Taking tramadol for opiate withdrawal

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Indeed, it is the only thing that ever has. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. Published: July 11, see history. Cureus 12 7 : e The increase in the prescription of opioid medications has resulted in a wildfire of misuse of opioids, both for medical and non-medical reasons, with over 1. While various medications, such as methadone, buprenorphine, and naloxone, among others, have been used in treating opioid withdrawal symptoms, concerns of the potential abuse of these drugs, the cost of procurement, legislations, and prescription policies have risen.

In recent times, tramadol has been considered a viable replacement for some of these treatment regimes. Several clinical studies conducted in the past ten years have identified the effects of tramadol in opioid withdrawal cases. The showed that it exhibits better efficacy and tolerance with fewer side effects in specific clinical scenarios as compared to existing available detox management.

We aim to examine the properties of tramadol Taking tramadol for opiate withdrawal opioid withdrawal through this systematic review of clinical studies on humans.

Taking tramadol for opiate withdrawal

The use of opioids dates back to more than years, occurring as natural extracts of the poppy plant, 'Papaver somniferum,' and it can also be synthesized []. Since the early 20th century, opioids have been accessed easily in the United States US and used for headaches, toothache, diarrhea, insomnia, anxiety, and cough, among others, and it has resulted in widespread opioid abuse and dependence [3].

The feelings of euphoria, tranquility, and sedation produced by opioids have led individuals to continue seeking the drug, especially in doses that overwhelm the respiratory drive and lead to death [4]. The Diagnostic and Statistical Manual of Mental Health Disorders DSM-5 published by the American Psychiatric Association APA Taking tramadol for opiate withdrawal defined opioid use disorder OUDas the repeated occurrence within 12 months of two or more of 11 problems, including withdrawal, giving up life events to use opioids, and excessive time spent using opioids [5].

A global epidemiology and burden of opioid dependence study showed that there were While some million Americans are estimated to misuse opioids and about two million diagnosed with OUD, with an average of five deaths per hour due to opioid overdose, it costs the US economy billion dollars annually []. Three-million eight-hundred thousand people in the United States aged 12 and older reported past-month misuse of prescription pain medication in [9]. Opioid use disorder prevalence among pregnant women increased from one and a half to six and a half cases per delivery hospitalizations from [10].

Approximatelypeople died from opioid overdoses from to [11]. As a response to the opioid epidemic, in Marchthe Centres for Disease Control and Prevention CDC released the 'Guideline for Prescribing Opioids for Chronic Pain,' stipulating that a quantity not higher than needed for the expected duration of pain severe enough to require opioids be given [12].

And as ofabout 33 states Taking tramadol for opiate withdrawal enacted legislation ordering on opioids prescription limits [12]. Drugs such as methadone, buprenorphine, naloxone, and clonidine have been used in the last three decades for treating opioid withdrawal [13].

Taking tramadol for opiate withdrawal

Methadone is used for both withdrawal and maintenance treatment but is limited by regulations that make it available only through d narcotic treatment centers [14]. Treatment with buprenorphine, while useful, is limited by its prolonged half-life, making it challenging to switch medication, and has a potential for abuse [15].

Complications of symptomatic hypotension and bradycardia are some of the limitations Taking tramadol for opiate withdrawal the use of clonidine in opioid withdrawal, leading to a low rate of treatment-seeking and a high detoxification failure rate [14]. Given the above, recent studies have sought alternatives for the treatment of opioid withdrawal. Tramadol has shown to exhibit opiate receptor activity. With its low potential for abuse, it is considered to have potential as an effective treatment for opioid withdrawal [16].

This systematic review aims to assess the effects of tramadol in opioid withdrawal management through qualitative analysis of past randomized controlled trials on humans. A similar strategy was adapted to search the ClinicalTrials.

Clinical trials in all phases, comparative studies, and clinical studies were examined by using the search term, 'Tramadol' in the context of 'Opioid Withdrawal' and 'Opioid Detox,' and that generated 35 studies in the .

Taking tramadol for opiate withdrawal

After reviewing study titles and abstracts, we excluded nine non-human studies and three duplicate studies. A further detailed review of full-texts of the studies determined nine eligible clinical studies for the qualitative synthesis of our research, as shown Taking tramadol for opiate withdrawal Figure 1. Tramadol is a 2- dimethylamino -methyl 3-methoxyphenyl cyclohexanol hydrochloride and a 4-phenyl-piperidine analog of opioid drug codeine, which was discovered and synthesized in by a German company for pain treatment.

