Is Tramadol a Narcotic? What You Need to Know About this Powerful Painkiller

The painkiller Tramadol is taken by thousands of people every day as a means to control moderate to severe pain. It has been marketed in Canada since 2005 (and since 1995 in the United States), and is available by prescription.

Until recently, tramadol had little to no restrictions. If you had a prescription, you could take it. But now the FDA and Health Canada are warning against it’s use – particularly in adolescents and children.

After reviewing several decades of adverse event reports from January 1969 to May 2015, the FDA identified 64 cases of serious breathing problems, including 24 deaths linked to codeine-containing medicines in children and adolescents. In addition, nine cases (including three deaths), were linked to tramadol (1).

In June of 2018, Health Canada put forth the notion that tramadol should be reclassified as a Schedule I narcotic. This would place new restrictions on how it is prescribed as a means to help reduce dependence and abuse (2).

Is Tramadol a Narcotic? What is Tramadol?

Is tramadol a narcotic? According to Drugs.com, Tramadol is a narcotic-like painkiller, a “centrally acting synthetic opioid analgesic.” It is used to treat moderate to severe pain, and it can lead to physical dependence when used for longer periods of time.

There is some debate surrounding tramadol, and whether it is an official opioid. According to an article written by Carly Weeks at The Globe and Mail, “tramadol is not a traditional opioid. It’s a painkiller that is metabolized into opioid compounds by the liver (3).” Because of this, tramadol is generally considered very similar to an opioid.

While tramadol is considered a “weak” opioid, when ingested, it is partially metabolized into opioids M1 and M5, two very potent opioids than tramadol itself (4).

Tramadol also contains the active ingredient hydrochloride, which functions as an anti-depressant (5).

Tramadol is the generic name for prescription pain relievers sold under brand names like Ultram®, Conzip®, Rybix ODT®, and Ultram ER®. They’re available as regular tablets, as well as in extended-release form.

Tramadol works by changing how your brain senses pain. For this reason, it is commonly used for those suffering severe back pain or cancer-related pain. The anti-depressant-like effects that come with tramadol also help create a sense of well-being (which is a sought-out feeling in those with chronic pain). With that being said, it is advised to only take tramadol for one to two weeks’ time to reduce dependency on the drug (6).

The most common side effects of tramadol include (7):
– Dizziness
– Headache
– Drowsiness
– Nausea and vomiting
– Constipation
– Lack of energy
– Sweating
– Dry mouth

In addition to the side effects mentioned above, the following side effects have also been reported with tramadol use (8):
– Hallucinations
– Tremor
– Diaphoresis (excessive sweating)
– Pruritus (intense itching)

Tramadol also interacts with alcohol, causing over 9 disease interactions, including (9):
– Acute alcohol intoxication
– Drug dependence
– Liver disease
– Renal dysfunction
– Seizure disorders
– Acute abdominal conditions
– Intracranial pressure
– Suicidal tendencies

Black Box Warnings and Tramadol

Tramadol has several black box warnings (the most serious warning you can get from the FDA).

This warning alerts doctors and patients about drug effects that may be dangerous, such as (9):
– Addiction and misuse warning
– Slowed or stopped breathing warning
– Accidental ingestion warning
– Life-threatening effects for children warning (should be avoided in anyone under the age of 18)
– Neonatal opioid withdrawal syndrome warning
– Interactions with certain drugs warning (amiodarone, quinidine, erythromycin, ketoconazole, ritonavir, and similar medications)
– Interactions with benzodiazepines warning

In an article from The Globe and Mail, Health Canada spokeswoman, Maryse Durette, said the decision to reclassify tramadol (as a Schedule I narcotic) was based on a 2018 review of the scientific evidence on the reports of “problematic use of tramadol and the rise in reported deaths” related to the drug. Durette wrote that since 2008, there have been 78 adverse events reported, relating to the problematic use of tramadol, including 14 deaths.

For Canadians, changing tramadol to a Schedule I drug would place new restrictions on how the drug is prescribed. For patients who have tramadol prescriptions, they would no longer be able to phone in requests to refill their prescriptions at their preferred pharmacy.

According to Northern Ireland’s top pathologist, Jack Crane, tramadol is claiming more lives than any other drug (including heroin and cocaine). The danger comes when users mix it with other drugs or alcohol.

In 2015, 33 deaths in Northern Ireland were linked to tramadol, with one of them being a 16-year-old girl and a pensioner in his 70s. “I don’t think that people realize how potentially risky taking tramadol is. I think it’s because it’s a prescription drug – people assume it’s safe,” Crane told Ireland TV.

Natural Alternatives to Tramadol for Pain Relief

If you’re looking for natural alternatives to narcotics like tramadol, or you don’t want to risk your life with synthetic pain relievers, there are other options. More and more people are turning to natural methods of pain relief, and you can too.

Here are 10 effective ways of dealing with pain, naturally:

• Anti-Inflammatory Diet: Switching to an anti-inflammatory diet, rich in fresh fruit and vegetables is a great way to help reduce inflammatory markers in the body. Avoid foods that trigger inflammation like refined vegetable oils (canola, sunflower and safflower), dairy, refined carbohydrates, conventional meats, refined sugar and trans fats.

• Dry Needling: targets myofascial trigger points, and is a cost-effective alternative for the management of back pain, jaw pain, pelvic pain, tendonitis, and other muscular, nerve or bone pain-related issues.

• Massage: helps to release tight knots that trigger the pain response. The most effective massage techniques are trigger point release and deep tissue massage. For soft-tissue therapy, the Graston Technique helps to “turn on” muscles that were previously “turned off” due to past injuries.

• Stretching: a great way to help release tight muscles and the nerves that surround them (which might be triggering a pain response in the body).

• Essential Oils: pain-relieving essential oils like copaiba, rosemary, frankincense and helichrysum are effective ways of providing a natural, anti-inflammatory agent to the site of inflammation.

• Foam Rolling: foam rolling is like getting a massage, but doing it yourself. It is cost-effective and can help release tight muscle fascia that often triggers pain in different parts of the body (even referred pain).

• Cold Therapy: cold therapy, or cryotherapy, can be applied in various ways, including icepacks, ice massage or cold whirlpools that bring down the temperature of the skin and tissues beneath it. By cooling certain spots of the body (or in the case of cold whirlpools – the entire body), pain receptors are de-activated, which normally carry pain signals to the brain.

• Exercise: being physically active, contrary to popular belief, can help alleviate pain instead of making it worse. Exercise helps release endorphins in the body, natural chemical messengers that make us feel good inside. Endorphins interact with the opiate receptors in the brain to reduce our perception of pain.

• Herbal Remedies: taking herbal remedies like turmeric and ginger is another great way to help reduce inflammation (and therefore, pain), in the body. Check out my article on herbal remedies that kill pain fast.

• Epsom Salts: soak in a tub with 1-2 cups of epsom salts to soothe muscle or joint pain. Epsom salts contain magnesium, which is one of the most powerful relaxation minerals in the world.