Understanding Tramadol Addiction
Tramadol is an opioid painkiller used to treat moderate to moderately severe pain. Ultram is a brand name for tramadol, which was developed by Ortho-McNeil-Janssen Pharmaceuticals, a subsidiary of Johnson & Johnson, and approved by the FDA in 1995.
Tramadon/Ultram addiction is a serious medical problem that can take a devastating toll on your life. It can wreck health, damage relationships and destroy your sense of wellbeing. Here, we look at why people abuse opioids like tramadol, how opioid abuse can transition to addiction and dependence, and how treatment can end even a severe addiction to opioids.
What Is Opioid Abuse?
When used exactly as prescribed by a physician, tramadol is a safe and effective medication for treating pain. However, according to the Centers for Disease Control, as many as one in four patients receiving long-term opioid treatment struggle with an opioid use disorder. 1
Prescription opioid abuse is characterized as using prescription painkillers in a way other than exactly as prescribed by a physician. This includes taking larger doses of opioids than prescribed, taking opioids that are prescribed to someone else, or using opioids with alcohol, illicit drugs or other psychoactive medications Klonopin or like Xanax.
Guidelines for Prescribing Opioids
Because opioid abuse is so common–it’s the number-one cause of preventable death among 18- to 25-year-olds–the Centers for Disease Control has issued a series of guidelines for prescribing opioid painkillers.
- Prescribing the lowest effective dose of immediate-release opioids.
- Prescribing the smallest possible quantity of opioids needed for the duration of the pain, typically three to seven days.
- Evaluating a patient for risk factors that increase the chances of becoming addicted or dependent.
- For chronic pain, exhausting all other non-opioid treatment options before turning to opioids.
- Evaluating the benefits and harms of the opioid therapy at least every three months when it’s used to treat chronic pain.
- Using urine testing before starting opioid therapy, and periodically thereafter, to assess for illicit drugs and other controlled prescription medications.
Why People Abuse Opioids
Opioid painkillers like tramadol produce intense euphoria and feelings of calm and wellbeing. However, opioids produce tolerance very quickly, which means that effects only continue to occur when dosage is increased. People who abuse opioids typically have underlying risk factors for abuse and addiction, including pain, chronic stress, trauma and mental illness.
According to the 2012 National Health Survey, two-thirds of people who abused opioids did so to reduce their pain. Only 10 percent reported abusing them to get high. A study published in JAMA found that up to 6.5 percent of people who are prescribed opioids for acute pain after surgery become persistent users. 2
- Abusing Opioids to Get High 10% 10%
Life situations like poverty, illness or abuse can cause chronic stress, which simmers below the surface and elevates stress hormone levels in the body, which can lead to serious medical problems. People who live with chronic stress may abuse opioid medications in order to relax and reduce the negative feelings and sensations that come with stress.
Trauma, such as being the victim of physical or sexual abuse or surviving situations involving violence or death, changes the brain in key ways. It increases the activity of the amygdala, which is responsible for the body’s stress response and produces feelings of anxiety and fear. Trauma can lead to nightmares, insomnia, anger and flashbacks. Some people with a history of trauma may use opioids to numb their emotional pain, reduce nightmares, improve sleep and cope with negative emotions.
Mental illnesses like anxiety and depression increase the risk of drug abuse and addiction. It’s common for people with a mental illness to self-medicate with drugs or alcohol in an attempt to feel better.
Abusing opioids to relax or reduce emotional pain may seem to make things better, but it ultimately reduces the body’s ability to cope effectively with stress, and it can worsen a mental illness or even cause the onset of new symptoms. It also dramatically increases the risk of overdose, and it can lead to addiction and dependence.
The greatest danger associated with opioid abuse is overdose. Around 115 people die each day from a prescription opioid or heroin overdose. Between 2000 and 2013, opioid overdoses quadrupled, and they continue to rise. From July, 2016 to September, 2017 alone, opioid overdoses increased by 30 percent in 45 states. In the Midwest, they increased by 70 percent.
- Increased in 45 States 30% 30%
- Increased in the Midwest 70% 70%
The Opioid Reversal Drug
Anyone prescribed or using opioids should have naloxone on hand. Known as the “overdose reversal drug,” naloxone is available over the counter in most states under the trade name Narcan. An opioid antagonist, naloxone knocks opioids out of the opioid receptors in the brain and reverses the drug’s depressive effects on the respiratory system
Tramadol Addiction and Dependence
While America accounts for just five percent of the world’s population, we consume 75 percent of the world’s prescription drugs, including 81 percent of the world’s oxycodone and 100 percent of its hydrocodone. Around two million American adults are addicted to or dependent on opioid painkillers like tramadol/Ultram. But addiction and dependence are not the same thing, although they usually occur together.
