Tramadol How Addictive

I have been taking Tramadol for 4 years 100mg x 3 times daily now as part of a range of drugs to try to manage my chronic back pain. I had a spinal fusion about 20 years ago that was successful in treating sever left side sciatica pain. I then had about 20 years of almost normal life then about four years ago damaged my back lifting a scuba tank over my head. This resulted in a re-injury to my spine and this time the sciatic pain is on my right hand side. Having tried everything possible I underwent another spinal fusion which at this early stage looks as if the results are promising.

I have tried coming of the Tramadol but soon realised that my body was addicted to the stuff and now need to work out how best to manage my withdrawal from this drug. I was thinking of reducing dosage by 50mmg each week and see how this works out for me. - Any suggestions out there?

You can come down by 50 mg per week until you get to the final 100 mg and then come down by 25 mg per week. You can open the 50 mg capsules and pour away half the powder then reseal. That way is less 'painful' than coming off the final 50 mg cold turkey. That is how I did it.

Since I wrote last week I have gone down from 500mg to 100mg a day. The first few days weren't the easiest in my life but they weren't the worst. It gets easier and easier. So long as I remember that I am feeling rotten because my body is readjusting then I could mentally accept what I was going through. Replacing the tramadol and controlling the withdrawal pain with paracetamol and ibuprofen really helps. This week I am going to go from 100mg to zero. I understand that it is not recommended to chop capsules in two. Thanks to everyone for their advice set out in this blog. My advice is 'dont try this at home, kids' Stick to non-addictive pain relief.

Hi Tony72, I would agree with evergreen.. the best way is to very gradually taper down the dose over a period of time.. depending on what dose you've been taking, and for how long, this may be a slow or fairly quick process.. I'm speaking from experience of someone who has battled with Tramadol dependency for 4-5 years now.. I've successfully come off it a number of times by tapering down, only to relapse and start taking it again!

Like evergreen said, the best way to taper down is to get the capsules if you can from Dr, then open them up which allows you to measure out the dosage you want to take in 25mg-50mg increments or lower.

You can either add the powder from the capsule to a glass of fizzy drink/orange (you will hardly notice it)..gradually you should be able to get yourself down to just a tiny bit of powder (10-20mg) and then after a few days you'll not feel any withdrawals when you stop.

I have had 2 shoulder operations (rotator cuff repairs) over a period of 18 months and as a result have been on and off Tramadol for a period of two years now. I didn't think it worked that well at first until I tried to stop

taking it. I was on 200mg 3 times a day.

I felt miserable paranoid and very bad tempered. Due to being post menopausal the joint pain in feet elbows and hands and somedays hardly being able to move at all,I have been using 100- 20mg once a day. I'm at

my wits end with the pain I feel everyday but I decided to go cold turkey and give up the Tramadol last

Monday. This is the only way for me to quit unfortunately. I was a smoker for most of my life but last year

on Boxing Day I gave that up - cold turkey. I have been told its a week to get the Tramadol out of your system? Is this true?

Tonight I'm just fed up with the pain which is obviously much worse now but I also have continuing flu like

symptoms and my skin feels tender and very sore all over. Sleep has been impossible for the last 4 nights.

Anybody with suggestions? Nights are the worst.

richardsw7: Well done successfully tapering down from such a high dose, I think you have made a wise choice to quit early rather than later, where you might face more severe withdrawal problems.

The worse thing with Tramadol I think (for me anyway) is not so much the withdrawal (which can be done easily as you've demonstrated with a careful taper)... it's the psychological dependency and cravings for Tramadol..

Eventually when it's fully out of your system (which can take days/weeks) you may feel that "meh" feeling without Tramadol...everything seems a drag and dull.. so you be tempted to take it again to feel better...

I think this is particularly the case if you suffer depression, seasonal depression or just low mood boubts due to serotonin imbalance from poor diet/lack of exercise..

