Tramadol Addiction: Sign and Symptoms

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Tramadol is an opioid painkiller prescribed for the management of moderate to severe pain, in both the short-and long-term.1 Like other opioid medications, many people abuse tramadol in order to experience the rewarding effects, but abusing tramadol can be harmful to your physical and mental health. It’s important to know the signs of tramadol addiction so that you can get yourself or a loved one the help necessary to recover from tramadol abuse.

What is a Tramadol Addiction?

Before learning the signs and symptoms of a tramadol addiction, you first need to know how addiction is defined. Addiction to tramadol is also known as a substance use disorder, which is characterized by a pattern of compulsive tramadol use despite negative consequences. If you are addicted to tramadol, you are likely unable to control your tramadol use.

According to the American Society of Addiction Medicine (ASAM), addiction is a “treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences.”2 An important part of this definition is the word “treatable.” No matter how debilitating your tramadol addiction is, you can always seek treatment to help you get sober.

Signs of Tramadol Abuse & Addiction

There are a number of signs of tramadol addiction to be aware of—both behavioral and physical. If someone you love is abusing tramadol, you may notice:3

  • Bloodshot eyes.
  • Constricted pupils.
  • Slurred speech.
  • Severe drowsiness.
  • Attention or memory problems.
  • Poor personal hygiene.
  • Mood swings.
  • Changes in appetite resulting in sudden weight loss or gain.

Many of the above signs are indicative of a tramadol high, but even if someone isn’t currently under the influence, there are other behavioral signs of tramadol addiction, such as:3

  • Neglecting previously enjoyed hobbies and social situations to abuse tramadol.
  • Using tramadol regardless of negative consequences at work, home, or school.
  • Mixing tramadol with alcohol or other drugs.
  • Being dishonest or secretive.
  • “Doctor shopping” for new doctors to prescribe tramadol.
  • Using tramadol while driving or operating machinery.
  • Failing to quit using tramadol, despite attempts to do so.
  • Spending a disproportionate amount of time getting and using tramadol, as well as recovering from a tramadol high.

If you or someone you know may be struggling with tramadol abuse or any other type of substance abuse, help is available. Call 800-681-1058 (Info iconWho Answers?) to speak to a treatment support specialist who can discuss tramadol addiction treatment options with you.

Am I Addicted to Tramadol?

Sometimes it may be easier to recognize a tramadol addiction in a loved one, but what about yourself? Here are some signs and symptoms of tramadol addiction to be on the lookout for in yourself:1,4

  • Tramadol tolerance: Abusing tramadol quickens the rate with which you develop a tolerance to the opioid, which means you need higher doses in order to feel high. If you notice that you don’t experience the same effects with the same dose, it’s likely that you’ve developed a tolerance. This can be dangerous, as taking higher tramadol doses increases the risk of overdose. While tolerance alone doesn’t mean you have an addiction, it is a risk factor for addiction.
  • Physical dependence: Tramadol abuse can lead to physical dependence, which means that you’ll experience distressing withdrawal symptoms when you suddenly stop using tramadol. Again, dependence isn’t the same as an addiction but it’s certainly a sign of addiction.
  • Withdrawal symptoms: If you notice symptoms, such as excessive sweating, pain, nausea, anxiety, tremors, insomnia, and flu-like symptoms, when you abruptly stop using tramadol, then you’re experiencing withdrawal. These withdrawal symptoms are typically so unpleasant that people may seek out more tramadol in order to alleviate them. This creates an uncontrollable cycle of abuse that can lead to addiction.

Additionally, you may experience negative consequences in many different areas of your life, such as:

  • Missing work or school.
  • Getting fired from your job.
  • Failing to fulfill parenting or spousal responsibilities.
  • Experiencing financial problems.
  • Going through a divorce or break-up.
  • Losing custody of your children.
  • Getting arrested for unlawful possession of tramadol.
  • Accidentally overdosing on tramadol.
  • Experiencing mental health problems as a result of tramadol use.

If you or someone you care about exhibits these signs and symptoms of tramadol addiction, it’s never too late to get help. Call 800-681-1058 (Info iconWho Answers?) to speak to a recovery specialist about tramadol addiction treatment options.

