Tramadol Addiction: Symptoms, Causes, Effect, and Treatment

Tramadol addiction occurs when individuals develop a reliance on tramadol. This condition manifests through compulsive drug-seeking behavior and continued use despite adverse 

consequences. In 2013, approximately 3.2 million people in the U.S. reported using tramadol for non-medical purposes, an increase from 2.7 million in 2012. By 2015, about 1.8 million individuals misused tramadol, representing 9.6% of those reporting its use, according to Reines SA et al.’s 2020 study titled “Misuse of Tramadol in the United States,”  published in the Journal of Substance Abuse. 

The symptoms of tramadol addiction are categorized into physical and psychological effects. Common physical symptoms include nausea, vomiting, drowsiness, constipation, and impaired coordination. Psychological symptoms involve intense cravings, mood swings, anxiety, and social isolation. As the addiction progresses, individuals neglect responsibilities and withdraw from social interactions, further worsening their condition. The presence of pinpoint pupils is another notable physical sign of tramadol use, reflecting its impact on the autonomic nervous system.

Several factors contribute to the development of tramadol addiction. Key causes include prescription misuse, due to chronic pain management genetic predispositions that heighten vulnerability to substance abuse and co-occurring mental health disorders such as anxiety or depression. Around 9.4% of the 14.6 million individuals aged 12 and older who used tramadol products in the past year reported misuse, according to the 2022 National Survey on Drug Use and Health. These factors create a complex interplay that leads to dependency, making it important for healthcare providers to monitor patients closely when prescribing tramadol.

The effects of tramadol addiction extend beyond immediate health concerns leading to cognitive impairments and social withdrawal. Long-term use results in chronic fatigue, respiratory depression, and even organ damage. 

Recovery from tramadol addiction typically involves a structured treatment approach that includes medical detoxification to manage withdrawal symptoms effectively. Treatment options encompass medication-assisted treatment (MAT), counseling, and support groups to address both the physical and psychological aspects of addiction. Withdrawal from tramadol is challenging, with symptoms beginning within 24 hours after the last dose and peaking around day three. 

What Is Tramadol?

Tramadol is a synthetic opioid analgesic used primarily to treat moderate to severe pain.  Initially classified as a non-controlled substance, tramadol was reclassified as a Schedule IV controlled substance in 2014 due to concerns about dependence and abuse potential, according to Dhesi M et al.’s 2024 research titled, ” Tramadol” published in the StatPearls Journal.

Tramadol is effective for managing acute and chronic pain, including postoperative pain. It works through a multimodal mechanism: similar to other opioids; it binds to the mu-opioid receptors in the brain. Also, it inhibits the reuptake of neurotransmitters such as serotonin and norepinephrine, which enhances its analgesic effects. This dual action helps alter pain perception and improve pain relief efficacy.

Healthcare providers prescribe tramadol for its effectiveness in treating pain while generally considering it less addictive than other opioids. However, misuse occurs, mainly when individuals take higher doses than prescribed or use it without a prescription. Prolonged use leads to tolerance, requiring larger doses to achieve the same effect, and withdrawal symptoms upon discontinuation, which include irritability and flu-like symptoms.

While tramadol is considered less potent and has a lower risk of addiction compared to stronger opioids like morphine or oxycodone, it still carries a risk of dependency. Approximately 9.4% of individuals who used tramadol in the past year reported misuse, according to Reines SA et al.’s 2020 study titled, ” Misuse of Tramadol in the United States,” published in the Journal of Substance Abuse.

Tramadol causes severe side effects, including seizures and respiratory depression, especially when misused or taken in conjunction with other substances. Overdosing on tramadol is possible and is life-threatening. Symptoms of overdose include extreme drowsiness, slow breathing, and loss of consciousness.

In 2022, around 6.1 million people aged 12 and older had an opioid use disorder, according to the Centers For Disease Control Report titled “Medications for Opioid Use Disorder (MOUD) Study.” This highlights the ongoing challenges associated with opioid medications, including tramadol. While tramadol serves an important role in pain management, awareness of its potential for misuse and addiction is crucial for both patients and healthcare providers.

Why is Tramadol Addictive?

