Does it not feel soothing when you are fighting with sheer pain and after dosing a pill with water that pain gradually diminishes? This is the magic of pain-relieving medications that have long been used to treat the various painful conditions. However, what is tragic is the fact that these medications are frequently misused, such that they are taken in greater doses or more than prescribed to benefit from the pleasure and ecstatic effect associated with them. Furthermore, these medications, especially opiates have the potential for developing dependence that leads to abuse and addiction and is used widely for recreational purposes. 

Tramadol is also an opiate which was considered as having a low potential for abuse, however, the upsurge in the cases of tramadol addiction has put this opinion to rest and this drug is strictly regulated and monitored by the authorities in the UK to prevent further rise in the already heightened index for addiction associated with this medicine. 

Tramadol is a narcotic analgesic and is entirely synthetic which means that it is not made from any natural substance. It belongs to the opioid class of analgesics and was prepared by German scientists in 1962 who were specialists in creating pain-relieving mediations. However, it was not until the 70s when this drug was available in the UK and US after multiple trials and testing after which it was approved for sale. 

Tramadol along with being an opioid is a serotonin-norepinephrine reuptake inhibitor or SNRI which is the property of anti-depressant medications. So it is not wrong to say that tramadol has dual effects on the body- interfering with the transfer of pain signals and increasing the level of serotonin which has a multitude of effects on the body. 

Tramadol is quite a strong analgesic and is used to relieve moderate to severe pain. It is used to treat pain that occurs post-surgical procedure, pain that is associated with any injury, or pain that is chronic and is not relieved by any other analgesics. 

Tramadol starts producing its effect within an hour and due to its quick onset of action, it is frequently used to treat both acute and chronic pain. The effect of tramadol stays for 4 to 6 hours after taking the medicine and it is considered 10 times less potent than morphine. Nevertheless, the danger associated with misuse of tramadol persists and care should be taken that it is not mixed with alcohol or any other central nervous system depressant as the risk for adverse reaction amplifies with such a combination.

Tramadol is sold under different brand names which include Ultram, Ultram ER, Ryzolt, Invodol, Larapam among others. As tramadol is used for recreational reasons, it has street names such as trammies, chill pills, ultras, and tramal lite. 

Tramadol acts both, as an opioid and as an SNRI. As an opioid, it acts on the opioid receptors that are present in the central nervous system majorly, and in the gastrointestinal tract and urinary bladder. It produces its analgesic effect by inhibiting the transfer of pain signals across the nerve cells in the brain thereby creating a pain-free effect. 

As an SNRI it acts on the serotonergic receptors, increasing the release of serotonin. Serotonin is a neurotransmitter that is involved in the brain’s reward system and produces a calming effect and promotes a feeling of pleasure and generalized well-being. It also improves sleep and appetite. 

To sum it all, tramadol produces an analgesic effect and simultaneously stabilizes mood, and makes the person feel sleepy, calm, and relaxed. 

In addition, tramadol has 100% bioavailability when taken orally which means that it is completely available at the site of action without any part of the dose being altered. 

Tramadol comes in a variety of strengths and also in different forms. It is available as tablets, capsules, and oral solutions. Tramadol comes as an instant release or fast-acting tablets or capsules of 50mg strength. Tramadol is available as an extended-release or slow-acting tablets that contain 50mg, 75mg, 100mg, 150mg, 200mg, 300mg, or 400mg of tramadol. Whereas, slow-acting capsules contain 50mg, 100mg, 150mg, or 200mg of tramadol.

Tramadol comes in an oral solution that contains 100mg of tramadol in 1ml of liquid and is used as drops that are swallowed. Tramadol is also available as soluble tablets that contain 50mg of tramadol. In addition, tramadol comes as tablets that dissolve in the mouth and people can keep it over the tongue or sublingually, it contains 50mg of tramadol. Lastly, tramadol also comes as an injection that is administered in the hospital after a surgical procedure.

