Tramadol Withdrawal

  • Generic Name or Active Ingridient: Tramadol

Definition

Rehabilitation specialists view Tramadol as a normal, predictable consequence of long-term opioid use. When the opioid-dependent person stops taking Tramadol, he experiences withdrawal symptoms. Experiencing withdrawal symptoms does not mean you have used Tramadol illegally - in fact, many people experience withdrawal symptoms after they have used a drug as prescribed to treat chronic pain.

Withdrawal symptoms can be physical or psychological. Physical withdrawal symptoms are similar to those of the flu and can last five or more days. Psychological symptoms of withdrawal are demoralizing and may last much longer than the physical symptoms.

Causes

The human body adapts to certain substances in the body, including opioids such as Tramadol by adjusting its own chemical balance. The body can become tolerant of certain chemicals, which means it takes an ever-increasing amount of opioids to cause a euphoric or pain-relieving effect. With prolonged use at high doses, the body may become dependent on the chemical; this means the individual must maintain a certain level of opioids for the body to feel normal.

If Tramadol levels plummet, the body fights to maintain its chemical balance, a process known as detoxification. The individual feels this struggle through physical and psychological withdrawal symptoms.

An individual can cause this sudden drop in opioid levels by taking a smaller dose than usual or by taking a drug, such as naloxone, that reduces opioids to non-toxic levels. Emergency doctors administer naloxone during drug overdoses to save the patient's life.

Facts

Tramadol is a narcotic-like painkiller prescribed to treat moderate to severe pain. The extended-release formula provides round-the-clock protection from chronic pain.

According to the Centers for Disease Control and Prevention, or CDC, prescription painkiller sales quadrupled between 1999 and 2009. Americans use more painkillers such as Tramadol than any other country on earth. According to the Institute on Addiction Medicine, Americans represent only about 5 percent of global population, yet consume 80 percent of the world's supply of opiates. In 2010, doctors prescribed enough painkillers to medicate every adult in the United States around the clock for one month.

Millions of Americans misuse these powerful pain relievers non-medically, either to get high or to treat an illness for which the medicine was not prescribed. Between the years 1992 and 2003, misuse of opioids rose 140 percent. In 2010, about one in 20 Americans over the age of 12 used prescription painkillers for non-medical purposes.

This high rate of prescription painkiller use and abuse leads to physical dependence on and subsequent withdrawal from drugs such as Tramadol. Estimates from a 2005 national health survey show that about two million Americans are dependent on opioids such as Tramadol; all these individuals will suffer withdrawal symptoms when they stop using opioids.

Withdrawal symptoms are painful and demoralizing, but usually not life threatening.

Symptoms

Opioid detoxification is typically associated with physical symptoms similar to the flu, but withdrawal also causes psychological symptoms whose demoralizing affects can be just as overpowering as the physical symptoms of withdrawal.

Symptoms of opioid withdrawal typically occur in two waves. The first set of symptoms usually begins 12 hours after the last dose of opioids and includes agitation, anxiety, muscle aches, watery eyes, insomnia, runny nose, sweating and yawning. Later symptoms include abdominal cramping, diarrhea, dilated pupils, goose bumps, nausea and vomiting.

Physical

Detoxification causes physical withdrawal symptoms as the body adjusts to lowered levels of opioids. Physical symptoms last five or more days, with the worst symptoms occurring on or about the fourth day. The fear of physical withdrawal symptoms prevents many Tramadol users from discontinuing this drug.

Physical symptoms of withdrawal include:

  • Abdominal Cramping
  • Diarrhea
  • Fever, Runny Nose or Sneezing
  • Goose Bumps and Abnormal Skin Sensations
  • Hot Sweats and Cold Sweats
  • Insomnia
  • Low Energy Level
  • Muscle Aches or Pains
  • Nausea or Vomiting
  • Pain
  • Rapid Heartbeat
  • Rigid Muscles
  • Runny Nose
  • Shivering, Tremors
  • Teary Eyes
  • Yawning

Psychological

Tramadol withdrawal also causes a variety of psychological symptoms that can be just as overwhelming as the physical discomforts. Left untreated or poorly treated, psychological withdrawal symptoms can make the opioid-dependent individual feel unable or unworthy of recovery.

Psychological symptoms of withdrawal include:

  • Agitation
  • Anxiety
  • Depression
  • Hallucinations
  • Irritability
  • Poor concentration
  • Restlessness
  • Social isolation

Possible Complications

While opioid withdrawal is not fatal, unsupervised Tramadol detoxification can result in dangerous complications. Complications of opioid withdrawal include vomiting and then breathing the stomach contents into the lungs, known as aspiration, which may result in pneumonia or lung infection. Extreme vomiting and diarrhea may result in serious dehydration requiring intravenous fluid replacement.

The primary complication of Tramadol withdrawal is the return to opioid abuse. Uncomfortable physical symptoms, demoralizing psychological effects and inadequate treatment leave the opioid-dependent individual in a discouraging cycle of drug abuse, withdrawal and relapse.