How Long Can You Take Tramadol?

If you were prescribed tramadol, you should follow your physician’s instructions exactly. Don’t take higher or more frequent doses of tramadol than prescribed and don’t take it for longer than prescribed. The latter is typically fairly easy to comply with because your doctor will likely not give you any refills without authorization.

In many cases, patients are prescribed tramadol for short-term use after a medical procedure. But occasionally, doctors will prescribe tramadol for the management of chronic pain, such as osteoarthritis, in which patients may take tramadol for a longer period of time.5 This increases the risk of developing a tolerance and dependence on tramadol.

It’s important to talk to your doctor if your current tramadol dose is no longer alleviating your pain or if you experience unwanted symptoms when you miss a dose. When it’s time to stop taking tramadol, your doctor will create a tapering schedule in which you slowly wean off of the opioid medication so that you don’t experience withdrawal symptoms.

What are the Side Effects of Tramadol Abuse?

Even when taking tramadol as prescribed, there’s a chance you may still experience side effects, but abusing tramadol significantly increases your risk of experiencing adverse effects, such as:1

  • Sleep problems
  • Excessive sleepiness
  • Nervousness and anxiety
  • Uncontrollable shaking
  • Muscle tightness
  • Heartburn or indigestion
  • Dry mouth
  • Mood disturbances

Some more serious side effects of tramadol abuse include:1

  • Hives
  • Seizures
  • Agitation
  • Hallucinations
  • Swelling of face, tongue, lips, throat, eyes, or hands and feet
  • Difficulty swallowing or breathing
  • Blisters or rash
  • Fever and sweating
  • Gastrointestinal problems
  • Rapid heart rate
  • Confusion
  • Loss of coordination or consciousness

If you or someone you know is experiencing these serious tramadol side effects, call your doctor immediately and discontinue use. If it seems like an emergency, call 911.

What are the Health Risks of Abusing Tramadol?

Long-term tramadol abuse can have detrimental effects on your health, with the most dangerous risks being overdose and death. Some common signs of tramadol overdose include:1,6

  • Pinpoint pupils.
  • Slow, shallow breathing.
  • Limp body.
  • Pale or blue face.
  • Cold, clammy skin.
  • Muscle weakness.
  • Unresponsiveness
  • Choking or gurgling sounds.

If you suspect someone has overdosed on an opioid, call 911 and try to keep them awake and breathing. If you have naloxone, the opioid overdose medication, administer it. Roll the person onto their side in order to prevent choking, and make sure you monitor them until the medical personnel arrives.6

Some potential long-term effects of chronic opioid use include:7

  • Severe constipation.
  • Increased risk of fractures.
  • Sleep-disordered breathing (such as sleep apnea and low levels of oxygen).
  • Increased risk of heart failure and heart attack.
  • Sexual dysfunction.
  • Infertility.
  • Decreased levels of testosterone in men and estrogen in women.

Abusing tramadol or any other opioids while pregnant can lead to:4

  • Low birth weight.
  • Neonatal abstinence syndrome (withdrawal symptoms in the baby).
  • Miscarriage.

Another major risk of abusing tramadol involves switching to heroin use. In many places, heroin is cheaper and easier to obtain than prescription painkillers like tramadol so users may switch to using heroin instead.4 Transitioning to abusing heroin can come with its own concerns, as heroin is an unregulated street drug that may be cut with other harmful substances.

Other health risks associated with using tramadol or other opioids depend upon the method of administration. People who inject tramadol are at risk for the following health problems:3

  • Track marks and lines.
  • Collapsed veins.
  • Infections.
  • HIV.
  • Hepatitis.

If you crush and snort tramadol, you may experience:3

  • Perforated nasal septum.
  • Nose bleeds.
  • Loss of smell.

What are the Tramadol Addiction Treatment Options?

The two main types of tramadol addiction treatment programs include inpatient treatment and outpatient treatment. At both types of programs, a doctor or mental health professional may prescribe you an opioid addiction treatment medication, which will help you avoid relapse while receiving therapy and counseling.

