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Tramadol Abuse, Addiction, And Treatment Options

Isaac Alexis, M.D., AAMA, AMP-BC

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

February 19, 2019

Tramadol is one of the least potent opioids and leads individuals to believe that they cannot become dependent on it. However, there is still a high risk of addiction if this drug is abused or taken improperly. Fortunately, treatment options for tramadol addiction are available.

Tramadol was not originally classified as a controlled substance when it was approved to treat moderate pain by the U.S. Food and Drug Administration in 1995. It was described as a “safe alternative to opioids”. This, however, was not the case. Some people were having severe reactions to the drug, and it became clear: tramadol is just as addictive as any other opioid, and there is a significant risk of abuse.

Since then, it has been reclassified, and is now a controlled substance, like other opioids. This was a result of reports of abuse, including a 2011 report of approximately 20,000 visits to emergency rooms that were a result of tramadol misuse. The Substance Abuse and Mental Health Services Administration stated that from 2005 to 2011, these visits to the ER increased by 250 percent.

The National Survey on Drug Use and Health (NSDUH) revealed that tramadol was being misused by 3.2 million people in 2012. People were obtaining it illegally, or abusing their own prescription, and the consequences were very similar to that of abuse of hydrocodone (Vicodin), codeine (Tylenol 3 or 4), and other opioids.

If a person becomes dependent on tramadol, entering a detox program is advised, followed by a substance abuse treatment program. Immediately stopping tramadol cold turkey can lead to uncomfortable, painful withdrawal symptoms. Medical professionals can taper down the dose which can reduce or even eliminate most withdrawal symptoms. This can help prevent relapse or seeking other opioids to alleviate withdrawal symptoms.

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Signs Of Tramadol Misuse, Abuse, And Addiction

Short-term opioid use (less than five days), generally does not result in developing dependence, needing to take tramadol in order to feel normal. However, if a person does not take tramadol as prescribed, addiction can occur in a very short amount of time. Long-term use, even as prescribed, often results in dependence. Once dependence develops, abuse and addiction may come next, and the individual may meet criteria for an opioid use disorder.

Knowing the signs and what to look for when a person is misusing tramadol is not always easy. In the beginning, the medication helps alleviate pain, so the person may appear happier, more active, and more like themselves. Over time, they may need more tramadol to achieve the same effects, called tolerance, and they may run out of their prescription before it is time to fill it again. Prescription misuse may be in the first indication there could be a dependence or tolerance issue developing.

Eventually, additional signs of misuse start to appear, and the following may indicate the person is abusing tramadol:

  • confusion
  • insomnia
  • constipation
  • nausea and vomiting
  • sweating
  • erectile dysfunction
  • pinhole-sized pupils
  • social withdrawal
  • money problems
  • seeking tramadol, or other opioids, from illegal sources

When tramadol is taken in high doses, or with other substances, more severe symptoms of abuse can occur. In some situations, a dangerous symptom of tramadol abuse, called serotonin syndrome can occur. If left untreated, serotonin syndrome can be fatal.

Seek medical attention if a person taking tramadol exhibits any of the following symptoms:

  • jerky or rigid muscles
  • tremors
  • confusion
  • lack of coordination
  • agitation
  • seizures
  • unconsciousness
  • coma

Tramadol Misuse And Other Substances

Tramadol has interactions with several prescription medications and substances of abuse. Any medication or substance that increases serotonin levels in the body can result in significant side effects when taken with tramadol. Antidepressant medications like selegiline (Emsam) or phenelzine (Nardil), as well as some street drugs, like cocaine, amphetamines, and ecstasy, can result in emotional disruption, seizures, and in some cases serotonin syndrome.

Medications that interact with opioid receptors in the body are should not be taken with tramadol. Common opioids, like morphine and oxycodone (OxyContin), can result in compounding side effects if taken with tramadol. The potential for overdose increases when tramadol is taken with these, or illicit substances, like heroin.

Tramadol also interacts with other depressants, like alcohol and benzodiazepines (Valium, Xanax). Combining depressants and tramadol can cause severe respiratory issues, including lack of oxygen and unconsciousness. An individual may appear more intoxicated with less alcohol if they have also been taking tramadol. Combining depressants with tramadol can be fatal.

It is important to communicate with your doctor and pharmacist about medications that you are prescribed when taking tramadol. Some medications, like quinidine (Quinidex), a medication that treats heart rates, can severely increase the effects of tramadol, whereas carbamazepine (Tegretol), a seizure medication, significantly reduces the effects of tramadol. Tramadol interacts with over 30 common prescription medications.

