January 20, 2019

How Long Does Tramadol Withdrawal Last?

Taking tramadol likely served you well for some period of time to relieve acute or moderate to severe chronic pain. Or, you could have been abusing the drug and taking it recreationally. Yet, tramadol, like other opiate pain relievers, is highly addictive, and now you may be in a position where you can’t just stop taking it. You want to discontinue tramadol, but you’re rightly worried about what’s in store for you. When you’re considering getting off tramadol, among the other aspects of detox and treatment, you want to know how long tramadol withdrawal lasts.

TRAMADOL DETOX: THE FIRST STEP

While discontinuing tramadol use (brand names Ultram, Ultram ER, Ultracet, Conzip) is your goal, experts caution against trying to detox on your own from the synthetic opiate analgesic, a Schedule IV controlled substance. You may be successful in dealing with some of tramadol’s more common physical symptoms, but you’re likely unprepared and ill-equipped to cope with the atypical withdrawal symptoms associated with tramadol use, including extreme anxiety, hallucinations, numbness/tingling in extremities, pain, panic attacks and paranoia, and rigor.

Uncommon adverse reactions include seizures and a potentially fatal reaction called serotonin syndrome. Adverse reactions to tramadol and misuse of the painkiller have been linked to a spike in emergency room visits in recent years. According to a report from the Centers for Disease Control and Prevention (CDC), drug overdose deaths involving synthetic opioids other than methadone (fentanyl, fentanyl analogs, and tramadol) increased by 45 percent between 2016 and 2017, from 6.2 to 9.0 per 100,000 people.

Still, while tramadol withdrawal generally isn’t physically dangerous or even life-threatening, that doesn’t mean it’s completely safe— especially if attempted without medical supervision. The safest, most effective way to detox from tramadol is through medication-assisted treatment (MAT) provided at an accredited drug and alcohol rehab facility specializing in detox from opiates. MAT, according to the Substance Abuse and Mental Health Services Administration (SAMHSA), is the use of medicines in combination with counseling and behavioral therapies in the treatment of substance use disorders (SUDs).

What happens during tramadol detox using MAT? You’re under constant medical supervision to make sure you’re as comfortable as possible and to minimize the common withdrawal symptoms from opiate drugs, as well as the atypical ones specific to tramadol. However, if you experience any complications during tramadol detox, or have a co-occurring mental health disorder such as anxiety or depression (which may have been exacerbated by stopping tramadol), or also have a dependency or addiction to alcohol and drugs, the fact that you have medical professionals by your side means you’ll receive immediate attention to address your issues.

Tramadol withdrawal starts between 12-20 hours after taking the last dose, although this can vary, depending on whether the medication is regular or extended-release. Compared to shorter 3-4 days of withdrawal symptoms for codeine analogs, acute tramadol withdrawal symptoms can go on for about a week. Overall tramadol withdrawal—getting past the physical withdrawal symptoms—generally lasts about 2 weeks.

The actual length of time for your symptoms to dissipate, however, is influenced by a number of factors:

How long you’ve used tramadol – Longer time abusing tramadol typically leads to more severe withdrawal effects and a lengthier withdrawal.
How frequently and the manner in which you’ve taken the drug – Using tramadol more often and snorting or injecting the analgesic generally produces withdrawal symptoms that are more complicated than pill form use.
Drug dosage – Higher doses lead to longer and more intense tramadol withdrawal.

Since the most severe symptoms of tramadol detox appear within the first 72 hours of taking the last regular dose, MAT uses tapered dosing to gradually reduce tramadol dosages before complete discontinuation of the drug. MAT may also employ buprenorphine (Suboxone) to help with withdrawal symptoms and cravings. In addition, a commonly used MAT medication to treat opiate withdrawal is clonidine. Clonidine is similar to lofexidine, a medication recently approved by the Food and Drug Administration). According to research published in the American Journal of Psychiatry, clonidine helps reduce opiate withdrawal symptoms and, as an adjunctive maintenance treatment, increases abstinence duration and helps prevent relapse.

Most of the common physical symptoms of tramadol withdrawal will subside fairly quickly, although some physical and psychological symptoms, such as lack of energy, insomnia and drug cravings may last considerably longer— perhaps for months. After tramadol has been eliminated from your system through medically-supervised detox, you’re well on the way to recovery. But you are still in tramadol withdrawal and need counseling and other treatments and skills-building to prevent relapse. After detox, you’re just not ready to deal with the psychological stressors and triggers that could propel you back to using tramadol. Taking part in a personalized treatment plan is the next step.

Learn more about tramadol withdrawal symptoms and timeline.

WHAT IS PERSONALIZED TREATMENT?

Treating the whole person, tailoring treatment approach, medications, adjunct therapies, counseling, and behavioral therapies are all part of creating a treatment plan that addresses the client’s needs. Many people who come to treatment for a specific SUD also suffer from another SUD, such as alcohol and prescription opiate addiction. They may also have undiagnosed and untreated clinical depression, anxiety or other mental health disorder. In fact, co-occurring mental health disorders can be a serious predictor of relapse if not treated. Another issue that personalized treatment addresses include the psychological withdrawal symptoms from tramadol, such as depression and drug cravings, that may appear even in the absence of clinical depression. By treating all issues—SUDs, polydrug use, co-occurring mental health disorder, etc.—personalized treatment can help provide a stronger foundation for recovery and building a comprehensive toolkit to prevent relapse.

According to the Journal of Current Psychiatry Reports, “more than two-thirds of individuals relapse within weeks to months of initiating [addiction] treatment.”