Tramadol is addictive because it interacts with the brain’s opioid receptors, primarily the mu-opioid receptors, and alters neurotransmitter levels, leading to both pain relief and feelings of euphoria. The misuse of tramadol poses a significant public health challenge, with rates varying widely among different age groups and demographics. 

Young adults report misuse rates between 1.9% and 77.04%, while professionals, particularly drivers, show non-medical use rates of 7.2% to 35.1%, and commercial motorcyclists face a staggering 76% misuse rate. Alarmingly, patients exhibit some of the highest levels of misuse, estimated between 77.1% and 92%, underscoring the urgent need for targeted public health interventions, according to Boun SS et al.’s 2024 study titled “Prevalence and Health Consequences of Nonmedical Use of Tramadol in Africa” published in the PLOS Glob Public Health Journal.

Tramadol is a mixed-mechanism opioid analgesic. It binds to mu-opioid receptors in the central nervous system (CNS), which are important for mediating pain relief. Activation of these receptors diminishes pain perception and triggers the brain’s reward pathways, leading to pleasure and euphoria. This effect is similar to that of stronger opioids, although tramadol is generally considered less potent.

In addition to its action on opioid receptors, tramadol inhibits the reuptake of norepinephrine and serotonin. This increases the availability of these neurotransmitters in the synaptic cleft, enhancing mood and contributing to its antidepressant-like effects. 

As individuals use tramadol over time, they develop tolerance, requiring higher doses to achieve the same effects. This escalation in dosage leads to physical dependence, where withdrawal symptoms manifest when the drug is reduced or stopped. 

The addictive nature of tramadol stems from its ability to bind to opioid receptors while also influencing neurotransmitter systems in the brain. This combination not only provides effective pain relief but also creates a risk for misuse and dependence, mainly when used outside prescribed guidelines or for extended periods. 

How Long Does It Take to Get Addicted to Tramadol? 

To get addicted to tramadol, the timeline varies based on individual factors such as dosage, frequency of use, and personal health conditions. Some users develop a dependency within just a few weeks of regular use, particularly if they exceed prescribed dosages or misuse the medication. For instance, individuals taking around 200-300 mg of tramadol daily find themselves physically dependent within approximately ten days, according to Dunn KE et al.’s 2019 study titled, “A Systematic Review of Laboratory Evidence for the Abuse Potential of Tramadol in Humans” published in the Journal of Front Psychiatry. 

Factors like genetics, mental health conditions, and the presence of other substances also influence the speed at which addiction develops.

About 84% of patients who abused tramadol in very high doses experienced seizures within 24 hours, highlighting the risks associated with rapid escalation in usage, according to Babahajian A. et al.’s 2019 study titled, “Seizure Prevalence and Its Related Factors in Tramadol Intoxication” published in the Academic Emergency Medicine. Therefore, it is important for healthcare professionals to carefully monitor patients who are prescribed tramadol and educate them about the potential risks of misuse and addiction.

How Much Tramadol Leads to Addiction? 

To get addicted to tramadol, one needs to take over 400 mg of tramadol per day for immediate-release formulations and over 300 mg per day for extended-release forms, according to Dhesi M, Maldonado KA, Patel P, et al.’s 2024 research titled ” Tramadol” published in the StatPearls Publishing.

Addiction  arises when individuals take higher doses than prescribed to achieve euphoria or pain relief. For example, some take two doses in one day if they miss a dose, significantly increasing the risk of overdose and dependence.

While tramadol is prescribed for pain management, misuse and exceeding recommended dosages increase the risk of developing an addiction. Users should be aware of their intake and consult healthcare professionals if they feel dependent on the medication.

What are the Symptoms of Tramadol Addiction?

The symptoms of tramadol addiction are physical symptoms like drowsiness, nausea, and impaired coordination; psychological symptoms like mood swings, anxiety, and cravings; and behavioral symptoms like neglect of responsibilities, social isolation, and compulsive drug-seeking behavior. The misuse rate of tramadol prescriptions was about 4%, with nearly 1.7 million instances of misuse reported in 2017 alone, according to Reines SA’s 2020 research titled “Misuse of Tramadol in the United States,” published in the Substance Abuse Journal.