Addiction causes compulsive drug-seeking and drug-using behaviors despite the negative consequences of abusing opioids. Someone who is addicted will continue to abuse opioids even though it’s causing serious relationship, legal, financial or health problems. Addiction is the result of changes in brain function associated with the learning, memory and reward centers of the brain. These changes lead to compulsive drug abuse, triggered by environmental factors and driven by intense cravings and dysfunctional thought and behavior patterns that develop with addiction.
Dependence is the result of brain changes that occur with heavy drug abuse as the brain alters the function of neurotransmitters in order to compensate for the presence of the drug. For example, opioids produce a dopamine release in the brain that’s 10 times greater than what can occur naturally. In response to heavy opioid abuse, the brain reduces the activity of the dopamine system in an attempt to maintain normal functioning. This leads to tolerance, or the need for increasingly larger doses. But as you increase the doses, the brain continues to change its chemical function. At some point, the brain may begin to operate more comfortably when the drug is present than when it’s not. Then, when you suddenly stop using, normal brain function rebounds, causing physical withdrawal symptoms.
Diagnosing Addiction and Dependence
Opioid abuse, addiction and dependence are diagnosed under the umbrella of “opioid use disorder,” or OUD. The Diagnostic and Statistical Manual, Fifth Edition sets forth 11 criteria that are used to determine whether an opioid disorder is present and whether it can be classified as mild, moderate or severe, depending on how many criteria are met.
Meeting two or three criteria denotes a mild OUD. Meeting four or five indicates a moderate disorder. If more than six criteria are met, the OUD is classified as severe. The criteria cover past-year use and are as follows:
- Taking larger doses of opioids or using them for a longer period of time than you intended
- Wanting or trying to cut down or quit, but finding you can’t
- Spending a large amount of time seeking, using and recovering from using opioids
- Experiencing intense cravings that make it hard to think about anything else
- Using opioids even though they’re causing problems at home, school or work
- Using opioids even though they’re causing problems with your interpersonal relationships
- Losing interest in hobbies and activities you used to enjoy
- Repeatedly finding yourself in risky situations as a result of your opioid use
- Using opioids even though they’re making a mental or physical illness worse or causing a new illness to occur
- Developing a tolerance for opioids, meaning you need increasingly larger doses to get the desired effects
- Experiencing withdrawal symptoms when you suddenly stop using opioids
Treating Opioid Dependence
Once dependence has developed, quitting opioids cold-turkey will cause the onset of withdrawal symptoms, which can range from mild to severe.
Not everyone will experience all of the withdrawal symptoms associated with opioid dependence, which include:
- Runny nose
- Body aches
- Cold and hot chills
- Nausea and vomiting
- Abdominal cramps and diarrhea
- Anxiety or agitation
- Intense cravings
Opioid withdrawal can last anywhere from a few days to a few weeks or longer, depending on:
- Severity of addiction
- How much of the drug is in the body at the time of detox
- Unique biology
- Overall state of physical and mental health
People who are dependent on opioids have two choices for ending dependence: Medical detox and medication-assisted treatment.
During detox, opioids are withheld from the body so that brain function can begin to return to normal. Most people who try to detox on their own will quickly go back to using opioids simply to end the discomfort of withdrawal. Medical detox is a medically supervised detoxification process that involves providing medications as needed to reduce the intensity of withdrawal symptoms and shorten the duration of detox.
High quality medical detox programs offer a high level of emotional support and include a variety of complementary therapies like restorative yoga and acupuncture to improve feelings of comfort and well-being. During medical detox, a range of assessments help care providers develop a comprehensive plan to treat the addiction once detox is complete.
The Substance Abuse and Mental Health Services Administration touts medication-assisted treatment, or MAT, as the gold standard for treating opioid addiction. 3 Medication-assisted treatment involves a combination of medication and counseling to treat dependence and the addiction.
This combination offers the best outcomes, according to a large body of research, which shows that MAT:
- Increases engagement in treatment
- Improves social functioning
- Increases the chances of finding and maintaining employment
- Reduces overdose risk
- Reduces the risk of relapse
- Reduces cognitive problems associated with opioid addiction
- Reduces illegal opioid abuse and crimes associated with it
- Reduces infections like hepatitis and HIV
- Improves birth outcomes for pregnant women
Three Medications have been approved for use with medication-assisted treatment, Methadone, Buprenorphine and Naltrexone.
