Tramadol Proves There’s No Such Thing as a ‘Safe’ Opioid

Tramadol Proves There’s No Such Thing as a ‘Safe’ Opioid

The opioid crisis is proving time and time again that our pharmaceutical systems are broken. Just when officials get a handle on one opioid, another dangerous new opioid surfaces and the process of putting a stop to over-prescription, getting the drug off the streets and allocating resources for opioid addiction treatment starts again.

Tramadol Proves There’s No Such Thing as a ‘Safe’ Opioid

The opioid crisis is proving time and time again that our pharmaceutical systems are broken. Just when officials get a handle on one opioid, another dangerous new opioid surfaces and the process of putting a stop to over-prescription, getting the drug off the streets and allocating resources for opioid addiction treatment starts again.

The latest drug to raise concern among law enforcement and the medical community is tramadol, an opioid painkiller long thought to be non-addictive. Tramadol is fuelling an opioid epidemic in West Africa, and cycling’s governing body, Union Cycliste Internationale (UCI), has banned tramadol for competitive cyclists despite its absence from the World Anti-Doping Agency’s prohibited list. All this leaves many wondering why tramadol’s pernicious effects weren’t known sooner, especially as numerous countries face the high human cost of opioid addiction.

What is Tramadol?

Tramadol, sold under the brand name Ultram or generically as tramadolis, is a synthetic opioid pain medication used to treat mild to moderately severe pain by blocking the brain’s pain signals. It’s about one-tenth as strong as morphine and equally potent as codeine, and can be taken in many different forms including pill, injection, syrup, suppository, powder, or elixir. The effects of tramadol normally peak within four to six hours.

Tramadol was first synthesised in 1962, and went on the market in 1977; it was developed by the same West German pharmaceutical company that marketed thalidomide as a treatment for morning sickness, resulting in thousands of birth defects. Tramadol was approved for use in Great Britain and the US in the mid-1990s, and has since gained a reputation among doctors as a ‘safe’ alternative to opioid painkillers.

But reports of tramadol abuse began to emerge, including one especially disconcerting incident in which four ninth grade girls ended up in the hospital after overdosing on tramadol. The US Drug Enforcement Administration (DEA) listed tramadol as a drug of concern in 2008, and in 2014 it was listed as a schedule IV drug, effectively banning possession without a prescription. Tramadol is also on the controlled list in Australia, and Canada recently reclassified tramadol after seeing prescriptions rise by 30 percent from 2012 to 2016. But despite the growing concern around tramadol’s addictive qualities, it was the 39th most-prescribed medication in the US in 2016.

Risks of Tramadol Use

Tramadol’s side effects have long been considered mild, but that’s not always the case. Possible side effects of tramadol can range from minor symptoms like nausea, dry mouth, constipation and light-headedness, to more serious side effects such as hallucinations, difficulty urinating, fainting, seizure, agitation and fast or irregular heartbeat. Tramadol is known to cause serotonin toxicity, a deadly condition that causes excessive nerve activity, and users are also at risk of adverse or allergic reactions.

Tramadol interacts negatively with various medications, both prescription and non-prescription: the list includes anti-depressants, alcohol, pain medications, naltrexone, MDMA, marijuana, some HIV drugs and St. John’s wort. This list is not exhaustive, and patients on tramadol must disclose all medications and substances they are using to their doctor.

The bottom line is that tramadol’s effects can be unpredictable and dangerous, particularly for those taking other medications, the elderly and patients with pre-existing health conditions. This supposedly innocuous medication can quickly become deadly in the absence of rigorous medical supervision.

