Tramadol (Ultram) is a low-potency opioid painkiller typically prescribed to relieve moderate to moderately severe pain. Ultram ER, the extended-release version of the drug, is usually only prescribed to individuals in need of round-the-clock pain relief from chronic conditions, such as cancer.
Abuse of tramadol is on the rise. There was a sharp increase in the number of emergency room visits in the U.S. involving tramadol from two million to four million between 2005 and 2011. U.S. law enforcement officials also estimate that roughly one billion tramadol tablets had been seized leaving India for illicit use in 2017.
Although tramadol is considered a weaker opioid, when it is abused in large doses for extended periods of time, it can become addictive. Tramadol’s potential addictiveness is dose-dependent. When taken as prescribed, it is not likely that an individual will become addicted, however, when the medication is chronically abused at higher doses, its addiction potential significantly increases.
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Signs And Symptoms Of Tramadol (Ultram) Abuse
Similar to other opioids, tramadol can produce adverse effects, especially when misused. If these side effects are noticed frequently or become more severe over time, they could indicate that someone is abusing the medication.
Possible signs and symptoms of tramadol (Ultram) abuse include:
- difficulty falling asleep or staying awake
- uncontrollable shaking in a part of the body
- muscle tightness
- changes in mood
- heartburn and indigestion
- dry mouth
These side effects may be warning signs that an individual is abusing tramadol, or taking it for non-medical purposes.
Effects Of Tramadol (Ultram) Abuse
When tramadol is taken orally, it is digested and then processed by the liver. The liver then produces a metabolite of the drug called M1, which has a higher affinity for the opioid receptors within the body and produces more pain-relieving effects than the original drug. The production of M1 is the reason tramadol is considered more potent when taken orally instead of snorting or injecting it.
Some people have a variation of the liver enzyme that changes tramadol into M1 faster and to a greater extent than others do. People with this enzyme are referred to as “ultra-metabolizers.” The number of people who are considered to be ultra-metabolizers varies depending on their ethnicity. For example, one to 10 Caucasians per 100 is ultra-metabolizers, while this condition occurs in only one to two East Asians per 100.
In addition to its pain-relieving effects, tramadol also acts on the brain structures that influence serotonin and norepinephrine. Both of these chemicals are produced naturally in the brain. Serotonin is believed to help regulate mood, social behavior, appetite and digestion, sleep and memory, while norepinephrine is vital for attentiveness, emotions, sleeping, dreaming and learning. Norepinephrine is also released as a hormone into the blood, where it can cause blood vessels to contract, resulting in an increased heart rate.
If an individual abuses tramadol for an extended period, it is possible for them to develop a condition called Serotonin Syndrome. An altered mental state and heightened neuromuscular and autonomic activity indicate the presence of this syndrome. Serotonin Syndrome can result in people seeing and hearing things that are not real and experiencing increased levels of paranoia.
It is also theorized that tramadol may have less of an immunosuppressant effect compared to other opioids. However, clinical trials are still controversial on this matter.
Risks Of Tramadol Addiction
There are many risks associated with abusing tramadol. In addition to the opioid effects, the stimulant effects of the drug can make some people feel as if they are “high functioning” while under its influence. This can be dangerous, as they may be inclined to drive a car or participate in more risky behaviors than usual.
Overdosing on tramadol is another risk associated with this drug. The risk of overdose is relatively high when the medication is taken in large doses. Most physicians do not recommend exceeding 400 mg/day. When taken in too large a dose or mixed with other CNS depressants, such as alcohol, tramadol abuse may result in a fatal overdose.
Possible tramadol (Ultram) overdose symptoms include:
- decreased pupil size
- difficulty breathing
- extreme drowsiness
- slowed heartbeat
- muscle weakness
- cold, clammy skin
Individuals who abuse tramadol and are already taking an antidepressant may experience more adverse reactions, as both medications manipulate the production and release of serotonin in the brain. If someone abruptly discontinues use of tramadol, they may experience a series of uncomfortable symptoms, also referred to as withdrawal.
Possible tramadol (Ultram) withdrawal symptoms may include:
- upper respiratory symptoms
Other, less common withdrawal symptoms of tramadol include hallucinations, panic attacks, severe anxiety and paresthesia (a burning or prickling sensation that is usually felt in the hands, arms, legs, or feet). Clinical experience suggests that withdrawal symptoms may be better managed or possibly avoided if the dose of tramadol is gradually tapered off at the time of discontinuation.
Tramadol (Ultram) Abuse And Addiction Treatment Options
Individuals with a severe addiction to tramadol will most likely need to complete a medically supervised detox from the drug. Medically supervised detox programs allow individuals to safely remove the drug from their system, before enrolling in a formal treatment program.
Clinical studies have proven that the most effective way to break an opioid addiction is to do so gradually and, if the case is severe enough, with the help of medication-assisted treatments, such as methadone or buprenorphine (Suboxone, Subutex). Completing a medication-assisted treatment program can increase an individual’s chances of long-lasting sobriety.
For more information on tramadol (Ultram) abuse, addiction and treatment options, contact a specialist today.