Tramadol is a drug from the opioid category (although there has been much debate about this between scientists over the years) that was only approved for use in the UK only as recently as 1994.
Tramadol is used to treat moderate to severe pain and is considered to be in the same category of opioid drugs as morphine, hydrocodone and codeine all of which have been established as opioid narcotics.
Tramadol does not totally eradicate pain but makes the pain more tolerable so that people experiencing severe pain can gain an improvement in the quality of their daily life. (6,12)
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Tramadol can come in the form of drops, tablets, capsules and even via injection in certain circumstances. Tramadol is a very fast-acting drug with a short half-life, and it tends to take effect within 30 minutes to one hour.
Tramadol is really only recommended for short-term use to help deal with the pain that is not expected to last for a long time, for example, pain after an operation or after a recently sustained injury.
Tramadol is not recommended therefore for patients with pain issues that need managing over the long term. (3)
Tramadol is considered a very addictive drug and research has indicated that it can be damaging to a patient’s health and in severe cases increase the risk of early death if misused.
Scientific research has indicated that it has high abuse and addiction potential and because of this it has become more tightly regulated. (7)
In 2014 Tramadol became a schedule 3 Controlled Drug (CD) which means that doctors prescribing the drug there are required to abide by certain conditions which include:
However, it is important to realise that Tramadol has a lower potential for abuse than heroin and oxycodone (oxycontin), so it is one of the safer controlled drugs and it has many benefits within the area of medicine if used, prescribed and managed carefully. (7)
Some of the side effects that users may experience when taking Tramadol include:
Tramadol is a strong opioid drug with many positive psychoactive effects which makes it a very easy drug to become psychologically addicted to.
As well as alleviating pain Tramadol:
This is a similar effect to other opioid drugs which contain chemical elements that attach to compatible opioid receptors in the human brain.
Once attached they activate the reward pathway in the brain that is responsible for providing us with positive feelings such as relaxation and euphoria.
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It is because it triggers the dopamine pathway and gives users a unique “high” that it is considered a powerful psychologically addictive drug as users become transfixed on re-experiencing the initial high they received when they first took the drug.
Their motivation to continue to take Tramadol is positively reinforced through the pleasurable effects it generates. (3,4)
Being a fast-acting pain killer for moderate to severe pain means that Tramadol is a very easy drug to become addicted to if the recommended instructions are not followed, whether this is deliberate or accidental.
People who have suffered injuries and experience moderate to severe pain and recreational users are at risk of becoming addicted to Tramadol.
Other indicators of Tramadol addiction include:
The presence of withdrawal symptoms is a sure sign that a person is physically dependent on Tramadol.
Withdrawal symptoms are instigated by the high amount of toxic chemicals present in Tramadol which have remained in the bloodstream causing a range of unpleasant physical sensations.
Physical dependence develops over a period of time and the first stage in the process occurs when a Tramadol user steadily increases their consumption of the drug.
The more often a person takes Tramadol the stronger the likelihood that they will increase their tolerance to the drug. This means they will need to consume higher doses of the drug to experience the same effects as they did when they originally took the drug. (1,5)
If, after a period of sustained use a Tramadol user goes 1-2 days without taking the drug (in some cases it can be as little as 8-10 hours) they will begin to experience withdrawal symptoms.
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This is because their central nervous system has become accustomed to processing Tramadol and the body has adapted to its presence to allow Tramadol users to function on a daily basis.
If Tramadol use is stopped suddenly the opioid receptors in the brain are thrown into a state of confusion and behave erratically resulting in a range of withdrawal symptoms.
Tramadol is a fast-acting drug which means that tolerance to the drug can build up quickly as it has a short half-life so the body adapts to the presence of the drug and processes it quickly and efficiently.
It is easy to become physically dependent on Tramadol within a few weeks as users consistently seek its effects which lessen each time they consume the drug. (1,5)
All opioid drugs differ slightly in their chemical structure and design even though they all tend to be very suitable for pain relief.
Tramadol is unique in that it generated many opioid-associated withdrawal symptoms when prolonged use is suddenly stopped but other atypical withdrawal symptoms are apparent when withdrawing from Tramadol which is not the case with other opioid drugs. (12)
The main side effects experienced when withdrawing from Tramadol include:
There are two main areas to the treatment process for Tramadol addiction, firstly treatment tends to focus on the patient’s physical dependence by utilising a pharmacological treatment known as detoxification, or detox.
Once a patient’s physical dependence has been brought under control they can begin their own personal therapy programme to target their psychological dependence on Tramadol. (4)
Senior medical specialists may recommend that patients diagnosed with moderate or severe Tramadol addiction follow a residential programme to help them overcome their addiction.
