Ultram is generally regarded as having a relatively low potential for addiction; however, significant symptoms during withdrawal are noticed on a consistent basis, and abuse, dependency, and psychological cravings for the drug amongst those prescribed are noticed amongst a large number of patients. For example, a 3-year study in the Journal of Family Practice revealed that 28% of patients prescribed tramadol developed an addiction to the drug.
Ultram, the trade name for tramadol, is a synthetic opiate pain reliever prescribed for moderate to severe pain. It can be habit-forming and can produce unpleasant withdrawal symptoms. Ultram's potential for abuse has been increasingly recognized in recent years, with the Drug Enforcement Agency naming it a Schedule IV controlled substance in August 2014.
Abuse of Ultram is rising, with many users taking excessive doses in order to simulate the euphoric effects of other stronger opiates.
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Tramadol (brand name: Ultram) is an opioid analgesic (painkiller). It is prescribed to treat moderate to moderately severe pain and is considered a safer alternative to other narcotic analgesics like hydrocodone (Vicodin, Lortab) and methadone.
Additional medications containing tramadol include Ultram ER, an extended release formulation for round-the-clock pain relief, and Ultracet, a combination of tramadol and acetaminophen (Tylenol).
Tramadol was originally considered to have a much better safety profile than other opioid analgesics like morphine or hydrocodone. The US Food and Drug Administration (FDA) originally approved tramadol for use in 1995, and recommended it not be classified as a controlled substance.
However, due to mounting evidence of abuse among the general public, as well as evidence of withdrawal symptoms upon cessation, the Drug Enforcement Administration (DEA) published revised rules in 2014 making tramadol a federally controlled drug (Schedule IV).
When taken orally in pill form, the liver metabolizes tramadol into several chemicals including O-desmethyltramadol, which produces much more potent effects than tramadol itself. Taken orally at high doses, tramadol can produce an euphoric high similar to another commonly abused opiate medication, oxycodone (OxyContin).
Tramadol abuse has also been documented among adolescents in high school, where the drug is also known by the slang name "ultras." Though there is scant reporting on national teen tramadol abuse, the Monitoring the Future survey revealed that 9.5% of high school seniors had ever taken a narcotic other than heroin - a group of drugs that includes tramadol - for non-medical reasons.
Furthermore, the availability of tramadol and other drugs from sources like Internet websites or friends with legitimate prescriptions mean parents should make sure their children are informed about the dangers of abusing any drug not prescribed to them specifically.
Although tramadol abuse is smaller in scope compared to other opiate painkillers, the number of people using this drug for nonmedical purposes and the consequences of that use are still significant. Some key tramadol statistics from the National Survey on Drug Use and Health and the Drug Abuse Warning Network include:
Tramadol is a prescription opioid painkiller for moderate pain. It's often used for pain after surgery or for chronic pain from conditions like fibromyalgia.
Tramadol most often comes in 50mg, 100mg, 150mg, 200mg, and 300mg tablets and is taken orally. Tramadol should never be taken in combination with other opioids. Brand names of tramadol include:
Common street names for tramadol include trammies, chill pills, and ultras.
Tramadol works by binding to opioid receptors in the brain, which relieves pain. Although it is effective at treating mild to moderate acute or chronic pain, tramadol is one of the least potent painkillers available. However, tramadol can still be addictive, especially when taken for a long period of time or when taken in larger doses than prescribed.
Those who misuse or abuse tramadol are at risk for developing an addiction. In some cases, even people who follow their doctor's directions can become addicted.
After frequent, prolonged tramadol use, many people develop a tolerance to the drug. This means they have to take larger doses to feel the drug's effects. Along with tolerance, tramadol users may experience withdrawal symptoms when they stop using the drug. Tramadol withdrawal can cause irritability, depression and flu-like symptoms.
Tolerance to and withdrawal from tramadol are common signs that someone has a tramadol dependence. They may also be signs of a tramadol addiction, a chronic, neurobiological disease with genetic, psychosocial, and environmental factors, all of which influence how it develops. Other signs of an addiction include frequent cravings, relationship problems caused by drug use, and uncontrollable use of tramadol.
Tramadol is sometimes abused alongside other drugs, which is called polydrug use. Typically, users combine tramadol with other substances to increase their high or self-medicate. The following drugs are commonly combined with tramadol:
The risk of developing an addiction to tramadol is higher when the drug is taken with other substances. As a CNS depressant, it can be very dangerous to mix tramadol with other CNS depressants, like alcohol, opioids and sedative hypnotics. Mixing these substances can lead to respiratory depression. It also increases the risk of seizure or overdose.