• Physical symptoms: Physical symptoms are visible in a person’s body and behavior. These symptoms include drowsiness, nausea, headaches, and impaired coordination. If someone is experiencing these symptoms frequently, it is a sign of tramadol addiction. Chronic use of tramadol also leads to tolerance and dependence, meaning the person needs increasingly higher doses to achieve the same effects.
• Psychological symptoms: Psychological symptoms are the thoughts and feelings that a person experiences due to their addiction. These include mood swings, anxiety, depression, and intense cravings for the drug. Tramadol affects the brain’s reward system and leads to changes in mood and behavior.
• Behavioral symptoms: Behavioral symptoms are actions or behaviors that indicate an individual is struggling with tramadol addiction. This includes neglecting responsibilities at work or school, isolating oneself from friends and family, and engaging in compulsive drug-seeking behaviors such as doctor shopping or stealing to obtain more tramadol.

Approximately 60 million people utilized opioids in the United States in 2021, and over 39.5 million of them suffered from drug use problems, according to a 2023 World Health Organization report titled” Opioid overdose.” This highlights the widespread issue of tramadol addiction and the need for effective treatment options.

What Causes Tramadol Addiction?

The causes of tramadol addiction are prescription mismanagement, genetic predisposition, co-occurring mental health disorders, and environmental factors.

The four causes of tramadol addiction include:

Prescription Mismanagement

Prescription management refers to the improper use of prescription drugs, which leads to addiction.  In the case of tramadol, it is prescribed for pain management. However, if the patient does not follow the prescribed dosage or uses the medication for longer than recommended, they develop a tolerance and dependence on the drug.

Between 2002 and 2014, lifetime misuse of oral tramadol rose from approximately 0.4% to 1.5%, as reviewed by Reines SA et al.’s 2017 study titled “Misuse of Tramadol in the United States”. This rise in misuse of oral tramadol is a cause for concern among healthcare professionals and policymakers. 

Genetic Predisposition

Genetic predisposition refers to the likelihood of developing an addiction based on one’s genetic makeup. Individuals with a family history of substance use disorders are at greater risk due to inherited genetic factors that influence how their brain responds to drugs. In a study involving young adults, 31.3% of participants reported having a first-degree relative with a SUD, which was associated with higher rates of substance use and mental health disorders, according to Grant JE et al.’s 2020 study titled “Family History of Substance Use Disorders”  published in the Journal of Behavioral Addictions. Genetic variations affect neurotransmitter systems, making some individuals more susceptible to cravings and tolerance development.

Co-occurring Mental Health Disorders

Co-occurring mental health disorders are the ones that occur with addiction. These disorders contribute to the development of substance use disorders and make it difficult for individuals to stop using drugs.  Approximately 18.5% of individuals with mental health disorders also have a co-occurring substance use disorder, with this rate rising to 28% among those receiving inpatient care, according to Rush B et al.’s 2008 study titled, “Prevalence and Profile of People with Co-occurring Mental and Substance use Disorders Within a Comprehensive Mental Health System” published in the Canadian Journal of  Psychiatry. Examples of co-occurring mental health disorders include depression, anxiety, PTSD, and bipolar disorder.

Environmental Factors

Environmental factors are referred to as the external influences that contribute to the development of addiction. Factors such as stress, trauma, and social environment contribute to an individual’s likelihood of misusing tramadol. For instance, individuals who experience high levels of anxiety or have traumatic backgrounds turn to tramadol addiction as a coping mechanism, increasing their risk for addiction. Among those who abused tramadol, 49.1% exhibited a high risk of dependence, indicated by a composite risk score of ≥27, according to Danso M et al.’s 2021 study titled, “Factors Associated with Tramadol Abuse” published in the Drugs- Real World Central Journal. Therefore, accessibility, whether through prescriptions or illicit sources, facilitates misuse and dependency.

What are the Effects of Tramadol Addiction?

The effects of tramadol include mental health impacts such as anxiety and depression, physical health effects like organ damage and chronic pain, and social impacts including isolation and strained relationships. In 2021, synthetic opioids, including tramadol, contributed to a notable rise in drug overdose deaths across the U.S, according to Dr M R Spencer’s 2022  Center for Disease Control research titled, “Drug Overdose Deaths in the United States, 2001–2021”.

The effects of tramadol addiction are written below:

• Mental health impact: Mental health impact refers to the effects of tramadol addiction on an individual’s psychological well-being. Tramadol, like other opioids, alters the brain’s chemistry and leads to changes in mood and behavior. This results in increased anxiety, depression, and even suicidal thoughts.

