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January 20, 2019

Tramadol Detox Guide

The opiate painkiller tramadol is less potent, and has less potential for abuse, than most drugs in its class. This does not, however, make it completely safe or non-addictive. This guide offers useful information for people who suspect their or a loved one’s tramadol use is becoming a problem.

First approved by the Food and Drug Administration in 1995, tramadol (aka Ultram, ConZip and Ultracet) is a synthetic opiate prescribed to relieve moderate or severe pain. By 2013, annual prescriptions in the U.S. were climbing toward the 45 million mark.

Besides blocking pain receptors, tramadol has an antidepressant effect: it increases the brain’s ability to use serotonin (which stimulates a sense of well-being) and norepinephrine (which boosts energy). Prescribed without controlled-substance restrictions for nearly 20 years, tramadol is now classified as a low-risk Schedule IV drug). Nonetheless, hundreds of thousands of Americans have , and thousands have suffered dangerous overdoses. People who have had other drug-addiction problems are considered at special risk for becoming addicted to tramadol.

If you think your or a loved one’s tramadol use may be turning into addiction, consider:

  • Are you becoming tolerant to the drug (your prescribed dose doesn’t have the effect it used to)?
  • Are the effects of tramadol, or the time spent obtaining it, interfering with everyday duties or relationships?
  • Have you ever taken more than the prescribed dose, asked additional doctors for additional prescriptions, or otherwise gone outside official recommendations?

 A “yes” answer to any of the above likely indicates a problem. So does experiencing withdrawal symptoms after a missed dose.

 TRAMADOL WITHDRAWAL SYMPTOMS

 Symptoms of tramadol withdrawal are typical of symptoms associated with opiate addiction:

  • Loss of appetite
  • Nausea and diarrhea
  • Vomiting
  • Heavy perspiration
  • Shaking all over
  • Mood swings

Because tramadol is specifically formulated to reduce depression as well as pain, the possibility of black moods or despair—even suicidal thoughts—is particularly high. Some people have all-out panic attacks or suffer hallucinations.

TRAMADOL WITHDRAWAL TIMELINE

 Typically, physical withdrawal takes one to two weeks, with symptoms worst around the third or fourth day.

  • Initial symptoms: “Something’s missing” cravings, mild agitation and discomfort.
  • Intensifying symptoms: Panicky and/or depressed thoughts, muscle cramps, perspiration and nausea, extreme restlessness.
  • Peak symptoms: Extreme nausea and pain. Loss of self-control and concentration. “I want to die” feelings.
  • Decreasing symptoms: Lessening pain. Moving back toward normal appetite and energy levels, regaining ability to think clearly.
  • Conclusion of detox: Last of physical discomfort abates.

Intensity and duration vary depending on a person’s overall physical and mental condition, how long the addiction has existed and the size of a typical tramadol dose.

For those on tapering-off detox plans (more on that below), withdrawal is less painful but more drawn out, sometimes taking a month or more for full weaning.

INPATIENT TREATMENT FOR TRAMADOL

Because of the risk for suicidal behavior or severe illness, tramadol detox should not be undertaken without medical supervision. Because cravings may recur periodically for months, many experts recommend up to twelve weeks of inpatient (residential) care after initial detox. The advantages of inpatient treatment include:

  • A 24/7 low-stress environment, free of “triggers” that might tempt clients to think they need another tramadol pill.
  • Easy access to relapse prevention therapy and emergency
  • Opportunities to meet and connect with others recovering from addiction.
  • On-site medical supervision for those on tapering-off detox plans.

Anyone without a solid support network on the outside almost certainly needs inpatient care. So does anyone with a dual diagnosis (a mental illness in addition to the addiction).

OUTPATIENT TREATMENT FOR TRAMADOL

However, inpatient care can cause its own problems if someone:

  • Has important family or vocational responsibilities on the outside. (This is a decision that should be made with the assistance of a professional counselor: “I have to handle this responsibility personally” may itself be a faulty-thinking relapse trigger. Consider: are your outside responsibilities a healthy distraction, or a source of additional stress? Can you rely on everyone involved to understand your recovery-related needs?)
  • Lacks financial means to pay for long-term residential care. (Do check your health insurance and all available sources of financial aid: but don’t borrow money or use credit, which may create fresh stress down the road.)
  • Is personally a poor fit with the detox center in personality or demographic group. (This can usually be avoided by advance research, but it does happen.)

