If you think tramadol is a benign drug, think again.

This past spring we met Gus, a middle-aged man from the southwest who was using large amounts of tramadol daily, originally for back pain. His doctor prescribed a certain amount, the rest he purchased online.

He educated himself enough to recognize he had developed quite a tolerance to the tramadol, and although he was able to wean himself down to a slightly lower dose, the side effects of withdrawal prompted him to seek help. He was also very concerned about having a seizure, a frightening complication often seen in people who take high doses of this medication.

Tramadol is used to treat pain in adults that is severe enough to require an opioid analgesic and for which other treatments do not work. It is sold under brand names including Ultram®, Conzip®, and Rybix®. In addition to acting at the opioid pain receptor, tramadol also inhibits the uptake of two neurotransmitters, norepinephrine and serotonin, which may add to its pain-relief effects, although no one is quite sure how that works.

Patients are often shocked to learn that tramadol can create a physical dependence. Indeed, tramadol was originally approved by the U.S. Food and Drug Administration (FDA) as a non-controlled analgesic. However, changes to the controlled substance status of tramadol were made when reports of drug abuse, misuse, and criminal diversion were noted. In fact, at the Coleman Institute for Addiction Medicine, we detox several people a year off of this medication.


Tramadol withdrawal causes not only the typical opioid withdrawal symptoms but because of its unique chemical structure, it can also cause anxiety, depression, severe mood swings, brain “zaps”, electric-shock sensations throughout the body, pins and needles, sweating, palpitations, restless leg syndrome, sneezing, insomnia, tremors and more. Often withdrawal from tramadol doesn’t set in for 12 to 20 hours after the last dose, and the withdrawal often lasts longer than that of other opioids.

Gus did well. We schedule a five-day minimum for a tramadol detox, but because Gus was taking over 500mg a day, we extended him out for seven days. He and his wife and young baby stayed at a nearby Airbnb in Richmond, Virginia, and came to the clinic daily for a medication review and to receive micro-dose naltrexone.

We work with a nearby pharmacy to deliver all the week’s medication to our office, so Gus’s wife didn’t have to travel in an unfamiliar town with a baby to pick up the medicines.

Each day we reviewed with her precisely what dosage and when to give Gus his comfort medications. By receiving a daily micro-dose of naltrexone, by day 7 most of the tramadol was off his opioid receptors and the final day of his detox went very smoothly.

Gus, his wife, and son were in a comfortable room, and we always provide a nice lunch for any support people. (The baby was happily nursing, so no need for us to feed him.)

Gus was so grateful to find a place that could help him. He is ready to be present for his wife and be a dad to his son.

If you have any questions about tramadol or how to safely stop using it, or are struggling to stop using medications such as Oxycontin®, Percocet®, Roxicet®, Vicoprofen®, fentanyl, heroin, Suboxone®, or methadone, please don’t hesitate to call us at 877-773-3869.

Our unique outpatient detox allows patients to comfortably get off their pain medication and safely begin long-acting naltrexone, a pure opioid blocker.

We have offices around the country and, more and more, insurance is covering the bulk of the cost.

Joan R. Shepherd, FNP



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