This allows them to be more closely monitored both physically and mentally to ensure they do not relapse or suffer adverse reactions during the early stages of detox.
However, this does depends on the budget of the patient as rehab treatment can be expensive and it can take a while for funding to cover the cost of treatment to be approved.
Outpatient programmes cost less and are suitable for patients with mild addiction who are supported by an understanding and caring family.
However, all patients have unique circumstances which need to be carefully reviewed by substance use professionals before a final decision is made.
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To treat physical dependence on Tramadol medical practitioners use a pharmacological approach called drug tapering to help with the detox process.
Detox treatment is necessary to help the patient gradually remove all traces of Tramadol from the body.
This has to be a gradual process because if the treatment is not managed carefully withdrawal symptoms can intensify and the whole treatment process would have to start again from the beginning. (12)
Tapering is a straightforward and reliable technique used to help patients detox off psychoactive drugs and involves doctors prescribing reduced doses of a substitute opioid drug (e.g methadone) over a period of weeks or months (depending on the patient’s pattern of use).
Methadone is a slower-acting drug so will be absorbed into the body gradually and will be able to keep withdrawal symptoms at bay for at least 24 hours.
The tapering schedule differs between all patients and the medical team will be required to review all of the patient’s drug history and medical records to establish the correct starting dose and schedule that is appropriate for them. The dose size should always be enough to prevent withdrawal symptoms.
After 2 weeks the dose size is reduced by 5-10% and the patient takes this dose daily for another 2 weeks at which stage the dose size is reduced again. This continues until the patient is on the lowest dose possible. (9,12)
Depending on the severity of their addiction some patients may wish to detox without entering a tapering regime, but their withdrawal symptoms still need to be managed. There are also other medications available to assist in alleviating uncomfortable withdrawal symptoms associated with Tramadol withdrawal.
Research has found that drugs in the benzodiazepine group such as clonazepam and lorazepam can help to decrease the withdrawal symptoms that patients experience. They are particularly effective for treating psychological symptoms such as anxiety, irritation, agitation and restlessness.
There are also hypertension medications available to help patients going through detox treatment for Tramadol addiction. Clonidine and Moxonidine have in the past proven to be very successful in helping many patients withdraw from opioid drugs.
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Tramadol like most psychoactive drugs elicits positive sensations in people who take the drug. These are very powerful sensations and play a huge role in helping to maintain a person’s addiction.
These powerful positive feelings such as an elevated mood or a euphoric state provide a source of comfort for the user, and they begin to learn that they can take Tramadol to improve their negative psychological and emotional state if they wish to.
Over time they gradually come to rely on the drug to boost their mood and help them cope with various stressors and difficulties in their everyday life. (5)
There is a strong research base that suggests that combing psychological therapies and emotional support alongside detox treatment improves patients’ chances of having a successful outcome compared with just receiving detox treatment alone. (4)
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Treatment programmes for Tramadol addiction also feature several psychological therapies and techniques designed to help clients overcome their psychological dependence on Tramadol.
These include:
CBT is a common inclusion in many drug addiction treatment programmes and is seen as an effective therapy for all kinds of psychological distress. CBT targets patients’ unhelpful and inaccurate thought processes that frequently lead to them experiencing anxiety, low mood and low self-esteem.
This negative mindset acts as a catalyst for them to seek out substances that elevate their mood and make them feel good.
This is because they mistakenly believe that taking drugs is the only way that they can obtain a positive experience. CBT will help them to change such irrational beliefs and incorrect assumptions. (5,10)
DBT is a combination of therapy and education as the patient learns effective strategies they can implement to deal with strong, challenging emotions which can at times be very overwhelming for them.
DBT therapists will work with the patient and explore situations in which they have difficult feelings to deal with and teach them how to tolerate these feelings without being consumed by them.
This means they will be able to remain calm, contained and free to focus on other aspects of their lives. (4,5)
Contingency Management is a psychological intervention or strategy utilised by treatment staff to keep the patient motivated on recovery rather than a form of therapy.
It involves offering rewards and incentives to keep patients on track with their progress towards giving up Tramadol. This intervention is based on behavioural psychology and in particular the concept of shaping people’s behaviour through positive reinforcement.
Patients, will for example be given a reward for attending therapy sessions, support group meetings and returning a negative drug test which demonstrates that they are making an effort to overcome their addiction.
By positively reinforcing the behaviour patients are more likely to remain motivated to carry on their good work. (4,10)
It is now well established in the addiction research field that trauma plays an important role in the development of addiction.
In response to this treatment centres have introduced several trauma-based therapies to help clients process the traumatic events in their lives that they have unconsciously repressed but still drive their behaviour. (10a)
There are several specialist forms of counselling and psychotherapy (e.g CBT) that have been adapted to help treat patients who have experienced severe trauma in their lives.