Treatment options

National Institute on Drug Abuse statistics show more than 23 million people in the United States over the age of 12-years needed treatment for alcohol or substance abuse in 2010. Of those patients, about 11 percent received treatment at a specialty facility. These treatment centers provide detoxification or counseling services.

It is impossible to know how many people try to detoxify their bodies alone, without the help of medicine to ease withdrawal symptoms. Anyone attempting self-detoxification faces a higher risk for dangerous complications, including aspiration, dehydration or return to opioid abuse.

Some people concoct a homemade treatment plan including medicines to reduce withdrawal symptoms. One such remedy is the Thomas Recipe, in which an individual takes Xanax or another anti-anxiety medication, preparations to ease diarrhea, vitamins and supplements to ease fatigue and body aches, along with hot baths to relieve muscle pain.

While the Thomas Recipe addresses physical withdrawal symptoms, it does not reduce the risk for complications or relapse.

A person who has recently attempted detoxification is at greater risk for overdose because detox reduces tolerance to opioids. Someone who has just tried detox can overdose on a much smaller dose than she used to consume.

Opioid overdose is a serious trend in the United States. In 2008, there were 14,800 Americans died from prescription painkiller overdoses, more than cocaine and heroin combined. Prescription painkiller use and abuse drove more than 475,000 people to the emergency department in 2009.

While at the hospital, patients receive life-saving care. Doctors and nurses administer naloxone and other drugs to return opioids to non-toxic levels, establish an airway to help the patient breathe and empty the stomach of any traces of Tramadol. Once the patient is in stable condition, he can participate in outpatient rehabilitation programs.

Outpatient programs can help a patient long before he has an overdose. Many rehabilitation clinics offer outpatient services that allow the individual to start with behavior modification and put off the uncomfortable detoxification process until he learns how to live without Tramadol.

Some physicians prescribe drug replacement therapy, or DRT, so that patients can skip the hospital stay and proceed directly to the counseling phase of treatment. DRT includes methadone, buprenorphine and Suboxone. These medications act nearly in the same way as Tramadol, so the patient does not experience withdrawal symptoms, but DRT medications do not produce the same euphoria as other opioids.

Supporters of DRT appreciate the way this therapy allows patients to carry on with their normal lives. Opponents worry it is merely trading one drug habit for another. After the patient learns to live without Tramadol, he must then wean himself from the replacement drug.

Even though replacement drugs do not get you high, discontinuing DRT drugs still cause withdrawal symptoms. Many individuals have to attempt DRT detoxification several times before successfully quitting. Harvard Medical School cites estimates that 25 percent of methadone DRT patients eventually abstain, another 25 percent continues to take the drug and 50 percent go on and off methadone.

DRT is just one type of MAT, or Medication-Assisted Treatment. MAT refers to any substance abuse treatment plan that includes drugs that reduce the severity and duration of withdrawal symptoms. According to the Substance Abuse and Mental Health Services Administration, or SAMSA, this medical intervention:

  • Improves Survival
  • Increase Retention in Treatment
  • Decreases Illicit Opioid Use
  • Decreases The Risk for Hepatitis and HIV
  • Decreases Criminal Activities
  • Increases Employment
  • Improves Birth Outcomes for Pregnant Women Battling Addiction

Inpatient Detoxification

Many people choose to overcome withdrawal symptoms before going on to rehabilitation. During inpatient detoxification, doctors administer naloxone and other medications to lower Tramadol levels, and add still more drugs to combat the ensuing symptoms of withdrawal. Nurses monitor the patient for complications. While this approach lessens the severity and length of withdrawal symptoms, the patient must still endure days of uncomfortable physical symptoms and disheartening psychological distress. After surviving detoxification, the individual then begins rehabilitation.

Rapid Detox

Most professionals consider Rapid Detox the most humane and efficient way to detoxify the body. During rapid detox, board certified anesthesiologists administer the standard medications to lower opioid levels alongside sedatives and anesthesia. The patient rests in a comfortable "twilight sleep" during detoxification, and awakens with no memory of the withdrawal process. Rapid detox is quick and comfortable, putting the patient in a better position for successful rehabilitation.

Rehabilitation

Rehabilitation for Tramadol abuse and withdrawal may take place as an outpatient, inpatient or in a long-term residential setting. Rehabilitation techniques usually include individual counseling, group counseling and other behavioral therapies.

Rehabilitation is not one-size-fits-all; no single treatment is appropriate for everyone and effective treatment addresses the multiple needs of the individual, not just her drug abuse. Many people with drug abuse problems also have other mental illnesses or social issues that make quitting Tramadol even more difficult.

Rehabilitation specialists continually assess the individual's condition and modify treatment plans to fit the persons's changing needs. Monitoring is necessary to prevent relapses, which occur frequently and are to be expected. The healthcare provider should also screen and treat patients for HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases common in drug abusers.

Treatment should be readily available, allowing the individual to remain in treatment for an adequate amount of time. Treatment does not have to be voluntary to be effective; legal coercion tends to keep individuals in treatment longer than those free to choose rehabilitation.

Long-term, professional treatment helps individuals overcome Tramadol withdrawal and reduces the risk for relapse.