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Tramadol (Ultram) Addiction Explained: Tolerance, Withdrawals and Finally Stopping

Though it isn’t mentioned often, Tramadol is a powerful opiate. As any news channel will regularly tell you, the American opiate crisis is still in full swing. Tens of thousands of victims are dying annually, and the staggering numbers are not dropping. The crisis has been fueled by the greed of Purdue Pharmaceutical as well as other giants in the industry. Millions of pills are distributed down a black market pipeline on a daily basis, making dealers rich off the backs of miserable addicts. Heroin is now typically laced with fentanyl or some of its more deadly derivatives such as sufentanil and carfentanil. Oxycodone and hydrocodone are regularly touted as gateway drugs of abuse, prescribed by doctors who are more concerned about kickbacks than patients. Tramadol is a drug that rarely, if ever, actually makes the headlines. It is not generally considered a drug of abuse. Because of this, many people are prescribed it for moderate to severe pain. Those prescriptions are often for unnecessarily long times. Unfortunately, this can, and often does, lead to addiction. Here, we will discuss the ins and outs of Tramadol abuse and addiction. By the end of this article, you will know what Tramadol addiction looks like, how to notice signs and symptoms of it–and how to treat it.

What is Tramadol (Ultram)?

Tramadol is an opioid pain medication sold under the brand names Ultram, ConZip, Ultram ER, and others. It is generally prescribed to treat moderate to moderately severe pain that can be chronic. Tramadol is considered effective for chronic pain due to being a more mild synthetic opioid than other, commonly stronger, drugs. It is generally prescribed to treat conditions such as fibromyalgia and diabetic neuropathy.  Physicians can use it as a go-to for many painful nerve-related conditions. It is also used to treat chronic muscular pain, but this is not as prevalent. A common 50mg dose of Ultram has the analgesic equivalency of 4 mg of morphine sulfate. That is, it takes 50 milligrams of Tramadol to equal the same pain relief one receives from 4 milligrams of morphine. This property is what generally makes Tramadol an attractive solution for maintaining chronic pain. If the pain is not managed adequately with Tramadol, physicians can always try a stronger medication. Tramadol works in two ways. First, it binds to the mu-opioid receptors just as any opiate narcotic. It also has SNRI properties. As a serotonin-norepinephrine reuptake inhibitor, Tramadol works as an antidepressant. This makes it unique. This also makes addiction to it particularly dangerous and tough to treat.

Tramadol Addiction and Physical Dependence

People can become addicted to any drug, substance such as food, or repetitive behavior such as gambling. Addiction is, in a sense, the development of compulsive habits to make up for psychological inadequacies a person may carry. These behaviors and substances replace feelings of emptiness inside a person, and will continue even though the person is suffering negative consequences from them. When speaking of drugs in particular, some come with the added risk of developing a physical dependence. Opioids are well-known for causing physical dependence. Tramadol (Ultram) is a synthetic opioid. When taken, the body breaks it down into a metabolite called O-desmethyltramadol, which is a much more powerful opioid. When this binds to the mu-opioid receptors, it relieves feelings of pain and malaise. It can create feelings of euphoria along with the pain relief it provides. In the most basic sense, opioids cause the body to produce massive amounts of endorphins, which are nature’s pain reliever. They are structurally almost identical to the chemical makeup of morphine. The name means “endogenous morphine”. When someone ingests opioids for a period of time, the body begins to rely on those opioids for the release of endorphins. The body will quit producing them naturally. When this happens, physical dependence on the opioid develops. Although they are not the same, physical dependence is one of the primary symptoms of addiction.

Telltale Signs There is a Pain Pill Abuse Problem

Opioid addiction and dependence has some telltale signs and symptoms to be aware of. If you are worried that you or someone you care about may be dealing with an opioid addiction, keep your eyes out for:

  • A noticeable elation or euphoria. A person who is abusing opioids can seem blissful when there is no discernable reason to be.
  • Marked sedation or drowsiness. As the body’s mu-opioid receptors are covered up by the drug, the brain will slow the body down. This is because all of the brain’s chemical needs are being taken care of by the drug.
  • Confusion.
  • Constricted pupils. The iris will be disproportionately large compared to the pupil, and the whites of the eyes will sometimes be very bloodshot.
  • A markedly slowed respiratory rate, which is caused by the brain’s receptors being saturated as mentioned earlier. When the brain has too many opioids in it, this can lead to respiratory arrest, as the brain forgets the need to breathe.
  • Intermittent nodding off or a temporary loss of consciousness, caused by the same receptors.
  • Conversely, the opioid addict can also be brimming with energy. The body releases massive amounts of endorphins after a workout, and someone high on opioids can achieve that same feeling without the exercise.