Methadone is an opioid agonist, which means that it acts on the same receptors that opioid painkillers act on. This means that it produces euphoric effects, although these set in more gradually and aren’t as intense as those produced by opioids. Still, methadone has a high potential for abuse, so it’s only available as a daily dose from a clinic or doctor’s office. This can make it difficult for some people to comply with their MAT program.
Buprenorphine is a semi-synthetic, partial opioid agonist. This means that while buprenorphine will produce some psychoactive effects, these are far weaker than the effects produced by a full agonist like methadone. Buprenorphine also has a ceiling effect, so taking larger doses won’t produce stronger effects. Because it has less potential for abuse, buprenorphine can be prescribed and taken at home.
Naltrexone is an opioid antagonist, which means that it blocks the effects of opioids. While methadone and buprenorphine can be taken immediately after quitting opioids, naltrexone can only be taken once all traces of opioids have left the body. Therefore, medical detox will be required before starting naltrexone.
The medications used with MAT reduce cravings, help brain function return to normal and prevent the onset of withdrawal. This enables people on MAT to focus on addressing the issues behind the addiction and learning the skills and strategies that will help them recover for the long-term. Medications used with MAT can be taken as long as they’re needed, from a few weeks to a few years. Some people will continue taking medication for the rest of their lives.
Treating Opioid Addiction
Medical detox and medications alone do very little to address an opioid addiction, which is far more complex than dependence. An Irish Medical Journal study of people in an opioid detox program found that 91 percent relapsed after detox–59 percent of them within a week. 4 But those who participated in a treatment program after detox either didn’t relapse at all or experienced a significantly delayed relapse.
- Relapsed After Detox 91% 91%
- Within a Week After Detox 59% 59%
Treating addiction requires a multi-pronged approach that addresses a wide range of issues of body, mind and spirit. Holistic treatment offers the best possible outcomes, according to the Substance Abuse and Mental Health Services Administration. A holistic treatment program involves a variety of therapies that promote whole-person healing.
A successful treatment program will address myriad issues behind an addiction, including:
- The underlying causes of the addiction, such as trauma or stress
- Any co-occurring mental illnesses, such as anxiety or depression, which may contribute to the addiction
- Unhealthy thought and behavior patterns that occur with addiction
- Unhealthy lifestyle choices that often result from addiction
- Relationship problems that stem from addiction
- A lack of purpose and meaning in life
- Life problems
- Missing coping skills and life skills that are needed for successful recovery
Traditional therapies used in high quality treatment programs include cognitive-behavioral therapy, which is a “talk” therapy that helps individuals identify and replace the dysfunctional thought patterns and outdated beliefs that lead to problematic behaviors. Other traditional therapies include family therapy, dialectical behavior therapy and psychoeducational classes, which educate individuals about addiction and related issues.
Complementary therapies used in treatment include art therapy, music therapy, mindfulness meditation and nature therapy. These treatments have been shown to be effective for treating addiction when they’re used along with traditional therapies. Complementary therapies help engage individuals in their treatment plan, and they reduce stress, improve mood and increase self-awareness.
In addition to traditional and complementary treatment therapies, a high-quality addiction treatment program will utilize a variety of interventions and services to address the multiple needs of individuals and help them create a new life that supports recovery. Vocational rehab, educational assistance, financial management classes and parenting classes are some of the additional interventions commonly used in treatment programs.
Just as it takes time to develop an addiction, it takes time to develop the skills and healthy lifestyle behaviors that promote long-term recovery. Staying in treatment for an adequate period of time is essential for successful recovery. According to the National Institute on Drug Abuse, treatment lasting less than 90 days is of limited effectiveness.
Why Some People Resist Treatment
Fewer than 10 percent of people who need help recovering from an addiction seek the help they need. People report a number of reasons why they don’t enter rehab:
- The high cost of treatment
- Fear that treatment won’t work
- Fear of what family members or friends will think
- Fear of what life will be like without opioids
- Fear of withdrawal
- Fear of losing their job
- Fear of losing their friends
While these are common fears, and they’re not unreasonable, the alternative to seeking help is to risk the devastating health problems associated with long-term opioid addiction, including overdose and organ failure. Addiction is a progressive disease that grows worse with time. Getting help now can save your life and help you create and live your ideal life.
Treatment works for most people who engage with their treatment plan and stay in rehab for an adequate period of time. No matter how severe your tramadol/Ultram addiction, treatment offers a new lease on life and the opportunity to find authentic happiness and wellbeing in your life for the long haul.