It was introduced by the name tramadol into the market in and became available in the US market in [17]. Prescriptions for tramadol have seen a steady rise from While it is considered safe owing to the lower risk of tolerance, abuse, and dependence, it is said to have less clinical value than other opiates, with only about one-tenth the pain-reducing qualities of morphine [17]. Tramadol is primarily used for the treatment of muscle, t, and wound pain and is usually not recommended for those under 16 years of age and those with a medical history of kidney disease, liver disease, stomach disorder, Taking tramadol for opiate withdrawal illness, depression, and suicidal ideation [18].

Opioid withdrawal symptoms OWS have different levels of severity and duration, depending on the half-life of the opioid, length of usage, and patient's individual characteristics such as health status. The most common symptoms include aches, muscle spasms, tremor, abdominal cramps, nausea, vomiting, anxiety, irritability, insomnia, hot flashes, heart-pounding, lacrimation, and sweating [1]. Sudden stop of short-acting opioids e.

It has been noted that the avoidance of OWS becomes the most compelling reason for continued usage, despite the pain relief, relaxation, self-medication, or pleasure-seeking, which may have informed a primary reason [20]. The physical dependence on opioids can be developed within days to weeks following repeated daily usage; tolerance and complete dependence become inevitable with prolonged usage [1]. Opioid maintenance therapy, also known as agonist replacement or agonist assisted therapy, is the administration of a prescribed opioid substance usually under medical supervision to prevent the emergence of withdrawal symptoms and reduce cravings.

Methadone offered orally and buprenorphine given sublingually are often used for opioid maintenance therapy [21]. The American Society of Addiction Medicine-approved medications for opioid addiction treatment are listed in Table 1 [21]. Methadone is a slow-acting opioid agonist that has been considered useful in opioid withdrawal management.

It is taken orally to dampen the euphoria associated with using other administration routes, thereby preventing OWS. Several studies have shown it to be preferred above abstinence-based approaches [22]. Treatment begins with an initial dose range from 10 mg to 30 mg, depending on the level of physical dependence evaluated in the first two to four hours.

Acute withdrawal symptoms are often reduced by relatively low doses of less than 30 mg per day, but such doses may not be able to suppress craving. While some patients respond to a maintenance dose of 30 mg to 60 mg per day, most do better with a steady and gradual increase in treatment dose of 60 mg to mg. However, doses of 80 mg to mg per day have been shown to produce better outcomes in randomized trials [23].

Cases of intolerable methadone side effects, lack of successful treatment outcomes, or a patient's desire to change treatment and suitability for an alternative regimen can result in switching to other opioid treatment medications [21]. Buprenorphine has shown to be an effective treatment for OWS, with a lower risk of lethal overdose in opioid-tolerant individuals as compared to other opioid medications [24].

It is unique for inhibiting drug Taking tramadol for opiate withdrawal void of the euphoric side effects associated with other opioids [21].

Taking tramadol for opiate withdrawal

Initial doses of 2 mg to 4 mg are recommended; later, patients are assessed within 60 minutes to 90 minutes for s of precipitated withdrawal and in their absence, the dose is increased by 2 mg to 4 mg. Many patients tolerate the drug well, but in cases of adverse side effects or no successful course of treatment, a switch can occur [24]. Naltrexone, a long-acting opioid antagonist with the properties of blocking the effects of opioids, is used to help relapse [21]. A review of 13 randomized controlled clinical trials, with a total of participants, compared treatment with oral naltrexone against either placebo or Taking tramadol for opiate withdrawal medication for OUD and showed that oral naltrexone is not superior in relapse prevention, but more effective in sustaining abstinence [25].

According to the guidelines provided by the American Society of Addiction Medicine ASAMthe recommended dosage of oral naltrexone is 50 mg per day or two mg doses three times a week, followed by one mg dose. The injectable naltrexone can be administered intramuscularly every four weeks [21].

Taking tramadol for opiate withdrawal

A clinical trial evaluation of a once-per-month extended-release injectable naltrexone formulation for patients with difficulty adhering to daily medication found effectiveness in treating polysubstance dependency with the reduced use of heroin and amphetamines [26].

An alpha-2 adrenergic agonist such as clonidine is an alternative non-opioid treatment method for withdrawal treatment, usually dosed at 0. Tramadol is metabolized in two phases, with phase I reactions Taking tramadol for opiate withdrawal slower than phase II. Metabolism of tramadol occurs in the liver, and the unchanged tramadol and its metabolites are excreted in urine [30].

