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A hand holding a Tramadol medicine capsule with other capsules scattered on the table.
May 21, 2019

What Does Tramadol Show Up As On a Drug Test?

Tramadol is a synthetic opiate analgesic that was first released in 1993 and marketed under the brand name Ultram. It has also been named ConZip, Ryzolt, FusePaq, and Rybix ODT. Tramadol is most commonly prescribed for chronic pain—especially post surgery—and is frequently used when other pain treatments are either not tolerated, or don’t work.  

Like other opiates, tramadol works by inhibiting the uptake of norepinephrine and serotonin, neurotransmitters located in the brain and central nervous system (CNS) which are believed to reduce or eliminate pain.  It also exhibits antidepressant properties, producing a heightened sense of euphoria when used regularly. Unlike other legal and illicit opiates, tramadol is undetectable via standard drug screening, appearing only on more advanced forms of testing geared specifically toward prescription medications.

History and Statistics

When first marketed, tramadol appeared to offer the exceptional pain-relieving benefits of more potent painkillers without spawning the unwanted byproducts of dependency and addiction. Thus, it became considered a safer alternative to narcotics and was widely accepted by the public.  It was also easier to obtain and prescribed with greater prevalence on the global market.

Prior to 1995, tramadol was massively over-prescribed and remained unregulated (non-controlled) by the Food and Drug Administration (FDA). Tramadol’s status was eventually changed due to rampant abuse and criminal diversion, practices which include proliferation on the street, a growing presence on the web-based black market, and skyrocketing overdose rates. Consequently, as of 2014, tramadol was deemed a designated Schedule IV Controlled Substance by the Drug Enforcement Administration (DEA)—subject to severe criminal penalties for trafficking or unauthorized use.  At present, prescriptions of tramadol cannot be refilled more than five times within a six month period from the original date of the prescription.  A new physician-authorized prescription is then required.

As part of the monstrous US opiate epidemic, tramadol continues to pose a significant danger to public health and safety. The following statistics underscore the severity and scope of the problem:

  • According to the National Institute on Drug Abuse (NIDA), approximately 115 people die daily in America as a result of opiate overdoses, and the total economic burden associated with the opiate epidemic is approximately $80 billion annually.
  • According to the American Society of Addiction Medicine (ASAM), in 2015, drug overdoses were the leading cause of accidental death in the US. That same year, approximately 55,000 people died as a result of drug overdoses—with approximately 21,000 related to narcotic painkillers.
  • The number of opiate-related deaths is approximately five times higher than it was in 1999, directly or indirectly affecting the lives of millions.

Side Effects of Tramadol

Although well-tolerated by most people when prescribed for severe pain management, tramadol is capable of causing serious side effects—especially when abused in tandem with other drugs (polysubstance abuse) or used habitually in excessive doses. According to the Drug Abuse Warning Network (DAWN), serious side effects due to tramadol use were responsible for half of the approximately 50,000 emergency room (ER) visits related to tramadol use.  Common side effects may include, but are not limited to the following:

  • Itching
  • Incoordination
  • Hallucinations
  • Sleepiness/fatigue
  • Vomiting
  • Seizures/convulsions
  • Nausea
  • Dizziness
  • Diarrhea or constipation
  • Heartburn
  • Stomach pain
  • Anxiety and agitation
  • Accelerated heart rate
  • Coma/death

How Long Does Tramadol Stay In Your System?

Tramadol features a half-life of approximately 6.3 hours, but it can take up to a day and a half for the substance to be completely eliminated from the body.  Similar to other legal and illicit drugs, exact time frames are difficult to establish due to individual variables such as age, weight, height, gender, overall physical and psychological health, etc.

Generally speaking, tramadol can be detected in hair, blood, saliva, and urine. Hair tests are characterized by a detection window being 10 and 90 days, with samples being sent to a lab for testing. Industry experts consider hair testing a very accurate method, detecting tramadol at levels as low as 0.176mg.  In contrast, saliva and blood tests don’t offer an extended window for detection—in most cases approximately 24 hours—and can’t show exact levels of the drug in the system. It will simply register as a positive or negative result.