 In Ireland, deaths linked to tramadol use rose from 9% to 40% of all drug misuse deaths between 2001 and 2011, indicating a troubling trend in its misuse and associated risks, according to N Bénédicte et al.’s 2022 research titled “Multiple Suicide Attempts Associated With Addiction to Tramadol” published in the Annals of General PsychiatryJournal.

• Physical health impact: Prolonged use of this drug causes damage to various organs such as the liver, kidneys, heart, and lungs. It also leads to weakened immune systems, respiratory issues, chronic pain, and gastrointestinal problems.
• Social impact: Social impact is the effect of tramadol addiction on an individual’s relationships and social life. As the addiction takes hold, individuals  A study indicated that 24.9% of participants reported tramadol abuse, with a notable prevalence among younger adults aged 21 to 30 years, according to Danso M et al.’s study titled, “Factors Associated with Tramadol Abuse” published in the Drugs Realworld Journal. 

 This highlights the concerning trend of tramadol abuse among young adults and the potential impact it has on their physical health and social lives.

How to Know If You Have Tramadol Addiction?

To know if you have tramadol addiction, consider taking a self-assessment quiz designed to evaluate your relationship with the drug, according to El-Hadidy MA et al.’s 2015 research titled, ” Medical and Psychiatric Effects of Long-Term Dependence on High Dose of Tramadol” published in the Journal of Substance Use Misuse. This quiz typically consists of “yes” or “no” questions based on your tramadol use over the past year, reflecting criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

The Self-assessment quiz helps you identify if you have a tramadol addiction. It is designed to evaluate your relationship with the drug by asking a series of “yes” or “no” questions based on criteria from the DSM-5, a manual used by mental health professionals to diagnose substance use disorders.

Some examples of questions that are included in a self-assessment quiz for tramadol addiction include the following:

• Have you taken tramadol without a prescription?
• Do you find yourself needing more and more tramadol to achieve the desired effects?
• Have you experienced withdrawal symptoms when trying to stop using tramadol?
• Have you neglected responsibilities or activities because of your tramadol use?
• Has your tramadol use caused problems in your relationships?

If you answer “yes” to a majority of these questions, it indicates that you have a problem with tramadol addiction. However, seeking professional help for an accurate diagnosis and treatment plan is important.

How to Treat Tramadol Addiction?

To treat tramadol addiction, several methods are used, including medical detox, counseling and therapy, and inpatient vs outpatient rehab. According to Mukau, L. et al.’s 2022 study titled ” Buprenorphine for High-dose Tramadol Dependence,” published in the Clinical Practice and Cases in Emergency Medicine, high-dose buprenorphine is effective in treating tramadol addiction.

The three treatment options for tramadol addiction include:

• Medical detox
• Counseling and therapy
• Inpatient vs outpatient rehab

1. Medical Detox

Medical detox is the initial step in treating tramadol addiction, where the goal is to manage withdrawal symptoms as the body eliminates the drug safely. This process typically requires supervision by healthcare professionals to ensure safety and comfort, as withdrawal is physically and psychologically challenging, although rarely life-threatening. 

In a case study involving a patient dependent on 1,400 mg of tramadol daily, successful treatment was achieved through a transition to buprenorphine over a 28-day inpatient program. This demonstrates the effectiveness of this approach for severe cases, according to Mukau L et al. ’s 2022 study, “Buprenorphine for High-dose Tramadol Dependence,” published in the Clinical Practice and Cases in Emergency Medicine Journal.

Several medications are utilized during detox to alleviate withdrawal symptoms and cravings associated with opioid dependence. Buprenorphine is a partial opioid agonist that effectively reduces cravings and withdrawal symptoms. High doses are beneficial for managing tramadol dependence. Methadone is another opioid agonist employed for pain relief and to help mitigate withdrawal symptoms. 

Clonidine, primarily used to treat high blood pressure, also alleviates some withdrawal symptoms related to opioid dependence, although it does not address cravings. Lastly, Naltrexone acts as an opioid antagonist that blocks the effects of opioids and aids in relapse prevention. Together, these medications form a comprehensive approach to managing withdrawal and supporting recovery from opioid use disorder.

