Tramadol is an opioid (also called a narcotic-like analgesic) used to treat moderate to severe pain. Opiates are natural derivatives of opium, which can be leeched from the poppy plant. Although opiates have an organic basis, they are not safe for use and are exceptionally addiction-forming. Opioids are synthetic, but similar to opiates in chemical compound structure. Opioid addiction is considered to be a public health epidemic, and public education is one of the best ways to prevent abuse as well as raise awareness to get current users into treatment.
The National Survey on Drug Use and Health (NSDUH) is sponsored by the Substance Abuse and Mental Health Services Administration and provides one of the most reliable sources of information on Americans current and past use of a variety of drugs. Based on a survey of a sample of Americans, the study estimates drug use. Prescription opiates, not surprisingly, are part of the drugs surveyed. The 2013 NSDUH findings regarding prescription opiate abuse include:
- In the past year, 1.9 million Americans aged 12 and older who were non-prescribed users of prescription painkillers were dependent upon or abused them.
- Of an estimated 8.7 million Americans aged 12 or older who were considered for survey purposes to be current users of illicit drugs other than marijuana, 4.5 million were non-prescribed users of pain relievers (1.7 percent of the population).
- Painkiller abuse rates among Americans aged 12 and older were steady compared to 2011 and 2012 when there were 4.5 million and 4.9 million current users, respectively.
- Among the 12-17 year old population, 1.7 percent were current non-prescribed users of prescription painkillers.
The prevalence of opiate abuse raises a question as to its illicit benefits. What’s so great about opiates for the unlawful user? In short, the main effect of an opiate is a rush of euphoria. Opiates send messages to the brain to increase dopamine, which then floods the reward system of the brain and gets translated on the physical level into pleasurable sensations.
Addiction science is complex, and a still evolving research area, but researchers have discovered that the reward system includes a memory recorder type feature. It is well known that opiate abusers are most often chasing the original high. At the time of first use, when the user has no physical tolerance to the drug, the rush may feel very intense and desirable. According to research, the brain actually records this experience, and this memory is then partly responsible for the user chasing that initial high/intense experience of pleasure.
Facts About Tramadol
While there are different opiate prescription medications in lawful circulation, the following facts on tramadol provide a useful snapshot of this particular pain reliever:
- It is distributed under the brand names Ultram/Ultram ER (extended release), Rybix ODT and Conzip.
- It is available in tablet and extended-release tablet or capsule (which is used to treat pain 24/7)
- In response to abuse of tramadol, in March 2010, the drug carried a new warning to doctors not to prescribe this drug to people with a history of addiction or suicide.
- At least two states, Arkansas and Kentucky, have classified tramadol as a controlled substance in response to reports of abuse and addiction (although tramadol is non-narcotic, it has greater potential for abuse that its manufacturer thought possible).
In 1995, the U.S. Food and Drug Administration (FDA) approved the first formulation of tramadol that was distributed under the brand Ultram. Today, the original pharmaceutical manufacturer’s patent has expired and different manufacturers are lawfully producing an FDA-approved generic version of tramadol (patents expire after 17 years under federal law). Tramadol abuse is part of a general problem of prescription drug abuse in America.
Public education is necessary to combat a public misconception that lawful manufacture and distribution of prescription drugs equates to them being safer than street drugs produced in illicit laboratories. This is not the case, and unfortunately, the more effective a prescription drug is for its intended purpose, the more it is prescribed, and a greater volume of the drug can be diverted to non-prescribed users (through street sales, or sale or as a gift from non-medical persons (e.g., friends, family, colleagues, neighbors).
