Stopping Tramadol and Withdrawal Effects

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Tramadol is a potent painkiller and alleviates lot of suffering, but it is not easy to wean of the drug.

There are two problems implicit in this title – First is “stopping tramadol” and secondly the “withdrawal effects”. Neither one is a pretty picture and both are difficult.

Tramadol is an opioid analgesic which is used to treat moderate to severe acute or chronic pain. It is perhaps most often used to treat the pain associated with fibromyalgia; back pains (strains, sprains or fractures as a result of pressure or trauma); cancer pain; rheumatoid arthritis, vulvodynia; and syringomyelia (also known as hydromyelia), a rare neurological disorder involving the spinal cord.

It should not be used in patients experiencing suicidal thoughts, acute alcoholism, head injuries, severe kidney impairment; raised intracranial pressure, hypersensitivity, liver disease, a history of epilepsy, obstructive bowel disease, asthma, low blood pressure, the elderly and children, and during pregnancy and breast-feeding.

Tramadol is an opioid analgesic. This means that it works by binding to the opioid receptors which are found throughout the brain, and also in the spinal cord and digestive tract. Opioid receptors are an active part of the body’s fight-or-flight response. In other words, tramadol works by blocking or limiting the fight-or-flight response, and reducing the way you view pain.

Tramadol is a synthetic opiate. Opiates are found in nature, such as in the opium poppy plant. The effects of opiates are many, most commonly as drowsiness, lethargy, constricted pupils, confusion, nausea and vomiting, reduced sexual urges, slurred and slow speech, pain relief, impaired coordination and–most commonly known–euphoria, including intense pleasure and strong feelings of warmth and wellbeing.

The Addiction

Because tramadol is an opioid analgesic, because it works to provide physical alleviation of pain, and results in mental euphoria, a patient can become dependent or addicted to it. A dependence on tramadol is a body’s tolerance of the medication, requiring more and more of it to overcome the pain or other factors that tramadol is intended to minimize or eradicate.

An addiction to it could arise due to its over-reliance in controlling pain or could also occur due to use of it for its own sake (the euphoria) rather than for its medical intentions. An addiction to it is most commonly as a result of using it in ways other than how it was prescribed, for example, by using it in higher doses, using it more frequently, or using it by other methods (such as crushing it into a powder and snorting it, or crushing it and dissolving it in water to inject it intravenously). Addiction to it is also common among those who were addicted to other drugs and/or to alcohol in the past.

Regardless of whether or not a person is dependent on, or addicted to tramadol, many people use it continually. Tramadol abuse is–perhaps strangely and inexplicably–very prevalent in Egypt and Iran.

In the United States, there were more than 26 million Tramadol prescriptions filled in 2008. If the average patient had four prescriptions filled that year then there were 6.5 million people–or more than 2%, more than 2 out of every 100 people–who took it. If the average was fewer than four then the number and percentage of people are much higher.

The Drug Enforcement Agency lists it as a controlled substance in many states currently.  It is listed as a Schedule IV (4) Drug, which means that it is a drug or other substance which is considered to have lower potential for abuse than are those listed in Schedule III. This makes it easier to get. In fact, there are an incredible number of websites that allow you to buy tramadol online and without a prescription.

On May 10, 2014, the patents expired. This means that any person or company can copy, produce and market the drug. This will make it even easier to obtain, and drive down the prices even more, removing an obstacle to continued use. Already, the internet sites charge as little as 18 cents a pill–far, far cheaper than any candy bar.

Tramadol abusers take the time-release capsules (which are meant to be swallowed once per day), crush it, and get the euphoric effects that are also found in heroin and OxyContin. The effects can last from 8 to 12 hours–much longer than the 4 to 6 hours experienced from using other opioids, and abusers compare the high more favorably than in heroin, OxyContin and morphine.

It certainly does not help that not only patients and users but also doctors think that tramadol is less harmful and addictive than OxyContin and other opioids. In 2011, there were 20,000 visits to the emergency room that were attributed to the use of tramadol.

In the state of Florida, alone, there were 379 overdose deaths involving tramadol that year. Since Florida has 6% of the country’s population, that could mean that there were a total of 6,300 such overdose deaths in the United States. In the U.K., there was one death in 1996 from an overdose of tramadol, and 154 in 2011 from such overdoses.

In short, it is easy to use and get tramadol, and it is equally easy to stop using it–you can simply die from it. Before that happens, and while you are still alive, there are more preferred ways of stopping the dependence or addiction, of stopping the abuse of tramadol.

The first step is to NOT quit “cold turkey”. It is extremely horrible (several people have described it as being worse than experiencing heroin withdrawal), and even dangerous (and can result in seizures) without experienced medical withdrawal. A person ought to see a doctor (assuming that the original need for tramadol was medical, and that there were prescriptions made for it) who can gradually taper off the dosage and/or replace it with methadone, buprenorphine or other medicines or drugs that have less severe side effects.

As with alcohol (as in AA, or Alcoholics Anonymous), tobacco and virtually every medicine, drug or addictive activity, there are support groups and treatment centers (just ask Lindsay Lohan, Charlie Sheen, Robert Downey Jr., Courtney Love, Drew Barrymore, Mackenzie Phillips and others).

As with Lindsay Lohan, it is better to first seek a local and convenient physical location (although the success for her, specifically, can be debated). You do not want to be alone in withdrawing from dependence or addiction to tramadol. Such places can be found through a search of “drug abuse clinic” or “substance abuse treatment” or similar words at the Local tab of Google+ for your desired locality. The support groups and online forums can come later, to help you stay off of the drug.

I wish that I can say that withdrawal from tramadol is easy, but it is not. The withdrawal symptoms typically start 12 to 20 hours after the last dose. The short term effects typically last 7 days, which is twice as long as withdrawals from other opioids. The longer term effects can last weeks or even months, depending upon the length of time in taking the drug, the dosage involved, and the individual’s physical and mental characteristics.

Withdrawal Symptoms

The symptoms experienced during withdrawal can include some or all of the following: nausea, diarrhea, flu-like symptoms, sweating, chills, tremors, anxiety, depression, irritability, aggressiveness, mood swings, headaches, insomnia, hallucinations, nightmares, poor appetite and tingling sensations.

They generally occur in this order:

1) 24-72 hours after withdrawal: Nervousness, anxiety, tingling, sweating, palpitations and anxiety are the first symptoms of withdrawal. Needless to say, people will crave the drug, and this symptom can be a long-term one.

2) During the rest of the first week: After the agony of the first three days, there can seem to be a return to “normalcy”. Insomnia is common, as is disorientation, blurred vision, dilated pupils, and continued craving for the drug.

3) The second week: Depression, irrational feelings and mood swings, anxiety, and Serotonin syndrome which is a host of symptoms which are potentially life-threatening.

4) The third to fourth weeks: apathy, irritability, depression, insomnia and other sleep disturbances can occur.

Life is not always easy. Stopping the use of tramadol and going through the symptoms of withdrawal is also not easy, but it is better than the alternative.

 

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Martin Nance
Hello, I am Martin Nance. I have recently retired after a lifetime of working as a pharmacist. I now live with my wife in Texas. In my 37 years of helping people manage medications and health, I know the meaningful impact a trusted pharmacist can bring to people's lives. I still love helping people and hope to provide information that can protect and help people in need.