Tramadol Symptoms and Warning Signs

The arrest of Laura Plummer in Egypt, and the substance abuse of X-Factor winner Matt Cardle have one thing in common: Tramadol. Plummer was arrested for carrying the prescription-only substance, which is banned in Egypt, and at one point she faced the death penalty for her crime. At his lowest point, Matt Cardle took tramadol to cope with psychological problems in his life.

Tramadol is a strong, opioid painkiller given to patients for post-surgery pain, as well as to cancer patients for whom other medications have not been effective. The prescription of opioids by GPs in England is steadily increasing, especially in poorer communities where residents aren’t fully aware of the dangers of opioid abuse. Tramadol was first synthesized by German chemists in 1962, and works by binding to mu-opioid receptors in the brain and other parts of the body.

While there are benefits to tramadol as an effective pain reliever, it also has negative side effects and a high potential for abuse and addiction. Doctors agree that the risk of building a tolerance is low if you follow prescription, but some patients still end up developing a tolerance even when they take the medication as prescribed.

Tramadol Abuse

Tramadol is a prescription-only opioid narcotic used to treat moderate to severe pain. It works by changing your brain’s perception of pain. Tramadol binds to opioid receptors in the brain to reduce nerve transmission of pain messages sent from your body to the brain.

Its level of effectiveness is comparable to, but less potent than, morphine. Because of this, patients should be closely monitored when they receive a prescription, especially if they already have mental health issues or a history of substance use disorder.

Tramadol can be administered orally, intramuscularly, rectally, or intravenously. It comes in many forms such as tablets, capsules, extended-release tablets, liquids, and more. Tramadol is metabolised by the O-desmethyltramadol molecule, and other molecules. This ensures that it binds more strongly to opioid receptors in the brain, making it more potent, therefore and increasing the risk of abuse.

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How is Tramadol Abused?

Because of the risk of abuse, GPs only prescribe tramadol for short periods. Addiction mostly occurs when you use tramadol, instead, for long periods of time. Mixing tramadol with other painkillers further increases the risk of addiction, as this would be a dangerous mix of at least two central nervous system depressants. This could lead to a fatal overdose, seizures, slowed breathing rate, and loss of consciousness.

You abuse tramadol when you take the medication outside of the way it was prescribed or if you use it for non-medical purposes. Various ways of abusing tramadol include:

  • Crushing the pill to inject, snort, or smoke
  • Chewing tramadol
  • Taking higher doses at increased frequency
  • Combining tramadol with alcohol and other addictive substances

The Side Effects of Tramadol abuse

Abusing tramadol increases the possibility of experiencing the drug’s side effects. Higher doses make your body and mind more susceptible to medical conditions and worsened mental health issues. For example, you shouldn’t operate heavy machinery or get behind the wheel when you take tramadol, because it causes drowsiness. Other common side effects of tramadol abuse include:

  • Sweating
  • Headaches
  • Constipation
  • Dry mouth
  • Nausea and vomiting
  • Fatigue
  • Severe side effects include:
  • Diarrhoea
  • Accelerated heart rate
  • Lack of coordination
  • Agitation
  • Slow reflexes
  • High body temperature
  • High blood pressure
  • Coma
  • Hallucinations

How Do I Know if Someone Is Abusing Tramadol?

It’s sometimes hard to tell if someone is abusing tramadol, especially when they have a legitimate prescription. When someone abuses tramadol, they might develop a physical and psychological dependence on the drug. This means that they crave the positive feelings tramadol produces, and they also crave the substance in their body.

A loved one who is psychologically dependent will become obsessed with getting tramadol. It becomes the primary objective in their life, and they will continue taking the pills even when they know the negative consequences of their addiction, and the medical conditions they might suffer as a result. Similar to other addictions, you’ll notice that they don’t care about hobbies or other activities that they previously enjoyed. They make excuses not to attend social events, and would rather spend all their time indoors where it’s easier to hide the signs of substance abuse.