Symptoms of Tramadol Addiction

Tramadol addiction is a very real risk, especially if you have a history of addiction or depression. Know the signs of addiction and get help immediately if you suspect that you or someone you love has become addicted. Here are some key signs:

  • Physical dependence: If you experience withdrawal symptoms such as sweating, anxiety, difficulty sleeping or seizures when you stop taking tramadol, you’re likely physically dependent on the drug.
  • Psychological dependence: If you feel like you need tramadol to get through the day and cope with life’s challenges, you could be psychologically dependent.
  • Continued use despite negative consequences: When your tramadol use begins to affect your health, relationships, finances and ability to follow through on work and personal commitments, yet you continue to use, you should seek help.
  • Deviation from prescribed use: If you’re not using tramadol as your doctor prescribed, or if you’re seeking tramadol from sources other than your doctor, your tramadol use has probably crossed the line into abuse.
  • Needing more and more tramadol to have a similar effect: If you’re taking tramadol for its euphoric effect, you will find yourself building a tolerance to the drug and needing more and more to produce that same euphoria. This is a sign you need to examine your relationship with opioid use.
  • Physical and psychological symptoms: Sleep disruption, loss of appetite, mood swings, muscle aches, depression and fever and some of the effects of tramadol abuse. Other effects such as dizziness, fatigue, constipation and dry mouth may overlap with the normal side effects of tramadol; if you are chronically experiencing side effects and also have one or more of the risk factors above, you may be addicted to tramadol.

Of course, not everyone who takes tramadol becomes addicted, but anyone who takes tramadol must take it only as prescribed and immediately tell their doctor if tramadol is becoming a problem.

How to Identify a Tramadol Overdose

The risk of overdose is highest for those who are addicted to tramadol, particularly when the drug is mixed with other opioids or antidepressants. Familiarize yourself with the symptoms of tramadol overdose in order to recognise it in yourself or a loved one:

  • Laboured breathing
  • Vomiting
  • Confusion
  • Loss of consciousness
  • Change in pupil size
  • Hyperthermia (extremely elevated body temperature)
  • Purple or bluish nails and/or lips
  • Seizures
  • Irregular heart rate
  • Weakness or limpness

If you suspect overdose, call for help immediately. If you have naloxone, you should administer it. Naloxone is an opioid antagonist that temporarily reverses the effects of an opioid overdose. Currently, Naloxone is only available by prescription in Australia and the US, but these countries are taking steps to increase availability. If you or someone you love is addicted to opioids, you should always have naloxone available. Just remember that naloxone is only a quick fix to be used in emergency situations, and that medical attention is still needed in the case of an opioid overdose.

Why Do Doctors Still Think Tramadol Is Safe?

Many drug epidemics have originated in the offices of doctors who believed that the drugs they were prescribing would help rather than harm. Tramadol addiction has been driven by widespread over-prescription by doctors, who originally believed the drug was a safe alternative to stronger opioids like morphine.

Research done around the time of tramadol’s introduction to the US market showed the incidence of tramadol addiction was about one to three for every 100,000 patients who were prescribed the drug; however, this research was signalled as possibly biased and non-representative by the World Health Organization, which commented that the research “may have underestimated the true incidence of (tramadol) abuse.”

There was also initially confusion over tramadol’s status as an opioid: it’s not structured like a typical opioid, and though it does bind to the same receptors as other opioids, it does so very weakly. The US government now identifies tramadol as an opioid, and in the DEA’s ruling to list tramadol as a controlled substance, several experts noted that underestimating its potential for harm had likely caused even more damage.

The truth is, there’s just not enough research to definitively conclude that tramadol has a low potential for abuse. The opioid crisis is always evolving as addicted patients turn to new drugs when officials restrict access to more commonly abused opioids.

Quitting Tramadol

If you or a loved one is suffering from tramadol addiction, it’s imperative that you get help. Quitting tramadol on your own is not recommended: withdrawal symptoms can be painful at best and dangerous at worst, and might cause you to see out the drug again to feel better. Effects of tramadol withdrawal include:

  • Flu-like symptoms such as nausea, vomiting and diarrhoea
  • Psychological effects such as agitation, confusion, depression and anxiety
  • Numbness or tingling of extremities
  • Insomnia
  • Hallucinations
  • Paranoia
  • Racing heart

For those who are physically dependent on tramadol, entering an in-patient detox facility is usually recommended before beginning addiction treatment. Here, detox-specialised medical staff will evaluate your condition, keep you safe and comfortable through the difficult withdrawal period and ensure you’re physically and mentally prepared to enter an opioid treatment programme. Detox is an important first step in addressing your addiction, but it’s important to remember that it’s only the first step of many. In order to fully recover, you must uncover and address the root cause of your addiction, and develop healthy coping skills and lifestyle practices that support your sustained sobriety.