Those were some of the signs and symptoms of opioid abuse in general. Tramadol is no different. If you are worried about how much of the drug you are taking, consider asking yourself these questions to see if you may have a problem:

  • Do you find yourself taking more of the drug than you intend to?
  • Will you take Ultram before the prescribed four hour window your doctor has prescribed, whether you need it or not?
  • Do you take your pills for any reason other than pain?
  • Have you used prescription drugs at higher doses than recommended or sought out having your prescription renewed before its time?
  • Do you ever feel guilty about your drug use?
  • Does your spouse or parents ever express concern about your drug use?
  • Have you been in trouble at work due to your drug use?
  • Have you lost friends because of your Ultram abuse?
  • Do you suffer withdrawal symptoms if you go too long between doses?
  • Have you neglected your family because of your drug use?
  • Have you gotten into fights or engaged in illegal activity because of drugs?

If you have said “yes” to any of these questions, then it may be time to consider getting some help for your Tramadol problem.

Noticing Ultram Abuse in Others

If you suspect that someone close to you may be struggling with a developing addiction to Ultram(ConZip), there are a few others signs that you can watch out for in addition to the ones listed above. Now, for the most part, none of these signs is conclusive that someone has a drug problem. Ultimately, it will be up to the drug abuser to determine whether or not he or she has a problem and is needing help. If you notice that the person you suspect may be using drugs runs out of their prescription early on a consistent basis, it could mean that the person is likely taking too many pills at one time. It could also mean that they are taking Tramadol more frequently than is recommended by the doctor. Neither of these symptoms alone necessarily means that the person is an addict. The person could legitimately be in pain. The pain medication in prescribed amounts could be unable to adequately treat the pain. This still doesn’t mean that it is acceptable to go against the doctor’s orders though. Perhaps have a conversation with your loved one. Suggest that before they take complete control of their pain management, they should discuss the problems they are having with their physician. The physician can likely find a more feasible way to moderate the pain. Of course, if the pills still continue to disappear on a regular basis, it could be that the person is abusing or selling them. Both are cause for serious concern. If you suspect the person is an addict, watch him.

Methods of Tramadol Abuse

Sometimes an addict will take Tramadol in ways not prescribed by the doctor, such as insufflating(snorting) it. When an addict snorts the drug, the body absorbs it faster. This is because the drug comes into direct contact with the bloodstream through the mucous membrane lining of the nose, and is able to completely bypass the digestive system. This will create a “rush”, a huge surge of euphoria, for the addict. This form of abuse is common for many opioid addicts. Unfortunately, it can be hard to spot if the abuser is not caught red-handed. There are a few signs to look for though. The person may have a continually running nose. It may also be constantly congested. He or she may also be prone to nosebleeds. There will also be a visible residue if the addict does not clean his nose. Intravenous (I.V.) use is also possible, though not as common for a Tramadol addict. If someone is using the drug intravenously, the veins in the bend of the arm will sometimes be bruised and can ultimately collapse. Scars can form along the lines of the veins in the body. Eventually veins will collapse all over the body. This is because the user has to try harder and harder to find places to inject as the use progresses. The person may keep cigarettes around even if they do not smoke. The cotton in the butt of the cigarette can be used as a filter. Addicts wad it up and place it in the spoon where the drugs are cooked. Though no method of drug abuse is safe, intravenous use is typically the most dangerous. One misjudged dose can lead a person to overdose and cardiac or respiratory arrest. Most accidental opioid deaths are from a single overdose versus chronic use.

Developing Tolerance and Tramadol/Ultram Withdrawals

Opioids are notorious for causing tolerance to develop in addicts and those physically dependent on the drug. As a matter of fact, development of tolerance is the direct physical result of a developing dependence upon the drug. As the user ingests more and more of the drug, the brain and body fight to maintain homeostasis, which is our state of normal, day-to-day functioning. As a result, the brain releases less and less endorphins every time the drug is taken. It also kills off more and more of our mu-opioid receptors. The brain doesn’t see the need for the mu-opioid receptors to release endorphins because it now constantly has Ultram to do this job for it. This is a direct example of the old adage “you use it or you lose it.” It becomes easy to see how addiction begins when looking at this like a hamster wheel. The person takes Tramadol, and a huge amount of endorphins is released. This feels wonderful to the user, so he takes more when the feeling begins to wear off. This time the brain releases fewer endorphins because it is being conditioned to expect the drug to do the job for it. After a short time, the user realizes that he doesn’t feel as good as he once did off of his initial dose, so he begins to up the dose or experiment with new routes of administration. When he does this, it increases that euphoric feeling, but it does so at the cost of the brain being able to produce endorphins on its own. Once the brain crosses a certain line in the sand, it gives up the ability to produce endorphins on its own. When this happens, the addict now becomes fully dependent on Tramadol. If he or she does not take the medication, withdrawals will soon follow.

