In 2020, 147,520 Canadians received a tramadol prescription in British Columbia alone. Additionally, around 20% of all Canadian post-op opioid prescriptions are for tramadol or tramadol-containing painkillers. Once marketed as a ‘safer’ opioid pain medication, tramadol is now known to be extremely dangerous. One of the most significant risks is drug interactions, such as the potential side effects of combining tramadol and alcohol. Are you or a loved one considering taking a tramadol prescription and drinking alcohol? Read this guide to learn why you may want to think twice.
Table of Contents
What Is Tramadol?
Tramadol is a synthetic opioid prescribed for short-term, moderate to severe pain. Like all opioids, tramadol targets the central nervous system (CNS). It suppresses pain signals from the body to the brain and spinal cord.
As a synthetic opioid, tramadol is similar to legal medications like hydromorphone, buprenorphine, and fentanyl and illicit drugs like heroin. Contrast synthetic opioids with natural opiates, such as morphine and codeine.
Another of tramadol’s effects is to switch on the brain’s dopamine reward system. When activated, this system reinforces the behaviour that triggered it. In this case, that would be tramadol use, leading to cravings for the drug.
Like all opioids, tramadol has the potential for abuse. Following a doctor’s guidelines is crucial to avoid this side effect.
Where to Get Tramadol
The only way to legally get tramadol is with a doctor’s recommendation. Otherwise, it is a controlled substance on Schedule I in Canada. It is illegal to possess or use a Schedule I drug without a valid prescription.
Generic tramadol is available. The drug is also sold under the brand names Ultram, ConZip, FusePaq Synapryn, Qdolo, Ryzolt, and Rybix. These prescription drugs may come as injections, capsules, or tablets.
Due to its risks, tramadol is mostly prescribed for short-term pain relief when other non-opioid painkillers have been ineffective. Most doctors do not recommend tramadol for long-term use.
People with chronic pain conditions may take a tramadol extended-release prescription. Extended-release drugs deliver a small amount of the substance over time instead of all at once (i.e., immediate release).
Some studies have found that extended-release opioids may have a lower abuse potential than immediate-release drugs. Yet, taking other substances like alcohol with tramadol may negate this effect.
Tramadol and Alcohol Interaction
People who take tramadol should not drink alcohol. As mentioned, tramadol is a CNS suppressant. In addition to reducing pain messages from the body to the brain, tramadol decreases overall CNS activity.
Alcohol’s effects on the brain are similar. Suppressing the CNS is not the only function these two substances share in common, though. They are also similar in that they both activate the brain’s dopamine reward system.
When taken together, tramadol and alcohol can suppress the CNS to dangerously low levels of activity. In the worst cases, combining them may lead to overdose and death.
Abusing alcohol and tramadol together also leads to a greater activation of the dopamine reward system than each alone. Also known as polysubstance abuse, using two or more potentially addictive substances together is an addiction risk factor.
Other Drug Interactions With Tramadol
People who take tramadol should also avoid other over-the-counter (OTC) and prescription medications. Substances that interact with tramadol include but are not limited to the following:
- Medications for allergies, asthma, blood pressure, motion sickness, irritable bowel syndrome (IBS), and overactive bladders
- Other opioids, whether natural or synthetic
- Benzodiazepines, including Valium, Klonopin, and Xanax
- Sleeping medications
- Muscle relaxers
- Medications with drowsiness as a side effect, including some antidepressants, stimulants, and migraine medications
- Parkinson’s disease medications
Those with a tramadol prescription should always consult their doctor before using a new OTC or prescription medication. Even some vitamins and supplements can interact with tramadol, so it is better to be safe than sorry.
Tramadol and Alcohol Effects
When used together, alcohol can worsen tramadol’s side effects. The most common symptoms people report experiencing after taking tramadol with a doctor’s prescription are:
- Dry mouth
Alcohol shares many of these side effects. For example, drowsiness and dizziness are common signs of intoxication. As such, people who accidentally ingest alcohol while on tramadol should not operate a vehicle or participate in activities requiring mental alertness.
Severe Side Effects of Mixing Tramadol and Alcohol
Some people experience more serious side effects after using tramadol. Drinking alcohol can worsen these severe symptoms, which may include:
- Serious breathing issues, such as slowed breathing or shallow breathing
- Physical dependence and addiction
One of the first signs someone is developing a dependence on or addiction to tramadol, alcohol, or both is withdrawal symptoms. Withdrawal symptoms occur upon cessation of use of a substance.
In this case, suddenly quitting tramadol may result in withdrawal symptoms like irritability and insomnia. Physical signs such as increased breathing, heart rate, dilated pupils, and gastrointestinal (GI) issues are also common during tramadol withdrawals.
Side Effects of Long-Term Tramadol and Alcohol Use
Alcohol and tramadol use can have long-term effects on the liver and kidneys. These internal organs are responsible for filtering toxins like alcohol and tramadol from the blood and breaking them down into substances the body can eliminate.
Alcohol and tramadol abuse alone can make the liver and kidneys work harder. Yet, when used together, they increase these organs’ efforts even further. Over time, the result can be the liver and kidneys becoming less effective at their jobs.
That’s not all. Using high doses of tramadol, taking tramadol for a long time, or combining it with other substances like alcohol increases the risk of liver or kidney damage. People with pre-existing liver or kidney conditions have an even higher risk of damaging these organs.
Can You Overdose on Tramadol and Alcohol Together?