In such a case, clients still shouldn’t be turned loose on their own after physical detox: without professional therapy and regular contact with sobriety peers, risk of relapse is dangerously high. Anyone recovering from tramadol addiction without long-term inpatient treatment should find a good source of outpatient treatment (reporting to aftercare facilities for follow-up therapy).

Outpatient programs are comparable to inpatient programs in duration (10–12 weeks), and usually require clients to come for three to six hours of therapy, three to five days a week. A partial hospitalization program requires more time commitment than an intensive outpatient option. Some treatment providers opt for a transition approach (inpatient care for up to a month, followed by another month or two in outpatient care), which can be the best approach for someone whose time off is limited but who still wants the benefits of early onsite care.

Anyone considering outpatient treatment should first answer the following questions on special challenges of returning to an old environment:

  • How far will I live from the detox center? How will I handle transportation and time concerns?
  • Can I rely on everyone in my household, and in my employment environment if applicable, to support and not sabotage my recovery?
  • Am I prepared to avoid or cope with all potential relapse triggers? (Be brutally honest!) What will I do if I meet an unexpected trigger?

CAN TRAMADOL DETOX BE DONE AT HOME? 

Remember, no matter how many factors may make professional treatment an inconvenience, “just stopping” without medical supervision is almost never a good idea:

  • As already noted, people withdrawing from tramadol frequently experience severe depression along with physical symptoms. Without medical supervision, there’s a real danger of turning suicidal.
  • No matter how well planned, home detox can’t provide the level of comfort, reassurance and medical attention available from experienced detox providers.
  • Without professional help in detoxing, relapse risks are multiplied because there is rarely adequate counseling, preparation and support to deal with future temptations.

Like many people with tramadol dependence, you may already have recovered from a previous addiction and know how intense the physical and mental struggles can get. Why make things even tougher by facing them alone?

TAPERED VS. COLD TURKEY

Substitute medications are rarely used to ease tramadol withdrawal, since most possibilities are more addictive and dangerous than tramadol itself. (Tramadol is, in fact, itself being considered as a detox medication for other opiate addictions.) However, the tapering approach—administering gradually reduced doses of tramadol and eventually phasing it out—is commonly used to ease patients off the drug.

Advantages of tapering include:

  • There’s less risk (although real physical danger is relatively rare with any opiate withdrawal) of serious reactions such as elevated blood pressure, erratic heart rate or seizures.
  • If someone has major depression or other mental-health issues, tapering off reduces the danger of suicidal behavior. (As already noted, this is a particular risk with tramadol.)
  • Patients are unlikely to get so miserable they take another dose (possibly an overdose) out of desperation.
  • A tapering-off program with medical supervision provides additional accountability and preparation for long-term sobriety.

Advantages of cold turkey include:

  • It’s the fastest way of getting completely clean.
  • When withdrawal is taken in one stage, there are fewer long-term temptations to tire of the whole procedure and go back to larger doses.
  • For some people, “toughing out” the full withdrawal experience is helpful in building confidence to stay clean for the long term.
  • If someone has tramadol-aggravated physical health issues, discontinuing the drug quickly may be the best way to reduce overall risks.

No approach is best for everyone under every circumstance. Always get medical advice before making the final decision.

CONSIDERATIONS/HOW TO DECIDE WHAT IS RIGHT FOR YOU

 Ideally, discuss the whats and hows of tramadol detox not only with your regular doctor, but with an experienced detox provider. There are over 14,500 specialized drug treatment facilities in the United States, most of which are open to visits from potential clients. (Reject any option that seems evasive about answering questions or letting you see its facilities.)  