A tramadol addict will go through their prescription faster than they were meant to, and will “doctor shop” to get multiple prescriptions from different pharmacies and hospitals. When that doesn’t work, they may be willing to risk buying from illicit drug dealers or the dark web, where no one knows what is in the pill they are buying. Watch out for physical signs such as dilated pupils, track marks on their arms (from injecting the liquid form), empty pill bottles around the house, pale skin, and increased drowsiness.

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Signs and Symptoms of Tramadol Abuse

Behavioural signs include:

  • Continued use even when they know the consequences of abusing drugs
  • Poor personal hygiene
  • Lying about their drug habits to get another prescription
  • Unexplained disappearance from work
  • Experiencing legal and financial woes because of their addiction
  • Always carrying tramadol

Psychological signs include:

  • Cravings for tramadol
  • Lack of control over their tramadol use
  • The belief that taking large doses of tramadol is the only way to get through the day

Recognising Tramadol Addiction

Only an addiction specialist, or medical profession, will be able to tell, after only a brief meeting, if someone is addicted or not. Keep an eye out for any of the signs mentioned above. When they stop taking the drug, you’ll then notice withdrawal symptoms. If they can’t quit without professional help, that’s also a sign of addiction. In the DSM-V, the measurement of the severity of an addiction is based on a criterion count from 2-11 with 11 being the most severe and 2 being the mildest.

4 signs you Might Be Addicted To Tramadol

Physical dependence

You’ve developed a physical dependence on tramadol. This occurs over a long period of continuous and increased use. If you’re dependent, you’ll likely experience the following withdrawal symptoms: coughing, sweating, panic, tremors, chills, body aches, difficulty sleeping, diarrhoea, runny nose, muscle spasm, and, in some rare cases, hallucinations and seizures.

Taking tramadol to get high

If you take tramadol for its euphoric effect, and not for the medical benefits, that’s is a sign of abuse. As a habit-forming medication, recreational use could quickly lead to addiction.

Compulsive use when you know the consequences of tramadol abuse

The primary differentiator between dependence and addiction is the lack of control or ability to stop, even when you know the damage it could do to your body and mind. Negative consequences include financial issues, job loss, medical conditions arising from substance abuse, the breakdown of relationships, and poor personal hygiene.

Exhibiting drug-seeking behaviour

This includes “doctor shopping”, lying that you’ve lost your prescription, faking pain to receive another prescription, and reluctance to provide medical records or undergo a medical examination.

Short-term Effects of Tramadol Abuse

Tramadol has several targets, as it modifies the way pain signals travel between the nerves and the brain. Some of these targets are mood-altering properties and others that help with pain relief. When tramadol binds to the opioid receptors in the central nervous system, it relieves pain, if you take prescribed dose, and produces a more euphoric “high” at a larger dose. This euphoric “high” is the primary reason why recreational users are attracted to tramadol.

Tramadol also increases the levels of norepinephrine and serotonin in the brain. These are partly responsible for the ability of tramadol to alleviate obsessive-compulsive and depressive symptoms in patients. The serotonin effects, however, might lead you on the path to dependence.

Other short-term effects include:

  • Reduced anxiety
  • Relaxation
  • Calmness
  • Sedation
  • Elated mood
  • The absence of pain

The Long-term effects of Tramadol Abuse


Most opioid painkillers are only meant for short-term use. The most common long-term effect of abusing tramadol is the building up of a tolerance to the drug. At this stage, the normal dosage level is no longer effective for pain relief, and you need larger doses to feel the original effect tramadol gave you. The right thing to do is to consult your doctor and notify them of what exactly is going on, so they can advise you on the safest option going forward.

Physical dependence

Tramadol could potentially affect GABA functions in the brain, in such a way that when stimulated, it decreases the production of dopamine, and prevents the reuptake of serotonin to reduce neuron activity. A study by the World Health Organisation revealed that some individuals in this cas develop mild dependence, and others develop strong psychological and physical dependence, that later leads to addiction.

