Tramadol abuse is one of the commonest abuse cases witnessed in Nigerian society today. Sadly, this is found among secondary school students below age 20. The drug is nick-named to obscure the guilt of its abuse but this does not in anyway obscure the dangers that tramadol abuse presents. Another sad observation is the easy access of the public to high strengths of tramadol which are sold unchecked by some unscrupulous vendors.
This article is very detailed and serves to enrich the reader to not only stay away from tramadol and narcotics abuse but join in sensitizing the society about the dangers of drug abuse. WHAT IS TRAMADOL
Tramadol is an opioid pain reliever that works by changing the way the body senses pain. It is also used to treat the symptoms of restless leg syndrome and fibromyalgia, including dental pain, osteoporosis, and neuropathy in both acute and chronic settings. It is also approved for treating cancer pain in periods less than 3 months.
Although, Tramadol has a lower clinical value than other opiates and narcotic analgesics (a tenth of the pain-reducing qualities of codeine and morphine), it is a commonly prescribed analgesic because of its ‘relatively’ lower risk of tolerance, abuse, addiction and a better safety profile compared to heroine, codeine and morphine.
However, two significant adverse reactions are known to potentially occur with tramadol: Seizures and serotonin syndrome.
These two adverse reactions may develop during tramadol monotherapy, but appear much more likely to emerge during misuse/overdose as well as with the co-administration of other drugs, particularly antidepressants.
As a narcotic pain reliever, tramadol is associated with a high risk of tolerance and dependence – both physically and psychologically.
In terms of specific neurotransmitter effects, at the central level, tramadol is a mu-opioid receptor agonist with an affinity 10-fold less than that of codeine. However, the active metabolite of tramadol, o-desmethyltramadol, has up to 200-fold affinity than that of the parent compound. In addition to its central effects on mu receptors, at the peripheral level, tramadol inhibits serotonin and norepinephrine reuptake. These latter effects are likely to be an important element in analgesia, but may also account for some of the adverse properties of the drug.
With regard to abuse and/or overdose, tramadol’s neurotoxicity is speculated to be related to the reuptake inhibition of serotonin and norepinephrine, rather than its opioid effects.
Tramadol – Law and History
Tramadol was created in 1962 by a German drug company that specializes in treating pain. The medication was tested for 15 years in Germany before being approved and brought to the foreign market in 1977 under the name Tramal. However, it became available in the US in 1995.
Tramadol was previously thought to carry only a low risk of abuse, dependence, and addiction, but recent information is changing the perception of the substance.
Tramadol drug is legal when taken as prescribed, but there have been some changes to its status. Tramadol was originally considered to have a much better safety profile than other opioid analgesics like morphine or hydrocodone. The US Food and Drug Administration (FDA) originally approved tramadol for use in 1995, and recommended it not be classified as a controlled substance.
The perceived dangers of Tramadol was informed by the records of emergency room visits, treatment facility intakes, and suicide attempts involving the drug as well as abuse and evidence of withdrawal symptoms upon cessation involving the general public. The Drug Enforcement Administration (DEA) published revised rules in 2014, to make Tramadol a federally controlled drug (Schedule IV) drug.
The schedule IV classification means : the drug serves a necessary medical purpose, has a low risk of abuse compared to schedule III drugs and requires monitoring and restrictions for prescriptions and refills.
WHY TRAMADOL IS ABUSED
- Tramadol can be abused if taken for longer or in higher doses than prescribed.
- Tramadol is often abused, because it creates a morphine-like high that can last up eight hours.
- When the drug is abused, it has desired effects similar to other opiates including:
- Feelings of euphoria.
- Feeling numb or detached from one’s body.
- Feeling lethargic and heavy.
- Feeling relaxed and calm.
A contributing factor is its accessibility.
- Tramadol is easier to obtain than drugs such as morphine and OxyContin, as these substances are regulated under the Controlled Substances Act.
- The perceived remedy it offers for premature ejaculation in men
Although widely prescribed, tramadol can be just as lethal as other opiates. Taken orally at high doses, tramadol can produce an euphoric high similar to another commonly abused opiate medication, oxycodone (OxyContin).
Even though the drug is thought to be relatively safe due to its low potential for abuse, addiction to tramadol, especially over long-term use, has been a growing problem in the US and around the world. Tramadol has often been cited as one of the more difficult drugs to stop using.
EFFECTS OF TRAMADOL ABUSE
The side effects from long term use, non-medical use or abuse of Tramadol are similar to other opioid drugs and include:
- Light headedness or dizziness.
- Loss of appetite.
- Dry mouth.
In individuals who use tramadol for non-medical purposes, these side effects can be a warning sign of abuse.
In addition to opioid receptor activity, tramadol exerts some of its effects via its actions on serotonergic and noradrenergic neurotransmission by increasing brain levels of the neurotransmitters; serotonin and norepinephrine. (Effects similar to those induced by antidepressant drugs.)
For this reason, there is also a known risk of seizures and convulsions in some patients.
The risks from these effects are said to even be more elevated in abusers seeking the euphoric effects, or “high,” produced by taking large doses of the drug.
Users are said to have reported that such mood-elevating properties caused them to take higher doses of or prolonged use of the drug than had been prescribed.
In addition to the euphoric and mood-enhancing effects sought by tramadol abusers, taking this drug for nonmedical purposes, or taking it in a manner different from that prescribed by a doctor, can result in disturbed sleep patterns resulting in insomnia.
This includes compulsive cravings for the drug to cope with everyday problems, anxiety which may incite other behavioural changes just to access the drug.
