View source for Tramadol

=== Also known as ===

Ultram, ultracet, ralivia, conzip, ryzolt, trammies, chill pills and ultras

=== Classification ===

Psychoactive substance, depressants
[[Category:Depressants]][[Category:Psychoactives]]
=== Overview ===

Tramadol, like other opiates, stimulates brain opioid receptors but it also increases brain serotonin levels. It is a medicine used to treat moderate to severe pain. It is only available with a prescription from your doctor. Other opiates include codeine, methadone and heroin.

Although tramadol is not as strong as heroin, it shares many of the same effects and both are addictive <ref name="1a">'''Tramadol''', 2017, http://www.talktofrank.com/drug/tramadol</ref>.

Tramadol can -

* produce feelings of warmth and well-being, relaxation and sleepiness.
* cause fatigue, drowsiness, loss of appetite, nausea and retching, diarrhoea, and dizziness or fainting.
* worsen side-effects and risks when used with certain antidepressants that tend to increase serotonin levels <ref name="1a"/>.

=== What does it look like? ===

Tramadol is usually available as white pills, tablets or coloured capsules, although liquid forms are produced <ref name="1a"/>.

=== Source ===

This is a pharmaceutical drug which is sometimes diverted from manufacturers, pharmacies or [[GP]]'s prescriptions <ref name="2a">'''Tramadol''', 2014, http://www.dan247.org.uk/Drug_Tramadol.asp</ref>.

=== Street price ===

'Street' tramadol costs between £1 - £2.50 per pill/tablet/capsule <ref name="1a"/>.

==== Sought after effects ====

* relaxation,
* sleepiness,
* pain relief,
* mild euphoria,
* warmth,
* well-being <ref name="2a"/>.

==== Undesired effects ====

* dizziness,
* nausea,
* constipation,
* dry mouth,
* headaches,
* sleepiness,
* sweating,
* tiredness,
* vomiting <ref name="2a"/>.

=== What are the different forms? ===

Tramadol is normally swallowed, but some people crush up the tablets and snort them <ref name="1a"/>.

=== How long do its effects last? ===
==== Onset of effects ====

* oral - 15 - 60 minutes <ref name="3a">'''Tramadol''', 2017, https://psychonautwiki.org/wiki/Tramadol</ref>, 1 - 2 hours <ref name="4a">'''Tramadol''', 2017, https://wiki.tripsit.me/wiki/Tramadol</ref>.

==== Peak ====

* oral - 2 - 6 hours <ref name="3a"/>, 3 - 4 hours <ref name="4a"/>.

==== Offset ====

* oral - 2 - 4 hours <ref name="3a"/>.

==== Duration of effects ====

* oral - 6 - 10 hours <ref name="3a"/>, 5 - 7 hours <ref name="4a"/>.

