Tramadol, also known as Ultram and Ultracet (with acetaminophen) carries a risk of substance abuse. While it appears that tramadol’s risk of substance abuse is low, abuse and addiction have been reported. Tramadol is also associated with a withdrawal syndrome that is typically seen in opioid withdrawal.

Tramadol is a centrally acting synthetic opioid analgesic. Its intended use is for managing moderate to moderately severe pain in adults. The mechanism of action is not exactly known, however it believed to be similar to morphine. It is believed to bind to certain opioid receptors in the brain which change the way that we perceive pain. It is also thought that tramadol inhibits re-uptake of serotonin and norepinephrine also changing the way pain is perceived.

Tramadol is frequently chosen to treat moderate pain for various reasons. It is often chosen by doctors whose patients are not tolerant of conventional narcotics such as codeine or hydrocodone. Tramadol is also an substitute for those who can’t take NSAID’s (non-steroidal anti-inflammatory drugs) due to stomach ulcers and stomach bleeding. Its side effects are less than those of conventional narcotics. It has a lower risk for respiratory depression as well as a lower abuse potential.

Although tramadol has a low abuse potential, dependency has been reported. The risk of abuse is greater when a patient has a history of drug or alcohol dependency. Tramadol is generally chosen over conventional narcotics when the risk of abuse is present. Withdrawal symptoms have been present even with those not experiencing dependency. Discontinuing the use of tramadol should not be made abruptly. Tramadol should be taken on a regular basis, trying not to miss a scheduled dose. The patient should gradually stop taking tramadol, especially if they have been taking it over a long period of time.

The withdrawal symptoms experienced with discontinuing tramadol likely leads to addiction. Tramadol abuse and addiction is more common in those individuals with prior drug or alcohol addiction/abuse; although there have been many reports of tramadol withdrawal symptoms in those patients with no prior addiction.

Tramadol is a relatively safe medication when taken as prescribed. Abuse and withdrawal symptoms are greatly reduced when taken as directed. Because it has a weak reaction with mu-opioid receptors, it is thought to have a lower affinity for dependency than other narcotics. This has not been greatly studied, so this theory is still widely debated. Tramadol is also a quite new medication as compared to conventional narcotics which have been used to treat pain and other ailments for centuries.

Unlike other narcotics, tramadol is not a scheduled narcotic. It is not bound by strict regulation as is codeine and morphine. It is however, obtained by prescription only. Since tramadol is not a scheduled narcotic, it gives physicians and patients the idea that it does not have potential for abuse or dependency.

Whether or not tramadol is addictive, more studies will need to be in order to prove the addictive and abusive extent of tramadol. This is a very debatable topic for now.