The extended-release or slow-acting tramadol is used to manage chronic pain as it is released in the blood over a prolonged period. Moreover, the maximum dose of tramadol taken in a day should not surpass 300mg when taking an extended-release formulation and 400mg when taking immediate or fast-acting tramadol.

Doses of tramadol should be taken at an interval of 4 to 6 hours or as prescribed by your doctor. 

You can take tramadol with or without food as it shows no significant interaction with food.

You should not crush or chew the tablets or capsules. 

Side effects are always tagged along with the benefits of medicines and Tramadol is no exception and some side effects are associated with tramadol. However, it should be noted that the presentation of side effects varies for each individual. 

Side effects of tramadol include:

  • Flu-like symptoms
  • Nausea
  • Drowsiness
  • Headache
  • Dry mouth
  • Lethargy 
  • Constipation
  • Agitation
  • Euphoria
  • Nightmares
  • Confusion
  • Mood swings

Some serious side effects associated with Tramadol that require prompt admission in an emergency include:

  • Difficulty in breathing and taking shallow breaths
  • Difficulty in urinating
  • Seizures 
  • Feeling very drowsy
  • Feeling confused
  • Experiencing hallucination 

According to WHO, seizures are less likely to occur if tramadol is taken in therapeutic doses but if it is taken more than the maximum dose that is 400mg for the fast-acting formulation then the chance of having seizures is increased significantly.

Initially, it was presumed that tramadol does not belong to the list of medications with the potential for addiction. However, with the rise in the cases of tramadol addiction, this view is not supported anymore and tramadol is acknowledged as a drug with significant potential for abuse and addiction although lesser in comparison to its potent opioid counterparts such as morphine. 

Just like other opiates, you will develop tolerance to the drug with overtime use. Tolerance to tramadol means that you will have to take higher doses of the drug to attain the same level of pain relief that was achieved at lower doses earlier. As a result, you start taking tramadol more frequently and in doses greater than prescribed, and soon dependence on the drug develops. When dependence on tramadol develops, you are no longer able to function normally without the drug. You will become physically and psychologically dependent on tramadol and will experience withdrawal effects as soon as the effect of the medicine wears off. 

Owing to its strong analgesic action and the simultaneous effect on the brain’s reward system, tramadol causes sedation accompanied by a euphoric effect that promotes the use of tramadol as a recreational drug to get high. People often crush tramadol and snort it when using it for illicit means. However, overdosing on a tablet or capsule form of tramadol can also result in disastrous consequences.

Many pieces of research have been conducted about what causes addiction to prescription drugs among certain users and the findings suggest that there are certain factors which if present in an individual, puts them at a higher risk of addiction. Firstly, prior history of drug abuse is a very significant factor that makes you prone to addiction to prescription medication and you should discuss with your doctor if this is the case so that your doctor will not prescribe you medicine such as tramadol with addiction potential.

Moreover, genetics play an important role. If you have a family history of abuse and drug addiction there is a higher chance that you will develop an addiction. People struggling with mental health issues are seen to be more at risk for drug addiction since they tend to consume drugs in excess to cope with their depressive episodes as the drug relaxes their nerves producing a calming effect and a temporary state of bliss.

The euphoric effect although short-lived but the deleterious consequences that follow after tramadol addiction put you in trouble for long. Peer pressure is another significant factor that contributes to drug addiction as many people tend to consume drugs after being influenced by their environment. Lastly, people associated with any trauma are also at an increased risk for developing addiction along with people who are facing financial hardships, or people who are going through rough relationships or having other stressors in life are likely to misuse prescription medication to keep their minds off the worries. 

It is suggested that you should be cautious while taking tramadol ad more so if you have any of the above risk factors that promote addiction. 

The opioid crisis is rising in the UK and tramadol belonging to opioids has been involved in various cases of addiction. It has been estimated by NHS Business Services Authority that 12.8% of the adult population in England was prescribed opioids in 2017-18. According to the Office of National Statistics (ONS) there has been an upsurge in the cases of deaths in which opioid pain medicine is involved, especially tramadol, which was reported to be present on the death certificate. As per the latest statistics of the UK, death rates related to tramadol have reached 224 deaths in a year. In 2014, there were 240 deaths due to tramadol which is the highest number recorded.