=== Pharmacology ===

The R- and S- enantiomers of tramadol act on different receptors in a complimentary manner. The R- enantiomer is a selective agonist of the mu receptors and inhibits serotonin reuptake while the S- enantiomer inhibits noradrenaline reuptake. Tramadol acts as an opioid receptor agonist <ref name="5a">Hennies, H. H. and Friderichs, E. and Schneider, J., '''Receptor binding, analgesic and antitussive potency of tramadol and other selected opioids''', ''Arzneimittel-Forschung'', 1988, 38, 7, 877-880, https://www.ncbi.nlm.nih.gov/pubmed/2849950</ref>, <ref name="6a">Frink, M. C. and Hennies, H. H. and Englberger, W. and Haurand, M. and Wilffert, B., '''Influence of tramadol on neurotransmitter systems of the rat brain''', ''Arzneimittel-Forschung'', 1996, 46, 11, 1029-1036, http://www.ncbi.nlm.nih.gov/pubmed/8955860</ref> serotonin releasing agent, <ref name="7a">Gobbi, M. and Moia, M. and Pirona, L. and Ceglia, I. and Reyes-Parada, M. and Scorza, C. and Mennini, T., '''p-Methylthioamphetamine and 1-(m-chlorophenyl)piperazine, two non-neurotoxic 5-HT releasers in vivo, differ from neurotoxic amphetamine derivatives in their mode of action at 5-HT nerve endings in vitro''', ''Journal of Neurochemistry'', 2002, 82, 6, 1435-1443, http://dx.doi.org/10.1046/j.1471-4159.2002.01073.x, http://onlinelibrary.wiley.com/doi/10.1046/j.1471-4159.2002.01073.x/abstract</ref>, <ref name="8a">Driessen, B. and Reimann, W., '''Interaction of the central analgesic, tramadol, with the uptake and release of 5-hydroxytryptamine in the rat brain in vitro''', ''British Journal of Pharmacology'', 1992, 105, 1, 147-151, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1908625/</ref>, <ref name="9a">Bamigbade, A. T. and Davidson, C. and Langford, R. M. and Stamford, J. A., '''Actions of tramadol, its enantiomers and principal metabolite, O-desmethyltramadol, on serotonin (5-HT) efflux and uptake in the rat dorsal raphe nucleus''', ''British Journal of Anaesthesia'', 1997, 79, 3, 352-356, https://doi.org/10.1093/bja/79.3.352, https://academic.oup.com/bja/article/79/3/352/386035/Actions-of-tramadol-its-enantiomers-and-principal</ref>, norepinephrine reuptake inhibitor, <ref name="10a">Frink, M. C. and Hennies, H. H. and Englberger, W. and Haurand, M. and Wilffert, B., '''Influence of tramadol on neurotransmitter systems of the rat brain''', ''Arzneimittel-Forschung'', 1996, 46, 11, 1029-1036, https://www.ncbi.nlm.nih.gov/pubmed/8955860</ref> NMDA receptor antagonist, <ref name="11a">Hara, K. and Minami, K. and Sata, T., '''The Effects of Tramadol and Its Metabolite on Glycine, -Aminobutyric AcidA, and N-Methyl-d-Aspartate Receptors Expressed in Xenopus Oocytes''', ''Anesthesia & Analgesia'', 2005, 100, 5, 1400-1405, https://doi.org/10.1213/01.ANE.0000150961.24747.98, http://journals.lww.com/anesthesia-analgesia/pages/articleviewer.aspx?year=2005&issue=05000&article=00037&type=abstract</ref> 5-HT2C receptor antagonist, <ref name="12a">Ogata, J. and Minami, K. and Uezono, Y. and Okamoto, T. and Shiraishi, M. and Shigematsu, A. and Ueta, Y., '''The Inhibitory Effects of Tramadol on 5-Hydroxytryptamine Type 2C Receptors Expressed in Xenopus Oocytes''', ''Anesthesia & Analgesia'', 2004, 98, 5, 1401-1406, https://doi.org/10.1213/01.ANE.0000108963.77623.A4, http://journals.lww.com/anesthesia-analgesia/pages/articleviewer.aspx?year=2004&issue=05000&article=00038&type=abstract</ref> (α7)5 nicotinic acetylcholine receptor antagonist, TRPV1 receptor agonist, <ref name="13a">Marincsák, R. and Tóth, B. I. and Czifra, G. and Szabó, T. and Kovács, L. and Bíró, T., '''The analgesic drug, tramadol, acts as an agonist of the transient receptor potential vanilloid-1''', ''Anesthesia & Analgesia'', 2008, 106, 6, 1890-1896, https://doi.org/10.1213/ane.0b013e318172fefc, https://www.ncbi.nlm.nih.gov/pubmed/18499628</ref> and M1 and M3 muscarinic acetylcholine receptor antagonist <ref name="14a">Shiraishi, M. and Minami, K. and Uezono, Y. and Yanagihara, N. and Shigematsu, A., '''Inhibition by tramadol of muscarinic receptor-induced responses in cultured adrenal medullary cells and in Xenopus laevis oocytes expressing cloned M1 receptors''', ''Journal of Pharmacology and Experimental Therapeutics'', 2001, 299, 1, 255-260, https://www.ncbi.nlm.nih.gov/pubmed/11561087</ref>, <ref name="15a">Shiga, Y. and Minami, K. and Shiraishi, M. and Uezono, Y. and Murasaki, O. and Kaibara, M. and Shigematsu, A., '''The Inhibitory Effects of Tramadol on Muscarinic Receptor-Induced Responses in Xenopus Oocytes Expressing Cloned M3 Receptors''', ''Anesthesia & Analgesia'', 2002, 96, 5, 1269-1273, https://doi.org/10.1097/00000539-200211000-00031, http://journals.lww.com/anesthesia-analgesia/pages/articleviewer.aspx?year=2002&issue=11000&article=00031&type=abstract</ref>.

The euphoric effects of this compound stem from the way in which opioids bind to and activate the μ-opioid receptor. This occurs because opioids structurally mimic endogenous endorphins which are naturally found within the body and also work upon the μ-opioid receptor set. The way in which opioids structurally mimic these natural endorphins results in their euphoria, pain relief and anxiolytic effects. This is because endorphins are responsible for reducing pain, causing sleepiness, and feelings of pleasure. They can be released in response to pain, strenuous exercise, orgasm, or general excitement <ref name="3a"/>.