Here's the thing with depression, it's the most common of all mental health conditions (with about half of the population experiencing it at some point in their life) yet many suffer depression (mild or chronic) and don't even realise it...

So if you're one of these people prone to getting depression bouts (or with an ongoing undiagnosed depression illness) when they take Tramadol it treats the depression as well as pain..

If after withdrawing from Tramadol and stopping completely, after some weeks if you start feeling down/getting a psychological urge to take Tramadol again (even in the absense of pain) it could well be depression you have..so it's well worth discussing this possibility with your GP rather than just asking for more Tramadol.

I'm exploring this option with my Doctor, as I've struggled with Tramadol dependency for years.. I can come off it without any problems, but staying off it, extremely very difficult.. my mood drops, I become lethargic and barely able to do anything (I checked NHS Direct online and many of what I experience are classic depression symptons)..when I take 50mg Tramadol and all is well again and all those symptoms disappear. That's why I've consistency said Tramadol has off-label uses as an instant anti-depressant. Whether it's suitable or safe for treatment of depression is another matter entirely of course and only Doctors and the MHRA/BMC can determine that.

I doubt any doctor would consider it as a first choice for depression because of the opiate action (although weak) and risk of dependency/tolerance. There's plenty of other SSRI anti-depressants that work just as well as Tramadol, but unfortunately they take longer to work and many have side effects Tramadol doesn't.

Cold turkey off tramadol is really tough because the physical symptoms are like flu and having been a punch bag for a boxer. Add to that the loss of the feeling of well being that tramadol gives. You will be depressed and hopeless. For some, tapering down works well. For others, it just prolongs the withdrawal. Since you are already doing cold turkey, hang in there. Do not take an anti-depressant unless you are already used to one. The physical symptoms last for 5-15 days. The tramadol is put of the system in a few days, but the brain chemicals are out of balance. The mental symtoms can continue for a year. If they go on beyond a year, your brain is unlikely to adjust and you can decide with a doctor if you need anti-depressants. One thing that can happen when stopping tramadol is restless leg syndrome. Restless legs are a part of the withdrawal, but again, brain chemicals do not alawys adjust back to pre-tramadol. Again, I would suggest you hold off all other drugs to treat restless legs or insomnia for a full year to give your brain a chance. This is advice from the Oxford Pain Clinic. I followed this advice and after a year am still low in mood, and have restless legs. But bith improved after 9 months. I have started tramadol... A dose of 50mg slow release twice a day. This has balanced my mood and greatly decreased the restless legs. It has also fully stopped the body aches in feet and writs, shoulders and thighs that I had after tramadol. I will take this dose for another year, and then come off again fully. The main thing is to know that your brain can adjust if you give it time, and avoid mixing it up with other solutions. Every drug comes with its side effects. Tramadol is least likey to mess with your weight, your libido, and your hormones than most other things. Yes, it is hard to come off,,, but it can be done. I did cold turkey 14 months ago. It is the only time I have ever smoked, and, yes...it helped. But I was a non-smoker, so it probably helped me more than a smoker or an ex-smoker. Eat simply. Rice cakes. Cups of tea. Make low demands of yourself. If you can't sleep, don't fight it... Get up and do something that is brain satisfying or creative. I used a study of logic, learning dog body language, and knitting hats. Mainly, know that you can do it...you are not going crazy...the dreams will stop, the insomnia will settle, the restless legs will improve.

Hi Ifira,

>I have had 2 shoulder operations (rotator cuff repairs) over a period of 18 months and as a result have >been on and off Tramadol for a period of two years now. I didn't think it worked that well at first until I tried >to stop taking it. I was on 200mg 3 times a day.

>I felt miserable paranoid and very bad tempered. Due to being post menopausal the joint pain in feet >elbows and hands and somedays hardly being able to move at all,I have been using 100- 20mg once a >day.