Siam Rehab Can Help You Recover from Tramadol Addiction

Addiction is a painful and lonely experience, but at Siam Rehab’s community-oriented treatment centre, you’ll be among friends. Our top-notch detox programme is overseen by an experienced medical director who specialises in opioid detox.

After detox, you’ll be able to enter treatment in our beautiful facility and reap the benefits of one-on-one and group counselling, equine-assisted therapy, mindfulness meditation training, fitness classes and the support of a community of like-minded people who are also working to recover from addiction. Siam Rehab’s scenic rural location in Chiang Rai, Thailand will take you out of the environment that spurred your addiction and return you to wellness.

Contact us today to learn more about how we can help.

King Baby Syndrome and Addiction

King Baby Syndrome and Addiction

Addiction is hard to experience and hard for loved ones to watch, in large part because it changes people. The disorder can transform generous and empathetic loved ones into self-serving and entitled strangers, and if you’re the one suffering from addiction, you may sometimes feel as if you don’t even know yourself anymore.

King Baby Syndrome and Addiction

Addiction is hard to experience and hard for loved ones to watch, in large part because it changes people. The disorder can transform generous and empathetic loved ones into self-serving and entitled strangers, and if you’re the one suffering from addiction, you may sometimes feel as if you don’t even know yourself anymore.

What many don’t know is that some people who have substance use disorder are falling prey to what addiction expert Tom Cunningham calls King Baby Syndrome. King Baby Syndrome causes addicts to act out, complicates recovery and makes people more susceptible to addiction in the first place.

The Myth of Narcissus

The ancient Greek myth of Narcissus tells the story of a young man named who was known for his beauty and pridefulness. After he scorned his admirer Echo so cruelly that she faded away out of despair, the gods decided to punish Narcissus and lured him to a spring to drink some water. Narcissus saw his reflection and immediately fell in love, not realising that he was looking at himself. Entranced, he couldn’t stop gazing at his reflection, but since his feelings could never be reciprocated, he died of heartbreak.

The story of Narcissus has been a touchstone in popular culture for over a millennium. Ovid popularised a version of the myth in 8 AD, Shakespeare frequently mentioned Narcissus in his poetry and the Romans depicted Narcissus in their art. But perhaps the most famous analysis of Narcissus came from famed psychoanalyst Sigmund Freud, who used the myth to illuminate his philosophies around the human psyche.

Freud argued that narcissism is useful when we are first born and must focus on our survival and development. As a normal result of learning about social conventions and rules of our society, children grow out of “primary narcissism,” as Freud called it, and adjust their expectations of themselves and others accordingly.

His Majesty, the Baby

However, some adults never grow out of primary narcissism, and continue to exhibit the self-gratifying behaviours common in children throughout life. Freud referred to this type of person as “his majesty, the baby” in his seminal essay “On Narcissism,” which led to Cunningham’s popular King Baby Syndrome designation.

Researchers have identified two possible causes of narcissistic tendencies: childhood environment and genetics. If a child grew up in a hostile, abusive or unsafe environment, they’re more likely to exhibit King Baby Syndrome. The same is true for children who were excessively praised or who had parents who didn’t impose boundaries. More research is needed into how genetics could influence the development of narcissism, but a 2013 study showed that brain scans of narcissists showed less grey matter in the region of the brain that is associated with empathy. Dopamine deficiency could also play a part in narcissism – a lack of self-awareness is a symptom of low dopamine as well as a common trait of narcissists.

It’s important to distinguish between narcissism and narcissistic personality disorder (NPD), which is a condition recognised in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Narcissism exists on a spectrum, and a healthy amount of narcissism in an individual is a good thing. Farther over on the spectrum, an overly confident person who exhibits excessively self-serving behaviours can be called a narcissist. However, for a clinical diagnosis of NPD, a patient must exhibit an extreme lack of object constancy and self-esteem disguised as overinflated self-confidence.

