Benzodiazepines and tramadol are CNS depressants, and using multiple CNS depressants is dangerous and compounds the effects of both.

Tramadol: An Atypical Opioid

Tramadol is a synthetic opioid analgesic that was developed in the late 1970s by the pharmaceutical company Grunenthal GmbH.

It was originally marketed as having less potential for abuse and addiction than other opioids such as hydrocodone and oxycodone. It was thought that tramadol was a safe alternative for pain management for opiate addicts and those in recovery from addiction, but experience has shown that tramadol is habit-forming and can lead to abuse and addiction.

The U.S. Drug Enforcement Agency (DEA) states that:“because of inadequate product labeling and lack of established abuse potential, many physicians felt this drug was safe to prescribe to recovering narcotic addicts and to known narcotic abusers. As a consequence, numerous reports of abuse and dependence have been received. Tramadol is most commonly abused by narcotic addicts, chronic pain patients and health professionals.”

The Journal of the American Academy of Physician Assistants provides a description of several case studies of tramadol addiction and dependence including one in which a prescribing physician became addicted to tramadol.

Tramadol’s mechanism of action is slightly different than typical opioids. Use of tramadol carries all the risks associated with use of other opioids and some additional risks as well. Like other opioids tramadol can produce physical dependence with severe flu-like withdrawal symptoms. Additionally withdrawal from tramadol can produce seizures which are not usually experienced as a consequence of opioid withdrawal.

The American Association of Poison Control Centers reports a total of 10,255 cases of tramadol exposure in 2009 with roughly half of those being single substance exposures that resulted in four overdose deaths. Although tramadol continues to enjoy unscheduled status under the Controlled Substances Act (CSA), authorities are becoming aware of the true nature of this drug. Arkansas and Kentucky have both scheduled the drug as a Schedule IV controlled substance under state law, and Louisiana has passed legislation identifying tramadol as a drug with a potential for abuse.

In 2009 the U.S. Food and Drug Administration (FDA) sent a warning letter to the manufacturer, Johnson and Johnson, alleging that a promotional website had “overstated the efficacy” and “minimized the serious risks” of the drug. In response the manufacturer has included stronger warnings about tramadol in the 2010 Physician’s Desk Reference.

The Nature of Benzodiazepines

Benzodiazepines such as alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium) and lorazepam (Ativan) are in the sedative-hypnotic class of drugs that includes alcohol and barbiturates. Sedatives are CNS depressants like opiates and opioids. Dr. Chris Ford, clinical director of Substance Misuse Management in Clinical Practice calls benzos the “bad guys” among all drugs of abuse.

Dr. Vernon Coleman, in his book Life Without Tranquilizers, states that:

“the biggest drug-addiction problem in the world doesn’t involve heroin, cocaine or marijuana. In fact, it doesn’t involve an illegal drug at all. The world’s biggest drug-addiction problem is posed by a group of drugs, the benzodiazepines, which are widely prescribed by doctors and taken by countless millions of perfectly ordinary people around the world. Drug addiction experts claim that getting people off the benzodiazepines is more difficult than getting addicts off heroin.”

Dr. Coleman stresses that the modest benefits to be gained by benzodiazepine use simply do not outweigh the serious risks involved. He states that “the uses of the benzodiazepines are modest and relatively insignificant. We can do without them. I think that the only genuine long-term solution is to be aware of these drugs and to avoid them like the plague. I don’t think that the benzodiazepine problem will be solved until patients around the world unite and make it clear that they are not prepared to accept prescriptions for these dangerous products.”

Despite the ever-increasing awareness of the dangers of benzodiazepine use even under a doctor’s supervision, benzos continue to be prescribed in large numbers for a variety of serious and minor ailments. According to IMS Health in 2009 doctors wrote 45 million prescriptions for alprazolam, 26.4 million for lorazepam, 24.4 million for clonazepam, 14.2 million for diazepam and 8.4 million for temazepam.

How Opioids and Benzodiazepines Interact

Opioid pills on top of a white prescription padBenzodiazepines and opioids (including tramadol) are CNS depressants. Both are highly addictive, and both classes of drugs produce tolerance in the user meaning that over time more of the drug is needed to achieve the same effect. Benzos produce tolerance very quickly.

Opioids and benzos work differently in the body, but as CNS depressants they compound the effects of one another. All CNS depressants are cross-tolerant with one another meaning that developing a tolerance for one will result in a tolerance for another.

A person who has used benzos for any length of time will find that tramadol is not as effective as expected, and the patient is likely to take larger than recommended doses of the drug.

Taking larger doses increases the risk of overdose, particularly when CNS depressants are combined. Benzodiazepine use can increase the lethality of tramadol, and, while benzos alone do not usually produce fatal overdose, they can when used in conjunction with an opioid. The combined sedative effects of tramadol and benzos are enough to cause death from depressed breathing.

Treatment for Addiction to Benzodiazepines and Tramadol

If you are addicted to benzos and/or tramadol, get help to get clean. We can help you find detox, recovery and aftercare resources, and we are here 24 hours a day to do so. Call us at 706-914-2327.