Is Tramadol Safer Than Other Opioids?

More of the Same?

Opioids are one of the most polarizing medications today. Many people are familiar with the wide variety of uses opioids have, ranging from treating people with severe pain symptoms to helping people detox from alcohol addiction. However, opioids are also familiar to people as the counterpart to methamphetamines, two epidemic drugs that led the way in widespread addiction and abuse from the close of the 20th century into the present day. Tramadol was one such opioid that came onto the scene during this time, but it didn’t follow quite the same trajectory as other notorious opioids like OxyContin. 

Tramadol has technically been around since the 1960s, but it didn’t hit the market in the United States until 1995. As an opioid analgesic, it is mainly used to treat moderate-to-severe pain, such as pain after surgery, according to Mayo Clinic. Initially, this drug was not even considered an opiate as it is today. So what changed? Unfortunately, the change came after Tramadol users experienced the same kinds of abuse and addiction as users of other opioids on the market. In 2017, the U.S. Food and Drug Administration (FDA) released a safety announcement restricting the approved use of Tramadol in children under age12 because of serious medical risks, such as difficulty breathing and even death. Along with this restriction, the FDA also recommends that breastfeeding mothers avoid taking this drug as well. 

Where the Difference Lies

If you’ve been following the pattern so far, it seems like we’re getting the same story with Tramadol that we have with other opioids. But is this actually the case? Not exactly. It is true that Tramadol has the potential for abuse along with other opioids. However, two differences between Tramadol and its counterparts include drug scheduling and potency. Based on the drug schedule the U.S. Drug Enforcement Administration (DEA) provides, heroin is a Schedule I opioid, which means it is highly addictive and has no approved medical use. 

Schedule II opioid drugs have the same danger of abuse and very limited medical uses. These include OxyContin and Vicodin, which the CDC lists as the most common prescription opioid drugs involved in overdose deaths. Fentanyl is also listed as a Schedule II drug, and it is arguably the most dangerous illicit drug of any kind to ever hit the streets. 

Unlike other opioids, Tramadol is a Schedule IV drug. These drugs are considered to have a low potential for abuse and a low risk of dependence. To be sure, Tramadol is not associated with overdose or death anywhere close to the level of these other opioids. Part of this is because Tramadol is not as potent as they are. When comparing the potency of opioids, morphine (Schedule II) is often used as a baseline. Hydrocodone has the same potency, while oxycodone and fentanyl are more potent. Tramadol is less potent than all of these, meaning that overdose and risk of death are lower as a result. In this sense, we can say Tramadol is safe, at least comparatively speaking.

Risk on a Sliding Scale?

This seems reassuring until we look at other drugs that appear on the Schedule IV list alongside Tramadol: Xanax, Valium, and Ambien. While these drugs are considered to have a low risk of abuse on paper, some medical experts consider Xanax at the front of an epidemic in the making for benzodiazepine abuse. Meanwhile, Ambien continues to receive bad press for traffic accidents and crimes that occur because of the drug’s amnesia-inducing effects. And despite a difference in potency, Tramadol still carries the FDA’s black box warning, the strongest warning it requires to indicate a significant risk and/or life-threatening adverse effects. You won’t find the words safe or harmless in this warning about Tramadol.

Tramadol may not dominate the opioid headlines today like fentanyl and heroin. It may not be considered a drug of epidemic proportions like Xanax, and it may not receive the bad press that Ambien does, but this doesn’t mean Tramadol is a harmless drug. The potential for addiction is different from person to person, and the use of other medications or alcohol can greatly increase the risk of Tramadol’s negative effects. 

We can say Tramadol is safer than other opioids, but when we look at the drug on its own terms, we should understand that a drug can and does take people down a road of abuse. If you or someone you know is addicted to Tramadol, it’s important not to downplay its danger. Instead, you should seek professional help and begin a road to full recovery.