YOUR COMPLETE GUIDE TO TRAMADOL ADDICTION AND TREATMENT FOR TRAMADOL MISUSE - Written by Dean Gustar, Relapse Prevention Specialist

One of the major challenges of medicine now and throughout time, is effective pain management. Pain is defined by the International Association for the Study of Pain (IASP) as "an unpleasant sensory and emotional experience associated with, or resembling that associated with actual or potential tissue damage".

Strategies to relieve pain and to manage chronic pain conditions include a range of pharmaceutical interventions. On the whole, we do not like to experience pain. However, it is a very subjective experience and tolerance of pain differs from person to person. Each of us has our own threshold of what level of pain is acceptable or bearable.

Opium has been used medicinally for the relief of more severe symptoms of pain since the time of the Ancient Egyptians. The sedative and euphoric effects of opium means that it has also been used - and abused - recreationally through the ages.

In modern times, opium has been developed into a range of medications. This started with the discovery of morphine and goes right up to synthetic opioid analgesic painkillers, such as fentanyl, oxycodone and tramadol.

What is tramadol?

Tramadol is one of the opioid medications commonly used to treat what is termed as moderately severe pain. It is part of a group of medicines known as opioid analgesics. Tramadol, and the other opioids in this group, bind to the opioid receptors in the brain and work on the central nervous system to reduce pain symptoms. Tramadol also increases levels of serotonin and noradrenaline.

Tramadol was first approved in Germany for use in 1977 and in America in 1995. At the time, in 1995, tramadol was not considered to be an opiate medication, but it is now considered to be an opioid agonist. In 2014, the FDA (US Food & Drug Administration) classified tramadol as a schedule IV controlled substance.

This change in classification indicated the growing recognition of the potential for tramadol abuse and addiction to tramadol. It is a lower category than many other opioids. This means it can be more easily prescribed than other, stronger opioid medications, with less oversight to identify potential risks of physical dependence or drug abuse.

People often ask, ‘is tramadol addictive?’ Research shows that tramadol is one of the most commonly abused pain relievers by individuals, with many believing it to be less dangerous than other opioid painkillers, and a safe drug, especially if they have a prescription.

According to the Substance Abuse and Mental Health Services Administration, emergency department visits attributable to tramadol abuse or tramadol addiction increased by nearly 250% from 2005 to 2011.

Tramadol is available in the form of extended-release tablets or capsules. Its effects appear gradually after ingestion and peak within four to six hours.

After taking it, the user feels a state of relaxation and euphoria and does not feel any pain, which enables the user to make a great effort, beyond their energy, without experiencing stress or pain. Tramadol works effectively and can be a really useful medicine for short-term pain relief.

The most common and serious potential side effects of tramadol

When should tramadol be avoided

There are circumstances that may mean using tramadol or opioid medication is contraindicated. The presence of contraindications means the medication should be avoided or only used under strict supervision.

It is really important doctors are given a full picture of a patient's history and current circumstances. This will help avoid potential problems, support better management and compliance with medication regimes, and reduce the risk of opioid addiction.

These contraindications would include the following:

• Patients under the age of 12

• Breastfeeding mothers

• History of substance abuse or substance use disorder

• Current use of other medications including selective serotonin reuptake inhibitors (SSRIs) such as some antidepressants because of risk of serotonin syndrome

• Any current use of other opioid drugs

• History of abusing tramadol or other drugs

• Poor medication compliance

• History of severe respiratory depression

• History of mental disorders

Signs and symptoms of tramadol addiction and tramadol abuse

Addiction to tramadol is a serious risk. It is important to be aware of the symptoms of tramadol addiction so it can be treated as early as possible.

The Diagnostic and Statistical Manual (DSM-V) has a list of symptoms to indicate the presence of opioid use disorders. You should expect to see at least two of these symptoms occurring over a 12 month period:

• Taking larger amounts or taking drugs over a longer period than intended.

• Persistent desire or unsuccessful efforts to cut down or control opioid use

• Spending a great deal of time obtaining or using the opioid or recovering from its effects

• Craving, or a strong desire or urge to use opioids

• Problems fulfilling obligations at work, school or home.

• Continued opioid use despite having recurring social or interpersonal problems.

• Giving up or reducing activities because of opioid use.

• Using opioids in physically hazardous situations.

• Continued opioid use despite ongoing physical or psychological problems likely to have been caused or worsened by opioids.

• Tolerance (i.e., need for increased amounts or diminished effect with continued use of the same amount)

• Experiencing withdrawal (opioid withdrawal syndrome) or taking opioids (or a closely related substance) to relieve or avoid opioid withdrawal symptoms.

There are other indicators or warning signs that may also point to tramadol addiction or tramadol abuse. It is highly likely that the person would be taking medications in higher doses than prescribed and at higher frequency. This will mean that the person will run out of tramadol.

In order to not experience withdrawal symptoms, people may claim to have lost prescriptions or left their medication somewhere in order to get a new prescription. It might be that they visit more than one doctor, or use online prescribing services, in an attempt to get a second line of supply.