2. Counseling and Therapy

Counseling and therapy involve behavioral interventions that address the psychological aspects of addiction. It aims to identify and correct negative thought patterns, coping mechanisms, and behaviors associated with substance use.

Various counseling and behavioral therapies are effective in treating tramadol addiction:

Cognitive-behavioral therapy (CBT) helps patients identify and change negative thought patterns and behaviors associated with drug use, teaching coping strategies for relapse prevention. 

CBT significantly aids in relapse prevention. One analysis reported an overall relapse rate of only 14% among patients who underwent CBT, indicating that most individuals maintain their recovery post-treatment, according to Levy HC et al.’s 2021 research titled, “ A Meta-analysis of Relapse Rates in Cognitive-behavioral Therapy for Anxiety Disorders” published in the Journal of Anxiety Disorders.

Motivational Interviewing (MI) enhances motivation to change behaviors by addressing ambivalence toward recovery. Group Therapy and Support Groups provide peer support through shared experiences; examples include Narcotics Anonymous (NA) meetings.

These therapies work by addressing underlying psychological issues related to addiction, fostering a supportive environment for recovery. Evidence suggests that combining behavioral therapies with MAT leads to better long-term outcomes in addiction treatment.

3. Inpatient vs. Outpatient Rehab

Inpatient rehabilitation involves a residential stay at a treatment facility where individuals receive 24/7 care. This option is recommended for those with severe addiction due to its structured environment, which minimizes distractions and provides comprehensive support. Benefits include intensive therapy sessions, medical supervision during detox, and a supportive community of peers. 

Inpatient rehab typically lasts from 28 days to several months, depending on the individual’s needs and the severity of their addiction, according to Lamb S et al.’s 1998 study titled, “Bridging the Gap between Practice and Research,”  published in the National Academies Press (US).

Outpatient rehabilitation allows individuals to live at home while attending treatment sessions. This option is suitable for those with less severe addictions or those who have completed inpatient care. Benefits include greater flexibility in scheduling, lower overall cost, and the ability to maintain daily responsibilities.

The severity of the addiction and individual circumstances should guide the choice between inpatient and outpatient rehab. Inpatient care is generally more effective for severe cases due to its structured support system.

Is Medication-assisted Treatment (Mat) Used To Treat Tramadol Addiction?

Yes, MAT is utilized in treating tramadol addiction. MAT combines behavioral therapy with medications like buprenorphine or methadone to manage withdrawal symptoms and cravings effectively. Research demonstrates that MAT effectively reduces illicit opioid use. 

For instance, one study found that patients on MAT had a 60% abstinence rate from illicit opioids five years after starting treatment, according to P Stefanie et al.’s 2015 study titled “Review of Medication-Assisted Treatment Guidelines and Measures for Opioid and Alcohol Use” published in the US Department of Human and Health Services Journal. This integrated approach improves treatment outcomes significantly by addressing both the physical and psychological aspects of addiction.

What are the Withdrawal Symptoms of Tramadol Addiction?

The withdrawal symptoms of tramadol lead to a range of physical and psychological symptoms.Tramadol withdrawal begins within 8 to 24 hours after the last dose, according to Rajabizadeh G et al.’s 20009 study titled, “Psychosis Following Tramadol Withdrawal,” published in the Addiction Health Journal.  The severity and duration of withdrawal symptoms vary depending on the individual’s usage and overall health. It is important to seek medical assistance during this time as the physical and psychological effects of tramadol withdrawal are challenging to handle alone.

The withdrawal symptoms of tramadol are listed below:

• Physical symptoms: Physical symptoms are visible and felt by the person experiencing them. Nausea and vomiting occur when a person feels like they need to vomit or feel nauseous. Diarrhea is the frequent and loose passing of stools. Muscle pain and body aches are joint withdrawal symptoms of tramadol because the body is reacting to not having the drug in its system anymore. Sweating, chills, and goosebumps occur as the body’s temperature regulation system tries to adapt without tramadol.
• Psychological symptoms: Psychological symptoms are challenging and affect a person’s mental state. Anxiety and agitation are common during tramadol withdrawal, as well as mood swings that range from intense anger to extreme sadness. Psychological symptoms include anxiety and agitation, mood swings and depression, intense cravings for tramadol, and panic attacks, according to Rajabizadeh G et al.’s 2009 study titled, “Psychosis Following Tramadol Withdrawal” published in the Addiction Health Journal. 

