The abuse of prescription opioids , including tramadol , has remained extremely high over the past 20 years, according to the World Health Organization (WHO) . In a therapeutic dose, the narcotic analgesic is safe. The harm associated with it is due to the development of dependence and cases of fatal overdose, especially in combination with other psychoactive substances.

Opioid analgesic tramadol

Tramadol (” Tramal “, ” Sintradon “) is a fairly old opioid analgesic that is widely used in medicine for the relief of moderate to severe pain, in particular in cancer patients. Its analgesic activity is only 5 times less than that of morphine. The substance is sold as a monopreparation or in combination with paracetamol ( Paratram , Zaldiar ).

Chemical properties

The features of a drug compound are due to its structure. Tramadol is a synthetic opioid with agonist-antagonist properties. Pharmaceutical action is carried out in accordance with the following mechanisms:

• Activation of opioid mu, delta and kappa receptors.
• Slowing down the metabolism of neurotransmitters (serotonin, norepinephrine) and their stabilization – the effect on the monoaminergic system.
• Opening of ion channels and hyperpolarization of the membranes of the cells of the nervous system.

The activation of one or several mechanisms depends on the optical structure of the substance. Tramadol is usually a mixture of isomers (racemate), so there is no significant overload of any of the systems. This explains the fewer side effects compared to the same morphine.

Is tramadol a narcotic drug?

During the initial study of tramadol , when the participation of the opioid system in the formation of the analgesic effect was confirmed, it was boldly attributed to the group of narcotic analgesics. The establishment of a mixed mechanism of action made it possible to explain the weak severity of side effects inherent in other “brothers” of morphine, but the question of its pharmaceutical affiliation remains open. On the territory of Russia, the drug is included in the list of Vital and Essential Medicines (VED), but in Ukraine and the Republic of Belarus it is included in the list of narcotic drugs.

Thus, according to the current classification of the Russian Federation, tramadol is not considered a drug, since it was classified as a potent substance, but you still need a prescription from a doctor to buy it. At the same time, the fact of non-medical use of the drug in doses that significantly exceed the therapeutic range remains indisputable. The exact path of development of addiction is still poorly understood, but it is generally accepted.

The worst consequence is irreversible mental deterioration

It is necessary to recognize addiction as early as possible and begin to treat it.

Recreational use

The analgesic is presented in various dosage forms, but the easiest way is to get capsules and tablets, the dosage depends on the manufacturer. Tramadol is popular for drug addicts for the following reasons:

• improves mood
• relieves feeling of tiredness
• relieves pain of varying intensity
• alleviation of symptoms of depression and anxiety syndrome
• causes a qualitative change in the perception of the surrounding reality

Often illegal users use the medication to increase the duration of intercourse. However, this effect is inconsistent and less pronounced than that of stimulants.

Narcotic effect

The maximum daily dose in medicine does not exceed 0.4 g. Recreational use starts from 0.6 g. In drug addicts taking tramadol , the narcotic effect has the following features:

• euphoria is strong, accompanies almost the entire period of intoxication;
• the duration of the “trip” – 7-10 hours;
• consumers have stereotypes – they begin to get a “high” from banal actions that attracted their attention, for example, from their own breath or prolonged observation of a tree;
• symptoms of depression of the central nervous system are expressed – slowness, inhibition of reactions, drowsiness, inhibition of reflexes;
• there is also a stimulating effect due to the duality of the mechanism of action.

It has been proven that even with regular intake in a dose of up to 300 mg, the development of tolerance and drug dependence is very rare.

Of course, the effect of tramadol on the body has its own characteristics. The propensity for drug addiction depends on the initial state of health (and psyche) of the person, as well as the concentration of the substance in the blood.

Findings from various studies suggest that high levels of abuse of tramadol are due to its easy access in pharmacies and the illicit market (it is sold in large quantities), its lower price compared to illegal drugs, and the opinion among consumers that tramadol is also safe as any other prescription drug and the ease with which it can be hidden. ”

Is tramadol effective for withdrawal ?

The exchange of supposedly useful information is actively flourishing among drug addicts. So, once they tried to conduct experiments on the relief of opiate withdrawal syndrome using this analgesic, but they showed disappointing results. According to current clinical guidelines and protocols, tramadol is simply useless for drugs and withdrawal symptoms.

Due to the pharmacological characteristics, the drug cannot be used for substitution therapy for persons with opioid dependence. Indeed, it can temporarily suppress the pain of withdrawal, but the consequences may be irreversible. Tramadol is not recommended for “withdrawal symptoms”, since its antagonistic properties can only intensify an already serious condition, up to a lethal outcome.

Toxicity

The use of an analgesic is considered relatively safe, and requires the establishment of clear indications for the appointment. It is important to take into account that in people with liver and kidney disease, the excretion of tramadol and its metabolites slows down . To avoid excessive accumulation of a toxic substance in the body, you should increase the intervals between doses, or replace it with another drug.

Therapeutic doses of tramadol practically do not have a negative effect on the cardiovascular system and respiration, but they inhibit the peristalsis of the digestive tract. Drug addicts sometimes exceed the permissible amount several times, so side effects cannot be avoided. The most dangerous mixing of an opioid with other psychoactive substances, including alcohol, due to excessive depression of the respiratory center.

Side effects and contraindications

Usually symptomatic tramadol treatment is well tolerated. Non-prescription use in large doses is accompanied by the following side effects:

• tachycardia
• drop in blood pressure with subsequent impairment of consciousness – fainting, coma
• sweating
• headaches
• overwhelming muscle weakness
• severe lethargy – stupor, stupor (the patient cannot even understand what is being asked of him)
• insomnia
• loss of coordination of movements, violation of gait
• epileptiform seizures – a distinctive feature of tramadol intoxication, typical for opiates with experience
• dry mouth
• nausea
• vomiting
• abdominal pain
• dysphagia – swallowing disorder
• acute urinary retention
• allergic reactions – rash, urticaria, Quincke’s edema , anaphylaxis
• dyspnea

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A paradoxical variant of the development of events is possible, when an overdose is accompanied by stimulation of the central nervous system – tremor (trembling of body parts), aggression, anxiety, psychosis with hallucinations. Tramadol is contraindicated in the following cases:

• clinic of severe respiratory depression, for example, with alcohol intoxication or pulmonary hypertension
• a history of opiate and other substance abuse
• suicidal tendencies
• concomitant use of antidepressants
• critical dysfunction (failure) of the liver and kidneys
• pregnancy and lactation
• epilepsy
• traumatic brain injury

Prescription analgesic abuse begins in adolescence. In young people, the severity of side effects is much greater, as is the likelihood of death in the outcome of complications. In case of acute development of suspicious symptoms, you must immediately call an ambulance team.

The consequences of long-term abuse

In the long term, the complications are not much different from those in other opioid addictions. After a few weeks of using overdoses of tramadol , the following consequences may develop:

• toxic hepatitis
• inflammatory lesions of the mucous membrane of the digestive tract – from dyspepsia to acute stomach ulcers
• multiple organ failure
• convulsions
• depression
• aggressiveness
• tendency to violence with abrupt withdrawal of the drug
• encephalopathy – a violation of the functioning of the nervous system, which is manifested by neuropsychiatric disorders

Clinical cases of the development of early infertility and menstrual dysfunction in young people who began to abuse the analgesic as early as adolescence are also described. Large doses of the substance lead to excessive inhibition of the regulatory centers of the central nervous system. The result is coma, status epilepticus, respiratory arrest and cardiac arrest.