Tramadol is classified as a class C drug in the UK under the Misuse of Drug Act 1971. A class C drug means that it is available only through prescription and over-the-counter sale of tramadol is illegal along with selling drug through the black web. You are not supposed to take the drug through illicit means neither you are supposed to pass the drug to someone else who was not prescribed the medication, either way, can result in imprisonment. As per the law, if you possess tramadol without a prescription you are sentenced to two-year imprisonment and unlimited fine and if you are found selling or giving away the drug then you are sentenced to fourteen-year imprisonment along with an unlimited fine.  

Keeping in view the surge in tramadol addiction and abuse, the tramadol prescription is written for 28 days only and the supply cannot extend beyond that. The doctor signs the prescription after clearly writing the number of doses to be taken each day and in this way the sales of tramadol are regulated. Tramadol is not repeatedly dispensed thus mitigating the risk of tramadol dependence and addiction. 

There is a marginal difference between dependence and addiction but enough to differentiate the two terms. Dependence on tramadol refers to the state after prolonged use of the drug after which the person becomes physically dependent on the drug such that they are unable to function normally if tramadol is not administered. This often happens when the person is taking drugs for medicinal purposes and if he takes the drug for longer than the prescribed period or in greater doses then it may result in the development of dependency. The person will experience withdrawal symptoms if he does not take the medicine on time or stops taking it altogether. 

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Addiction follows dependence. Tramadol addiction is the compulsive use of the medicine, in this case, tramadol long after knowing its negative consequences. When a person takes an increased amount of drug for a long duration of time, it causes biochemical changes in their brain leading to change in behavior and altered mood.

This leads to physical as well as psychological dependence on tramadol and people find it quite hard to quit the drug since the withdrawal symptoms are intense. Addiction can lead to overdosing on tramadol and it results in disastrous consequences and can even be fatal at times. Usually, external support in the form of rehabilitation centers and detox programs helps the person in coping with the withdrawal symptoms and helps in achieving a drug-free state.

When a person is abusing tramadol or any other drug, he may develop a myriad of symptoms that helps in recognizing the habit of drug abuse and prompt action can then be taken to save him from destroying his life. Similarly, you can help your loved ones by noticing if they have any of the symptoms of drug abuse and provide the care and treatment accordingly.

Following are some symptoms of Tramadol abuse:

  • Physical dependence: It is very usual for physical dependence to develop after using tramadol over time. Physical dependence presents as withdrawal symptoms once you stop taking the drug and it may include sweating, diarrhea, nausea, and vomiting. It manifests as panic attacks, nervousness, muscle spasms, runny nose, cold chills, and difficulty sleeping. With chronic use of tramadol, seizures can also develop as withdrawal symptoms. Hallucinations may present but rarely. 
  • Psychological dependence: Once psychological dependence develops it is very hard to work without the drug and the person will be agitated, restless, and low on energy with a depressed mood if they are unable to get tramadol.
  • Taking the drug for other than therapeutic purposes: It is commonly seen in addiction that people tend to take the drug to get high and to experience the feeling of euphoria and calmness that results after administering the drug. Initially, the drug which was prescribed for medicinal use is used long after the pain has subsided, this time for recreational purposes. 
  • Continued use of Tramadol even after facing negative consequences associated with drug addiction: Despite facing extreme difficulties in life due to tramadol addiction, a drug addict may feel a compulsion to continue using the drug even if it comes at the cost of health issues, financial issues, and broken relationships. Such people tend to have poor personal hygiene and grooming and are unable to fulfill their personal and financial responsibilities. 
  • Using tramadol without prescription through illegal means: People often use illicit ways to obtain the drug when they are unable to get hold of the drug through prescription. 
  • Taking more than the prescribed dose: It is seen that people who are addicted to the drug take higher doses of tramadol and more frequently. 
  • Drug-seeking attitude: When people are addicted to tramadol they develop an altered behavior such that they are occupied with arranging the drug from pharmacies, by manipulating the doctors, by stealing tramadol from others, and by using illegal means to get the drug. Such people are often seen hiding their pills out of fear of being caught.