Depression is also a common psychological symptom during withdrawal from any substance. Intense cravings for tramadol is overwhelming and difficult to ignore, leading to a strong desire for the drug. Panic attacks are sudden feelings of intense fear and anxiety that occurs during tramadol withdrawal.

What are the Different Stages of Tramadol Withdrawal?

The different stages of withdrawal from tramadol are early acute symptoms, peak symptoms (Days 13), subacute symptoms (Days 4 to 7), longer-term and psychological recovery (Days 8+), according to Rajabizadeh G et al’s 2009 study titled, “Psychosis following Tramadol Withdrawal” published in the Addiction Health Journal.

 Early acute symptoms manifest within 8 to 24 hours after the last dose. During this initial phase, individuals experience mild symptoms such as anxiety, restlessness, sweating, nausea, vomiting, diarrhea, and mild muscle aches. As the body reacts to the drug’s absence, these symptoms escalate quickly. 

According to Rajabizadeh’s study, the intensity of withdrawal generally peaks around Days 2 to 3, where individuals face more severe discomfort characterized by intense cravings for tramadol, flu-like symptoms (including chills and body aches), insomnia, mood swings, irritability, and gastrointestinal distress. This peak period is critical as it represents the height of physical withdrawal,  accompanied by significant emotional and physical distress.

Following this peak, symptoms gradually subside between Days 4 and 7. However, persistent cravings, sleep disturbances such as insomnia, and continued anxiety or confusion linger. Most physical symptoms should have resolved by the end of the second week (Days 8 to 14), yet psychological symptoms persist for weeks or even months. This prolonged phase includes Post-Acute Withdrawal Syndrome (PAWS), which encompasses depression, anxiety, mood swings, difficulty concentrating, and sleep issues. PAWS complicates recovery and increases the risk of relapse, underscoring the necessity for ongoing support and treatment during this time.

In the long-term recovery phase that extends from weeks to months, individuals focus on addressing underlying psychological issues associated with addiction. This involves therapy and support groups aimed at managing cravings and enhancing emotional well-being. 

Some individuals endure lingering psychological effects for months or even years after cessation of tramadol use, highlighting the importance of comprehensive treatment strategies. Understanding these stages aid individuals in navigating the withdrawal process effectively while emphasizing the need for professional support throughout recovery.

How Long Does Recovery from Tramadol Addiction Take?

Recovery from tramadol addiction typically involves a structured approach that varies in duration depending on individual circumstances. The withdrawal symptoms from tramadol generally begin within 8 to 24 hours after the last dose and last from 4 to 10 days if untreated, according to Shah, K et al’s 2020 title “Tramadol for the Management of Opioid Withdrawal” published in the Cureus Journal.

However, the recovery timeline is extended if a tapering strategy is employed, which stretches the process over several weeks to months. Factors influencing the speed of recovery include the duration and dosage of tramadol use, individual health conditions, and whether the person has a history of substance abuse or co-occurring mental health disorders. 

Medical supervision during detoxification is crucial as it helps manage withdrawal symptoms effectively and reduces the risk of complications, thereby enhancing the overall success of recovery efforts.

The success of treatment for tramadol addiction also hinges on various psychological and social factors. Individuals with solid support systems like family and friends tend to have better outcomes. Conversely, those with a history of trauma or emotional distress find their recovery more challenging due to underlying issues that contribute to substance misuse. 

How to Help Someone Addicted to Tramadol?

To help someone addicted to tramadol requires a compassionate and informed approach like emotional support, educating them on tramadol addiction and other intervention strategies.  Approximately 24.9% of surveyed participants reported abusing tramadol, with a high risk of dependence noted among younger users, according to Danso M et al’s 2021 study titled “Factors Associated with Tramadol Abuse”.

When initiating conversations, use “I” statements to communicate your feelings without placing blame, such as, “I’ve noticed you seem different lately, and I’m worried about you.” This non-judgmental approach encourages them to share their experiences and feelings, fostering trust and connection.

Encourage them to seek professional help. Treatment options typically include detoxification under medical supervision to manage withdrawal symptoms safely, followed by therapy to address the psychological aspects of addiction.