What Is Opioid Withdrawal
What Is Opioid Withdrawal

Understanding Opioid Withdrawal Symptoms & Treatment

What Is Opioid Withdrawal rise in opioid prescriptions has triggered a broad outbreak of opioid abuse, both for medical and non-medical reasons, with over 1.7 million people in the United States (US) suffering from various diseases as a result of opioid usage.

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While numerous pharmaceuticals have utilize to treat opiate withdrawal symptoms, such as methadone, buprenorphine, and naloxone, among others, worries about possible abuse, procurement costs, laws, and prescription rules have grown. Tramadol has recently ski as a potential substitute for several of these therapy approaches.

Tramadol is a centrally acting synthetic analgesic having opioid-like effects due to its metabolite binding to the mu ()-opioid receptor, with a low potential for abuse.

\The effects of tramadol in opioid withdrawal cases have been documented in several clinical studies conducted in the last ten years. In certain therapeutic circumstances, the results demonstrated that it has superior efficacy and tolerance with fewer negative effects than currently available detox management. 

We need to learn more about tramadol’s effects in opioid withdrawal.

Opioid withdrawal symptoms are a primary reason why opioid treatment programmes fail so frequently. Shaking, muscle and bone pain, nausea, despair, anxiety, and drug craving are all common symptoms of severe opiate withdrawal.

Tramadol is a pain reliever that is now use to treat moderate to severe pain in cancer patients, joint pain, and surgical pain. Tramadol may be useful in treating opioid withdrawal due to its pharmacological characteristics. More study is neede to validate tramadol’s benefits for opioid withdrawal.

What Is Opioid Withdrawal?

When you stop using opioid medicines after your body has become adapted to them, you experience opioid withdrawal. It has a variety of effects on you. Opioids bind to receptors on nerve cells in your brain, spinal cord, and other parts of your body to inhibit pain signals that your body sends to your brain.

They also cause the release of dopamine, a feel-good hormone in your brain. When you have surgery or have been injure, opioid medicines like oxycodone or morphine can help with the pain.

Prescription opioids are generally safe to take for a limited period of time and as directed by your doctor. Consult your doctor if you need to discontinue using long-term opioids. To accomplish it safely, you must gradually reduce the amount of medicines you take while being closely monitore by a medical professional.

How does Opiate Withdrawal occur?

When you take opiates for a long time, your body develops a tolerance to the medication. This indicates that you’ll need more of it to get the desired results.

The structure of nerve cells in your brain transforms when you use opiates for a long time. These cells will eventually require the medication to function properly. When you quit using opiates suddenly, your body reacts, causing withdrawal symptoms. Long-term withdrawal symptoms can follow these initial phases, which can last anywhere from a week to a month.

Long-term symptoms are more likely to be emotional or behavioral in character than physical.

There are two stages to opiate withdrawal. A number of symptoms can be in the early phase, including:

  • Muscle aches
  • Restlessness 
  • Anxiety
  • Agitation 
  • Tearing eyes
  • Runny nose
  • Excessive sweating
  • Sleeplessness 
  • Excessive yawning
  • Low energy

The second phase includes:

  • Diarrhea 
  • Abdominal cramps
  • Nausea and vomiting
  • Dilated pupils
  • Rapid heartbeat
  • Goosebumps 

How Can Tramadol Be Used for Opioid Withdrawal?

Tramadol is a centrally acting analgesic that works by modifying ascending pain pathways via partial agonism of mu (µ)-opioid receptors and inhibitors of serotonin and norepinephrine.

It is extensively metabolized in the liver and forms an active metabolite via CYP2D6. It has two chiral centers and is utilized as a 1:1 racemic mixture of the R, R-enantiomer ((+) -tramadol) and the S, S-enantiomer ((-) -tramadol. The (+)-tramadol enantiomer inhibits serotonin reuptake the most, while the (-)-tramadol enantiomer inhibits norepinephrine and serotonin reuptake the most.

Tramadol is metabolizing two steps, the first of which is slower than the first. In the first step  it is catalyze by cytochrome P450 2D6 (CYP2D6) and cytochrome P450 3A4 (CYP3A4), with the O-demethylation reaction to the active O-desmethyl tramadol (M1) metabolite catalyzed by CYP2D6. 

