Is Tramadol An Opioid?

The medication tramadol is considered to be an opioid drug or narcotic. However, tramadol has a more complex method of action, different overall effects, and a markedly lower potency than other well-known prescription opioid medications like oxycodone, codeine, or morphine.

Tramadol Vs. Other Opioids

While most other opioids interact directly with opioid receptors in the central nervous system, blocking pain signals and slowing neurotransmitter activity, tramadol (mostly) does not.

Instead, tramadol is a prodrug that is metabolized in the liver to form the metabolite compound desmethyltramadol, which is around 700 times better at attaching to opioid receptors than tramadol itself, but still about ten times weaker than morphine.

Secondarily, tramadol is also known to partially block the reabsorption of the neurotransmitters serotonin and norepinephrine in the nervous system, increasing neurotransmitter activity and acting as a mild serotonin and norepinephrine reuptake inhibitor (SNRI).

An increase in norepinephrine is generally understood to provide a limited degree of pain relief, while increased serotonin can increase mood and feelings of well-being, which is why so many serotonergic medications are used as antidepressants.

Tramadol’s History

Tramadol hydrochloride was originally created in Germany in 1962 before being marketed to other nations in 1977. The United States was slow to approve this new pain management drug, however, and it wasn’t until 1995 that tramadol was cleared for US medical use.

At this point, tramadol was not classified as a controlled substance and was freely available as an over-the-counter pain medication, with formulations often pairing it with the mild pain-reliever acetaminophen, the active ingredient in Tylenol.

However, Tramadol’s overarching action on the body is similar to that of other opioid drugs. And, like these other drugs, tramadol soon proved that it had abuse potential and could be seriously habit forming following long-term use or abuse.

Tramadol Today

In 2010, responding to growing reports of tramadol substance abuse, the U.S. Department of Health and Human Services (HHS) recommended to the United States Drug Enforcement Agency (DEA) that Tramadol be reclassified as a schedule IV controlled substance.

Other schedule IV drugs include benzodiazepines like Xanax (alprazolam) and Valium (diazepam).

This change, finalized in 2014, acknowledged the medical value of tramadol, as well as the drug’s relatively low but still considerable potential for misuse and addiction.

Tramadol is produced in both immediate-release and extended-release formulations generically and under brand names including Ultram, Conzip, and Ultracet.

It is one of the most commonly prescribed pain medications in the world and is used to treat mild, moderate, and severe pain, including chronic pain.

Tramadol is regulated differently in a variety of different countries, and, unfortunately, is readily available without a prescription through many illicit pharmacy websites and backchannels.

Tramadol Dependence & Addiction

As with every other opioid drug, taking regular doses of tramadol can trigger the development of physical dependence over time. And abusing the drug with high doses only accelerates this process.

Once dependence develops, any attempt to reduce your dosage or stop taking tramadol may trigger a period of unpleasant withdrawal symptoms as the body’s internal balance readjusts.

Withdrawal Symptoms

According to the DEA, around 90% of those experiencing tramadol withdrawal suffer traditional opioid withdrawal symptoms including:

• nausea and vomiting
• gastrointestinal pain
• diarrhea
• muscle aches
• body pains
• sleep problems

The other 10% also experience withdrawal effects related to SNRI antidepressants, including:

• confusion
• paranoia
• anxiety
• panic attacks
• hallucinations
• tingling or numbness

Note that unlike other opioid drugs, which often generate acute withdrawal symptoms for around three or four days, tramadol’s acute withdrawal phase tends to last for seven days or longer.

Tramadol Drug Interactions 

Because of tramadol’s low potency, it is unlikely to cause serious overdose events on its own. However, the side effects of tramadol in combination with certain other substances can lead to serious or even life-threatening medical emergencies.

CNS Depressants

Opioid drugs generally depress central nervous system (CNS) activity, causing drowsiness and sedation, and tramadol is no exception.

If tramadol is taken with other CNS depressants, especially in large doses in order to get high, there is a risk that this sedation can lead to serious overdose effects, including life-threatening respiratory depression.

As such, tramadol should not be taken with other CNS depressants, including:

• other opioids
• alcohol
• benzodiazepine medications
• barbiturates

Serotonin Syndrome

Use of tramadol with other serotonergic (serotonin-increasing) medications and supplements can trigger a potentially life-threatening health condition known as serotonin syndrome, a type of serotonin overdose.

Common symptoms of serotonin syndrome include altered mental state, muscle rigidity or tremors, increased reflexes, high body temperature, dilated pupils, sweating, diarrhea, and vomiting.

Serotonergic medications and supplements include:

• certain classes of antidepressants (SNRIs, SSRIs, TCAs)
• triptans
• dextromethorphan
• St. John’s wort
• monoamine oxidase inhibitors (MAOIs)

For information on our outpatient treatment programs for opioid abuse or addiction, please contact Northeast Addictions Treatment Center today.