It's good you lowered your dose considerably, but try to do it gradually. If you've been taking 600mg daily (the maximum dose) then it's probably better to go down very gradually over a period of weeks, rather than drop down to 1/6th or 1/3rd of the dose you were on previously, overnight. You could taper down the dose in 100mg, 50mg increments or 25mg, over a period of several weeks, whatever feels comfortable for you. It may be a case of trial and error to get it right. Everyones brain chemistry is different and react differently to Tramadol (and withdrawals).

>I'm at my wits end with the pain I feel everyday but I decided to go cold turkey and give up the Tramadol >last Monday. This is the only way for me to quit unfortunately. I was a smoker for most of my life but last >year on Boxing Day I gave that up - cold turkey. I have been told its a week to get the Tramadol out of >your system? Is this true?

It's a VERY bad to quit Tramadol cold turkey in your situation due to the high dose you've been taking and length of time. The reason is primarily because of the serotonin action Tramadol has on the brain. It can really mess up your brain chemistry if you just quit suddenly or lower the dose dramatically. I know some GP's suggest quitting cold turkey or dopping the dose suddenly and often just switch patients onto other pain meds, but really, they don't understand the withdrawal problems of Tramadol from patients who have been taking it at high doses over a longer period (probably from lack of patient experience with Tramadol or feedback from patients).

If you are experiencing any Tramadol withdrawal symptoms, my advice is to discuss with your GP about a taper-down and painkiller transition regime You should be able to do this alongside any new painkillers he gives you* and he/she may do it so that the dosage of the new killer increases proportionally to the decreasing dose of Tramadol so you get equilavent pain-relief still..or you may just start on an optimal dose of the new painkiller while you taper down off Tramadol.

Tramadol as far as I know, has very little potential for any serious interaction with other opiate-class painkillers, other than potentiating their effects. But since Tramadol is only a weak opiate action painkiller, it's unlikely to significantly worsen the usual symptoms of opiate-class painkillers nausea or constipation etc.

>Tonight I'm just fed up with the pain which is obviously much worse now but I also have continuing flu >like symptoms and my skin feels tender and very sore all over. Sleep has been impossible for the last 4 >nights.

I feel for you :-/ It sounds like what you're experiencing is both a combination of the reduced pain-relief from lowering your Tramadol dosage, and also, some withdrawal symptoms too by the sounds of it (you mention your skin feeling sore/and flu-like symtoms, and restlessness/insomnia)..these are common symptoms of Tramadol withdrawal.

>Anybody with suggestions? Nights are the worst.

You can either stick it out, and perhaps ask for something to help with the sleep problem, or, you can do as I suggested and tell your GP you may be experiencing Tramadol withdrawal symptoms from cutting the dose too fast too soon, and ask to go back to your previous dose and taper down more gradually under your GP's guidance..

For the pain relief.. that's really up to your GP and depends on the type of pain it's duration, how severe, and how long you're likely to need pain relief for.

When I had major surgery on my knee a few weeks ago, I was on morphine 3x a day in hospital.

On discharge I was given a combination of Tramadol, Paracetamol 500mg 4x daily, and Dihydrocodeine (DHC). DHC is approximately 1.5x stronger than codeine. I was experiencing pretty severe and constant pain. These painkillers only took the edge of it really but were better than nothing. I was only given 4 weeks supply of each, which turned out to be all I needed. I found, during the worse of the pain (first 2 weeks) Subutex was far more effective than all these painkillers combined, even at tiny dose (200mcg).

Subutex is a very good painkiller for chronic long-term pain-relief (40x more potent than codeine) with an excellent side effect profile (less chance of chronic constipation, nausea or sedation) and very long half-life (36-72 hrs) so need to keep re-dosing. However getting a GP to prescribe it for pain-relief might be difficult as most view Subutex as a detox drug for breaking chronic and severe opiate-addiction (usually to heroin).

With Subutex at 200mcg you can take it, yet not feel any euphoria or the classic "opiate high". You just feel normal.. minus the pain. So it's a great first choice drug for long-term chronic pain relief.