Yes, you can overdose on tramadol and alcohol together. In fact, someone can overdose on CNS depressants together faster than if they were using tramadol or alcohol alone.
One of the biggest dangers of co-abusing substances that reduce CNS functioning is to the respiratory and cardiovascular systems. Among other activities, the respiratory system controls breathing, and the cardiovascular system controls heart rate.
When alcohol and tramadol both suppress respiratory and cardiovascular system activity, people may stop breathing. The brain needs oxygen to survive. If someone’s breathing rate is too low or stops, they may eventually go into a coma or die.
Recognizing and Responding to a Tramadol and Alcohol Overdose
Overdosing on alcohol, tramadol, or both is a medical emergency. People who experience or have a loved one experiencing the following symptoms of overdose should seek medical attention immediately:
- Losing consciousness
- Slow breathing
- Shallow breathing
- Pale or blue skin
While waiting for emergency help to arrive, ensure the person does not fall asleep or go unconscious. However, avoid providing interventions unless you have certification to do so.
Of course, the best way to help someone overdosing on tramadol and alcohol is to prevent it altogether. That is where treatment comes in. We will talk more about tramadol and alcohol treatment in a moment.
How Long After Taking Tramadol Can I Drink Alcohol?
How long after taking tramadol you can drink alcohol depends on factors like formulation, dosage, and route of administration, as well as genetics and age. In general, people taking tramadol should wait 20 to 40 hours before drinking.
Experts have come up with this timeline based on how long it takes the body to metabolise tramadol. Tramadol has a half-life of six to eight hours. A half-life is how long it takes to eliminate half of a substance from the body.
The body can completely metabolise a drug in four to five half-lives. Experts have used these facts to come up with the 20 to 40-hour range. Of course, this estimate does not account for factors that slow the body’s ability to eliminate substances.
The following factors may mean people should wait longer than 40 hours to drink after taking tramadol:
- Taking higher doses of tramadol
- Taking tramadol every day or more than once a day
- Taking tramadol for a long time
- Taking capsules or tablets rather than injections
- Having a slow metabolism due to genetics or other factors
- Having conditions that impact liver or kidney function
- Being older
Not waiting long enough can increase the risk of the acute and long-term side effects we mentioned above. People who are still concerned should talk to their doctors about exactly how long to wait.
Signs of Tramadol and Alcohol Addiction
Failing to wait long enough to drink after taking tramadol may increase the risk of addiction. People who purposefully abuse these substances together can also become physically and mentally dependent.
To identify if someone is addicted to tramadol, alcohol, or both, look out for the symptoms of a substance use disorder (SUD). An SUD is a mental health condition where someone’s brain and behaviour change due to substance abuse, resulting in uncontrollable substance abuse.
Below, we explain the 11 signs or criteria of an SUD according to the Diagnostic and Statistical Manual of Mental Health Disorders. Note that it only takes two or three criteria to diagnose a mild SUD.
Impaired control happens when someone feels they no longer have control of their drug or alcohol use. There are four things to look for to identify this sign of an SUD:
- Consuming more of a substance than intended
- Unsuccessful attempts to quit using a substance
- Spending significant time obtaining a substance
- Experiencing cravings
Cravings are an intense urge to use drugs or alcohol. Drug and alcohol cravings can be so strong that the individual can’t go about their day without accessing and using their substance(s) of choice.
Social impairment happens when someone fails to fulfil their financial and social obligations due to substance abuse. The following behaviours could be a sign of an SUD:
- Being unable to meet work, school, or home life obligations due to substance use
- Continuing to use the substance(s) despite negative social, work, or interpersonal issues
- No longer participating in previously enjoyed activities to use substances
Some high-functioning addicts may not display any of these issues. However, they may still qualify for an SUD due to other criteria listed in this section.
Risky use refers to the physical safety aspects of an SUD. People with SUDs may put themselves in situations with the potential to harm their health.
For example, one criterion under this category is continuously using substances in unsafe locations. The second sign in this category is that someone persists in their substance use despite actual or potential physical or mental damage.
Pharmacology refers to how substances like drugs and alcohol move through the human body. Two hallmarks of addictive substance pharmacology are tolerance and withdrawal.
Tolerance happens when someone needs more and more alcohol or a higher and higher dose of a drug to achieve the same effects. Withdrawals are negative symptoms that occur upon stopping the use of a substance.
Treatment for Tramadol and Alcohol
Treatment for tramadol and alcohol abuse depends on the problem’s severity. Someone with a mild SUD may only require outpatient therapy, complete with group and individual counselling sessions.
People with moderate to severe tramadol or alcohol use disorders may benefit better from inpatient treatment. Inpatient treatment takes place at a private facility where individuals can live away from temptation while recovering.
Inpatient treatment begins with detoxification. Also known as detox, the process involves eliminating all traces of substances from someone’s system.
During detox, individuals undergo withdrawal under medical supervision. Drugs may be available to make this process more comfortable.
Getting through withdrawals is often the hard part. Once the process is over, the next step is individual and group counselling, as well as alternative therapies and lifestyle changes to promote healing.
Get Help for Tramadol and Alcohol Abuse
Tramadol and alcohol do not mix. Combining or abusing these substances can increase the risk of side effects, addiction, overdose, and death. Treatment can help people avoid these potentially devastating consequences.
Are you searching for an ‘addiction treatment centre near me’? Simcoe Addiction and Mental Health in Ontario is here for you or your loved one. Contact Simcoe to learn more about our treatment programmes.