Symptoms Of Tramadol Abuse And Addiction

When someone is misusing tramadol, there are symptoms that indicate that there is a developing problem that could expand into an addiction. Some of these symptoms are:

  • problems sleeping
  • headaches
  • dizziness
  • dry mouth
  • depression
  • agitation
  • trouble concentrating

Tramadol dependence, abuse, and addiction are diagnosed under an opioid use disorder (OUD). When determining if tramadol misuse might be an OUD, the following questions may be asked:

  • Have you taken more pills than prescribed at a time? Or for a longer than you thought you would?
  • Am I using tramadol in a way that is not intended (ie. crushing and snorting or smoking)?
  • Do you want to stop or control the amount of tramadol you are taking?
  • Have you tried and failed to stop taking tramadol?
  • Are you spending a lot of time trying to find tramadol?
  • Is using tramadol negatively impacting your responsibilities (work, school, home)?
  • Is using tramadol causing problems in your relationships with others?
  • Are you using tramadol in unsafe situations?
  • Are you having to take more tramadol to have the same effect as before?
  • Do you experience withdrawal symptoms if you stop taking tramadol?

If a person answers “yes” to two or more of the above questions, criteria for a mild OUD has been met. Opioid use disorder is a medical condition, just like any other disorder, and there are treatment options for OUD at any level, from mild to severe.

Tramadol Overdose

It is important to know the signs of a tramadol overdose, because a person who is experiencing an overdose may be unable to take the necessary steps to save their own life. Accidental overdoses often occur when a person has developed a tolerance for tramadol and taking more is required to get the same effect.

Tramadol overdose symptoms include shallow, irregular breathing or breathing difficulties, weak pulse, pupil constriction, clammy skin, body temperature dropping, vomiting, seizures, passing out, and becoming generally unresponsive.

If a person exhibits these symptoms at any point, notify emergency services, such as 9-1-1 right away.

Tramadol Withdrawal

Withdrawal from tramadol has a range of symptoms that are similar to opioid and SSRI (selective serotonin reuptake inhibitors) withdrawal symptoms. Some of the physical withdrawal symptoms include nausea, sweating, cramping, diarrhea, vomiting, sleep disturbances, tingling, goosebumps, and restlessness. These symptoms can last up to 14 days and range in intensity.

Psychological withdrawal symptoms can also occur with tramadol withdrawal. These symptoms can vary in intensity and some can last more than 12 months after stopping tramadol. These symptoms include mood swings, intense anxiety, agitation, depression, and paranoia. In some cases, some people going through withdrawal from tramadol have had symptoms of psychosis, including hallucinations.

Taking advantage of the detoxification program offered by opioid treatment facilities can help lessen and sometimes eliminate withdrawal symptoms associated with tramadol. Attending a rehab program that treats OUD can help develop coping strategies that can assist in alleviating long-term symptoms, reduce cravings, and prevent relapse.

Treatment Program For Tramadol (Opioid Use Disorder Treatment Facilities)

The first step toward the treatment for tramadol misuse is to obtain an opioid use disorder (OUD) diagnosis. Due to federal regulations, every person enrolled in an opioid treatment facility must have a diagnosis for OUD.

Making an appointment with a primary care physician, mental health provider, or during the intake/assessment process of an opioid treatment facility are ways to explore if an OUD diagnosis is appropriate. Afterward, an opioid treatment program will consist of detoxification, therapy, medical, education, vocational assistance, and aftercare services.


It is encouraged that anyone struggling with an opioid use disorder, including tramadol, go through detoxification before or early on in treatment. Some opioid treatment facilities have a detoxification center on-site, others have off-site locations in places like hospitals. In these settings, patients can be given other medications to help decrease opioid withdrawal symptoms. This part of rehab can last from a few days to up to a week.


Therapy is a key component in substance abuse rehabilitation centers. Many different types of therapy are used and are helpful in maintaining abstinence. Building coping skills, helping a person to understand their own addiction, coming to terms with negative feelings associated with addiction, moving forward, and staying sober, are all topics that can be covered in therapy during treatment.

Therapy is always led by a mental health professional, like a counselor, psychiatrist, psychologist, or therapist. These sessions can be individual, or involve family, partners, or groups. Different types of therapy that are beneficial to individuals in substance abuse rehab programs include cognitive behavioral therapy (CBT) and contingency management (CM) therapy.

Medication-Assisted Treatment (MAT)

There are medications available to treat dependence on tramadol. Methadone, buprenorphine (Suboxone, Subutex), and naltrexone (ReVia, Vivitrol) are considered maintenance medications, which are believed to alleviate and sometimes prevent withdrawal symptoms without producing the euphoric feeling associated with tramadol use.

Medical Services

It is often the case that individuals who struggle with tramadol and other opioid misuses also have medical concerns that have compounded their opioid use. Providing medical care for those in treatment for opioid use disorder is theorized to help maintain sobriety after treatment is over.

Education And Vocational Support

When a person enters treatment, understanding addiction and the mechanisms behind it may help increase long-term sobriety. If a person learns their triggers and how to adapt to situations without resorting to drug use, it can prove to be very beneficial.

Vocational support can help a person build on the stable foundation of sobriety. It is not uncommon for people who struggle with employment options after treatment. Some may be entering the workforce for the first time or after a long period of time has gone by.

Exploring potential work interests and employment options in their home area can assist with setting them up for success at the end of treatment. Learn more about these and other treatment options for tramadol abuse and addiction by contacting us today.

U.S. Food and Drug Administration (FDA) - Tramadol Information

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