Americans are one of the most medicated societies on the planet, and prescription drug abuse is considered an epidemic in the United States.
Prescription pain relievers are at the top of the list of abused pharmaceuticals. Tramadol is a prescription synthetic opioid medication most often used to treat pain. Tramadol differs from traditional opioids as it is a partial opioid agonist, binding to opioid receptor sites, blocking pain sensations and creating feelings of relaxation and calm, as well as a serotonin/norepinephrine reuptake inhibitor (SNRI) with small antidepressant effects. Tramadol comes in both short- and extended-release tablet forms of varying dosages with brand names, such as:
- Ultram ER
- Ultracet (combination of tramadol and acetaminophen)
Opioids enhance moods and may produce euphoric effects, leading to instances of abuse and dependency. The Drug Enforcement Administration, or DEA, reported that 43.8 million prescriptions for tramadol were dispensed in 2013, and as of 2012, approximately 3.2 million Americans aged 12 and older had used tramadol for nonmedical purposes in their lifetime. Any use of prescription medications beyond their intended scope is classified as abuse.
Tramadol Overdose and Other Dangers
The Drug Abuse Warning Network (DAWN) reported that 20,000 people sought emergency department (ED) treatment for an adverse reaction related to tramadol abuse. The DEA also reported nine deaths in 2012 associated with tramadol abuse.
Tramadol may be abused by taking more of a dose than is prescribed or taking tramadol when it is not medically necessary. Abusers may crush tramadol tablets in order to snort, smoke, or inject the drug, bypassing the intended absorption method, sending it directly across the blood-brain barrier and increasing the risks for a life-threatening overdose.
The Centers for Disease Control and Prevention, CDC, cites drug overdose as the leading cause of injury death in America, and 44 people die from a prescription opioid overdose every day in the United States. If you notice any of the following overdose symptoms, seek medical attention:
- Blue colored and/or clammy skin
- Irregular heart rate
- Extreme drowsiness
- Pinpoint pupils
- Slowed or shallow breathing
- Heart attack
- Loss of consciousness
Mixing tramadol with other drugs or alcohol can increase the side effects and odds for an overdose. Other central nervous system depressants, such as alcohol, may depress breathing to dangerous levels when mixed with tramadol. Combination tramadol products containing acetaminophen, such as Ultracet, may cause damage to the liver as well.
When mixed with other serotonergic or SSRI medications, tramadol may cause a dangerous serotonin syndrome indicated by hallucinations, muscle twitching and agitation, which differs from opioid toxicity. This syndrome is more common in those taking antidepressant medications, although Pharmacology Weekly asserts that higher doses of tramadol alone can also cause a toxic buildup of serotonin in the central nervous system.
Common side effects of tramadol use include itching, headache, drowsiness, constipation, nausea or vomiting, dizziness, impaired cognition and anxiety. Abusing tramadol can increase side effects and their intensity, and more serious symptoms may occur, which may include seizures, suicidal thoughts, low blood pressure, skin issues, slowed heart rate and shallow or trouble breathing. Another side effect of abusing tramadol is the risk of developing a physical and psychological dependence to the drug, which may lead to an addiction.
Dependence, Tolerance and Addiction
Tramadol is sometimes used to treat opioid dependency and help manage withdrawal symptoms during detox. Being an atypical opioid, it has long been considered to have a low risk for dependency; however, recent research indicates otherwise. One case study published in the Indian Journal of Psychological Medicine highlights that there is a high potential for tramadol abuse and dependency especially in those who were formally opioid dependent. As of August 18, 2014, tramadol was further classified as a Schedule IV controlled substance by the DEA, making tramadol and its products more regulated in the United States and formally recognizing its abuse and dependency potential. The brain functions by sending chemical messengers, or neurotransmitters, throughout the central nervous system, telling you how to feel and think.