Some of these therapies are integrated to help patients deal with the distressing symptoms of post-traumatic stress disorder (PTSD) and make them feel safe again away from the perceived threats that their distressing intrusive memories generate.
EMDR is a treatment process and form of psychotherapy that helps patients unblock previous traumatic memories which have somehow become stuck in their memory processing system causing them significant distress.
The therapy sessions are combined with exercises which involve instructing the clients to perform sideway eye movements at certain moments in the session when they talk about distressing memories.
EMDR has a strong scientific base behind it and has produced promising results in alleviating trauma-associated symptoms. (10a)
There is a range of holistic therapies available at treatment centres, all of which have contributed to client’s well-being including:
These therapies offer a unique approach to help untangle difficult emotions as they offer a different route to expressing feelings instead of the traditional talking approach that is a feature of psychotherapy and counselling sessions. (4)
Treatment centres also offer a range of group therapies to help patients process any social and relational difficulties they may have developed as a result of their addiction.
Support groups – Attending peer support groups such as Narcotics Anonymous enables clients in recovery to build meaningful connections with other people who have been through similar experiences.
Their shared experiences enable them to forge strong bonds which enable them to support, motivate and encourage each other to recover. These groups adopt the AA principle that fellowship leads to recovery (5)
Therapy groups – Attendees can improve their social skills and obtain an understanding of their communication patterns and social behaviour, which they may not have been aware of during group therapy.
They can also learn that they share many things in common with other people in the group that they may not have previously realised. By engaging with other group members clients in recovery can develop empathy and begin to value the beliefs and perspectives of others which will only benefit their recovery.
Family therapy – Will help to address unconscious negative family dynamics and poor communication patterns that may have negatively impacted the mental health of family members
Couples Therapy – Helps to reconnect couples who have lost trust between them due to the fact one of them has struggled with addictive behaviour. It is important to inform the partner of the patient that addiction is a disease and not a choice and that they can play an important role in helping their spouse recover. (10,12)
At Rehab 4 Addiction, we offer free advice from a team of non-judgemental professionals, many of whom are in recovery and understand how hard it can be to change your relationship with addiction.
For more information, simply reach out to our 24/7, confidential hotline on 0800 140 4690.
Relapse prevention is a significant part of a patient’s treatment plan as it provides patients/clients with a range of psychological skills that will help prevent them from engaging in Tramadol use in the future.
There are usually two stages to relapse prevention:
Treatment organisers strive to help patients continue their recovery after their treatment plan has been completed, although realistically speaking treatment is never over as recovery is an ongoing process that can last a lifetime.
Consideration of the following points ensures that patients continue to remain abstinent: (12)
(1) Buttner, B, (2014) The Neuropathology of Drug Abuse in Madras, B. & Kuhar, M. (ed) The Effects of drug abuse on the human nervous system. Academic Press. London.
(2) DrugAbuse.gov (2021) Prescription Opioids Drug Facts (online) @Prescription Opioids DrugFacts | National Institute on Drug Abuse (NIDA)
(3) Harvard Medical School (2022) Is Tramadol a risky medication? available@Is Tramadol a risky pain medication? – Harvard Health
(4) Herie, M. & Skinner, W. (2014) (ed) Fundamentals of Addiction: A Practical Guide for Counsellors. CAMH. Canada.
(5) Moss, A, Dyer, K (2010) The Psychology of Addictive Behaviour. Palgrave McMillan. New York.
(6) National Health Service (2023) Tramadol, available@ Tramadol: strong painkiller to treat severe pain – NHS (www.nhs.uk)
(7) National Health Service (2014) Recent changes in controlled drug legislation for Tramadol, lisdexamfetamine, zopiclone and zalepon. available@Recent changes in controlled drug legislation for Tramadol, lisdexamfetamine, zopiclone and zalepon – NECS Medicines Optimisation (necsu.nhs.uk)
(8) Newton, D.E. (2016) Prescription Drug Abuse. ABC-CLIO California
(9) Rajabizadeh, G. et al (2009) Psychosis following Tramadol Withdrawal. Addiction and Health. 1(1). available@ Psychosis following Tramadol Withdrawal – PMC (nih.gov)
(10) Rassool, G.H. (2011) Understanding Addictive Behaviours. Palgrave MacMillan
(10a) Shapiro, F. EMDR Therapy: Basic principles, protocols and procedures. Guildford Press
(11) Wills, S. (2005) Drugs of Abuse. Pharmaceutical Press. London.
(12) Yoon, R. (2014)Opioid Addiction In Herie, M. & Skinner, W. (ed) Fundamentals of Addiction: A Practical Guide for Counsellors. CAMH. Canada.
