Living with pain isn’t easy. For people with chronic conditions like arthritis, handling even simple tasks like washing dishes or walking the dog could be painful. For those dealing with short-term orthopedic conditions, like pulled muscles or strained tendons, the sudden appearance of pain can be jarring or distracting, and that can keep them from working or handling family duties.
Tramadol, a prescription medication, is designed to help people deal with pain that is moderate to severe. The U.S. National Library of Medicine reports that tramadol is a narcotic medication that works by changing the way the brain and the body respond to signals of pain.
While tramadol can help with pain, it has also been linked to brain changes that lead to addiction. People who are addicted often begin to make terrible decisions about how they use the drug they are addicted to. One such poor decision involves combining tramadol with alcohol.
At one point, experts believed that tramadol was not an addictive drug. It does not have the same chemical formula as opioids, which are painkillers that are associated with substance abuse and addiction. As a result, experts believed that people would not develop an addiction to tramadol, no matter how much they took. Later, researchers realized that it can indeed spark an addiction.
In one study, published in the journal Drug and Alcohol Dependence, researchers demonstrated how tramadol works on the body as an opioid analgesic. In this study, people with a history of opioid abuse were given either tramadol or high/low efficacy opioid agonists. The rates of use were similar, and higher doses of tramadol, like other mu opioids, act as reinforcers to those who abuse opioids.
Studies like this showcased how someone addicted to an opioid could transfer that addiction to tramadol, and these studies prompted changes in how it was prescribed. At one point, the drug came with low levels of control. In some parts of the world, it didn’t even require a prescription. Once the risk of abuse became clear, rules tightened. Now, doctors must follow very strict rules to prescribe the drug, and people must follow similarly strict rules in order to get the drug.
Those who take tramadol may experience a sense of euphoria, caused by chemical changes in the brain. That sense of intense pleasure is easy for the brain to remember, and the brain cells may call out for more tramadol in response. Adding other drugs to the dose can make the pleasurable response stronger, but this mixing can be dangerous.
Tramadol can increase serotonin levels within the body. Serotonin is also a neurotransmitter, which influences psychological functions pertaining to mood, appetite, sleep, memory, and learning. Serotonin can also affect body functions such as the cardiovascular system, muscle, and body temperature. When serotonin levels rise too high, a variety of very serious health problems can take hold. Combining tramadol with medications that also increase serotonin can raise the risk of serious health issues.
In the journal Emergency Medicine News, researchers highlight the case of a woman taking tramadol, an antidepressant, and a muscle relaxant. The three medications, when combined, raised the patient’s serotonin to dangerous levels. She began to develop muscle spasms, first in her hand and then moving throughout her body.
This case study is interesting, in that the woman was prescribed all of these medications by doctors. She did not experiment with these medications on her own, and she didn’t shop from doctor to doctor to get them. They were prescribed as a group by doctors who just didn’t realize how dangerous tramadol can be.
This highlights how recently we’ve discovered the dangers of tramadol. Even doctors aren’t aware of the risks that come with mixing this medication with other drugs. If doctors don’t know about the risks, it’s impossible for average people to know about all the risks.
We do know, however, that tramadol can have an impact on breathing rates. The U.S. National Library of Medicine points out that tramadol can increase the space between breaths. People on this medication may breathe much slower than they would normally. When people add this drug to another that slows down breathing, people can breathe so slowly that they don’t provide their brain cells with enough oxygen. That can result in death.
Mixing tramadol with any of these substances of abuse could slow down breathing to the point that it becomes life-threatening. Alcohol can also slow down breathing rates, which makes it a dangerous substance to use in tandem with tramadol. But alcohol comes with other unique risks that increase the danger.
It is not at all uncommon for people to mix alcohol with tramadol. In a study in The International Journal of Clinical Practice, researchers found that 28 percent of people who abused tramadol did so in combination with alcohol or other drugs. They combined the substances to increase its effect, researchers report.
Combining alcohol with tramadol can leave a user feeling very relaxed and sleepy. The combination can also spark brain chemical changes, leading to euphoria. For addicted people, the combination of pleasure and relaxation can be quite enticing.