Since tramadol acts on both the opioids and serotonin receptors, the side effect of tramadol addiction involves interference in both the mechanism. 

Following are the list of the adverse effect of tramadol addiction:

  • Physical side effects include nausea, vomiting, change in appetite, drowsiness, seizures, slurred speech, headaches, impaired coordination, jerky muscles, pinpoint pupils, headaches, tremors, seizures, coma, shallow breathing, slow heart rate (bradycardia).
  • Psychological side effects include poor focus and concentration, impaired judgment, hampered memory, anxiety, mood swings, anger outbursts.
  • People with tramadol addiction are at risk of developing Serotonin Syndrome which is a potentially life-threatening condition due to increased levels of serotonin and presents as heightened temperature, shivering, rapid pulse, muscle twitches, agitation, and confusion

Tramadol long term side effects on the brain

Overtime use of tramadol causes damage to brain cells through oxidation as the brain has an abundant supply of oxygen, this damage happens so rapidly that it surpasses the ability of brain cells to recover and results in altered brain functioning. Tramadol interferes with the signaling in the brain by increasing serotonin, norepinephrine, and dopamine in the brain and the brain becomes dependent on the increased levels of these neurotransmitters. When the drug is not available, the cognitive functioning of the brain is hampered and the brain tries to adapt to working without the drug and it results in depression, anxiety, and anger. 

Tramadol overdose symptoms are similar to that seen in an opioid overdose. 

Tramadol overdose results in central nervous system depression that promotes respiratory system depression and this can result in coma. It is important to know about the symptoms of tramadol overdose so that prompt medical help can be administered to save the life of your loved ones.

Following are the symptoms of tramadol overdose:

  • Pinpoint pupils
  • Vomiting
  • Bluish tinge to fingernails and lips
  • Low blood pressure
  • Loss of consciousness 
  • Cardiovascular collapse 
  • Confusion
  • Coma
  • Respiratory arrest 
  • Convulsions

You should not overlook these symptoms since slight negligence can be fatal and in time medical intervention can save the life of a person who succumbed to intoxication due to tramadol overdose.

Tramadol withdrawal occurs in a person who quits the drug after developing dependence on it. Since the brain has adapted to function in the presence of tramadol it takes some time for it to adapt. All this while, withdrawal symptoms ensue that can range from mild, moderate to severe. 

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Since the mechanism of action of tramadol is slightly different from other opioids in the sense that it is also an SNRI so there are two sets of withdrawal symptoms:

  • Typical withdrawal symptoms- common to all opioids. These include nausea, vomiting, gastrointestinal pain, diarrhea, muscle aches, and body pain.
  • Atypical withdrawal symptoms- specific to tramadol owing to its property of interference with serotonin receptors. These include extreme anxiety and panic attacks, intense paranoia, hallucinations, confusion and depersonalization, and numbness and pricking sensation in the extremities.

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You will have an initial assessment for both your physical and mental state, to deliver you the finest treatment for optimum recovery. You will receive round-the-clock assistance from a qualified team consisting of doctors, nurses, consultant psychiatrists, counselors, psychotherapists, and holistic practitioners. A variety of therapies are offered including yoga, meditation, acupuncture, art therapy, music therapy, and equine therapy. 

Along with all the above-mentioned facilities, you will have a private chef, driver, and housekeeping making your stay very accommodating. You will also be offered a luxury pool, big garden, and absolute privacy with no one intervening in your treatment. 

This luxury rehabilitation treatment aims to help you with your withdrawal symptoms with maximum ease making your experience rewarding and helping you become drug-free with minimal hassle. 

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