Those who have a history of substance abuse are more likely to develop an addiction to tramadol. However, even those who have never abused alcohol or drugs are at risk. Tramadol is commonly prescribed because it is considerably less addictive than most other medications, but that definitely does not mean it is risk free.
A person who abuses tramadol may not necessarily be addicted to the drug. The presence of both a physical and psychological dependence on tramadol typically indicates an addiction.
As mentioned, in addition to its opioid-like effects, tramadol also increases brain levels of the neurotransmitters serotonin and norepinephrine, similar to the changes induced by antidepressant drugs including venlafaxine (Effexor).
Users have reported that such mood-elevating properties caused them to take higher doses of the drug - or take it more often - than had been prescribed.
In addition to the euphoric and mood-enhancing effects sought by tramadol abusers, taking this drug for nonmedical purposes, or taking it in a manner different from that prescribed by a doctor, can have negative and sometimes dangerous results. These include disturbed sleep patterns resulting in insomnia, and the aforementioned increased risk of convulsions or seizures.
Additionally, abusing tramadol can lead to tolerance and dependence. Examples of Ultram dependence include:
Individuals who abuse tramadol for an extended period of time and develop psychological dependence may begin to experience compulsive cravings to take the drug and to feel that they need it to cope with everyday problems.
People who are psychologically addicted to tramadol can feel anxiety if they do not have access to the drug and will engage in behaviors such as doctor shopping or prescription forgery in order to maintain their supply.
Often times, the anxiety can get out of control, to the point where the Ultram addict will behave irrationally and even appear to be significantly disturbed mentally. If he or she is unable to access the drug, they may look to other drugs to help combat the feelings of anxiety and paranoia. Alcohol is a popular option.
Abusers who continue to take tramadol long enough and at high enough doses will eventually develop a physical dependence on the drug and experience unpleasant, or even dangerous, symptoms of withdrawal if they stop taking the medication.
As one of the least potent opioid painkillers, many people believe tramadol is not addictive. This false sense of security can lead some people to develop an addiction without even realizing it.
Using tramadol without a prescription or taking it in higher doses, more often or for longer than prescribed are all considered abuse of this drug. Combining tramadol with other substances to increase its effects is also abuse.
It's important to recognize the signs of tramadol abuse as early as possible to prevent an addiction from developing. Signs and side effects of tramadol abuse include:
Tramadol misuse or abuse has the potential to lead to severe adverse reactions, such as seizures. Seizures are most likely when large dosages are taken (usually 400mg or more daily), for extended periods of time. Seizures are also more common when tramadol is taken with of antidepressants.
More severe symptoms of tramadol abuse typically occur when higher doses of the drug are taken or when tramadol is taken in combination with another substance. Severe symptoms of tramadol abuse can include seizures and central nervous system depression.
CNS depression is when the central nervous system slows down to the point where the heart rate and breathing decreases, which can lead to loss of consciousness, coma, and potentially even death.
According to the Diagnostic and Statistical Manual of Mental Disorders, there are 11 criteria that characterize addiction. Depending on how many of the criteria apply, a person can have a mild, moderate or severe substance use disorder or addiction.
The following behaviors are commonly associated with an addiction to tramadol:
The development of tolerance and withdrawal symptoms are signs of a physical dependence on tramadol. Craving the drug is a very common sign of a psychological dependence.
Overcoming a tramadol addiction typically involves drug detox, an inpatient or outpatient treatment program and ongoing therapy and support groups. Detox—the process of removing toxins from the body—is the first step toward sobriety for tramadol users.
Medical detox is offered in most inpatient and outpatient programs. Doctors usually recommend weaning tramadol users off the drug to reduce withdrawal symptoms during detox. Tapering off the drug under the supervision of a physician is more comfortable and effective than quitting "cold turkey."
Once the user is free of their physical dependence on tramadol, treatment then focuses on eliminating their psychological addiction to the drug. Inpatient and outpatient rehabs offer various therapies to aid in this process, like one-on-one counseling and group therapy.
After rehab, support groups and ongoing therapy can help recovering tramadol addicts remain sober. The support of family and friends is also extremely important in recovery.
Inpatient rehab is ideal for those with severe addictions and co-occurring mental disorders. These programs provide a high level of care and supervision, and also allow tramadol users to immerse themselves in treatment without temptations or distractions.
Residential treatment centers usually offer programs that last from 28 to 90 days. However, in the event that a person needs to stay in treatment for longer than 90 days, many rehabs will extend the length of the program. Most inpatient rehabs operate under strict rules and require their residents to stick to a schedule.
When choosing a treatment center, it's important to find a program with experience treating tramadol addiction. Some rehabs specialize in the treatment of certain substances - including Ultram addiction, as well as co-occurring disorders and polydrug use.