When Does Tramadol Use Become Abuse?
Drugs are prescribed with the expectation that they will be appropriately used by the patient, for the alleviation of whatever condition necessitated the prescription.
If that remained the case, prescription drug abuse would not be one of the biggest health care problems facing the United States today. A combination of need, potency, and recklessness can make any drug a source of addiction. The line between healthy and unhealthy consumption can be disarmingly small, and with a powerful drug like tramadol, the question of when tramadol use becomes abuse is an important one that needs to be understood before using it.
Intro to Tramadol
What is tramadol? To start, it is the generic name for a prescription pain reliever that is sold as Ultram, Ultram ER, Conzip and Rybix ODT. Because it comes from a category of drugs known as opiate narcotic analgesics, it is used for the treatment of moderate to severe levels of pain. Within one hour of consumption, says the journal of Drugs, the effects of tramadol are felt. Patients are advised to take 50 mg to 100 mg every four to six hours, although more frequent consumption may be prescribed for conditions like osteoarthritis, where pain levels are more chronic.
Like any prescription medication, tramadol is powerful enough to cause a number of side effects, even when taken in moderation. As a result, patients may experience:
- Nausea
- Constipation
- Dizziness
- Drowsiness
- Sweating
These effects should not be a cause for alarm, although a doctor or pharmacist should be informed if the effects persist or if they become excessive.
The journal concludes by saying that tramadol lacks the potential for being significantly abused (contrasted to other prescription narcotics), but there are enough concerns about risky use of the drug that, in 2010, the U.S. Food & Drug Administration and Janssen Pharmaceuticals (tramadol’s approved manufacturer) advised doctors not to prescribe tramadol to patients who are suicidal, suffering from depression, at risk for addiction, or who currently take tranquilizers or depressants.
This is because, notwithstanding tramadol’s relative safety, the opioid constituents of the drug can give users the same kind of narcotic-like high that they can get from other opioids, both legal and illegal. To that effect, a Chinese medical journal found that there is a high potential for abusing tramadol among people who are already addicted to opioids.
Unfortunately, this does create the possibility of excessive and risky use of tramadol to the point of physical danger. In 2011, says Medpage Today, 20,000 emergency hospitalizations were attributed to the improper use of tramadol (high doses of tramadol can stop breathing and can cause seizures, reports ABC News). That same year (2011), there were 379 overdose deaths in the state of Florida where tramadol was found to be a factor.
Tramadol and the DEA
With this in mind, and despite the initial perception of tramadol being a comparatively safe drug, the U.S. Drug Enforcement Administration classified it as a Schedule IV substance in 2014.
As part of the process to schedule tramadol, a multi-agency prescription drug abuse task force told the DEA that tramadol is a loophole drug, meaning that many patients and doctors were unaware of the dangers of tramadol because there had been little regulation surrounding its distribution and prescription (and, as with most cases of prescription drug abuse, there is a lack of understanding that such medications can be life-threatening if taken improperly). However, the task force described tramadol as a drug that could cause addiction, a drug that could be abused, and a drug that could be used for purposes beyond its medical intentions (a situation known as “diversion”).
An example of how tramadol can be misused was reported by the Egyptian Journal of Forensic Sciences. In 2010, an “increasingly alarming phenomenon” of Egyptian youths taking tramadol for various reasons related to sexual functioning (remedying premature ejaculation, prolonging orgasm and generally increasing sexual pleasure) was attributed to its wide availability and promotion, implying a widespread lack of knowledge about the proper uses of tramadol and its dangers. Al-Jazeera describes how many young men simply use tramadol as an energy boost, paying $3 for 10 pills, even as the head researcher in Egypt’s National Research Addiction Program explains that tramadol creates an extreme dependency in its users, even greater than that associated with heroin.
There is enough support for tramadol (among advocates for elderly patients, for example, or prescribers who fear that complete regulation of the drug would create a black market and unnecessarily deter health care providers who would otherwise prescribe tramadol) for the DEA to put tramadol on its Schedule IV list. Drugs on this schedule have a relatively low potential for abuse when compared to Schedule III substances, but there is enough cause for concern to merit federal regulation.
The Opioid Effect of Tramadol
One of the key components in the DEA’s decision to schedule tramadol as a controlled substance involves the opiate chemical compounds that make it so effective. Opioids work by binding to, and activating, specific receptors on the brain. The National Institute on Drug Abuse explains that these receptors are created naturally, and they affect the parts of the brain that deal with feelings of pain and reward-based pleasure.