==== Bioavailability ====

* Oral - 68% - 72%,
* Rectal - 77% <ref name="3a"/>.

==== Toxicity ====

Tramadol has a low toxicity relative to dose. As with all opioids, long-term effects can vary but can include diminished libido, apathy and memory loss. It is also potentially lethal when mixed with depressants like alcohol or benzodiazepines and generally has a wider range of substances which it is dangerous to combine with in comparison to other opioids. It should not be taken during benzodiazepine withdrawals as this can potentially cause seizures <ref name="3a"/>.

=== Mode of use ===

Tablets and capsules are swallowed orally <ref name="2a"/>.

=== Signs of usage ===

* [[pinpoint]] pupils,
* changes in appetite,
* nausea or vomiting,
* drowsiness,
* seizures (without a history of epilepsy),
* slurred speech,
* headaches,
* impaired coordination <ref name="16a">'''Tramadol Symptoms and Warning Signs''', 2017, https://www.addictioncenter.com/painkillers/tramadol/symptoms-signs/</ref>.

Another potentially dangerous symptom of tramadol abuse is serotonin syndrome, which can be life-threatening if left untreated. It occurs when too much serotonin, a chemical that relays signals in the brain, is produced or remains in the brain. Serotonin syndrome most commonly occurs in patients who take tramadol and antidepressants at the same time <ref name="16a"/>.

=== Effects ===

Tramadol is an opiate. Although it is weaker than heroin and methadone, it still causes all the typical opiate effects, alongside some effects due to increases in serotonin activity <ref name="1a"/>. The effects include -

Feelings of warmth and well-being, relaxation and sleepiness <ref name="1a"/>.

==== Common effects ====

* fatigue,
* drowsiness,
* nausea,
* retching,
* constipation,
* confusion <ref name="1a"/>.

==== Less often effects ====

* diarrhoea,
* dizziness,
* fainting,
* excessive sweating,
* itching,
* raised blood pressure,
* tightness in the airways,
* muscle weakness,
* sensory disturbances,
* hallucinations,
* fits,
* blood disorders <ref name="1a"/>.

==== Physical effects ====

* physical euphoria,
* pupil constriction,
* stimulation,
* appetite suppression,
* cough suppression
* orgasm suppression,
* pain relief,
* sedation,
* constipation,
* difficulty urinating,
* itchiness,
* nausea <ref name="3a"/>.

==== Cognitive effects ====

* cognitive euphoria,
* compulsive redosing,
* dream potentiation,
* thought acceleration,
* anxiety suppression,
* decreased libido <ref name="3a"/>.

==== Positive ====

* euphoria,
* pain relief,
* elevated mood,
* overall feeling of contentedness <ref name="4a"/>.

==== Neutral ====

* itching <ref name="4a"/>.

==== Negative ====

Some users may experience -

* nausea,
* constipation,
* CNS depression,
* drowsiness,
* hot/cold flashes,
* dizziness,
* vomiting,
* [[urinary retention]] <ref name="4a"/>.

==== High doses ====

In high doses, overdoses, or in patients not tolerant to opiates, tramadol can cause -

* shallow breathing,
* bradycardia,
* cold-clammy skin,
* [[apnoea]],
* hypotension,
* [[miosis]],
* circulatory collapse,
* respiratory arrest,
* death <ref name="4a"/>.

==== Side-effects ====

* nausea,
* vomiting,
* constipation,
* lightheadedness or dizziness,
* drowsiness,
* headache,
* loss of appetite,
* dry mouth <ref name="17a">'''Tramadol Abuse''', 2017, http://drugabuse.com/library/tramadol-abuse/</ref>.

==== Overdose ====

* sleepiness,
* unconsciousness,
* coma,
* seizures,
* [[respiratory depression]],
* abnormally low blood pressure,
* slow heart rate,
* sweating or clammy skin,
* weak muscles,
* pinpoint pupils <ref name="16a"/>,
* irregular heart rhythm,
* vomiting,
* hyperthermia,
* muscle rigidity,
* muscle pain,
* limp or weakened body,
* [[cyanosis]] <ref name="18a">'''Tramadol''', 2017, http://drugabuse.com/?s=tramadol</ref>.

==== Side-effects of snorting tramadol ====

* insomnia,
* muscle tension,
* headache,
* shakiness,
* feeling nervous or worried,
* shifting moods/irritability,
* sexual dysfunction,
* problems with breathing,
* difficulty swallowing,
* hoarseness,
* hallucinations,
* dry mouth,
* heartburn,
* poor appetite,
* nausea and vomiting,
* constipation,
* drowsiness,
* loss of consciousness,
* an inability to smell,
* nosebleeds,
* runny nose,
* difficulty swallowing <ref name="18a"/>.

