Tramadol Use and Abuse

Tramadol is an opioid pain reliever (OPR) that belongs to the same family as fentanyl and oxycodone. Tramadol, however, ranks far lower in strength than fentanyl or oxycodone. Apart from reducing pain, it is also known as a mood enhancer. This medication works best in cases where the patient is suffering from moderate to severe pain. It is also considered for use in people who are recuperating after surgery.


Tramadol is categorized as a Schedule IV drug because of a lower threat perception for inducing abuse in users. People commonly underestimate its addictive properties because it is weaker than other opioid medications. Since it is an opioid, however, the danger of addiction is still present and looms large on regular users of the drug.

Is Tramadol Dangerous?

Tramadol usage is always accompanied by the possible threat of adverse reactions, even when used with caution and under medical supervision. While typical reactions of its usage range from nausea to dizziness, its abuse can lead to more intense reactions. The medications usage, in combination with other habit-forming substances, can sometimes lead to fatal consequences.

Street Names

People suffering from addiction or misusing the medication usually procure tramadol illegally from the unregulated markets and street vendors. Some common street names of the drug include Chill Pills, Trammies, and Ultras (a take on the generic brand).

Tramadol Warnings

Since Tramadol is among the least potent of opioid painkillers, there is a common misconception that it does not lead to addiction. It is precisely this misinformation that has led many people on the path to addiction and substance abuse.

If a person is using this drug without obtaining a prescription, this is considered tramadol abuse. Similarly, those who are steadily increasing their dosage or continue to use it even after they are no longer prescribed it are also signs of a substance addiction. The same notion applies when using it in combination with other habit-forming drugs or substances.

That’s why identifying the signs of abuse at the earliest stage is essential to prevent the onset of addiction.

The Scope of Tramadol Abuse in America

In 2017, 47,600 people in the United States died from drug overdoses involving opioids.1
In 2017, 43,036 people in the United States died from unintentional drug overdoses involving opioids.2

A total of 2,586 people died of drug overdoses of undetermined intent involving opioids.3

In 2016, an estimated 91,840 hospitalizations occurred for opioid-related poisonings in the United States.4
Prescriptions for Tramadol increased 88 percent from 23.3 million in 2008 to 43.8 million in 2013.5
In 2011, Tramadol was ranked ninth in the list of narcotic pain relievers secured in law enforcement operations and analyzed by federal, state, and local forensic laboratories.6
More than 399,000 people died from overdoses involving any opioid, including prescription and illicit opioids from 1999-2017.7

Tramadol Addiction

Unfortunately, and ironically, many people who faithfully follow their physicians’ prescriptions are at risk of suffering addiction.

Frequent and prolonged usage of this drug has been known to lead to drug tolerance in many people. As a result, people must take larger and larger dosages to experience the drug’s effects. In addition to developing tolerance, Tramadol users can expect to suffer from withdrawal symptoms when use suddenly stops. Typically, withdrawal is known to cause symptoms such as irritability, depression, and flu-like symptoms.

If a person exhibits tolerance to the drug and also suffers from withdrawal symptoms when they stop using, they are most likely struggling with Tramadol dependence and addiction. Some of the telltale signs of substance addiction are frequent cravings, uninhibited use, and relationship problems that stem from drug use.


Doctors usually prescribe Tramadol because of its relatively lower potential to cause addiction as compared to many of the other opioid painkillers. This point is also underlined by the fact that it is classified as a schedule IV substance, while the majority of opioid painkillers are listed under schedule II of the Controlled Substances Act.

More often than not, the feeling of calmness and euphoria that this drug generates in users is the main reason for its abuse. Those who abuse it usually do so in an attempt to feel unnaturally relaxed and carefree. People suffering from severe pain are also likely to take higher doses of the drug, thus exposing them to greater threats of dangerous side effects that could include seizures and respiratory depression.

Tramadol is a central nervous system (CNS) depressant and thus tends to effect lung and heart function negatively. Those who take very large doses of this drug (much higher than what would be prescribed) might stop breathing altogether and may experience a fatal overdose.

Side Effects of Tramadol Abuse

Some of the typical signs and side effects of Tramadol abuse are:

  • Vomiting coupled with nausea
  • Pinpoint pupils (pupils are very small)
  • Changes in appetite
  • Drowsiness
  • Impaired coordination
  • Slurred speech
  • Headache

Tramadol abuse can potentially result in negative reactions of extreme nature, such as seizures. Seizures usually occur when larger dosages are consumed (averaging 400 mg or more per day), over extended time frames. Seizures also manifest more often when this medication and antidepressants are taken together.

Overdose and Withdrawal


Some of the symptoms associated with Tramadol overdose are:

  • Drowsiness
  • Unconsciousness
  • Abnormally low blood pressure
  • Slow heart rate
  • Sweaty or clammy skin
  • Weak muscles
  • Respiratory depression
  • Seizures
  • Coma
  • Pinpoint pupils

Tramadol Withdrawal Symptoms

One of the problems linked to extended usage or high doses of Tramadol use is the possibility of suffering from withdrawal symptoms. When a person with tramadol dependence stops taking it, the body struggles to perform normally. As a result, the very effects that the drug was prescribed to heal might reappear.
  • Agitation
  • Anxiety
  • Delusions
  • Depression
  • Panic attacks
  • Paranoia
  • Diarrhea
  • Flu-like symptoms
  • Body pain
  • Tingling sensation in the extremities
  • Vomiting

Early and Late Withdrawal Symptoms

Opioid withdrawal is characterized by two main phases: early and late withdrawal. The early withdrawal phase starts when the drug leaves the bloodstream while the late withdrawal phase happens sometime later. Depending upon factors such as intensity and duration of addiction or substance abuse, opioid withdrawal symptoms vary according to the phase in which the patient is currently passing through.
  • Accelerated heart rate
  • Anxiety
  • Agitation
  • Fast breathing
  • Hypertension
  • Insomnia
  • Muscle and body aches
  • Restlessness
  • Runny nose
  • Sweating
  • Yawning
  • Chills
  • Cramps
  • Depression
  • Diarrhea
  • Difficulty concentration
  • Dilated pupils
  • Drug cravings
  • Goosebumps
  • Irritability
  • Loss of appetite
  • Stomach pain
  • Vomiting

Withdrawal Timeline

The onset of opioid withdrawal symptoms typically begins within about 12 hours of taking the last dose. According to figures released by the Drug Enforcement Administration (DEA), approximately 90% of people experience traditional withdrawal symptoms when stopping use. The remaining 10% might experience symptoms such as severe confusion, extreme paranoia, panic attacks, anxiety, hallucinations, and even tingling or numbness in their extremities.

Tramadol Detox

When people experience intense drug cravings, it is usually an indication that a detox or rehabilitation center would be beneficial as a first point of treatment. Tramadol detox gives the body a chance to regain its original healthy condition without suffering the discomforts associated with the withdrawal symptoms. Rehabilitation equips people with the strategies required to tackle chemical cravings and triggers that encourage the use of drugs.

When administered under medical supervision in a safe and conducive environment, there are significantly higher chances of the patient successfully completing addiction therapy than without formal treatment.

  1. Ibid.
  2. Ibid.
  3. Ibid.
  5. Ibid.
  6. Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and Opioid-Involved Overdose Deaths – United States, 2013-2017. WR Morb Mortal Wkly Rep. ePub: 21 December 2018
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