What are the Long-Term Effects of Tramadol Addiction?

Tramadol, also known as Ultram, has managed to keep a relatively low profile in the world of addiction in part because it is an atypical opioid and not technically considered a narcotic. However, like other opioids, it presents a host of dangers, particularly as tolerance builds and you graduate to higher doses over time. As your dose increases, so too does your risk for adverse events associated with short-term use, including nausea, dizziness, vertigo, fatigue, and constipation. While these may not appear to be significant at first, they can interfere with your quality of life and functionality. Long-term tramadol use, however, can cause much more severe damage:

Seizures

Tramadol is known to cause seizures in some users. While the risk is particularly significant for those with epilepsy, they can occur even in those with no prior history of seizures. High doses may increase risk of seizure for some, but a number of studies “demonstrate that seizures may also occur in therapeutic ranges—especially in association with consumption of other drugs such as alcohol, selective serotonin reuptake inhibitors, tricyclic antidepressants, and antipsychotics.” Overall seizure risk is estimated to be between 8 and 35%, but research suggests that risk increases over time, which means that long-term users are particularly vulnerable.

Adrenal Insufficiency

The adrenal glands are endocrine glands responsible for producing a number of hormones such as cortisol, adrenaline, and aldosterone. These hormones play a variety of critical roles, such as controlling blood pressure and heart rate, allowing your body to sufficiently metabolize nutrients, and maintaining immune system function. Chronic tramadol use is associated with adrenal insufficiency, which means that your body’s ability to produce these substances is diminished. As a result, a multitude of vital functions are compromised and you may experience symptoms such as muscle weakness, fatigue, and low appetite.

Androgen Insufficiency

Androgens are sex hormones, particularly testosterone, associated with secondary sex characteristics in men as well as bone and muscle development, metabolism, and sexual and reproductive health. Research suggests that long-term use of opioids, including tramadol, can lower these sex hormone levels and and cause androgen insufficiency. This can lead to a host of potential symptoms including loss of libido and sexual enjoyment, fertility problems, decreased muscle and bone mass, and mood disturbances like depression. While typically associated with and studied in men, androgen deficiency can affect women as well and produce many of the same symptoms.

Respiratory Problems

While the risk of respiratory depression as not as severe as that associated with other opioids, tramadol can cause slow and shallow breathing. In turn, this can lead to fainting, dizziness, and confusion. Risk of respiratory depression is heightened with use of alcohol, benzodiazepines, or hypnotics.

Hallucinations

Although not well-researched, there are anecdotal reports of tramadol-induced hallucinations, particularly in elderly users.

Serotonin Syndrome

Serotonin syndrome occurs due to excessive serotonergic activity that disrupts the normal function of the central nervous system. As a result, you may experience agitation, loss of muscle control, rapid heart rate, rigid muscles, sweating, and coordination difficulties. In severe cases, it can cause loss of consciousness, irregular heartbeat, and seizures, potentially resulting in death. While serotonin syndrome typically occurs when tramadol is combined with medications such as selective serotonin reuptake inhibitors (SSRIs), selective serotonin/norepinephrine reuptake inhibitors (SNRIs), or monoamine oxidase inhibitors (MAOIs), there is evidence of serotonin syndrome developing due to tramadol use alone “without concomitant use of other serotonergic medications.”

Liver and Kidney Damage

Long-term tramadol use is associated with liver and kidney damage. In particular, high doses of tramadol may cause liver failure.

Behavioral and Psychological Effects

Tramadol addiction, like other forms of addiction, can produce significant behavioral changes due to compulsive drug seeking and preoccupation with using. You may neglect healthy social interactions and obligations or experience increased interpersonal conflict, damaging even your most important relationships. You may also neglect or struggle to participate in professional or educational obligations and responsibilities, threatening your career and your livelihood. Your financial security may be compromised as you spend increasing amounts of money on drugs and you could face legal consequences for your actions, particularly if you obtain tramadol illegally or engage in illegal activities in order to afford the drug. In some cases, even regular self-care may fall by the wayside, keeping you from engaging in vital activities like healthy eating, exercise, and basic hygiene. Additionally, you are at heightened risk for other forms of substance abuse. As a result of both these consequences and your own feelings about your addiction, you can experience profound psychological and emotional disturbances including depression, anxiety, and loss of confidence.

The majority of long-term effects associated with tramadol can be fully or partially resolved upon discontinuation of the drug. As such, many people who recognize the dangers of their addiction want to get off tramadol as quickly as possible. However, sudden discontinuation can produce uncomfortable and even dangerous withdrawal effects due to the changes in neurotransmitter activity that have occurred as the result of long-term use. These withdrawal symptoms can include:

• Anxiety
• Depression
• Muscle pain
• Sleep disturbances
• Gastrointestinal problems
• Muscle spasms
• Fatigue
• Irritability
• Paranoia
• Confusion
• Psychosis
• Hallucinations
• Seizures

Experiencing such withdrawal symptoms can be distressing, cause relapse, and may even be fatal.

Due to the dangers of withdrawal, your recovery journey should begin with medically supervised detox. In a medically supervised detox program, you will receive the pharmacological and emotional support to discontinue tramadol safely and comfortably, minimizing or eliminating withdrawal symptoms. However, detox is only the first step toward healing.