Physical Withdrawal from Tramadol

Being an opioid, Tramadol carries a host of symptoms when it is abruptly stopped. These can be mitigated if the drug is tapered properly under the care and direct supervision of a knowledgeable physician. They will be most uncomfortable if the drug is stopped cold turkey. Tramadol withdrawals will mimic symptoms of other opioid withdrawals, such as oxycodone or heroin. Symptoms will generally begin within 12 to 24 hours of cessation and can persist for up to two weeks. When withdrawing, one can expect:

  • Anxiety
  • Depression
  • Loss of appetite
  • Heart palpitations
  • Sweating
  • Diarrhea
  • Anger
  • Increase in aches and pains
  • Abdominal cramps
  • Tremors
  • Lacrimation (Excessive tearing)
  • Drug cravings

Tramadol also carries some risks that traditional opioids do not where it has the SNRI component, and these symptoms absolutely need the monitoring of a doctor:

  • Nightmares
  • Suicidal Ideation
  • Seizures

If you have a seizure or are prone to seizures, be sure to discuss your cessation of Tramadol with your doctor immediately so that the two of you can devise your best course of action for stopping the use of the drug. Withdrawal from a physical dependence and addiction to any opioid drug such as Ultram is extremely uncomfortable and difficult, but there is good news. Tramadol withdrawal is likely not fatal, and no matter how bad a person feels during it, it will end. Some people being showing serious signs of improvement within four days, and many are almost out of the woods within a week. When withdrawing, it is extremely important to stay hydrated. It is likely that you will vomit often and have a difficult time keeping food on your stomach. If this is the case, sports drinks and water can help ease some of the discomforts you are enduring. And while the only way out is through the withdrawal, one can treat him or herself symptomatically. If you are having problems sleeping–which you likely will–consider an all-natural sleep aid such as melatonin. Having the ability to rest the mind and body during this ordeal will make the withdrawal much more bearable.

Deciding to End Your Tramadol Addiction

All addicts know that any form of active addiction is misery. Opioid addiction in particular is extremely difficult to recover from. Relapse rates are staggering. Tramadol addiction is even nastier than many other pharmaceutical opiates due to its antidepressant properties. With all that being said: know that you can do this if you are ready to commit to stopping. Although unnecessary, consider admission into a medical detox facility for the first stage of your physical withdrawals. A medical detox facility–whether a standalone detox, hospital, or part of a rehab–will give you the added advantage of supervision and monitoring should you have a seizure. The physicians on hand will also be knowledgeable in what medicines to provide for your comfort as you withdraw. The staff will have seen this many times before and can be great allies in your fight–even if all you need is friendly conversation. Tramadol withdrawal can be very uncomfortable and severe, though it is not considered likely to be fatal unless you have some underlying medical conditions the withdrawal could exacerbate. If you decide to withdraw from the drug at home, be aware of what you are getting into. Let someone who you trust know about what you are going through. Though there is nothing that you can take to completely alleviate opiate withdrawal, send someone after comfort medications. Over-the-counter pain medications and stomach remedies can be lifesavers. Eat what you can, when you can, and stay hydrated. This can’t be stressed enough. If you are vomiting on a regular basis, your body is losing important nutrients that will need replenished. Consider keeping sports drinks on hand.

How to Handle Tramadol Withdrawals When You Quit

The peak of the withdrawal should hit somewhere between hours 72 and 96. Afterward, it will slowly begin to subside. When you are at your peak, know that you will soon physically be feeling better. During those hours it would be wise to have a sitter. The cravings can be intense, and you don’t want to risk all of the progress you have made so far. Remember, so long as you don’t take any more, you never have to feel this way again. Within a week, you should be feeling better. Once you get through the withdrawal, the real work begins. Consider this a time of self-improvement. Aftercare is generally advised, and there are many ways to go about it. Medication-assisted treatment has come a long way in recent years with Suboxone, Subutex, Methadone, and Naltrexone. In combination with therapy,  all of these medications are viable options for a successful recovery. Twelve-step meetings have been saving lives for almost a century now. They certainly aren’t for everyone, but consider checking some out. You may just find something to fill the hole that you addiction was filling. As the saying goes: “there is nothing more therapeutic than one addict helping another.” Finding like-minded individuals who have common experiences to share gives comfort to many a newly clean addict. Your body will also likely not be in the best physical condition. Ultram withdrawal can be difficult. Make an appointment with your doctor to have some bloodwork and a general physical done. You want to make sure that no serious damage has been done to your body through neglect. Your body will be an important part of your recovery. When the body feels good, so will the mind.

Healing and Recovery Take Time, but It’s Worth It

Take care of yourself. Begin eating better. Get some exercise. Those little things will make a world of difference in the mindset of an early recovering addict. Beware that cravings will likely surface from time to time. Reach out to those closest to you and let people know that you are struggling. Recovering from Tramadol can be very touch and go for a while. Be sure to set up and rely on a support system; whatever one will work for you. They can get you through the tough times. Take everything one day at a time, because you are going to have good days and bad. What is important to remember is that you will get better. If we fight hard enough, we do recover.