=== Risks ===

Although tramadol is not as potent as the strongest opiates like heroin, it still acts as an opiate, and also has additional risks due to its actions on serotonin levels -

* if you have epilepsy or are taking certain antidepressants you should definitely only take tramadol with clear medical advice because of the known risks,
* tramadol can depress breathing and may be risky in asthma and chronic obstructive pulmonary disease,
* tramadol use has been linked with 'serotonin syndrome'. This is a potentially life threatening condition where the serotonin receptors are over stimulated, which can lead to high fever, rapid pulse, shivering, sweating, trembling, muscle twitches and agitation and confusion,
* pregnant women should not use tramadol as it can be toxic to the developing foetus <ref name="1a"/>.

==== Long-term ====

* tolerance,
* physical dependence,
* psychological dependence,
* withdrawal symptoms,
* increased risk of adverse effects <ref name="2a"/>.

=== Purity ===

Only tramadol tablets that were dispensed from a pharmacy directly to you are reliably pure and have the strength indicated. It is important to think quite hard about any 'medications' you take from an uncertain source <ref name="1a"/>.

=== Addiction ===
==== Can you get addicted ====

Tramadol is addictive.

Over time, using tramadol produces 'cravings' and a psychological desire to keep on using.

Tolerance can also build, so that users have to take more just to get the same effects or to avoid an unpleasant withdrawal <ref name="3a"/>.

==== Tolerance ====

As with other opioids, the chronic use of tramadol can be considered moderately addictive with a high potential for abuse and is capable of causing psychological dependence among certain users. When addiction has developed, cravings and withdrawal symptoms may occur if a person suddenly stops their usage.

Tolerance to many of the effects of tramadol develops with prolonged and repeated use. The rate at which this occurs develops at different rates for different effects, with tolerance to the constipation-inducing effects developing particularly slowly for instance. This results in users having to administer increasingly large doses to achieve the same effects. After that, it takes about 3 - 7 days for the tolerance to be reduced to half and 1 - 2 weeks to be back at baseline (in the absence of further consumption). Tramadol presents cross-tolerance with all other opioids, meaning that after the consumption of tramadol all opioids will have a reduced effect <ref name="3a"/>.

=== Dangerous interactions ===

* '''depressants (1,4-Butanediol, 2m2b, alcohol, barbiturates, benzodiazepines, GHB/GBL, methaqualone)''' - This combination can result in dangerous or even fatal levels of respiratory depression. These substances potentiate the muscle relaxation, sedation and amnesia caused by one another and can lead to unexpected loss of consciousness at high doses. There is also an increased risk of vomiting during unconsciousness and death from the resulting suffocation. If this occurs, users should attempt to fall asleep in the recovery position or have a friend move them into it.
* '''dissociatives''' - This combination can result in an increased risk of vomiting during unconsciousness and death from the resulting suffocation. If this occurs, users should attempt to fall asleep in the recovery position or have a friend move them into it.
* '''stimulants''' - It is dangerous to combine tramadol, a depressant, with stimulants due to the risk of excessive intoxication. Stimulants decrease the sedative effect of tramadol, which is the main factor most people consider when determining their level of intoxication. Once the stimulant wears off, the effects of tramadol will be significantly increased, leading to intensified disinhibition as well as other effects. If combined, one should strictly limit themselves to only taking a certain amount of tramadol.
* '''psychedelics''' - Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures <ref name="3a"/>.

==== Dangerous ====

* '''αMT'''
* '''Ketamine'''
* '''MXE'''
* '''DXM'''
* '''PCP'''
* '''Amphetamines''' - Tramadol and stimulants both increase the risk of seizures.
* '''MDMA''' - Tramadol and stimulants both increase the risk of seizures.
* '''Cocaine''' - Tramadol and stimulants both increase the risk of seizures.
* '''Alcohol''' - Heavy CNS depressants, risk of seizures. Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely.
* '''GHB/GBL''' - The sedative effects of this combination can lead to dangerous respiratory depression.
* '''Opioids''' - Concomitant use of tramadol increases the seizure risk in patients taking other opioids. These agents are often individually epileptogenic and may have additive effects on seizure threshold during coadministration. Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present
* '''Benzodiazepines''' - Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present. Vomit aspiration a risk when passed out, lay down in recovery position if ingested.
* '''MAOIs'''
* '''SSRIs''' <ref name="3a"/>.