Drugs interfere with this process, and opioids stimulate opioid receptors and the production of dopamine, which is a neurotransmitter involved in feelings of reward and motivation. This is why taking opioid drugs such as tramadol make you feel good initially. The more of these drugs you take, the more your brain begins to rely on the artificial stimulation, however, and it may stop producing dopamine at normal or previous levels, thus chemically changing your reward circuitry. Now, you may feel agitated, anxious, irritable and on edge without the drug, creating drug cravings in order to feel normal again. You may build up a tolerance to certain doses of the drug, requiring you to take more and higher doses in order to obtain the same desired effects. This is considered dependency, which is both physical and psychological.
You may also experience withdrawal symptoms when the drug leaves your bloodstream. Tramadol withdrawal may occur in one of two ways, and 90 percent of the time, the tramadol withdrawal syndrome is typical of opioid withdrawal, bringing about flu-like symptoms as well as agitation, anxiety, restlessness, insomnia and drug cravings, according to the DEA.
The other 10 percent of the time is atypical of opioid withdrawal and may include symptoms such as numbness or tingling in extremities, paranoia, extreme anxiety, panic attacks, hallucinations and confusion.
Tolerance, withdrawal and drug cravings are side effects of physical dependence as well as addiction. You can become dependent without being addicted, however. Addiction is a brain disease indicated by compulsive drug-seeking behaviors and an inability to stop taking drugs.
When to Get Help
Prescription opioid abuse cost American society $55.7 billion in 2007 in lost workplace production, health care costs, criminal justice and legal costs, as published by the CDC. Approximately 21.6 million Americans age 12 and older needed treatment for substance abuse or dependence in 2013, although the NSDUH reports that only 2.5 million actually received the necessary care.
Addiction is a treatable disease, and with the proper treatment, recovery is attainable. It may be time to seek professional help if you recognize any of the following signs of tramadol abuse and addiction:
- Altering medications to use in a way other than prescribed
- Seeking additional prescriptions
- Taking more than a prescribed dose
- Spending excessive amounts of time obtaining the drug, taking it, and recovering from its effects
- Mood swings and/or shifts in personality
- Changes in personal appearance and weight changes
- Irregular sleep patterns
- Loss of appetite
- Lack of interest in activities enjoyed in the past
- Trouble with interpersonal relationships
- Drop in work or school performance
- Trouble focusing or concentrating
- Signs of impairment
- Attempts to stop taking the drug are unsuccessful
Often, the first step in treating tramadol addiction is to manage the physical dependence. Opioid withdrawal can be uncomfortable, and it is therefore not recommended to stop taking an opioid on your own without proper medical supervision. A medical professional may help you to set up a tapering schedule wherein you slowly lower the amount of tramadol you are taking in a controlled manner, over time, until you are drug-free.
Medically assisted detox may use pharmaceuticals in order to manage drug cravings and withdrawal symptoms. Buprenorphine products are commonly used during opioid detox, which are long-acting, partial opioid agonists that dispel withdrawal symptoms and cravings, usually without the euphoric effects. Mood stabilizers may also be used as adjunct medications during detox as well.
After physical balance is restored, the emotional components of addiction can be addressed. Behavioral therapy is an effective tool for helping you to discover what may have led to addiction in the first place, identifying potential triggers and developing coping mechanisms to handle them in the future. Self-destructive and negative thoughts and behaviors are recognized and modified. Group and individual therapy and counseling sessions help you to regain a healthy emotional balance. Peer support groups provide a positive network to help guide you through recovery, keep you accountable and reduce episodes of relapse.
Educational opportunities that teach you about the disease of addiction and what to expect during recovery are important as well. Reaching a healthy emotional and physical balance is a vital part of a successful recovery, and developing an exercise regime, eating a nutritious diet, and sticking to regular sleep patterns are all good ways to ensure long-term success.
The Oaks at La Paloma offers a variety of recreational opportunities and amenities in a private and supportive environment staffed by compassionate professionals specially trained in the most up-to-date and evidence-based treatment models. Admissions coordinators are standing by to provide you with a free and confidential assessment to help you determine what type of care is right for you or your loved one. Call now.