This includes withdrawal symptoms such as:
- Gastrointestinal pain.
- Agitation,anxiety and confusion.
- Numbness in the extremities.
- Ringing in the ears.
- Distress and Paranoia.
- Nausea, Vomiting, Severe unbearable pain,
- Body ache
- Cold sweats
DEPENDENCE AND RISK OF ABUSE
When tolerance to tramadol is developed amongst patients who take the drug frequently, there is then the need to increase the amount or frequency of the doses administered to achieve the desired effects. This puts users at risk of accidental overdose, symptoms of which include:
- Decreased size of the pupils of the eyes (miosis).
- Slow breathing or difficulty breathing.
- Extreme drowsiness.
- Cold, clammy skin.
- Slow or irregular heartbeat.
- Loss of consciousness.
As a central nervous system (CNS) depressant, tramadol slows down lung and heart function. Those who take large tramadol doses can stop breathing altogether and may experience a fatal overdose.
Symptoms of tramadol overdose can include:
- Respiratory depression
- Abnormally low blood pressure
- Slow heart rate
- Sweating or clammy skin
- Weak muscles
- Pinpoint pupils
Common Tramadol Drug Combinations
Tramadol is sometimes abused alongside other drugs, which is called polydrug use. Typically, users combine tramadol with other substances to increase their high or self-medicate.
The following drugs are have been observed to be commonly combined with tramadol:
- Alcohol, Other painkillers, Sedatives, like benzodiazepines and sleeping pills, Serotoninergic drugs (Amphetamines, Antidepressants, Cocaine, Cold and Flu medication, MDMA (3,4-Methylenedioxymethamphetamine (MDMA), commonly known as ecstasy (E)), Opioids)
The risk of developing an addiction to tramadol is higher when the drug is taken with other substances. As a CNS depressant, it can be very dangerous to mix tramadol with other CNS depressants, like alcohol, opioids and sedative hypnotics. Mixing these substances slows down brain activity and function and can lead to:
- Acute alcohol intoxication
- Acute abdominal conditions
- Brain damage
- Intracranial pressure
- Liver disease
- Loss of consciousness
- Respiratory depression (Individuals with asthma or other respiratory conditions are at a much higher risk for this side effect)
- Seizure disorders
- Tramadol/drug dependence
Such mixtures also increases the risk of seizure or overdose.
TRAMADOL ABUSE TREATMENT
Tramadol abuse and dependence present many of the same challenges as addictions to other opiate drugs, and can be addressed by the same facilities and services.
Medically supervised detoxification and treatment is the safest way to overcome a tramadol addiction in a bid to properly manage intense and dangerous withdrawal symptoms.
Rehabilitation facilities and services (support groups, inpatient and outpatient treatment programs) used to address other opiate addictions can follow after the aforementioned detoxification for a full recovery.
“My pain typically would occur over two or three days. I took one or two a day until it eased. But I noticed on the days I took tramadol I felt more relaxed and coped with life better. Since the doctor had prescribed so many, at least two or three boxes, I started taking one every day….They had come from a doctor, so I was sure they couldn’t harm me…..I didn’t worry whether they were safe or not, I just needed them.” – JINA KAUSER
Managing or avoiding dependence and addiction
- Tramadol should not be administered concomitantly with alcohol, sedatives, tranquilizers, or other narcotic medications.
- Tramadol should not be taking in doses larger than or for longer than prescribed.
- Tramadol tablets should be be taken whole. Extended-release drugs are not to be crushed or broken to avoid exposure and overdose which may be fatal.
- Seizures (convulsions) are recurrent side effects of Tramadol and may likely occur in patients with a history of seizures or head injury, a metabolic disorder, or in patients taking antidepressants, muscle relaxers, narcotic, antiemetics or medicine for nausea.
- Tramadol is not to be share with persons for whom it was not prescribed. This can lead to misuse, addiction and overdose.
- Patients especially pregnant women are to discuss taking Tramadol with their pharmacists or doctors to ensure there are no other risks, as Tramadol may cause life-threatening withdrawal symptoms in a newborn.
- Tramadol administration is not to be stopped suddenly without speaking with your pharmacist or doctor first, especially if you’ve been on the medication for a while. Untapered cessation of opiate medications can result in withdrawal symptoms.
- Tramadol related stories
Toyosi Ogunjobi, a 19-year-old public secondary school student in Lagos, who is into the abuse of the drug told The Nation that he mixes tramadol with alcohol when he wants to engage in manual labour. He claims it allows him to work harder and longer but that if he takes the mixture without working, it weakens him.
- Gabriel Oladoye, a 21 year-old undergraduate of the University of Agriculture, Abeokuta also admits to abusing tramadol. To him, tramadol serves as an aphrodisiac. He says he normally takes the drug few minutes before sex and it enables him last longer and perform better in bed.
- Bode, a 27 year-old liquor seller says mixing tramadol with Bullet alcohol drink helps him last longer during intercourse, since he normally suffers from premature ejaculation. He shared an experience in which he engaged in intercourse all night with a commercial sex worker after taking tramadol with ‘Bullet’. He said they had marathon sex all night, but confessed that he had to visit the clinic during the day, when he began experiencing pains on his manhood. The doctor, after checking him up for infections, warned him to desist from such medications and marathon sex, as he was lucky not to have ruptured his tissues.
This article has been compiled by Pharm. Nkoli Okafor and edited by Pharmacists Kester Onwuka for Pharma-Guide Nigeria