“I don’t think that people realize how potentially risky taking tramadol is. I think it’s because it’s a prescription drug – people assume it’s safe.”
~ Professor Jack Crane, State Pathologist for Northern Ireland
As what the Centers for Disease Control and Prevention have called an “opioid epidemic” continues, there is a threat that has gone largely unnoticed by both physicians and patients alike – tramadol.
Also known as Ultram, tramadol is marketed as a safe, effective painkiller that is a good alternative to other opioids, because of its low abuse potential.
But more information is coming to light that is allowing drug experts and addiction recovery professionals in America to learn what the rest of the world already seems to know – tramadol has the potential to be not only dangerous but deadly.
Tramadol – an Opioid is an Opioid is an Opioid
Tramadol is an opioid medication, derived from the opium poppy. And, like other opioids, it is effective at alleviating pain. Compared dose-to-dose, tramadol is approximately one-tenth of the potency of morphine, on the same level as codeine. For moderate pain, its effectiveness is equal to morphine, but it is less effective in severe pain.
But as is also the case with other opioids, consumption of tramadol carries certain risks:
- Harmful interactions with other substances, particularly amphetamines, benzodiazepines, or alcohol
- Physical dependence
- Withdrawal when the drug is discontinued
- Recreational misuse
- Overdose and death
The risk of suicide is so pronounced that in 2010, the US Food and Drug and Administration added a warning to the labels of medications containing tramadol. A letter was sent out by the FDA to healthcare professionals saying:
“Tramadol-related deaths have occurred in patients with previous histories of emotional disturbances or suicidal ideation or attempts, as well as histories of misuse of tranquilizers, alcohol, or other (central nervous system-active) drugs.”
How Tramadol Got Its Unearned Reputation as a “Safe” Opioid
When tramadol was first discovered in 1977, its effects were tested via injection, and it was discovered that the potential for abuse was low. This is why when the World Health Organization first reviewed tramadol in 1992, it concluded that it did not need to be regulated. With that assessment, tramadol consumption quickly skyrocketed:
- In 1994, the world-wide consumption of tramadol was less than 25,000 kg.
- By the year 2000, the global shipment of tramadol had reached 148,000 kg.
- Between 2000 and 2012, global consumption increased by another 186%.
- Consumption of other, more tightly-controlled opioids rose at comparatively modest rates:
- Codeine – 119%
- Morphine – 49%
- Dihydrocodeine – 40%
Because tramadol is not regulated, the International Narcotics Control Board does not set quotas on how much of the drug can be produced, and it does not limit or track exports. Consequently, huge shipments of tramadol pills are shipped throughout the world.
And therein lies the problem – while injectable tramadol has a low potential for abuse, tramadol taken orally is a different matter altogether.
In 2006, researchers for Johns Hopkins University and the US National Institute on Drug Abuse published data showing that oral tramadol is much stronger, because of the way that it is processed by the liver. This increased potency also means that the risk of misuse, dependence, addiction, and overdose is also increased.
The WHO still declined to regulate tramadol, because regulation would mean that people living in poorer developing countries would face difficulties in acquiring the drug for legitimate reasons.
How Addictive Is Tramadol?
Studies have shown that opioid addicts may actually prefer tramadol to stronger drugs like oxycodone.
In 2012, one study gave both oxycodone and 400 mg of tramadol – about four times the normal dose – to a group of opioid abusers. The next day, study participants were told they would be given the drugs again incrementally if they continued to click a computer mouse.
- 7800 clicks would deliver all of the drugs
- 56% of participants clicked the mouse at least 5300 times to get the tramadol
- Only 11% of participants did so to get the oxycodone
Tramadol Statistics in the United States
Tramadol use and misuse are on the rise in America:
- 2008-2012, the number of tramadol prescriptions the United States increased from 25 MILLION to almost 40 MILLION
- In 2011, there were more than Two-and-a-half MILLION Americans who use tramadol for non-medical purposes, according to the Drug Enforcement Agency
- That same year, there were 20,000 tramadol-related ER visits in America
Roger Knaggs, Associate Professor at Nottingham University, says,
“Patients prescribed opioids such as tramadol need close monitoring – and should be seen at least once a month to see if they’re getting any benefit from them.”