How Long Does Tramadol Stay in Your System?

When seeking the answer to how long does tramadol stay in your system, one must understand the type of medication it is and how it travels through the body. Tramadol is an opioid, part of a pain-relieving class of medications and drugs with similar effects to morphine. It was approved in Europe in the 1970s to treat moderate-to-severe pain and has been approved in the US for this purpose since 1995. It is also sold under the commercial name Ultram.

Tramadol itself is not as potent as most other opioids, but within the liver it is converted to a more potent opioid. Reflecting its low potency compared to other opioids, it is classified by the U.S. Drug Enforcement Administration (DEA) as a Schedule IV medication, which is a designation given to medications legally described as narcotics but with relatively lower abuse potential.

Until 2015, physicians had been increasingly prescribing tramadol for pain control due to its perceived lower abuse potential. Over 43 million prescriptions were written for tramadol in 2013. Many patients and even physicians were not aware that tramadol is an opioid, in part because the DEA did not list it as a controlled substance until 2014, 19 years after its U.S. approval. Similarly, the perception that tramadol was not addictive led to a sharp rise in its recreational usage.

Tramadol’s mechanism of action helps explain some of its pharmacological qualities, such as how long it stays in the body and what it does within the central nervous system. It is converted by enzymes in the liver to its potent form, called desmethyltramadol, although a small portion of it remains as tramadol. In both forms, the drug mimics the effects of endorphins, the body’s natural pain control molecules.

The elimination half-life of tramadol, which is the time it takes for the body to clear half of the concentration of the drug in the bloodstream, is about six to eight hours. That means tramadol would likely maintain a concentration above 5 percent of that of the initial ingestion, which is an accepted marker for how long a drug “stays active,” for 24 to 32 hours after its initial use.

Like many other drugs, there are several determining factors of the course tramadol takes within the human body.

1. The first of these factors is how much of the drug is available, which is affected by both the amount consumed and how the drug’s formulation interacts with body tissues. Tramadol can be taken orally, rectally, or as an injection into a muscle or vein. It is 100 percent available to the bloodstream (this is called “bioavailability”) via injection routes, whereas the oral and rectal routes make about 75% of the drug available.
2. Second, when a drug enters the bloodstream, it may remain there or get redistributed elsewhere. Some of the tramadol will enter directly into cells. Some of the drug will be outside of the cell. The remainder can be found in the bloodstream. How the tramadol is distributed within the body depends on several individual factors like genetics and body composition.
3. Next is how tramadol affects protein binding, or how much of the drug is attached to proteins in the bloodstream. Twenty percent of the tramadol initially administered ends up protein-bound: attached to a raft-like protein in the blood, allowing for easier transport but also rendering that portion of the drug inactive and unavailable to the other body compartments or for activating a receptor.
4. When tramadol is inside a body compartment, the body must decide what it wants to do with the drug. The enzyme CYP3D6 breaks down tramadol into the potent desmethyltramadol. The rest either remains as the native form of tramadol (both tramadol and desmethyltramadol are free to act on mu-opioid or nerve cell receptors) or is slowly filtered by the kidneys, from the blood into the urine, where it is excreted from the body. This is known as clearance. A small percentage of tramadol is filtered by the digestive tract into feces for excretion.

Drugs that are being regularly consumed are also being regularly eliminated. When the rates of consumption and elimination balance out, the percentage of drug remaining is referred to as the steady state concentration.

Once in the urine, tramadol can be detected by specialized urine drug screens. Standard drug screens test for opioids using codeine or morphine markers, which tramadol does not produce. Therefore, drug screens testing for tramadol use gas chromatography to identify it, where it can be detected for about four days after initial ingestion (sometimes longer if the drug has been regularly taken).

Hair and blood samples contain tramadol amounts that provide information about when and how much tramadol has been consumed, and are sometimes used in forensic cases, such as determining a cause of death in an overdose. Blood samples can contain detectable amounts of tramadol one week after ingestion, and hair samples can retain quantities of tramadol for one month.

If you think you may have a tramadol addiction or are struggling with tramadol abuse, seek professional help as soon as possible. Comprehensive treatment, medically-supervised detox (if necessary), behavioral therapies such as cognitive behavioral therapy (CBT), and relapse prevention strategies are most effective and lasting when provided at a residential treatment facility. Chances for successful recovery from tramadol addiction are excellent with professional treatment and ongoing support.