As I said though, it depends entirely on whether you can persuade your GP to put you on it. And there is a risk of tolerance/addiction, but if you stay at 200mcg one daily I think this would be a very low risk.

If nothing else is working and you're concerned about side effects/withdrawal of other strong painkillers, it's certainly worth considering Subutex with your GP and seeing if they're open to the idea. You can also get it in patches now I think.

Very good advice happyjoy, it may help a lot of people in this situation.

That's the problem with Tramadol I think. Due to it's three-way action on the brains chemistry and receptor pathways (noticeably Serotonin), it can mask underlying undiagnosed depression (and several other mental illness which could be treated with an anti-depressant). And so, when a patient like that withdraws from Tramadol, they experience a worsening of the mental withrawal symptoms which may be prolonged. Many in that situation may not attribute to an illness at all, but rather to Tramadol withdrawal/addiction.

happyhoy said: "The mental symtoms can continue for a year. If they go on beyond a year, your brain is unlikely to adjust and you can decide with a doctor if you need anti-depressants. "

Very true. I think if you experience the listed mental symptoms of withdrawal (lethargy, restlessness, insomia, anxiety, low mood, lethargy, lack of motivation, difficulty concentrating...etc) months or up a year after quitting Tramadol, as you pointed out, it could be indicative of a depression illness that alreadt existed before you went on Tramadol. Coming off Tramadol just makes it more apparent you have that illness and the symptoms more prominent/severe due to the serotonin boosting and stablising effect of Tramadol. It is basically an effective anti-depressant and does even have off-label uses as such.

So yes, I would echo what happyjoy said:

If anyone here is experiencing what appear to be mental withdrawal symptoms, months, or years after coming off Tramadol, don't suffer in silence or be tempted to go back on Tramadol...instead, consider the possibility you may have undiagnosed depression and discuss with your GP about going onto anti-depressants or being referred for a clinical diagnosis and counselling therapy.

Very good advice happyjoy, it may help a lot of people in this situation.

That's the problem with Tramadol I think. Due to it's three-way action on the brains chemistry and receptor pathways (noticeably Serotonin), it can mask underlying undiagnosed depression (and several other mental illness which could be treated with an anti-depressant). And so, when a patient like that withdraws from Tramadol, they experience a worsening of the mental withrawal symptoms which may be prolonged. Many in that situation may not attribute to an illness at all, but rather to Tramadol withdrawal/addiction.

happyhoy said: "The mental symtoms can continue for a year. If they go on beyond a year, your brain is unlikely to adjust and you can decide with a doctor if you need anti-depressants. "

Very true. I think if you experience the listed mental symptoms of withdrawal (lethargy, restlessness, insomia, anxiety, low mood, lethargy, lack of motivation, difficulty concentrating...etc) months or up a year after quitting Tramadol, as you pointed out, it could be indicative of a depression illness that alreadt existed before you went on Tramadol. Coming off Tramadol just makes it more apparent you have that illness and the symptoms more prominent/severe due to the serotonin boosting and stablising effect of Tramadol. It is basically an effective anti-depressant and does even have off-label uses as such.

So yes, I would echo what happyjoy said:

If anyone here is experiencing what appear to be mental withdrawal symptoms, months, or years after coming off Tramadol, don't suffer in silence or be tempted to go back on Tramadol...instead, consider the possibility you may have undiagnosed depression and discuss with your GP about going onto anti-depressants or being referred for a clinical diagnosis and counselling therapy.

Morphix & Happyjoy thanks so much for your replies and oncern. I live on a tiny Island in the middle of the Pacific Ocean.... Yeah sounds idyllic but it has problems when it comes to health. Health services are very

limited and the choice of qualified Drs are very few and transient. There is nobody to diagnose depression unless you can get the insurance to pay for medical treatment overseas. They don't tend to cover for

depression. We can get anything over the counter here though, so I might try subtext if the chemist has it. I

have tried panadine forte but that also is dangerous. It takes the edge off the pain but codeine scares me

enough to only take it when I get a really bad head ache.