==== Unsafe ====

* '''Mushrooms''' - Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.
* '''LSD''' - Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.
* '''DMT''' - Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.
* '''Mescaline''' - This combination can cause seizures due to the lowering of the threshold by tramadol and the potential of mescaline to cause seziures.
* '''DOx''' - Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.
* '''NBOMes''' - Tramadol is well known to lower seizure threshold and NBOMes have also shown a tendency to cause severe seizures
* '''2C-x''' - Tramadol is well known to lower seizure threshold and psychedelics raise the risk of seizures.
* '''2C-T-x'''
* '''5-MeO-xxT''' <ref name="3a"/>.

==== Caution ====

* '''Nitrous oxide''' - Both substances potentiate the [[ataxia]] and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely <ref name="3a"/>.

==== Serotonin syndrome risk ====

Combinations in the list below may increase the amount of neurotransmitters such as serotonin and dopamine to dangerous or even fatal levels <ref name="3a"/>.

* MAOIs such as syrian rue, banisteriopsis caapi, 2C-T-2, 2C-T-7, αMT, and some antidepressants,
* Serotonin releasers such as MDMA, 4-FA, MDAI and αMT
* Selective serotonin re-uptake inhibitors (SSRIs)
* Serotonin-norepinephrine reuptake inhibitors (SNRIs)
* 5-HTP <ref name="3a"/>.

See [[Serotonin syndrome]] for more information.

=== Withdrawal ===

Symptoms include -

* nervous tremors,
* anxiety,
* yawning,
* sweating,
* runny nose,
* sleep disturbance,
* nausea,
* diarrhoea,
* goose-bumps,
* restlessness,
* abdominal cramps,
* muscle spasms <ref name="1a"/>,
* agitation,
* depression,
* cravings,
* nausea and vomiting,
* headaches,
* confusion,
* loss of appetite,
* blurred vision,
* insomnia,
* mood swings,
* irritability,
* tingling sensations,
* nightmares,
* dizziness <ref name="16a"/>.

==== Timeline ====

* '''days 1 - 3'''	- onset of general withdrawal symptoms, including feelings of pins and needles, sweating, nervousness, nausea, anxiety, palpitations, insomnia and drug cravings.
* '''days 4 - 7'''	- drug cravings persist, along with insomnia, disorientation and confusion, and blurred vision.
* '''days 8 - 14''' - symptoms should be fairly mild by this point. Depression, anxiety, and irrational thoughts may persist <ref name="16a"/>.

=== Legality ===

Tramadol is a class C drug and is only available with a prescription from a doctor or other healthcare professional that is qualified to prescribe. As a class C drug, it is illegal for anyone else to supply tramadol, to have it or to give it away, even to friends <ref name="1a"/>.

==== What if you're caught? ====

If the Police arrest you in possession of tramadol unlawfully, they'll always take some action. This could be a formal caution or arrest and possible conviction.

Having tramadol that is not prescribed for you for your own use (called illegal possession) could result in up to two years in prison and/or an unlimited fine. While selling or giving tramadol away for free, even to friends (called supplying) could result in up to fourteen years in prison and/or an nlimited fine.

A conviction for a drug-related offence could have a serious impact. It could make it harder, even impossible, to visit certain Countries- for example the United States - and limit the types of jobs you can apply for <ref name="1a"/>.

==== Did you know? ====

Allowing other people to supply drugs in your house or any other premises is illegal. If the police catch people supplying illegal drugs in a club they can potentially prosecute the landlord, club owner or any person concerned in the management of the premises.

Like drinking and driving, driving when high is illegal - and you can still be unfit to drive the day after using tramadol. You can get a heavy fine, be disqualified from driving or even go to prison <ref name="1a"/>.

=== Mixing with other drugs ===

Mixing tramadol with alcohol can have serious consequences – an overdose is more likely and this can lead to a coma or respiratory failure and death <ref name="1a"/>.

=== Harm reduction ===

* do not drive or operate machinery while under the influence of tramadol,
* alcohol and many other drugs are extremely dangerous to combine with tramadol,
* mainly, do not combine with benzos, other opiates, or other serotogenic drugs,
* tramadol effects serotonin levels in the brain. For this reason it is recommended to taper on and taper off use over an extended time period <ref name="4a"/>.

==== Seizure Risk ====

We cannot stress this enough - if you have a history of seizures, we strongly urge you to stay away from tramadol as a recreational substance. By itself, it can decrease the seizure threshold. When combined with SSRIs, tricyclic antidepressants, or in patients with epilepsy, the seizure threshold is further decreased. Seizures have been reported in humans receiving excessive single oral doses (700 mg) or large intravenous doses (300 mg). However, there have been several rare cases of people having grand-mal seizures at doses as low as 100 - 400 mg orally <ref name="4a"/>.

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== References ==

<references />