Inpatient Tramadol Abuse Treatment

Inpatient treatment for tramadol addiction involves living at the facility for an extended period of time. Most inpatient rehab programs last for 30, 60, or 90 days, although you may stay longer if necessary. Every inpatient treatment facility has different offerings and different rules. Some require that you share a room while others are more upscale and include extra features, such as spa treatment and massages. Likewise, every inpatient program has a different treatment philosophy.

You can find inpatient programs that include 12-step meetings in their treatment plans and others that incorporate SMART Recovery meetings (alternative support group) or mindfulness practices.

Regardless of treatment philosophy, you’ll likely receive the following interventions during inpatient treatment:

  • Individual therapy
  • Group counseling
  • Family therapy
  • Medication

Outpatient Recovery

If you don’t want to reside at a treatment facility during rehab, you could opt for an outpatient program in which you are still able to work and live at home. Much like inpatient treatment, outpatient programs vary considerably, especially in intensity and frequency of meetings.

Below are the different types of outpatient programs:8,9

  • Partial hospitalization programs (PHP): Also known as “day treatment,” this is the most intensive option—you’ll attend a PHP program between 4 and 6 hours per day for 5 days a week.
  • Intensive inpatient treatment (IOT): You attend a treatment clinic for at least 9 hours per week, spread out over 3 to 5 days, but it could be as much as 30 hours.
  • Standard outpatient: You’ll attend therapy 1-2 times per week, for 1-2 hours at a time.

Outpatient treatment programs are not generally recommended for individuals with:

  • A severe tramadol addiction.
  • An addiction to more than one substance.
  • A co-occurring mental health disorder, such as major depressive disorder or obsessive compulsive disorder (OCD).
  • Several drug-using triggers at home, including people currently abusing tramadol or other drugs.

Many times before beginning an inpatient or outpatient tramadol treatment, people will enter a short-term detox program to help alleviate tramadol withdrawal symptoms while the substance is getting out of their system. These programs may provide you with medical monitoring, in which a team of nurses or a doctor provide you with supportive treatment while you detox, while others may provide medication-assisted detox using opioid detox medications.

Once you have safely detoxed, you’re ready to transition into a recovery program where you can learn to rectify maladaptive drug-using patterns and live a clean and sober life.

Opioid Treatment Medications

While recovering from a tramadol addiction, you may be prescribed an opioid addiction treatment medication that can help prevent tramadol cravings and relapse. These medications include:10

  • Methadone: A long-acting opioid medication that alleviates cravings and doesn’t cause a tramadol high.
  • Buprenorphine: A partial opioid medication that prevents tramadol cravings and doesn’t cause euphoric or pleasurable effects.
  • Naltrexone: Naltrexone blocks opioid receptors in the brain so that an individual won’t feel the rewarding effects of tramadol if they wind up using it. This can reduce motivation to seek out and use tramadol or any other opioids.


  1. S. National Library of Medicine. Medline Plus: Tramadol.
  2. American Society of Addiction Medicine. Definition of Addiction.
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders(5th ed.). Arlington, VA: American Psychiatric Publishing.
  4. National Institute on Drug Abuse. (2020). Prescription Opioids DrugFacts.
  5. Robert H. Shmerling, M. (2020, December 07). Is tramadol a risky pain medication?
  6. Centers for Disease Control and Prevention. Preventing an Opioid Overdose.
  7. Baldini, A., Korff, M. V., & Lin, E. H. (2012). A Review of Potential Adverse Effects of Long-Term Opioid Therapy. The Primary Care Companion For CNS Disorders. doi:10.4088/pcc.11m01326
  8. Chapter 3. Intensive Outpatient Treatment and the Continuum of Care. (2012). In Substance abuse: Clinical issues in intensive outpatient treatment. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment.
  9. National Institute on Drug Abuse. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide: Treatment Settings.
  10. Kosten, T., & George, T. (2002). The Neurobiology of Opioid Dependence: Implications for Treatment. Science & Practice Perspectives, 1(1), 13-20. doi:10.1151/spp021113
Marisa Crane, BSHS
Writer / Editor
Marisa, B.S. in Health Sciences, has been an editor and writer in the addiction and rehab space for over seven years. Prior to her editing career, she worked as a behavioral health worker and mental health worker for children and adolescents in both a school and partial hospitalization setting. When she isn’t working on, she enjoys camping with her family.