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Signs & Symptoms of Tramadol Abuse

If someone you love is abusing tramadol, you may notice they were withdrawing from you and others, being secretive, and doctor shopping to get extra prescriptions. You may find empty pill bottles and several prescriptions as well as paraphernalia for snorting or injecting it.

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Signs of tramadol abuse include appetite changes, mood changes, euphoria followed by drowsiness, nausea, digestive issues, pinpoint pupils, and reduced coordination and balance. Other symptoms of misuse include using the medication non-medically, increasing tolerance to the drug, and tramadol withdrawal symptoms when use stops or is reduced.

Tramadol abuse occurs among individuals who take the drug for medical and nonmedical purposes. It is important to closely monitor tramadol use, as dependence, addiction, and overdose are possible. Knowing the signs and symptoms of tramadol abuse can empower you to help your loved one find treatment for tramadol addiction.

Signs & Symptoms of Tramadol Abuse

Tramadol is a prescription opioid used for the treatment of moderate to moderately severe pain. [1] However, many people abuse it to get high or relax, which can be dangerous, as tramadol misuse is a risk factor for tolerance, dependence, overdose, and addiction.

Signs and symptoms of tramadol abuse include:[2],[3]

  • Reduced appetite
  • Poor coordination and balance
  • Cravings for tramadol
  • Withdrawal symptoms when use is suddenly stopped or reduced
  • Poor sleep and hygiene habits
  • Nause and vomiting
  • Euphoria followed by being “on the nod”
  • Sedation or drowsiness
  • Mental confusion
  • Slowed breathing
  • Constipation
  • Drug paraphernalia, such as mirrors or needles
  • Empty pill bottles
  • Several prescriptions
  • Doctor shopping
  • Lying
  • Being secretive

Someone struggling with tramadol abuse may also begin to isolate themselves from friends and family members. As abuse increases, they may focus increasingly on obtaining and consuming more tramadol, often to the detriment of personal relationships as well as personal and professional responsibilities. 

Signs of Injecting Tramadol

Some of the signs of tramadol misuse depend on how the person is using the drug. For example, those who inject tramadol may experience:[3]

  • Increased risk of HIV and hepatitis B and C
  • Bacterial infection of the heart lining
  • Cellulitis
  • Abscesses
  • Collapsed veins
  • Track lines
  • Bruises on extremities

Signs of Snorting Tramadol

Signs that your loved one is snorting tramadol include:[3]

  • Nosebleeds
  • Chronic sinusitis
  • Damage to nose
  • Perforated nasal septum

Recognizing Tramadol Withdrawal Symptoms 

Chronic tramadol abuse can lead to physiological dependence, which means the person’s body needs tramadol or another opioid to function optimally. If they suddenly stop taking tramadol or dramatically reduce their use, they’ll experience tramadol withdrawal symptoms, such as: [3],[4]

  • Diarrhea, nausea, and vomiting 
  • Muscle aches
  • Bone pain
  • Difficulty or inability to sleep
  • Sweating
  • Fever
  • Cold flashes and goosebumps
  • Yawning
  • Teary eyes and runny nose
  • Stomach cramps
  • Tremors
  • Anxiety
  • Agitation

It is common for people struggling with tramadol abuse and addiction to go through cycles of withdrawal and relapse. You may notice your friend or family member gets sick more frequently, especially with flu-like or cold-like symptoms. And then they may get better if they are able to obtain more tramadol or other opioids.

However, your loved one doesn’t have to go through tramadol detox on their own—professional detox services are available to ease withdrawal symptoms and cravings and ensure their comfort and safety. A medical detox program can provide medical care, withdrawal medications, and counseling.