It is important to remember that a negative outcome on a saliva or blood test doesn’t mean that one hasn’t taken the drug; it simply means the amount of the drug present in the system is lower than the cut-off value.  If a positive result is noted on a blood test, which indicates the drug was used within the previous (72 hours) three days, it is necessary to have another confirmatory test. In urine, tramadol can be detected for a period of approximately 2-40 hours, with the amount of time it takes to exit the body dependent on multiple factors such as:

  • Absorption—the time it takes for tramadol to penetrate the bloodstream and the amount of drug following the dose.  The type of tramadol used, food intake, and digestive health are all considered important variables that directly or indirectly affect absorption rates.
  • Metabolism – this is the process whereby various enzymes, like those found in the liver (the organ responsible for metabolizing most drugs), converts the drug into other chemicals.  Any liver disorder, such as hepatitis, cirrhosis, or fatty liver, reduces this capacity and slows down the metabolic process. The half-life of tramadol is also increased in the elderly due to poorer blood flow and the increase in additional medications that can interfere with how a dose of tramadol is metabolized.  
  • Distribution – represents the amount of tramadol present in various bodily tissues after it is fully absorbed by the blood. The greater the body mass, the quicker the pain medication will exit the system.  However, people with a higher percentage of body fat tend to hold onto the drug longer since tramadol is known to bind to fat and build-up over time.
  • Elimination – is the process of flushing tramadol or its metabolites out of the body. Kidneys are the body’s primary organs of elimination, and any kidney disorder can significantly slow down excretion. Additionally, taking the medication with food slows down its exit time, while taking it with fluids increases its clearance from the body through urine.
  • Dosage—the amount of tramadol taken affects how long the pain medication remains in the body.  Taking a high dosage will obviously take much longer to metabolize than a smaller one. Higher doses also increase the likelihood of binding to fat, causing it to remain detectable over a longer span of time.
  • Type—tramadol comes in two forms—immediate release, or quick acting—which releases the entire amount in the body at once, or extended-release which releases the medication slowly over a 24-hour timespan.  The extended-release version of tramadol takes longer to be eliminated from the body than the immediate release version. The amount of time that the drug is taken is also pertinent as someone taking the medication over a short period of time will have less build up in the body than someone taking it for longer periods.
  • Other Medications—using other drugs—especially polysubstance abuse—can also affect the rate at which tramadol is metabolized by the body, so it is important to be informed as to what other medications are being taken.  

It is also important to remember that everyone’s body processes drugs in different ways, and what may take one person days to clear tramadol from their system, can take someone else several hours. Again, tramadol will not appear on a standard pre-employment test—better known as a SAMHSA-5 panel drug test; however, it will appear on toxicology screenings designed specifically for detecting prescription drugs.


Like other mind-altering substances, tramadol is highly addictive when abused. In many cases, what begins as casual recreational use quickly spirals out-of-control and develops into a full-blown addiction. Once an addict tries to stop using, they may also suffer from various tramadol withdrawal symptoms, which only continues the vicious cycle of drug dependence.  Tramadol’s addictive potential is not exclusively reserved for those with genetic susceptibility, a family history of substance abuse, or those who abuse it outside the scope of legitimate medical practices. Anyone, at any time, can find themselves addicted to tramadol and in need of professional help.   

If you or someone you love is addicted to tramadol and in need of medical assistance, contact our Florida rehab center today. Never be ashamed of the fact that you need help. And remember, in the event of a tramadol overdose, call 911 immediately or seek addiction treatment at the nearest hospital emergency room (ER).

For those suffering from a tramadol addiction, please remember that there are other alternative methods for managing pain without opiates. For further assistance and resources, please call Beach House Recovery today and get back to living a clean and sober life. Learn more about the programs available at our detox center in Florida.