Effects of Tramadol
Tramadol is associated with mild to serious side effects. The occurrence, severity, and type of side effects experienced depend on a host of contributing factors including the user’s age, health condition, length of use, and amount of use. It is important to be attentive to all side effects, however mild. The following effects are considered to be among the less severe grade (this is not a complete list):
- Nervousness or anxiety
- Spinning feeling or dizziness
- Constipation or stomach problems
Serious side effects require a call to the prescribing doctor or may even necessitate emergency medical services. Serious effects can include but are not limited to:
- Shallow or weak pulse
- Seizure or convulsions
- Agitation, hallucinations or fever
- Fast heart rate or fainting
- Blistered, red or peeling skin
An overdose on tramadol is possible when the drug is used in isolation, or in combination with alcohol and other drugs. An overdose can result in death, and it critical to get emergency medical help when overdose occurs. Signs of a tramadol overdose include but are not limited to:
|· Depressed respirations
||· Sleepiness that turns to coma
|· Muscle limpness
||· Small pupils
|· Cold, clammy skin
|· Cardiac arrest
||· Low blood pressure
Developing a tolerance is a general effect of taking most drugs. When a person consumes a drug on a continuous basis, the body builds a tolerance as part of its self-regulation efforts. Abuse of illicit drugs causes a dysregulation; even though drugs are harmful to the body, once the body habituates to them, it will send out messages in the form of cravings to ensure the drug’s intake. When the body does not continue to receive the drug, or the regular dosage is lowered, the body reacts with withdrawal symptoms. Symptoms of tramadol withdrawal include, but are not limited to:
|· Aggression, anxiety or irritability
||· Tremors or tingling sensations
|· Mood swings
||· Poor appetite
As tramadol users have formed a physical dependency on this drug, the first phase of treatment will need to be detox. Today, detox programs are either holistic or medication-assisted. Opioid withdrawal can be painful and uncomfortable, and for this reason, some rehab programs use medication to assist the detox process, as well as the abstinence maintenance process.
After detox, which may last three to 10 days (and sometimes longer), a recovering addict will need an effective abstinence maintenance program. These programs occur in an inpatient (residential) setting or on an outpatient basis. The type of program depends on a constellation of factors, including severity of abuse, relapse risk, availability of family support, and insurance coverage. A residential program is usually a minimum of 28 days, which may include the initial detox portion of the stay.
As part of an inpatient or outpatient program, the recovering substance abuser will receive behavioral therapy to help identify the root causes of the substance abuse. Both individual and group counseling or group recovery meetings (many are based on the 12-Step program) are usually recommended. In addition, depending on the recovery program, complementary therapy may be available. This type of treatment may include non-Western practices medicinal practices, such as acupuncture, yoga, and even equine-assisted therapy where available. Complementary therapy is intended to supplement, not replace, traditional approaches to therapy.
According to the National Institute on Drug Abuse, relapse rates post-recovery are as high as 40 to 60 percent. To combat the possibility of relapse, an effective aftercare program is needed and may include residence in a sober living home. At present, independent owners who have varying levels of experience with addiction often operate sober living facilities. At a minimum, a sober living home should maintain an absolutely drug-free environment and offer some on-site services, such as group recovery meetings. Essentials of an aftercare program – whether the recovering addict resided in a sober living home or elsewhere – include individual counseling, attendance at group recovery meetings, meeting with a drug counselor (including submitting to drug tests), and continuing education about the effects of drugs.
For persons recovering from opioid addiction who are utilizing medications as part of their abstinence maintenance program, it is important to note that some may face opposition. The use of drugs to treat drug recovery remains a debated topic. Some recovery groups and sober living homes demand a participating person to be 100 percent drug-free (i.e., to show “negative” on all drug tests). However, there are many aftercare support programs and meetings that are entirely welcoming of recovering addicts in medication-assisted programs. An important key to a successful recovery is finding a suitable rehab program, and then an effective and inviting aftercare support.
We understand that the wide circulation and abuse of prescription pain relievers raises numerous unsettling questions about the addictiveness and risks associated with these drugs.
If you are experiencing dependence on a prescription pain reliever, such as tramadol, we can help you locate a well-qualified and expertly credentialed treatment program. Call us to learn more.