Thanks again guys.

If I manage to get out and pay golf from a buggy at the weekend I'm going to have to do something about

pain management afterwards. That will be the real test for me. But i'm sure beating the hell out of a small ball will help. I'll pretend the golf ball is a tamadol pill. I'll let you know if that therapy helps..

Morphix & Happyjoy thanks so much for your replies and oncern. I live on a tiny Island in the middle of the Pacific Ocean.... Yeah sounds idyllic but it has problems when it comes to health. Health services are very

limited and the choice of qualified Drs are very few and transient. There is nobody to diagnose depression unless you can get the insurance to pay for medical treatment overseas. They don't tend to cover for

depression. We can get anything over the counter here though, so I might try subtext if the chemist has it. I

have tried panadine forte but that also is dangerous. It takes the edge off the pain but codeine scares me

enough to only take it when I get a really bad head ache.

Thanks again guys.

If I manage to get out and pay golf from a buggy at the weekend I'm going to have to do something about

pain management afterwards. That will be the real test for me. But i'm sure beating the hell out of a small ball will help. I'll pretend the golf ball is a tamadol pill. I'll let you know if that therapy helps..

evergreen: You can come down by 50 mg per week until you get to the final 100 mg and then come down by 25 mg per week. You can open the 50 mg capsules and pour away half the powder then reseal.

That way is less 'painful' than coming off the final 50 mg cold turkey. That is how I did it.

Absolutely, me too. If you have capsules you empty out the powder and measure out doses precisely right down to 10mg on a milligram scale, or get a fairly accurate idea by "eyeballing" and dividing the 50mg dose up into 5 doses. Ut if you don't have an accurate milligram scale (you can buy those very cheap on eBay though for around £7). The powder is bitter, but can be added to a glass of orange or fruit juice, and you won't notice it. Else you can also buy empty capsules on eBay cheap.

If you have Tramadol in tablet form and are planning a taper down to sub-50mg doses, then it's probably easier to switch to capsules on your next refill, so ask your GP to switch if possible. Saying that, I have sliced 50mg tablets before down to roughly 10mg doses when I've tapered in the past. I just used a sharp knife and a saucer, but you can get pill cutters cheaply on eBay again.

Some Tramadol tablets are bigger/easier to cut than others ;-)

You can also get Tramadol in sublingualand water soluble format format, which may make tapering down easier, ask your GP/Pharmacist what's available if you have trouble with existing pills being too hard to cut down to small pieces.

Some people who haven been on higher doses have no problem cutting down to 50mg and then quitting, but others who do have problems, or just prefer (for psychological reasons) to ween off by going to lower and lower doses ie. 40mg for x days, 30mg for x days, 20 mg for x days..etc, until you get down to 10mg. Once you get below the 10mg the theraputic and biochemistry effects of Tramadol should be hardly apparent (certainly no painrelief)

There's no right or wrong way really. Try whatever works best for you. I personally think its better and safer (to avoid withdrawals) to go slowly and cautiously with a taper as low as you can.. the longer you have been on Tramadol and the higher the dose, the more useful this "slow and gradual" approach is in my experience to avoid withdrawals.

But coming back to what happyjoy even if you do taper off, and avoid any "brain zaps" or physical discomfort from withdrawal, be prepared that you may still experience mental withdrawal symptoms.. and be prepared for the possibility that this may be unrelated to Tramadol, and may indicate depression or another underlying mental illness.

The reason I came off tramadol cold turkey was that I was diagnosed with depression by my doc after tapering down to about half, and put on prozac. The result of that was seretonin syndrome which was sudden and serious and I had to stop everything suddenly. Be careful. Be careful what you take with tramadol ,and be careful not to jump to a pill as a quick answer. Depression is a real and common illness, but it does not always need a pill to fix it. Yes, if it needs treating, treat it. A doctor is best.

Wise words again happyjoy