What does personalized treatment entail on a day-to-day basis? Personalized treatment includes individual counseling, group therapy, evidence-based behavioral therapies, alternative and holistic treatment approaches, participation in peer support and 12-step group meetings, learning coping skills, healthy lifestyle tips, family therapy, and developing a relapse prevention plan.

Residential treatment, also called inpatient treatment, is the best way to receive personalized treatment. In many cases, you’ll likely transition from detox to treatment at the same accredited drug and alcohol treatment center. How long you’ll remain in treatment will be determined based on your length of time addicted to tramadol, any co-occurring substance abuse and mental health disorders, prior treatment and relapse, medical condition, and other factors. Residential treatment may be 35 or 65 days, or longer, as the situation warrants. Research shows that longer time in treatment positively influences post-treatment outcomes, particularly abstinence.

Learn more about inpatient drug and alcohol rehab.

INTENSIVE OUTPATIENT PROGRAM

You may not need it, but an intensive outpatient program (IOP) may be helpful for some who’ve completed medically managed tramadol detox and an inpatient treatment program and need ongoing care on a stepped-down basis. This continuing care program, which may last for 65 days, blends the best aspects of residential treatment and outpatient care.

Why consider an IOP? Advantages include access to ongoing counseling and group therapy support, MAT to help address and manage cravings, life skills and vocational prep, 12-step groups, and interacting with peers in a supportive community.

Learn more about intensive outpatient programs.

AFTERCARE FOR TRAMADOL WITHDRAWAL

Following the completion of treatment, most of your physical withdrawal symptoms will be long gone. Yet, dealing with continuing psychiatric symptoms, especially if you have a co-occurring mental health disorder such as anxiety, depression, post-traumatic stress disorder, and others, means you can benefit from continuing care or aftercare. Such programs are available through the best drug and alcohol treatment facilities and are considered an important part of ongoing maintenance therapy, medication management, access to counseling, treatments, group activities and 12-step group meetings.

Learn more about continuing care.

WHEN IS TRAMADOL WITHDRAWAL OVER?

There is no absolute number of days or weeks for when tramadol withdrawal is over. Since each person is unique, the length of time for tramadol withdrawal in one person is different from another individual’s experience. It is correct to say, however, that long-term or chronic tramadol users (those with a painkiller addiction) will likely undergo a longer overall withdrawal process than someone who’s only been on the drug a short period of time.

An important note is that those who are struggling with another substance use disorder, including alcohol use disorder (AUD), other medical conditions requiring ongoing treatment, and/or who have a mental health disorder will also likely have a longer overall tramadol withdrawal experience. The best way to further the recovery journey is to take proactive steps to heal, including aftercare, good self-care, building and maintaining strong support and social networks and adopting a positive attitude.

You will know that your tramadol withdrawal has neared or is at the end when you feel strong and confident in your recovery foundation, are able to successfully combat stress and avoid triggers, know what to do if cravings occur, and have a supportive network that helps reinforce your commitment to sobriety. Tramadol withdrawal, on its own and not complicated by multiple drug use and/or mental health disorder is less extensive than for narcotic pain relievers such as oxycodone (OxyContin), hydromorphone (Dilaudid). It still takes time, though, and you must be patient, diligent in tending to your relapse prevention plan and practicing healthier behaviors.

For more about Tramadol, addiction, detox, withdrawal, and rehab, check out these articles:

Sources:

Addiction. “A randomized controlled trial of buprenorphine taper duration among opioid-dependent adolescents and young adults.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26918564

American Journal of Psychiatry. “Clonidine Maintenance Prolongs Opioid Abstinence and Decouples Stress From Craving in Daily Life: A Randomized Controlled Trial With Ecological Momentary Assessment.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25783757

Centers for Disease Control and Prevention. “Drug Overdose Deaths in the United States, 1999-2017.” Retrieved from https://www.cdc.gov/nchs/data/databriefs/db329-h.pdf

Drug Enforcement Administration. “Controlled Substances: Alphabetical Order.” Retrieved from https://www.deadiversion.usdoj.gov/schedules/orangebook/c_cs_alpha.pdf

Drugs.com. “ERs See Spike in Narcotic Painkiller Abuse Cases.” Retrieved from https://www.drugs.com/news/ers-see-spike-narcotic-painkiller-abuse-cases-56797.html

Drugs.com. “Tramadol: 9 Things You Should Know.” Retrieved from https://www.drugs.com/slideshow/tramadol-facts-1192

Journal of Current Psychiatry Reports. “New Findings on Biological Factors Predicting Relapse Vulnerability.” Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674771/

MedicineNet. “tramadol.” Retrieved from https://www.medicinenet.com/tramadol/article.htm#what_is_tramadol_how_does_it_work_mechanism_of_action

MedPage Today. “FDA Approves First Non-Opioid Drug to Treat Withdrawal Sx.” Retrieved from https://www.medpagetoday.com/painmanagement/opioids/72938

MedPage Today. “Killing Pain: Tramadol the ‘Safe’ Drug of Abuse.” Retrieved from https://www.medpagetoday.com/painmanagement/painmanagement/43554

National Institute on Drug Abuse. “A look at drug craving.” Retrieved from https://www.drugabuse.gov/news-events/latest-science/look-drug-craving

Substance Abuse and Mental Health Services Administration. “Buprenorphine.” Retrieved from https://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine

Substance Abuse and Mental Health Services Administration. “MAT Overview.” Retrieved from https://www.integration.samhsa.gov/clinical-practice/mat/mat-overview

Substance Abuse and Mental Health Services Administration. “Substance Use Disorders.” Retrieved from https://www.samhsa.gov/disorders/substance-use