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.
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.
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.
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:
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.
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:
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.
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.
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:
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.
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.