When an opioid attaches itself to a receptor, it dampens the information flowing to and from the brain and the rest of the body. This is why opioids are useful in the treatment of pain, because the signals transmitting the physical distress to the brain are blocked by the presence of the opioid; however, since the patient feels good and happy with the opioids in their system, this is how an addiction can start, especially since the opioids work by triggering a sense of reward in the patient. She literally feels like she has accomplished something by taking the opioid, and the natural inclination is to take more.
Eventually, consumption of the opioid goes beyond simply alleviating pain and discomfort, and graduates to becoming the only source of pleasure that the patient feels. This is one of the key criteria for how and when even beneficial drugs can be abused, and it explains the danger of how using tramadol (which, explains The Fix, is a synthetic opioid, meaning it was designed in a laboratory to have an identical chemical structure to natural opioids) can become abusing tramadol.
The DEA’s concerns are based on the fact that, when taken in sufficient quantities and for a sufficient period of time, tramadol produces effects that are dangerously similar to other controlled drugs (such as OxyContin, which Fox News called “one of the most abused drugs” in America). The Milwaukee Journal Sentinel found that tramadol use increased from 25 million prescriptions in 2008 to 40 million in 2012.
The Tipping Point
But what is the tipping point between simply using tramadol to endure moderate to severe pain, and actively abusing it for its narcotic highs? A clear sign of unhealthy drug consumption is if the patient starts to change her behavior or routine in order to keep using her drug of choice. This may mean lying to a doctor (or simply exaggerating) about the levels of pain and discomfort, in order to secure more tramadol. If the patient consumes more tramadol than her prescription advises her to take, this could also be a warning that she cannot control, or is unwilling to control, her intake. The reason behind this is that she is developing a tolerance to the drug, meaning that more and more tramadol is required to have a standard effect. Tramadol abuse should be differentiated from an actual addiction to tramadol, where the patient cannot function on a day-to-day basis without constant tramadol intake. In a case of tramadol abuse, the patient certainly endangers her physical and mental health by consuming more of the medication than she should, but she still possesses the willpower to walk away from the more serious problems lurking around the corner. She may even be able to stop taking tramadol, whereas a patient who is actually addicted to tramadol will suffer painful and excruciating withdrawal symptoms if she is deprived of the drug after a short period of time.
However, even a patient who is still at the abuse stage of tramadol use can nonetheless benefit from help weaning herself off the mental desire to keep using tramadol to take care of her pain. The abuse of a drug is considerably easier to break than the addiction to a drug; therefore, a medical intervention at this stage, whether initiated by the patient or by her loved ones, offers the best chance of success.
Such an intervention may involve a program of detoxification to wean the patient off tramadol. In the case of abuse, her intake is not as problematic as it would be if she were outright abusing the medication. Even so, her tolerance to tramadol is compromised, and further consumption of the drug (even with the appropriate monitoring) would significantly increase the risk for developing a psychological dependence on tramadol.
Getting Help for Tramadol Abuse
For that reason, a patient looking to get away from tramadol would do well to leave detoxification in the hands of a doctor or staff members at a treatment center. Such professionals can help curate the actual detox process (for example, by administering a low-dose benzodiazepine as suggested by the journal of Drug and Alcohol Dependence), ensuring that the resulting withdrawal symptoms can be properly managed and mitigated.
Once the patient completes detox, a course of counseling will help her learn how she can guard against the temptation to abuse further drugs. A patient who has abused tramadol knows that there is the possibility of abusing another drug or developing a full dependence on whatever medication she is prescribed for her pain. Even though her use of tramadol was arrested before it caused serious problems, she needs to know how to take the steps to properly protect herself from such a situation ever arising again. That is why psychotherapy is an inherent part of a complete drug rehabilitation program.
If you are worried that your use of tramadol is getting out of hand, give Black Bear Lodge a call today at 706-909-9811. We have admissions coordinators standing by who can tell you what you need to know about tramadol, prescription medication and the proper limits of taking your doses. Talking to one of our trained professionals can help you take control of your health, while getting you the help you need regarding how to safely and properly manage your pain.
Dangers of Using Benzodiazepines With Tramadol
Benzodiazepines and tramadol are CNS depressants, and using multiple CNS depressants is dangerous and compounds the effects of both.
Tramadol: An Atypical Opioid
Tramadol is a synthetic opioid analgesic that was developed in the late 1970s by the pharmaceutical company Grunenthal GmbH.
