Tramadol Addiction

Tramadol is one of the weaker prescription opioids, but use of the drug can still result in physical dependence and addiction. Because tramadol works slightly differently from other opioids, it may cause unusual side effects. If you’re struggling with a tramadol addiction, treatment can help.
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Fast Facts: Tramadol

Abuse Potential
Scientific Name
Tramadol hydrochloride
Drug Class
Street Names
Trammies, chill pills, ultras, hillbilly crack
Side Effects
Seizures, trouble breathing, stupor, coma, death
How It’s Used
Legal Status
Schedule IV

Tramadol is a popular prescription painkiller used to treat moderate to severe pain. The synthetic opioid is similar to codeine and about one-tenth as strong as morphine.

Despite its relatively low potency, tramadol carries many of the same dangers as other opioids. Because it binds with the brain’s opioid receptors and depresses the central nervous system, tramadol can cause respiratory depression and death.

People who take tramadol can also become physically dependent on the drug. Tramadol addiction is also a risk, especially in those with a history of substance use problems.

What Is Tramadol Used For?

Also known by the brand name Ultram, doctors prescribe tramadol for a variety of chronic pain conditions, including back pain, osteoarthritis and fibromyalgia.

It’s also commonly used to treat neuropathic pain, which is caused by malfunctioning or damaged nerves.

Conditions such as diabetes and spinal stenosis, a narrowing of the spaces within the spine, are common causes of neuropathic pain. Patients often describe neuropathic pain as burning, stabbing, tingling or electric shock-like sensations.

Tramadol is sometimes prescribed to treat post-surgical pain.

Tramadol works similarly to other opioids by binding to the brain’s opioid receptors and blocking pain signals. But unlike other opioids, tramadol also affects brain levels of serotonin and norepinephrine, which exerts an anti-depressant effect that also appears to lessen pain.

Is Tramadol Addictive?

When it made its debut in the United States in 1995, tramadol wasn’t regulated as a controlled substance. The drug had been used widely in Europe since the 1970s, and federal regulators believed the drug had a low potential for abuse and addiction.

But as use of tramadol increased, so did reports of people abusing and overdosing on the seemingly safe painkiller. An estimated 20,000 emergency department visits in 2011 were related to tramadol use.

Signs of tramadol addiction and dependence may include:

  • Needing to use larger amounts of tramadol to experience the drug’s effects
  • Using tramadol to relieve nausea, anxiety, sweating, shaking and other withdrawal symptoms
  • Doctor shopping to obtain the drug
  • Using more than you intended to and being unable to cut back or stop when you want
  • Neglecting activities you once enjoyed to use tramadol
  • Engaging in secretive behaviors to hide your use
  • Continuing to take tramadol despite its negative impact on your life
  • Taking risks, such as driving while under the influence of tramadol

In 2014, tramadol was classified as a Schedule IV drug, putting it in the same class as Ambien, Ativan and Xanax. Schedule IV drugs are deemed to have a “low potential for abuse and a low risk of dependence.”

Most other opioid painkillers — including oxycodone, morphine and hydrocodone — are defined as Schedule II drugs, meaning they have a high potential for abuse and psychological or physical dependence. Heroin is regulated as a Schedule I drug because it has a high potential for abuse and no accepted medical use.

But people who’ve been addicted to tramadol say it can be just as treacherous and habit-forming as other drugs.

Matt Cardle, a British singer and the 2010 winner of Great Britain’s “The X Factor,” nearly died from a drug and alcohol addiction that started after he was prescribed tramadol for an injury.

Soon, he was taking the drug “for fun.”

“It doesn’t carry the tag like other illegal drugs do. Others seem more dirty on the surface,” after attending rehab. “Tramadol is almost very clean and it’s prescription so people think ‘how can it possible be bad?’ But these things are more addictive than crack at times.”

Tramadol Side Effects and Dangers

Even though it’s one of the weaker opioids, tramadol can cause a range of unpleasant and even dangerous side effects. Because of its unique properties, tramadol also carries certain risks that other opioids don’t.

Possible side effects of tramadol include:

  • Dizziness and vertigo
  • Nausea and vomiting
  • Constipation
  • Headache
  • Tiredness
  • Itching
  • Sweating
  • Stomach upset
  • Nervousness and anxiety
  • Trouble sleeping
  • Dry mouth
  • Diarrhea
  • Low energy

Tramadol can also cause more serious reactions, including severe respiratory depression and seizures.

Individuals with a history of epilepsy may face a higher risk of developing seizures while taking tramadol. Seizures are more likely when a person takes high levels of tramadol or takes tramadol along with certain types of antidepressants.

Some people have developed a serious complication known as serotonin syndrome while taking tramadol.


Even though tramadol is less potent than other opioids, the drug can suppress a person’s natural breathing reflex. When this happens, a person may stop breathing, lapse into a coma and die.

