of tramadol used with each dose and the length of time using it, as higher doses and a longer duration of use or abuse can increase dependence
- How tramadol is used or abused (i.e., altering the drug by chewing it, or by crushing it and then snorting, smoking, or injecting it, can elevate the level of dependence)
- Using other drugs or alcohol in conjunction with tramadol
- Co-occurring mental and/or medical disorders
Potential Complications of Tramadol Withdrawal
Withdrawal involves the physical and psychological symptoms that occur after tramadol is processed out of the body. For an opioid drug such as tramadol, physical withdrawal symptoms are similar to a bad case of the flu. The central nervous system, which is suppressed by tramadol during use, becomes more active, and things like heart rate, respiration, body temperature, and blood pressure can spike.
Tramadol dependence also changes the way dopamine is produced and absorbed back into the brain. With regular use or abuse of the drug, the brain may change how these messengers send their signals. The chemical makeup and even circuitry of the brain can be impacted by tramadol dependence. At this point, the brain may rely on tramadol to keep emotions and behaviors in check. When the drug isn’t there, a significant decline in dopamine levels may occur, leaving individuals feeling fatigued, mentally “foggy,” and unable to feel pleasure. Moods dip and cravings can increase. Suicidal thoughts and impulses may therefore be elevated during tramadol withdrawal especially if a mood or anxiety disorder is also present.
Tramadol withdrawal may be intense enough to encourage a person to use the drug to avoid the symptoms. A relapse after any length of time not using the drug can be catastrophic. Chronic tramadol abuse creates a tolerance in the brain and body, and a person likely has to increase the amount of the drug they take each time in order to keep feeling its effects. If a person detoxes from tramadol and then returns to using it, they may go back to the dosage that was taken before. The body may no longer be used to the same amount of the drug. As a result, returning to previous amounts can cause a toxic buildup of the drug, potentially leading to overdose.
Opioid overdose is considered an epidemic in the United States, as the CDC (Centers for Disease Control and Prevention) reports that six out of every 10 fatal drug overdoses (of which there were nearly 50,000 in 2014) involved an opioid drug. Relapse and overdose are potential complications of tramadol withdrawal that can be especially dangerous.
Tramadol Detox Timeline
The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that the bulk of opioid withdrawal symptoms last between four and 10 days. Withdrawal symptoms typically start as soon as the drug wears off, which according to the National Library of Medicine (NLM), is generally around 12 hours after the last dose.
Tramadol has a half-life of 3-10 hours, the DARU Journal of Pharmaceutical Sciences reports. A drug’s half-life depends on the dosage and formulation of the drug and refers to the time it takes for the drug to be halfway out of a person’s system. Therefore, tramadol withdrawal is likely to start between six and 20 hours after stopping use.
Opioid withdrawal usually starts out with agitation, irritability, anxiety, insomnia, sweating, tearing of the eyes, runny nose, and muscle aches in the first few days. About 2-3 days into detox, symptoms likely peak and will also include abdominal cramps, nausea, vomiting, diarrhea, goosebumps, dilated pupils, drug cravings, and depression. Symptoms tend to taper off after they peak and start to lessen in severity over the next few days. Sleep and mood disturbances as well as drug cravings may continue for a few weeks.
Medical Detox for Tramadol
Detox refers to the natural purging of toxins like tramadol from the system while withdrawal is the range of side effects that occur after drug dependence has formed. Withdrawal is often accomplished via an inpatient or outpatient program in a specialized treatment center. Detox programs generally last 5-7 days on average for an opioid drug like tramadol.
The most comprehensive form of detox is called medical detox, and it provides the highest level of care and security during withdrawal. Trained medical treatment providers are on hand during medical detox to monitor vital signs and ensure they stay within normal levels. Mental health professionals encourage and support clients to ensure personal safety and to prevent relapse. Medical detox can help to minimize withdrawal symptoms and therefore help to shorten the overall withdrawal timeline as well.
Since tramadol is an opioid drug, it is not recommended to stop taking it suddenly. Instead, one’s tramadol dosage may be lowered slowly over a set amount of time in order to keep withdrawal symptoms from being as severe as they could be. This is called tapering and is often performed during detox.
Other longer-acting opioid drugs, like buprenorphine or methadone to name a few, may be substituted for tramadol during detox as well. These medications can be given out in lower doses less often and still keep receptors in the brain filled with opioids in order to minimize withdrawal symptoms.
Several different medications may be useful to help manage symptoms of withdrawal during medical detox. Mood-stabilizing drugs may be useful in helping to regulate emotions, and sleep aids can promote healthy sleep, for example. Medications and supplements can also be beneficial for stabilizing the central nervous system and keeping physical symptoms from becoming as significant.
The National Survey on Drug Use and Health (NSDUH) publishes that close to 2 million people battled addiction to prescription painkillers in 2014. Drug dependence and withdrawal symptoms typically accompany drug addiction. They are optimally controlled and minimized through a medical detox program.