In the short term, mixing the two substances can lead to life-threatening complications. Tramadol’s impact on serotonin levels can lead to seizures, and adding alcohol can increase the risk of seizures. In a study in the journal Clinical Toxicology, researchers report that these seizures tend to take hold within 24 hours of taking tramadol, and seizures are more common in people who abuse alcohol at the same time.
Seizures like this can be life-threatening, especially if they begin in a secluded place without access to medical care. Someone who has hidden an addiction from view may be accustomed to using drugs in private, and this person may have terrible seizures that family members just don’t see. Someone like this can die without proper help.
In the long-term, the inclusion of alcohol can make an underlying tramadol addiction much worse.
Tramadol comes in extended-release tablets, designed for people with intense pain. These pills drop just a little bit of active ingredient into the bloodstream at a time, allowing for a slow release of relief throughout the day. In a study in the journal Drug Development and Industrial Pharmacy, researchers demonstrate that alcohol can break down this time-release function, allowing all of the active molecules of the drug to be available all at once.
A large hit of tramadol all at once can be difficult for the brain to process, and that drug dumping can cause brain cell damage that makes the addiction stronger. Someone who abuses tramadol like this may need very high doses of the drug to get that big high. This is a worsening of addiction, and it is caused by the inclusion of alcohol.
Taking tramadol with alcohol is dangerous and it can lead to an overdose. The method by which that overdose is treated depends on the symptoms the person is experiencing.
Someone with very slow breathing rates caused by tramadol may benefit from an opioid antagonist, delivered during the overdose. This form of treatment removes all tramadol molecules from their receptors, which can render the drug useless almost immediately. For some people, this is the only immediate form of treatment required.
Someone who has experienced seizures due to a tramadol overdose may need antiseizure medications and fluid therapy in addition to an opioid agonist. Until serotonin levels return to normal, this person may be at risk for additional seizures.
The best way to know what kind of treatment is required is to get the person to the hospital immediately.
Tramadol and alcohol make a dangerous partnership that can lead to death. In a study in the Journal of Forensic and Legal Medicine, researchers found that 36 percent of tramadol fatalities came in combination with alcohol. Only 23 percent of fatalities involved tramadol alone.
Research like this makes it clear that there is no safe dose of alcohol and tramadol. It just isn’t safe to experiment to determine what kind of dosing program could allow for a big high without loss of life. People who perform these experiments are gambling with their lives.
(November 2018) Tramadol. U.S. National Library of Medicine. Retrieved from from https://medlineplus.gov/druginfo/meds/a695011.html#why
(April 2013) Abuse Liability and Reinforcing Efficacy of Oral Tramadol in Humans. Drug and Alcohol Dependence. Retrieved from from https://www.sciencedirect.com/science/article/pii/S0376871612003821
(January 2017) The Case Files: Tramadol vs. Everything 744 Drug Interactions and Counting. Emergency Medicine News. Retrieved from from https://journals.lww.com/em-news/Fulltext/2017/01171/The_Case_Files__Tramadol_vs__Everything_744_Drug.2.aspx
(April 2014) The Non-Medical Use of Tramadol in the UK: Findings From a Large Community Sample. The International Journal of Clinical Practice. Retrieved from from https://onlinelibrary.wiley.com/doi/pdf/10.1111/ijcp.12429
(October 2008) Seizures Associated with Intoxication and Abuse of Tramadol. Clinical Toxicology. Retrieved from from https://www.tandfonline.com/doi/abs/10.1080/1556365050014418
(August 2008) Influence of Alcohol on the Release of Tramadol from 24-Hour Controlled-Release Formulations During In-Vitro Dissolution Experiments. Drug Development and Industrial Pharmacy. Retrieved from from https://www.ncbi.nlm.nih.gov/pubmed/18618305
(March 2014) Tramadol Deaths in Northern Ireland: A Review of Cases From 1996 to 2012. Journal of Forensic and Legal Medicine. Retrieved from from https://www.sciencedirect.com/science/article/pii/S1752928X14000079