Consuming large doses of tramadol or mixing tramadol and alcohol increases your risk of an overdose — but overdose can still occur when the drug is used as directed.

The risk of breathing problems is greatest during the first few days of therapy and whenever a person increases their dose. Older people and people with respiratory problems have an increased risk of developing breathing problems while taking tramadol.

Warning signs of a tramadol overdose include:

  • Extreme sleepiness
  • Seizures
  • Weak or floppy muscles
  • Cold and clammy skin
  • Tiny pupils
  • A rapid or slow heart rate
  • Low blood pressure
  • Stupor or coma
If you suspect someone is experiencing a tramadol overdose, call 911 and stay with the person until help arrives. If the person is not breathing, you may need to perform rescue breathing until medical assistance arrives.

You can give them naloxone, which can reverse opioid overdoses, but be warned: administering naloxone may trigger a seizure in a person who has overdosed on tramadol.

According to a 2012 report in the Journal of Paramedic Practice, the risk of seizure doesn’t mean naloxone should be withheld — but medical personnel should be aware of the risk and ready to respond.

Serotonin Syndrome

Because tramadol affects levels of serotonin in the brain, it can cause a life-threatening complication known as serotonin syndrome.

Serotonin is a key neurotransmitter that regulates mood, body temperature and other processes. Elevated serotonin levels can cause a person to become seriously ill with symptoms including nausea, twitching muscles, jerky movements and confusion.

Other features of serotonin syndrome include:

  • Muscles spasms
  • Rapid heart rate and high blood pressure
  • Rapid breathing
  • Muscle rigidity
  • Overactive reflexes
  • Dilated pupils
  • Fever
  • Shivering
  • Diarrhea
  • Agitation
  • Hallucinations

In severe cases, serotonin syndrome can lead to seizures, coma, an irregular heartbeat and death.

It’s rare to develop serotonin syndrome from tramadol use alone. But mixing tramadol with certain types of medications, including antidepressants and antipsychotics, can increase a person’s risk of developing serotonin syndrome. That’s why it’s important to consult with your doctor or pharmacist before taking tramadol.

Tramadol Withdrawal

As you develop a physical dependence on tramadol, you’ll need increasingly high levels of the medication to experience the same effects. You’ll also experience uncomfortable or flu-like withdrawal symptoms when you lower your dose or stop taking the drug.

Common symptoms of tramadol withdrawal include:

  • Anxiety and restlessness
  • Cravings
  • Sweating
  • Yawning
  • Body aches
  • Nausea and vomiting
  • Large pupils
  • Goosebumps
  • Depression

A small percentage of people develop atypical symptoms when withdrawing from tramadol. These are unlike the usual opioid withdrawal symptoms.

Atypical symptoms of tramadol withdrawal can include:

  • Panic attacks and severe anxiety
  • Numbness and tingling in your extremities
  • Hallucinations
  • Paranoia
  • Confusion

Tramadol withdrawal usually develops within 12 to 20 hours of stopping the drug and can last for up to a week or more.

Tramadol withdrawal can be minimized or avoided by slowly tapering off the drug under a doctor’s care. Unfortunately, people who are severely addicted to the drug may be unable to do this on their own.

Treatment for Tramadol Addiction

If tramadol has taken over your life, rehab can help you reclaim it.

The first step in treating opioid addiction is helping you rid your body of the drug. This can be a scary thought, and the fear of withdrawal often prevents people from getting help.

But a medically supervised detox can minimize the symptoms of withdrawal. At a detox facility you’ll be medically monitored around the clock and receive medications and other support to help you through this critical phase of recovery.

Once you’re on more stable footing, the real work of recovery can begin.

Opioid addiction treatment often involves a combination of behavioral therapy and medication-based treatment. Medication can control some of the withdrawal symptoms and cravings associated with addiction. Intensive counseling and therapy, meanwhile, will provide you with important insight into the disease of addiction.

Addiction is a chronic and relapsing disease, but rehab will equip you with important coping skills and strategies for reducing cravings, avoiding relapse and staying the course on your recovery journey.

Medical Disclaimer: aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.

Amy Keller, RN, BSN
Content Writer,
As a former journalist and a registered nurse, Amy draws on her clinical experience, compassion and storytelling skills to provide insight into the disease of addiction and treatment options. Amy has completed the American Psychiatric Nurses Association’s course on Effective Treatments for Opioid Use Disorder and continuing education on Screening, Brief Intervention and Referral to Treatment (SBIRT). Amy is an advocate for patient- and family-centered care. She previously participated in Moffitt Cancer Center’s patient and family advisory program and was a speaker at the Institute of Patient-and Family-Centered Care’s 2015 national conference.
Kim Borwick, MA

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