Tramadol is a popular pain-relief medication. In just two decades, it has become one of the most popular prescription drugs for pain treatment in the U.S.
Still, tramadol raises lots of questions. Is it safe to take tramadol with methadone, oxycodone and other pain relievers? Does it work with opiate withdrawal? Is it an effective treatment for depression?
These and other questions are answered in the sections below.
What Is Tramadol?
Tramadol is an opioid-derived pain reliever that is used by patients coping with moderate and severe body pain. The drug is sold under the brand names Ultram, Ultram ER and Conzip. Tramadol is classified by the Drug Enforcement Administration (DEA) and the Food and Drug Administration (FDA) as a schedule IV controlled substance.
The patent for tramadol was filed in 1963. In 1977, the drug was first marketed in Germany as Tramal. Since the mid-1990s, it has been prescribed to patients in Great Britain and the United States. Tramadol hydrochloride currently ranks 32nd on the Top 300 list of prescription drugs in the U.S. Generic forms of tramadol are also sold around the world.
What Is Tramadol Prescribed For? Is It Dangerous?
Tramadol is often prescribed for the treatment of osteoarthritis. It can be taken orally (in pill or tablet form) or through injection. In the U.S., you can get as many as five prescription refills within a six-month period.
The American Academy of Orthopaedic Surgeons views tramadol as effective in this area and recommends it as a prescription medicine for people coping with osteoarthritic pain.
As a pain reliever, tramadol is sometimes misused by patients. When taken in excess, the drug can have heavy side effects. Abusers of the drug have likened the experience to that of heroin. Tramadol abuse has been cited as an aggravating factor in the rise of the Nigerian Islamist terrorist organization Boko Haram.
What Kind of Opiate is Tramadol?
When it was first green-lighted by the FDA in 1995, tramadol was not considered an opiate by medical professionals. That perception changed during the ensuing decade as some patients exhibited abuse symptoms. While the drug is still considered safe and useful as a pain reliever, its 2014 classification as a controlled substance indicates that tramadol does pose danger if used in excess quantities.
As a moderate pain reliever, tramadol is often likened to codeine. But whereas codeine is sourced from poppy, tramadol is a synthetic drug. It is made from a combination of tramadol hydrochloride, magnesium stearate, microcrystalline cellulose, colloidal anhydrous silica and sodium starch glycolate.
Tramadol is not recommended for anyone under age 17. For children under 12, the drug is only administered in special cases and must be done under a doctor’s supervision.
Does Tramadol Test Positive for Opioids?
Tramadol levels may be diagnosed in blood and plasma. This information can be used by doctors to determine a patient’s overuse or addiction. In cases of fatal poisoning or unexplained death, tramadol testing may be used as part of a medical autopsy. In advanced screenings, traces of tramadol can be detected within the following time limits:
- Urine test: anywhere from one-to-four days after use.
- Blood test: only within 12-24 hours of use.
- Hair sample: within four-to-six months of use.
- Saliva test: within 48 hours of use.
However, most commercial immunoassay screenings (i.e. employee drug tests) are not effective indicators of substantial tramadol levels in the human body.
Opioid Withdrawal Symptoms: Can Tramadol Help?
Opioid use disorder often starts when users grow addicted to the euphoric aspects of a strong prescription painkiller. As a drug used to treat mild pain, tramadol may help patients cope with opioid withdrawal symptoms.
Tramadol is less potent than a drug like meloxicam, which is used to treat severe pain. Patients with tramadol subscriptions are usually satisfied within the recommended dosages and rarely exceed those amounts. Tramadol can therefore help a patient recover from withdrawal symptoms like shaking, bone pain, drug cravings, muscle pain, nausea and joint pain.
According to a randomized clinical trial conducted by Dunn KE, Tompkins DA, Bigelow GE and Strain EC for JAMA Psychiatry, tramadol is an effective suppressant of opioid withdrawal symptoms. The effects of the drug are comparable to buprenorphine and superior to clonidine.
Can I Alternate Tramadol and Oxycodone?
Prescription drugs are meant to be taken consistently, typically once per day, in their recommended dosages. If you skip days, you’ll break the cycle of treatment. For these reasons, you should never mix or alternate two different pain killers.
Oxycodone is prescribed to patients who suffer chronic pain that cannot be relieved with any other medication. It must be taken consistently according to the dosage recommended by your doctor. As an opioid, oxycodone can easily be addictive if overused. It usually takes a week to get used to the drug and its side effects. Oxycodone is a Schedule II drug.
As one of the lighter pain relievers, tramadol is meant for people in need of only mild relief. Most users have a lower drug threshold than patients who use the more addictive pain relieves. Consequently, it’s dangerous to mix tramadol with other pain relief medication. The effects of tramadol should be enough for your symptoms.
If you combine tramadol with an opioid such as oxycodone, it could double the side effects of the two drugs and over-impact your system. Common side effects of oxycodone include fatigue, nausea, dizziness, constipation, headaches, stomach pain and vomiting.
Another dangerous combination is methadone and tramadol. Like oxycodone, methadone is a Schedule II opioid prescribed to patients for pain relief. The side effects include seizures and respiratory distress. Combining or alternating methadone with other drugs could be fatal.
Clonidine/tramadol mixtures are also dangerous, especially for older people prone to brain fog and muscle aches. The side effects of clonidine include confusion and drowsiness.
Mixing these drugs would increase your risk of side effects. It can also create a cycle of abuse where you become addicted to the euphoria, then suffer painful side effects and consume more of these drugs to fight the pain.
Effects of Tramadol on Clinical Depression, Bipolar Disorder
At present, studies on tramadol and its effectiveness with depression treatments are inconclusive. Tramadol is foremost a pain-reliever that, by extension, can ease the depression caused by chronic pain. It’s effects on depression unrelated to pain could depend on where the user sits on the mood spectrum.
Tramadol is most likely to alter the moods of users with psychiatric histories. If you don’t have a history of depression, a daily dose of tramadol won’t likely affect your mood. If you struggle with depression, a 50 mg dose of tramadol could change your mood for at least four hours.
Tramadol can sometimes cause hypomania in depressed users. Hypomania is a state where the individual feels super-energetic and behaves out of character. Symptoms include restlessness, fast-talking, compulsive cleaning, disorganized thoughts and far-fetched ideas. Such states often last for a few hours and represent the manic side of bipolar disorder.
If you are seeking treatment for depression, substance abuse, opiate withdrawal or chronic pain, contact your nearest medical treatment professionals. There are public health support groups throughout the United States that specialize in all forms of treatment. Tramadol can be a helpful prescription pain reliever, but only if you fit the profile and use the proper dosage.