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Is Tramadol 100mg highly addictive amongst opioids?

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Substance abuse or excessive drug use is a problem currently affecting millions worldwide. The WHO drug reports released by UNODC have stated that globally 35 million people suffer from disorders caused by drug abuse, and only 1 in 7 people receive treatment yearly. The report has also stated opioid drugs are majorly abused affecting around 53 million people, and responsible for around two-thirds of deaths related to substance abuse in 2017.

Death rates

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The United Kingdom has one of the highest rates of drug-induced deaths in Europe, accounting for almost 76 deaths per million. Almost 1829 opioid-related deaths were reported in England in 2017, and 815 opioid deaths were reported in Scotland. Among the opioid misuse, UK data surveyed by researchers have concluded that nonmedical use of Tramadol medication is a reason behind the increasing number of deaths.

It is important to know about Tramadol briefly to understand its addictive properties. Before we jump directly into the Tramadol abuse, let’s learn a bit more about the pain management drug.

Tramadol in brief

Tramadol 100mg is a synthetic opioid medication that treats moderate to severe pain caused by a number of musculoskeletal conditions. In addition to being available in extended-release and immediate-release versions, Tramadol is also available in intravenous form. Chronic osteoarthritis pain, surgical pain, and cancer-related pain are some prevailing conditions that respond well to Tramadol. Off-label, it is used in the treatment of fibromyalgia and treatment of anxiety-induced psychological pain. The rapid-acting, longer-lasting, multimodal analgesic effects of Tramadol tablets make it a popular form of pain management medication. However, sadly, it is one of the commonly misused drugs, and it is highly addictive.

How does Tramadol work for reducing pain?

Unlike other opioids, Buy Tramadol has a dual mechanism of action that enables it to establish its therapeutic effects. To induce analgesia, Tramadol causes reuptake inhibition of the noradrenergic and serotonergic system and activation of the mu-opioid receptors by weakly targeting the δ- and κ-opioid receptors. Studies have also suggested that Tramadol has indirect serotonin-releasing action, which contributes directly or indirectly to its addiction potential.

Mechanism of action

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Tramadol addiction – The insights

Serotonin and norepinephrine are related to the individual’s mood, anxiety, and other cognitive aspects. Subsequently, an increase in the levels of serotonin and norepinephrine neurotransmitters for a prolonged period of time results in a sense of euphoria in the individual, and it becomes habit-forming over time. Being an opioid by nature, long-term use or consumption of higher doses of the medication can result in physical dependence.

Animal studies have shown that Tramadol UK can cause psychological dependence, especially when pretreated with other opioid medications. Users developing Tramadol addiction often develop typical opioid withdrawal symptoms in addition to atypical symptoms. Typical withdrawal symptoms develop on the usage of the medication for a certain phase of time, after which they develop a tolerance for the medication and higher doses are required for the desired therapeutic relief.

In turn, the body starts to depend on the medication, and the person starts to experience withdrawal symptoms when the drug is taken in higher doses. The following are the initial symptoms of Tramadol addiction.

Initial Tramadol addiction signs

  • Using the medication for a longer time or in larger doses than advised
  • Spending a lot of time obtaining, using, and recovering from the effects of the substance
  • Continuing using it despite physical, personal, and social problems associated with its use
  • Experiencing cravings or intense urges for the drug
  • Increased tolerance with experiencing withdrawal symptoms of varying degrees on discontinuation

Typical symptoms of Tramadol withdrawal

Typical Tramadol withdrawal symptoms occur due to the opioid nature of the medication, with their severity depending on the dose with usage period of the medication. A runny nose, muscle ache, agitation, anxiety, and hypertension with restlessness are some of the early opioid symptoms occurring within a few hours of elimination of Tramadol from the system. Diarrhea, vomiting, difficulty concentrating, and loss of appetite with stomach cramping are some late symptoms that occur a day or two after discontinuation.

Atypical Tramadol withdrawal symptoms

Atypical Tramadol withdrawal symptoms result from serotonin and adrenergic imbalance and symptomize in the form of hallucinations, anxiety, severe mood swings, numbness and tingling sensation in the hands or legs, confusion, disorientation with intense paranoia symptoms. Serotonin toxicity can even occur in these conditions with life-threatening symptoms. These complications can pose a difficulty for the user along with the people in their surroundings and need urgent medical attention.

Other symptoms and their consequences

Following the incidence of the Tramadol crisis in the Middle East and the African countries, a study was conducted to investigate the misuse of Tramadol in patients presenting to emergency departments across Europe. Of the reported 24,957 emergency department presentations, Tramadol misuse was reported in 105 cases. On arrival, 14 (13.3%) of presentations were in a coma, and 9 of these had a respiratory rate <12 breaths/min. These presentations potentially pose a significant burden on emergency departments, with a large proportion requiring admission to the hospital for ongoing care.

Key points associated with Tramadol addiction

  • Patients treated with Tramadol in emergency departments have a higher risk of opioid misuse at the one-year follow-up than those treated with NSAIDs or dipyrone.
  • Tramadol, compared with Codeine, is associated with a higher risk of all-cause mortality, cardiovascular events, and fractures but with an increased risk of constipation, delirium, falls, opioid abuse/dependence, or sleep disorders.
  • Tramadol is associated with an increased risk of hyponatremia requiring hospitalization.
  • Long-term Tramadol analgesic use before breast cancer diagnosis might be associated with poor overall survival in patients with chronic pain compared with patients who did not receive long-term Tramadol analgesic treatment.

Global impact of Substance Use Disorders

Global Impact

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Substance use disorders account for a high amount of disease burden to the world in addition to causing an economic impact on countries. Early intervention is often the most important factor that reduces its impact significantly.

The ACMD has advised that Tramadol can be controlled as a Class C substance under the Misuse of Drugs Act 1971 and listed in Schedule III of Misuse of Drugs Regulations 2001, which it considers would provide the proper controls to prevent diversion and misuse. The ACMD has further advised that prescribers and other health care practitioners who come into contact with people using Tramadol should be given appropriate training and support regarding its misuse and adverse effects, especially its dual-action for the safety of the users. Public awareness about the dangers associated with indiscriminate use of Tramadol can go a long way in keeping consumers safe and enabling them to obtain maximum therapeutic effects of the medication.

References

  1. https://www.statista.com/topics/7547/drug-use-in-the-united-kingdom-uk/
  2. https://www.unodc.org/unodc/en/frontpage/2019/June/world-drug-report-2019_-35-million-people-worldwide-suffer-from-drug-use-disorders-while-only-1-in-7-people-receive-treatment.html
  3. https://www.statista.com/topics/7547/drug-use-in-the-united-kingdom-uk/
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8183256/#:~:text=In%20England%2C%201829%20opioid%2Drelated,2007%20in%20England%20%5B4%5D.
  5. https://pubmed.ncbi.nlm.nih.gov/32503085/
  6. https://pubmed.ncbi.nlm.nih.gov/33273995/
  7. https://pubmed.ncbi.nlm.nih.gov/25460534/
  8. https://pubmed.ncbi.nlm.nih.gov/35330383/
  9. https://www.sciencedirect.com/topics/medicine-and-dentistry/tramadol
  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4256037/