It was originally marketed as having less potential for abuse and addiction than other opioids such as hydrocodone and oxycodone. It was thought that tramadol was a safe alternative for pain management for opiate addicts and those in recovery from addiction, but experience has shown that tramadol is habit-forming and can lead to abuse and addiction.
The Journal of the American Academy of Physician Assistants provides a description of several case studies of tramadol addiction and dependence including one in which a prescribing physician became addicted to tramadol.
Tramadol’s mechanism of action is slightly different than typical opioids. Use of tramadol carries all the risks associated with use of other opioids and some additional risks as well. Like other opioids tramadol can produce physical dependence with severe flu-like withdrawal symptoms. Additionally withdrawal from tramadol can produce seizures which are not usually experienced as a consequence of opioid withdrawal.
The American Association of Poison Control Centers reports a total of 10,255 cases of tramadol exposure in 2009 with roughly half of those being single substance exposures that resulted in four overdose deaths. Although tramadol continues to enjoy unscheduled status under the Controlled Substances Act (CSA), authorities are becoming aware of the true nature of this drug. Arkansas and Kentucky have both scheduled the drug as a Schedule IV controlled substance under state law, and Louisiana has passed legislation identifying tramadol as a drug with a potential for abuse.
In 2009 the U.S. Food and Drug Administration (FDA) sent a warning letter to the manufacturer, Johnson and Johnson, alleging that a promotional website had “overstated the efficacy” and “minimized the serious risks” of the drug. In response the manufacturer has included stronger warnings about tramadol in the 2010 Physician’s Desk Reference.
The Nature of Benzodiazepines
Benzodiazepines such as alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium) and lorazepam (Ativan) are in the sedative-hypnotic class of drugs that includes alcohol and barbiturates. Sedatives are CNS depressants like opiates and opioids. Dr. Chris Ford, clinical director of Substance Misuse Management in Clinical Practice calls benzos the “bad guys” among all drugs of abuse.
Dr. Vernon Coleman, in his book Life Without Tranquilizers, states that:
“the biggest drug-addiction problem in the world doesn’t involve heroin, cocaine or marijuana. In fact, it doesn’t involve an illegal drug at all. The world’s biggest drug-addiction problem is posed by a group of drugs, the benzodiazepines, which are widely prescribed by doctors and taken by countless millions of perfectly ordinary people around the world. Drug addiction experts claim that getting people off the benzodiazepines is more difficult than getting addicts off heroin.”
Dr. Coleman stresses that the modest benefits to be gained by benzodiazepine use simply do not outweigh the serious risks involved. He states that “the uses of the benzodiazepines are modest and relatively insignificant. We can do without them. I think that the only genuine long-term solution is to be aware of these drugs and to avoid them like the plague. I don’t think that the benzodiazepine problem will be solved until patients around the world unite and make it clear that they are not prepared to accept prescriptions for these dangerous products.”
Despite the ever-increasing awareness of the dangers of benzodiazepine use even under a doctor’s supervision, benzos continue to be prescribed in large numbers for a variety of serious and minor ailments. According to IMS Health in 2009 doctors wrote 45 million prescriptions for alprazolam, 26.4 million for lorazepam, 24.4 million for clonazepam, 14.2 million for diazepam and 8.4 million for temazepam.
How Opioids and Benzodiazepines Interact
Benzodiazepines and opioids (including tramadol) are CNS depressants. Both are highly addictive, and both classes of drugs produce tolerance in the user meaning that over time more of the drug is needed to achieve the same effect. Benzos produce tolerance very quickly.
Opioids and benzos work differently in the body, but as CNS depressants they compound the effects of one another. All CNS depressants are cross-tolerant with one another meaning that developing a tolerance for one will result in a tolerance for another.
A person who has used benzos for any length of time will find that tramadol is not as effective as expected, and the patient is likely to take larger than recommended doses of the drug.
Taking larger doses increases the risk of overdose, particularly when CNS depressants are combined. Benzodiazepine use can increase the lethality of tramadol, and, while benzos alone do not usually produce fatal overdose, they can when used in conjunction with an opioid. The combined sedative effects of tramadol and benzos are enough to cause death from depressed breathing.
Treatment for Addiction to Benzodiazepines and Tramadol
If you are addicted to benzos and/or tramadol, get help to get clean. We can help you find detox, recovery and aftercare resources, and we are here 24 hours a day to do so. Call us at 706-909-9811.
Continue Reading