Long-Term Risks of Tramadol Abuse

Long-term tramadol abuse can be very harmful to your loved’s one health and can even be life-threatening. Some long-term risks of misusing tramadol include:[5]

  • Infertility
  • Erectile dysfunction
  • Depression
  • Osteoporosis
  • Fractures and accidents
  • Tooth decay
  • Chronic constipation
  • Severe bowel obstruction
  • Poor immune system functioning
  • Increased sensitivity to pain
  • Sleep-related breathing problems
  • Heart attack
  • Tramadol overdose
  • Tramadol addiction

Tramadol Overdose: A Dangerous Sign of Misuse

Since it’s an opioid, it is possible to overdose on tramadol. Consuming too much tramadol at once or taking illicitly-made tramadol that has been cut with potent opioids like fentanyl can cause profound respiratory depression and a life-threatening overdose.

Signs of a tramadol overdose to watch out for include the following:[6]

  • Slowed or stopped breathing
  • Slowed or stopped heartbeat
  • Limp body
  • Pale and clammy face
  • Purple or blue fingernails or lips 
  • Vomiting 
  • Gurgling noises
  • Inability to wake up
  • Coma

If you witness someone having an opioid overdose, quick action can prevent the overdose from being fatal. First, call 911 for emergency medical support. 

If available, naloxone (Narcan) should be administered to immediately reverse the life-threatening effects of the overdose. Naloxone can be readministered every few minutes until the person is no longer overdosing and breathing has returned to normal. However, even if you administer Narcan, you still need to call 911 because this life-saving medication doesn’t last very long and the person still needs emergency care.

Recognizing that Tramadol Abuse Has Progressed to Addiction

Long-term tramadol abuse can lead to tramadol addiction, also known as opioid use disorder. This is a chronic and complex condition characterized by compulsive tramadol misuse despite negative consequences.

Common signs and symptoms of a tramadol addiction include:[3],[7]

  • Using higher and more frequent doses of tramadol than intended
  • Trying and failing to control or cut down on tramadol use
  • Spending a great deal of time obtaining and using tramadol
  • Experiencing strong tramadol cravings
  • Continuing to use tramadol despite inability to fulfill obligations at work, school, or home
  • Neglecting previously enjoyed hobbies or important activities in favor of tramadol use
  • Continuing to use tramadol despite psychological or physical health caused or worsened by use
  • Continuing to use tramadol despite experiencing interpersonal issues caused or worsened by use
  • Needing higher doses of tramadol to get high (tolerance
  • Experiencing tramadol withdrawal if they stop or reduce tramadol use

Getting Help for a Tramadol Addiction

Help is available for people with a tramadol addiction. Inpatient, outpatient, and short-term or long-term Tramadol addiction treatment programs specifically designed to treat opioid addictions are available throughout the country. Certain medications also play an important role in addiction recovery.

MAT is known to significantly increase the likelihood of successful recovery from an opioid use disorder (OUD). Buprenorphine and methadone can lessen opioid cravings and largely eliminate withdrawal symptoms. 

With MAT, medications are combined with behavioral counseling to address the root causes of substance use and help individuals develop effective coping strategies to remain sober. To find a treatment program, begin by speaking with your doctor who can conduct a brief evaluation and make appropriate treatment referrals.

Updated December 18, 2023
Resources
  1. Tramadol. (January 2022). National Library of Medicine.
  2. Prescription Opioids. (June 2021). National Institute on Drug Abuse.
  3. Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association. (2013).
  4. Effective Treatments for Opioid Addiction. (November 2016). National Institute on Drug Abuse.
  5. Long-term opioid therapy reconsidered. Von Korff, M., Kolodny, A., Deyo, R. A., & Chou, R. (2011). Annals of internal medicine, 155(5), 325–328.
  6. Opioid Overdose. (January 2023). Substance Abuse and Mental Health Services Administration.
  7. Opioid Use Disorder. (April 2023). StatPearls.
  8. Opioid Use Disorder: Pernicious and Persistent. (October 2022). The American Journal of Psychiatry.
  9. Effects of Medication-Assisted Treatment (MAT) for Opioid Use Disorder on Functional Outcomes: A Systematic Review. (June 2020). Rand Health Quarterly.
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