King Baby Syndrome certainly lies somewhere along that spectrum: many of the behaviours that identify His or Her “Majesty” are associated with narcissism, and the condition has even been called “Peter Pan Syndrome” after the childishness that characterises it.

His Majesty, the Addict

So what exactly do Narcissus, Freud and King Baby Syndrome have to do with addiction? As it turns out, a lot. Tom Cunningham popularised the phrase King Baby Syndrome with the release of a pamphlet on the subject, published by Hazelden in 1986. He argued that people with substance use disorders are especially prone to the condition, and that King Baby Syndrome can cause addictions to be more intense and recovery more difficult.

Recognizing King Baby behaviours is important for those in recovery. Recovery is not about simply abstaining from your substance of choice, but also digging deeper to identify how you were drawn into an addiction in the first place. Learning about harmful thought patterns and behaviours helps recovering addicts to see their own behaviour more clearly and take steps to change it. Here are some common traits of King (and Queen) Babies:

  • Issues with authority figures
  • Belief that rules shouldn’t apply to them
  • All-or-nothing thinking: everything is either fantastic or terrible, black or white, with no middle ground
  • Rage when criticised
  • Big plans and lack of follow-through
  • Tendency to suppress feelings, leading to inability to experience feelings
  • Need for approval that supersedes self-identity
  • Extreme behaviour
  • Lack of personal responsibility: when things go wrong, they blame everyone but themselves
  • Constant dissatisfaction
  • Intense fear of abandonment
  • Excessive focus on money and material possessions
  • Thrill-seeking behaviours
  • Intense fear of failure and rejection
  • Unkindness to people deemed “unimportant”
  • Loneliness and a feeling of not belonging

Every King Baby is different, of course, but they all share a lack of personal responsibility and the childlike belief that the universe revolves around them. Lacking a solid sense of self, addicts who are King or Queen Babies will seek fulfilment from external sources, just as Narcissus did when he gazed at himself in the pond. Addiction is a way for the King Baby to mask the pain that is causing his behaviour.

It’s also important to note that King Babies aren’t bad people, but due to an untreated mental illness, history of trauma or brain chemistry imbalance, they have some learning to do about how to satisfy their needs without harming others. In his pamphlet, Cunningham uses the image of a frightened child hiding deep inside the addict suffering from King Baby Syndrome. The child is a representation of our trauma, and the King Baby will incessantly attempt to destroy the scared child by seeking approval, using substances or acquiring material things. However, the scared child is a void that cannot be filled with money or substance or any other external factor: only when the addict’s relationship with themselves is improved will they experience any sort of satisfaction.

How King Babies Can Grow Up

You might be discouraged to recognise some of these behaviours in yourself, but identifying King Baby behaviour is the first step in changing it. An important part of recovery is becoming more aware of yourself and how your behaviour impacts those around you.

A big part of Cunningham’s solution was to put faith in a higher power, but even if you don’t subscribe to the Alcoholics Anonymous tenet of religion, he still had a few good recommendations for King and Queen Babies in recovery:

  • Try to live in the moment, rather than thinking about the past or worrying about the future
  • Focus on how you can improve yourself rather than dwelling on the shortcomings of others
  • Let go of grudges and resentment
  • Follow a policy of honesty and don’t tell people what you think they want to hear
  • Remember that the same rules apply to you as to everyone else
  • Keep calm when things don’t go your way

And most importantly, you should always seek the guidance of a therapist or medical professional to help you work through the issues that caused King Baby Syndrome in the first place. A therapist can also help you learn healthy coping skills and establish strong positive thought patterns to eradicate the control King Baby has over you.

Healing the Scared Child Inside

At Siam Rehab, we believe that a person is more than just their addiction. To simply stop using a substance isn’t enough: for complete recovery, we employ a multifaceted approach that treats the whole person. We combine the 12 Steps with cognitive behavioural therapy, mindfulness meditation, yoga and physical fitness programs in order to heal the mind, body and spirit.

Contact us today to find out how we can help you.