Tramadol is Break down in the liver, and the unaffect drug and its metabolites are eliminate in the urine. It has an opioid agonist-like action but is less likely to be abused than conventional analgesics. Oral tramadol dosages of 200 mg to 400 mg were demonstrated to inhibit moderate opioid withdrawal in a prospective human laboratory investigation.

Tramadol was found to be more effective than clonidine in lowering all symptoms on COWS during opioid withdrawal. Similarly, in a research of 59 people withdrawing from tramadol and 85 withdrawing with clonidine found that those withdrawing with tramadol were less likely to depart against medical advice than those withdrawing with clonidine, suggesting that tramadol is more successful than clonidine.

When compared to placebo, hydromorphone raised VAS ratings of like and excellent effects, and when combined with methylphenidate, ratings of high and drug effects increas. 

  • Tramadol did not significantly increase ratings of drug liking, good effects, high or drug effects, though it did significantly increase stimulant scale scores at higher doses, which could be attribut to its slower onset and lower efficacy at -opioid receptors in comparison to full-opioid agonists. These sets of statistics show tramadol as a viable therapy option for low-level opioid dependency or mild to moderate opioid withdrawal, according to the researchers.
  • Tramadol was  to have a similar effect to buprenorphine in terms of persistence and withdrawal suppression. Participants taking clonidine and tramadol ER had lower SOWS withdrawal scores, whereas those on buprenorphine had a little rise. Tramadol ER treatment did not result in a rise in withdrawal symptoms after the medicine was tapere, indicating that it can use to treat opioid withdrawal.
  • In a study, tramadol exhibited signs of opioid withdrawal suppression without significant observer or subject-rated opioid agonist effects. It found no evidence of tramadol abuse among opioid-dependent people. Tramadol is an effective treatment for opioid withdrawal.
  • In this study, tramadol was compar to clonidine’s effectiveness in the treatment of opioid withdrawal. Tramadol was proven to be more effective at preventing perspiration, restlessness, aches, runny nose, gastrointestinal disturbance, yawning, anxiety, and goose skin than other pain relievers. It can b used efficiently in outpatient therapy settings for opioid withdrawal.
  • The researchers looked at the extent of physical dependence and opioid blockade efficacy induced by taking oral tramadol on a daily basis. Tramadol was find successful as a treatment for people with modest degrees of opioid dependency or for withdrawal during opioid detoxification, but it is not effective as a maintenance medication due to a lack of opioid cross-tolerance.
  • Tramadol’s discriminative stimulus effects in humans were investigat. where tramadol was to boost subjective evaluations of reinforcement. It’s a drug that could use to treat opioid addiction and withdrawal.
  • For the treatment of opiate withdrawal, the researchers assessed the efficacy and safety of tramadol versus methadone. It was fou that tramadol could use instead of methadone to treat opioid withdrawal, and it could be just as effective as methadone.
  • The effectiveness of extend-release tramadol in treating opioid withdrawal was investigat. where a lesser dose of extended-release tramadol is used, opioid withdrawal is mildly reduced. so it may use to treat opioid withdrawal.
  • Tramadol and buprenorphine were evaluate in terms of managing withdrawal symptoms in patients with opioid dependency syndrome. In comparison to buprenorphine, tramadol exhibited reduced detoxification efficacy in moderate to severe opioid withdrawal. It could be useful in cases of mild to moderate opioid withdrawal.
  • Tramadol and buprenorphine were evaluat in the treatment of heroin withdrawal in opioid-dependent patients. In the treatment of opioid addiction, tramadol does not beat buprenorphine. It showed effectiveness in terms of detoxification and relapse prevention in patients with a moderate level of opioid dependence and withdrawal.
  • The efficacy of extended-release tramadol in the treatment of opiate withdrawal was examining. In a comprehensive tapering approach, tramadol’s extend-release was finding more effective than clonidine and comparable to buprenorphine in minimizing opioid withdrawal symptoms.


Given its limited potential for abuse and high tolerance, there is sufficient evidence to support tramadol’s efficacy in treating opiate withdrawal.

Tramadol has shown promise in treating mild to severe withdrawal symptoms at larger doses than those used for pain. It has also demonstrated promise as an alternative treatment option.

More well-design studies and clinical trials with a broader range of characteristics, such as dose, safety, efficacy, and contraindications.  need to determine its comprehensive function in immediate and long-term opiate withdrawal therapy.

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