Cognitive decline

Long-term abuse of tramadol leads to slower reaction times and cognitive impairment. You’ll find it harder to complete any task that requires concentration and cognition. This makes you a danger to yourself and others when operating heavy machinery or driving.

Other long-term effects include:

  • Clogged blood vessels
  • Weak immune system
  • Coma
  • Increased risk of contracting infectious diseases such as hepatitis and HIV
  • Respiratory depression

The Dangers of abusing Tramadol

Recreational users are not the only ones at risk of addiction. Even patients with a legitimate prescription might experience adverse side-effects, such as dizziness and nausea. Tramadol is a potent medication that binds more powerfully to opioid receptors than other painkillers. This increases the risk of severe side effects if you use the drug long-term.

The risk is further exacerbated when you combine tramadol with other CNS depressants such as benzodiazepines, opiates, and alcohol. It produces a cocktail which can cause you to feel the sedative and depressant effects of both substances. The physiological effect of combining alcohol with tramadol could lead to a slow heart rate, respiratory depression, and low blood pressure. Slowed neural functions increase the risk of organ damage, due to a lack of blood flow and oxygen to areas of the brain that need it to function properly.

Snorting tramadol accelerates the addiction timeline. The lining of your nose ensures that the drug goes straight into your brain and bloodstream instead of being metabolized in your body as it would be if you took it orally. Side effects include fatal overdose and seizures.

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Tramadol Overdose

The danger with tramadol is that it might take a little while to feel its effect, which could give a false perception that the dose you took was too small or didn’t work. It’s dangerous to abuse any drug that acts on the central nervous system because it affects your breathing, heart rate, and body temperature.

As addiction develops, you’ll start to take higher doses which significantly increases the risk of overdose. Over 60% of drug-related overdoses in 2014 involved opiates, and there were roughly 20,000 hospital visits involving tramadol abuse in 2011. The methods of administration that mostly lead to overdose are smoking and snorting the powder, done to circumvent the natural metabolism and send it directly to your bloodstream. An overdose is a medical emergency. Knowing the signs could prevent severe fatalities in yourself or others.

Symptoms of tramadol overdose include:

  • Lack of muscle control
  • Weak pulse
  • Difficulty breathing
  • Drowsiness
  • Confusion
  • Bluish tint to lips and fingernails
  • Low blood pressure
  • Seizures
  • Coma
  • Death

Staging an Intervention for Tramadol Abuse

When you notice your loved one is addicted to tramadol, encourage them to get help. Be patient and let them know you’ll be there for them. If they refuse to seek treatment, it might be time to stage an intervention. An intervention should be carefully planned with other participants. Make sure the location is non-threatening, and that the addict doesn’t feel like it’s an ambush, or they could become defensive.

The best way to ensure success is to involve a professional interventionist who will be there to guide the process and prevent proceedings from escalating into violence. Plan and rehearse what you’re going to say before the big day. Remember that the primary goal is to help the addict seek treatment, not criticise them for their choices.

Tramadol addiction treatment

The journey to recovery starts with detoxification, which is used to remove all harmful toxins from your body. While most of the symptoms are not life-threatening, it’s safer and more secure to undergo detox treatment at a medically-supervised facility, where medical professionals are on hand to supervise the entire process. Withdrawal generally lasts between 5-10 days, and longer in some patients. During detox, you’ll meet with a therapist who will help to treat your psychological symptoms, such as depression and anxiety.

After detox, you can continue treatment either as an inpatient or outpatient. Both are effective drug rehabilitation programmes that help you understand the underlying reasons why you started to abuse tramadol, identify all triggers that might cause a relapse, and equip you with the coping skills for dealing with triggers when they arise.

Treatment programmes at a rehab centre include:

  • Relapse prevention planning
  • Skills training
  • Educational classes
  • Participating in 12-step programmes
  • Family and group counselling
  • Behavioural therapies such as Motivational Interviewing and Cognitive Behavioural Therapy
  • Stress management
  • Aftercare

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