It exhibits some opioid agonist-like effect, with a lower potential for abuse as compared to typical analgesics [31]. In a prospective human laboratory study, oral tramadol doses of mg to mg were shown to bring about moderate opioid withdrawal suppression [32]. In this study, nine randomized control trials were reviewed for the qualitative analysis of the evidence of tramadol's effectiveness and efficacy in opioid withdrawal. In another double-blinded, randomized control trial RCT10 residential opioid-dependent adults participated to understand the suppression efficacy of oral tramadol for opioid withdrawal.

Taking tramadol for opiate withdrawal

Opioid-dependent adults were maintained on morphine for a six-week duration and induced withdrawal before the experimental sessions to assess the effect of placebo, tramadol 50 mg, mg, mg, and mg orallynaloxone 0. Morphine and naloxone were observed to produce a dose-related increase of typical opioid agonist and antagonist effects, respectively, while the effects of tramadol varied per individual and depended on time and dose.

Effects Taking tramadol for opiate withdrawal 50 mg and mg tramadol were similar to placebo, while mg and mg yielded evidence of suppression of opioid withdrawal. However, that suppression was slower than seen with morphine, which could be a result of differences in routes of administration as well as the conversion of tramadol to its active metabolite, M1.

The researchers noted that tramadol is not linked with ificant positive drug effects such as feeling high, drug liking, or good effects, suggesting that acute doses of tramadol show low abuse liability when used in opioid withdrawal. It also provided evidence of its effectiveness in opioid withdrawal with mg and mg doses without subject and observer-rated agonist effect [33].

A total of 60 patients with heroin dependence were recruited to compare the effectiveness of tramadol with clonidine in opioid withdrawal. An equal of participants received clonidine treatment and tramadol treatment. The clonidine group was administered mg to mg given three to four times per day, while the tramadol group had mg to mg with two to three doses per day.

The clinical opioid withdrawal scale COWS was administered in all participants to evaluate the efficacy of both treatment groups. showed that treatment with tramadol reduced withdrawal symptoms in all 11 items on COWS, and mean withdrawal scores were lower on subsequent days for the tramadol group than the clonidine group.

As tramadol was more effective in preventing sweating, restlessness, aches, runny nose, gastrointestinal GI upset, yawning, anxiety, and goose skin, the study concluded that it could be effectively used in opioid withdrawal in outpatient treatment settings [34]. Lanier et al. Nine residential opioid-dependent adults maintained on two doses daily of oral tramadol mg and mg to test the acute effects of intramuscular placebo, naloxone 0.

Findings showed that the challenge dose of 0. Withdrawal severity from naloxone Taking tramadol for opiate withdrawal seen to be greater with mg versus mg per day tramadol [35]. Findings suggest that tramadol may exhibit low opioid-like subjective effects in human beings, which makes it have low abuse potential. It was also found to create dose-related opioid physical dependence but does not produce dose-related attenuation of agonist challenge effects.

No evidence was found for opioid cross-tolerance linkage to daily tramadol administration. Hence, it may be useful in treating individuals with opioid withdrawal or as a detoxification agent but not for maintenance treatment due to the risk of physical dependence owing to prolonged use []. In a study by Duke et al. Eight non-dependent volunteers with active stimulant and opioid use were trained to discriminate between placebo, hydromorphone 8 mgand methylphenidate 60 mg.

Taking tramadol for opiate withdrawal

Participants were given samples of each and informed that they might either experience no effects, stimulant effects, or other effects and were Taking tramadol for opiate withdrawal pay attention to the effects of each letter-coded drug. The participants underwent three phases: discrimination training to identify each condition by letter code, a test to assess if each participant could correctly identify each drug condition by letter code, and discrimination test sessions.

Doses of hydromorphone 4 mg and 8 mgmethylphenidate 30 mg and 60 mgtramadol 50 mg, mg, mg, and mgand placebo were tested. Through the visual analog scale VASparticipants rated drug effects as high, like good effects, bad effects, sick, desire for cocaine now, similar to opioids, and similar to stimulants [37]. showed that participants were able to identify each drug condition at least once correctly. Doses of hydromorphone were majorly identified as an opioid agonist, doses of methylphenidate as a stimulant, while lower doses of tramadol were identified as placebo and higher doses as an opioid agonist.

Hydromorphone 8 mg was observed to increase VAS ratings of like and good effects compared to placebo, hydromorphone, and methylphenidate's increased ratings of high and drug effect; tramadol did not ificantly increase ratings of like or good effects [37]. The researchers noted that these findings suggest tramadol as a useful treatment option for low-level opioid dependence or mild to moderate opioid withdrawal and along the lines with the findings of Lanier and Threlkeld [35,38].

Taking tramadol for opiate withdrawal

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