Tramadol Addiction: What Is It & How Is It Treated?

Tramadol Addiction.

Tramadol is a prescription painkiller used to treat moderate pain. It is also sold under the name Ultram. It is a synthetically produced and not as strong as the opioid

What is Tramadol?

Tramadol is in the same family of drugs as oxycodone and hydrocodone, but it works in a different way compared to opioid painkillers. Like other opioids, tramadol changes how the body responds to pain through its interaction with the opioid receptors which are associated with increased dopamine, increasing the risk of abuse.

Tramadol was not considered a controlled substance when it was first approved by the FDA in 1995. It wasn’t until years of reports of people misusing the drug that it was listed as a Schedule IV controlled substance in 2014.

Is Tramadol Addictive?

While it is considered to have a lower potential for abuse than opioids like oxycodone, tramadol dependence can still occur, especially if used for long periods of time.Once a person’s brain gets used to its effects, tolerance develops requiring higher doses to experience the same effects.

With repeated use, people can develop physiological dependence and at this stage, if use stops, withdrawal symptoms will occur.

Neither tolerance nor physical dependence means someone is addicted to the drug although tolerance and dependence may lead to compulsive use that is seen with opioid use disorders. Tramadol addiction and opioid use disorders are characterised by compulsive use that may have harmful consequences with long-term changes to the brain.

Signs of Abuse

Substance use disorders are not always easy to recognise and should be left to a medical practitioner to diagnose. However, over a 12 month period, if 2 or more of the following are present, you may meet the criteria for a diagnosis of a substance use disorder involving tramadol.

The DSM-5 criteria for an opioid use disorder involving tramadol include:

  • Using more tramadol than was originally intended.
  • Taking tramadol even though you know it makes a physical or emotional issue worse.
  • Spending a good deal of your day looking for tramadol, using tramadol, and recovering from using tramadol.
  • Increased conflict with loved ones over using tramadol.
  • Failing to meet expectations at work, school, or home due to your use of tramadol.
  • Giving up hobbies that you used to enjoy to keep using tramadol.
  • Using tramadol in high-risk situations—e.g. driving under the influence of tramadol.
  • Making unsuccessful attempts to cut back or stop taking tramadol.
  • Cravings to use tramadol.
  • Developing a tolerance to tramadol, so that you need to keep taking more of it to feel its effects.
  • Experiencing physical withdrawal when you stop taking tramadol.

It is important to note that tramadol abuse may be more likely in people who have a personal or family history of substance abuse and or mental illness.

Signs of Addiction

Here are some signs to watch for if you think a loved one is hiding an addiction:

  • Personality changes, mood swings, irritability, anxiety, paranoia, aggression
  • Behavioural changes such as lying, secrecy, relationship problems, social isolation, poor performance at work or school
  • Changes in appearance, poor hygiene, weight loss, constricted pupils, sleeping too much, look tired and out of it
  • Financial issues may arise so pay attention to suspicious requests for money

Side Effects

The effects of Tramadol are similar to other opioids and include:


  • relaxation
  • euphoria
  • confusion


  • pain relief
  • Slow breathing
  • fatigue
  • dizziness
  • sweating
  • nausea, vomiting
  • headache
  • constipation
  • Itching
  • erectile dysfunction

Signs of Overdose

Tramadol overdose is not common although it is possible. Overdose may occur when taken inappropriately, such as by taking more than the prescribed dose, taking someone else’s medication, or taking tramadol illegally.

Mixing tramadol with other substances like opioids,alcohol and other depressants such as benzodiazepines, can increase the risk of oversedation, respiratory issues, coma or death.

Symptoms of overdose include:

  • Slow or shallow breathing
  • Slow heartbeat
  • Low blood pressure
  • Extreme sleepiness
  • Constricted pupils
  • Muscle weakness.
  • Cold, clammy skin
  • Seizures
  • Coma

Withdrawal Symptoms

If dependence develops, withdrawal symptoms may be present including:

  • Insomnia
  • Restlessness
  • Irritability
  • Excessive yawning
  • Runny nose
  • Sweating
  • Chills
  • Weakness
  • Joint and muscle pain
  • Loss of appetite
  • Nausea
  • Vomiting
  • Stomach cramps
  • Diarrhea
  • Increased respiratory rate
  • Increased blood pressure
  • Rapid heart rate


Medically supervised detox may be required at the start of treatment because suddenly quitting tramadol can lead to uncomfortable withdrawal symptoms. Detox and withdrawal management can keep you safe and comfortable and reduce the risk of relapse.

Withdrawal from tramadol is not life-threatening, but it can be very hard to manage on your own. Medical detox during early recovery is becoming the standard of care with opioid use disorders, as nonpharmacologic withdrawal can lead to unnecessary discomfort.

In rare cases, withdrawal can be associated with medical complications, such as dehydration and electrolyte disturbances for people with severe gastrointestinal symptoms. Also, people with cardiac issues could experience problems due to increased heartbeat or high blood pressure.

There are medications to help with tramadol withdrawal and can be used to manage long-term risk of relapse. These medications include:

  • Methadone is a long-acting full opioid agonist which can help to reduce withdrawal symptoms and control cravings for tramadol.
  • Buprenorphine is a partial opioid agonist which can help to manage opioid withdrawal symptoms and reduce cravings.

There are effective behavioural therapies used to help treat substance use disorders which include:
  • Cognitive Behavioural Therapy (CBT) is used to help identify and change problematic behaviour patterns through learning and teaching new skill sets, like developing positive coping strategies and avoiding triggers that can lead to relapse.
  • Motivational Enhancement is commonly used and incorporates interviewing techniques to help people overcome any hesitance they have to engage with treatment. Some programs use motivational enhancement with CBT.
  • Family Therapy is used throughout treatment to help resolve the issues that have grown during one’s addiction. It works on education on addiction, providing tools to ensure healthy communication and boundary setting, just to name a few.

If you or someone you care about is struggling with tramadol addiction, know that help is available. The Hills is a leading provider of addiction treatment and offers world class treatment in a luxury setting for affordable prices. To learn more about the program and how it can help you, give them a call today.

The Hills Rehab Chiangmai


Dr. Sutthipan Takkapaijit

Dr. Sutthipan Takkapaijit

Clinical Psychiatrist

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