Sometimes it means turning to the blackmarket. Prescription drugs, including opioids, are available through the Dark Web and easily purchased. These medications are often highly dangerous and often contaminated with other highly dangerous substances, for example fentanyl.

We have also seen that people engage in other substance abuse. For example, perhaps they start taking illicit drugs, such as heroin, if they cannot get their usual tramadol supply and begin to experience tramadol withdrawal symptoms.

Tramadol is designed to manage pain, so people can operate and live their lives with reduced pain and discomfort. If a person is regularly nodding off and sleepy when taking their medication then it could also be a sign that they are abusing the medication and taking too much.

Factors and causes that increase the risk of tramadol dependency

There are a group of factors that may be, in one way or another, a major cause of tramadol dependence, and they can be summarised into four main factors:

Societal reasons

An individual's environment and the surrounding community may play a significant role in the possibility of an individual's substance abuse and entry into the cycle of addiction.

Substance abuse may be due to the possibility of easily obtaining tramadol from his surroundings due to the availability and normalisation or by the presence of tramadol use by family or friends.

Psychological Reasons

Individuals who suffer from mental illnesses such as anxiety, depression or bipolar disorder are more likely to be addicted to tramadol. Those with mental conditions could develop drug addiction disorder in general due to their desire to escape from reality and try to overcome the bad psychological feelings they are experiencing.

Genetic and Familial Reasons

Genes and family history greatly influence an individual's likelihood of addiction. A person with a family history of parents or grandparents with a substance abuse disorder is significantly more likely to develop tramadol or other addictions.

Psychological Trauma and Abuse

One of the most common reasons that may lead an individual to opioid addiction is their exposure to violent psychological shocks. These traumatic experiences may lead them to take tramadol to feel better and try to overcome the negative feelings resulting from those traumas.

Factors like the individual’s exposure to abuse, bullying and societal neglect may also result in the dependence on tramadol, resulting in addiction.

Tramadol addiction treatment

There are many different substance abuse treatment centres that can provide tramadol treatment programmes. It is important that you research the different approaches of the treatment centres.

Do not be afraid to contact a treatment centre and ask questions about their approach and expertise. A good addiction treatment centre will welcome such enquiries.

When people who have abused tramadol are ready to address their tramadol use it is important to act quickly while motivation is high. Look for an addiction treatment centre that implements evidence-based treatment and has a strong medical team.

The medical team are really important to support the tramadol withdrawal process and also address the underlying pain issues that the tramadol was prescribed to support. Effective tramadol recovery must include pain management as part of the overall treatment plan. If attention is not paid to this there is a danger the person may abuse tramadol again in the future.

The components of an effective treatment for tramadol addiction would include:

• In-depth assessment of the person of concern

• Requests for previous medical reports

• Strong medical team and detox support team

• Development of a withdrawal management plan

• Psychotherapy and counselling

• Family support and therapy

• Post-treatment aftercare and continuing care planning

Can I treat myself at home for tramadol addiction?

Due to the severe withdrawal symptoms of addiction to this drug, we do not recommend trying to overcome it at home. Trying to do so on your own may cause serious problems, not only for you but for those around you as well. We highly recommend you resort to specialised psychiatric medical centres in order to be able to recover completely and safely.

How we treat tramadol addiction at The Kusnacht Practice

At The Kusnacht Practice, we have the best experts to deal with all types of addiction to prescription drugs. Each case is dealt with in complete confidentiality, in an understanding and supportive environment.

We understand that battling tramadol addiction is not easy. To begin the addiction treatment, we would negotiate a medical detox and withdrawal management plan. Our aim is to keep withdrawal symptoms to a manageable level, with clear goals and high levels of medication care and supervision. We would also screen for any other substance use disorders and include them in the treatment planning.

It is highly likely people who abuse tramadol actually started taking it as part of a regime to help manage chronic pain. Our dedicated Medical Team supports the treatment process by understanding and treating the underlying medical conditions and developing safer pain management and recovery strategies.

At The Kusnacht Practice, we believe that each individual has their own underlying internal causes that prompted them to become addicted. Here, we carry out an effective and specialised medical treatment to address the root of the psychological problems within each patient. We identify the causes of the problem and develop a specialised treatment plan, in addition to our extensive experience in dealing with withdrawal symptoms.

Through our programmes, we work to restore the balance between your mind, body, and energy through various treatments, such as psychotherapy, BIO-R, complementary therapies, spiritual counselling, and much more. As well as being important aspects of the treatment programme, these interventions will also help to reduce withdrawal symptoms during the detox phase.

We also have a strong focus on post-treatment care. Our Continuing Care Team will work with the person of concern, and the family, to ensure that the challenges of returning to the home environment are able to be faced and the risk of relapse or return to tramadol abuse are mitigated.

All this is done in a safe environment, with luxurious hotel accommodation in your five-star room amidst the picturesque Swiss nature.

In order to learn more about tramadol addiction treatment at The Kusnacht Practice contact our specialists.

Written by Dean Gustar