Other factors to consider include:

  • Cost, including what your health insurance covers
  • Geographic location
  • Demographics of typical clients: age, gender, religion, psychological bent
  • Long-term support for clients who complete the detox program

RECOVERY SUCCESS AND AFTERCARE SERVICES FOR TRAMADOL

 The question of aftercare is important. As with other chronic illnesses, around half of patients treated for addiction have at least one subsequent relapse. Your chances of recovering from a relapse—or avoiding one altogether—are significantly improved if you maintain long-term contact with a professional therapist and a peer-support group. If your detox center doesn’t offer these programs, ask for referrals to outside options.

 Also, make sure that every member of your household, plus your primary care physician, understands how to support you in sobriety. Ideally, get your family to attend therapy with you.

WHO NEEDS TRAMADOL DETOX?

If you notice symptoms of possible tramadol addiction as listed at the beginning of this guide, don’t shrug them off with “I can handle it.” Make an immediate appointment with your prescribing doctor to discuss your concerns. If your doctor can’t answer these concerns, ask a drug hotline or counselor.

Even with low-risk prescription drugs like tramadol, a possible addiction should never be ignored. The longer you delay getting help, the worse the long-term consequences are likely to be.

SOURCES

Blum, Karen (2017, November 14). “Tramadol: A Viable Detox Alternative?” Johns Hopkins Medicine. Retrieved from https://www.hopkinsmedicine.org/news/articles/potentially-viable-detox-alternative

Fauber, John (2013, December 22). “Killing Pain: Tramadol the ‘Safe’ Drug of Abuse.” MedPage Today. Retrieved from https://www.medpagetoday.com/painmanagement/painmanagement/43554

Harrigan, Thomas M. (2014, June 27). “Final Rule: Placement of Tramadol Into Schedule IV.” U.S. Department of Justice, Drug Enforcement Administration, Diversion Control Division. Retrieved from https://www.deadiversion.usdoj.gov/fed_regs/rules/2014/fr0702.htm

McIntosh, James (2018, February 2). “What Is Serotonin and What Does It Do?” Medical News Today. Retrieved from https://www.medicalnewstoday.com/kc/serotonin-facts-232248

National Institute on Drug Abuse (2016, November). “Effective Treatments for Opioid Addiction.” Retrieved from https://www.drugabuse.gov/publications/effective-treatments-opioid-addiction/effective-treatments-opioid-addiction

National Institute on Drug Abuse (2018, January). “Drug Addiction Treatment in the United States.” Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/drug-addiction-treatment-in-united-states

Pietrangelo, Ann (2017, April 24). “Tramadol vs. Hydrocodone.” Healthline.com. Retrieved from https://www.healthline.com/health/pain-relief/tramadol-vs-hydrocodone

Pietrangelo, Ann (2017, December 7). “Tramadol vs. Vicodin: How They Compare.” Healthline.com. Retrieved from https://www.healthline.com/health/pain-relief/tramadol-vs-vicodin

TheFix.com (2015, January 21). “Signs, Symptoms, and Risks of Tramadol Addiction.” Retrieved from https://www.thefix.com/content/tramadol-addiction

Tjaderborn, M., AK Jonsson, J Ahlner, and S. Hagg (2009, December). “Tramadol Dependence: A Survey of Spontaneously Reported Cases in Sweden.” Pharmacoepidemiology and Drug Safety, Vol. 18, No. 12, pp. 1192–1198. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/19827010

WebMD.com. “Tramadol HCL.” Retrieved from https://www.webmd.com/drugs/2/drug-4398-5239/tramadol-oral/tramadol-oral/details

WebMD.com. “What Conditions Does Tramadol HCL Treat?” Retrieved from https://www.webmd.com/drugs/2/drug-4398-5239/tramadol-oral/tramadol-oral/details/list-conditions

For related information on Tramadol, other prescription opiates and addiction recovery, see the following articles:

  1. Dangers of Long-Term Suboxone Treatment
  2. How Long Does It Take for Opiates to Leave Your System?
  3. 12 Questions to Ask When Choosing a Treatment Center
  4. What Is a Halfway House and Should You Consider It for Your Recovery?
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