Tramadol is an opioid medication that is prescribed for pain relief. It is labeled as a Schedule IV controlled substance. There were approximately 44 million prescriptions given for tramadol products in the U.S. in 2013. The chemical makeup of the brain can be physically changed when a person takes a tramadol product on a regular basis. By acting on opioid receptors in the brain, tramadol is designed to suppress pain and enhance feelings of relaxation. More of the drug will be needed to have the same effect, and the usual dose of tramadol will become less effective after prolonged use. The drug has a potential to create a dependency in its users, therefore there are warning labels on products containing tramadol. Even if a person takes the drug as prescribed, dependency can still occur, but it typically happens more quickly when the drug is abused. It is estimated that 3.2 million Americans have used tramadol for nonmedical purposes at some point in time. The potential for a dependency on tramadol is higher in individuals who are abusing the drug, or if they have a history of addiction or substance abuse according to the World Health Organization (WHO). Dependency can also form when taken for an extended period of time even with a prescription. Withdrawal & Detox Symptoms of Tramadol There are usually 2 phases of Tramadol detox or withdrawal: early withdrawal and late withdrawal. Early tramadol detox & withdrawal are experienced once the drug leaves the bloodstream. Symptoms will vary depending on what stage of withdrawal a person is going through. Early withdrawal symptoms: Agitation Sweating Insomnia Anxiety Muscle and Body Aches Yawning Tearing up Accelerated Heart Rate and Breathing Runny Nose Restlessness Hypertension Late withdrawal symptoms: Depression Loss of Appetite Irritability Difficulty Concentrating Depersonalization Cravings Stomach ache and cramps Diarrhea Vomiting Chills and Goosbumps Pupil Dilation Symptoms of tramadol withdrawal or detox usually start within 12 hours of the last dose taken. Approximately 90% of people will experience traditional withdrawal symptoms. 10% of people may experience symptoms like, panic attacks, anxiety, hallucinations, severe confusion, extreme paranoia and numbness or tingling of the extremities, as published by the DEA. Timeline of Withdrawal Physical side effects of tramadol detox or withdrawal may be similar to having the flu. These symptoms typically peak within a few days and then start to taper off. Psychological withdrawal symptoms may last longer. Different factors may influence how long symptoms will last and their severity, so symptoms in each individual will vary. The level of dependency on tramadol is a major contribution to the duration and severity of withdrawal. This directly correlates to the length of time and amount of the drug a person has been taking. It may take longer to normalize a brain’s chemistry that is heavily dependent on tramadol after long-term use. An additional factor is the way the drug is used. When taken as prescribed, it causes less dependency as opposed to someone who may be injecting, smoking or snorting the drug. The level of dependency and severity of withdrawal symptoms is also increased if someone has been using other drugs or drinking alcohol in addition to taking tramadol. Depending genetics, biology and personal physiology, some people may become dependent more easily. Underlying medical conditions can also have an effect on drug dependence as well as co-occurring mental health issues. Genetics are thought to be a factor about half of the time when it comes to drug dependence according to the NCADD (National Council on Alcoholism and Drug Dependence). Abuse, neglect, chronic stress and trauma also affect the onset of a drug addiction, as well as the age a person first uses drugs. In adolescents, the areas of the brain that control learning, decision making, memory and impulse control may be damaged by drug use during a person’s teenage years because the brain is not fully formed, as published by the journal of Clinical EEG Neuroscience. When people abused drugs before the age of 14, they were more likely to suffer from addiction than those who used drugs after the age of 18, according to a publication by the U.S. Department of Health called National Survey on Drug Use and Health. Medical Detox Tramadol detox and withdrawal is best managed through medical detox, just as most drug dependencies. It is not recommended to stop taking the drug “cold turkey” or without the help of a medical professional. In a medical detox, an individual will have access to 24-hour monitoring and a high level of care. The desire to keep taking the drug will intensify as withdrawal symptoms increase. Cravings as well as depression can be managed with the help of medication during detox. The FDA has approved three types of medications for opioid withdrawal: methadone, buprenorphine, and naltrexone. These medications can help with withdrawal symptoms and as well as drug cravings. Each medication has beneficial properties that can help in different ways during detox. Methadone: Methadone acts as a substitution for tramadol. It keeps withdrawal symptoms from starting and it is a longer acting medication. It should be used cautiously though, because it is an opioid and has the potential for dependency. Buprenorphine: This medication also fills opioid receptors in the brain for a longer period of time like methadone. However, it does not activate the receptors in the same manner. Buprenorphine can minimize symptoms and also not create a feeling of being high, like other drugs. If more than the recommended dose is taken, it will no longer produce any effect and it will not plateau which can help reduce the risk for abuse. There are four types of buprenorphine products approved by the FDA for opioid dependency treatment: Suboxone, Zubsolv, Bunavail and Subutex. All for of these medications contain buprenorphine and naloxone. Withdrawal symptoms may be triggered by naloxone if abused, therefore acting as a deterrent. Products containing naloxone are optimal when used after the initial stages of detox and they may be helpful to prevent relapse. Naltrexone: Naltrexone will block opioid receptors from being activated by opioid drugs once tramadol is fully removed from the body and during early withdrawal. Naltrexone products are labelled as Depade, ReVia and Vivitrol. During medical detox, a variety of these medications or supplements may be used for specific withdrawal symptoms. Mood-enhancing medications or antidepressants are commonly used during detox to help alleviate withdrawal symptoms. The DEA has warned that tramadol should not be combined with any selective serotonin reuptake inhibitors (SSRI’s) or monoamine oxidase (MAO) inhibitors. This can cause a risk of serotonin syndrome which can cause convulsions, muscle pain or rigidity and hyperthermia. Medical management can be helpful in easing the withdrawal symptoms of tramadol and also create physical stability. Stress, drug cravings and mood control can also be helped with other therapeutic tools. The best way to treat substance use disorders, dependence and addiction is a balanced combination of medications, therapeutic and support techniques. During tramadol detox and withdrawal, Resolutions Behavioral Health will provide a supportive and comprehensive medical environment throughout all stages of detoxification to ensure a successful recovery. If you or a loved one need help, call one of our professional admissions team members today for a free and confidential assessment.