Tramadol addiction and consequences of use

General information

The drug is marketed under the name Tramadol or Tramal. Both medications have the same effect and can cause physical dependence. By their structure, these are synthetic opiates that were synthesized for medical purposes.

Tramadol is used to relieve severe pain when there is no effect from non-narcotic analgesics. Indications for prescribing it as an anesthetic are the following conditions:

• Injuries involving bone or soft tissue damage.
• Severe somatic pain.
• Oncology stages 3-4, when severe pain occurs due to tumor growth and spread of metastases. In such cases, Tramal can be part of complex pain therapy.
• Carrying out operations in surgical and traumatology practice.

The official instructions indicate that the drug has many side effects, can affect the patient’s consciousness, slow down the reaction and cause withdrawal symptoms after the end of the effect. Recommended age of appointment is after 14 years.

Tramadol has been used for recreational purposes for more than 30 years. Moreover, some drug addicts who switched to heroin or other opiates started with Tramadol or its analogues.

The distribution of the drug became possible due to its frequent use in medicine. This resulted in Tramal becoming a very accessible drug and could be purchased for relatively little money. As a result, the release of Tramadol has been limited in the Russian Federation and is now available only by prescription.

If you use high doses of tramadol in order to get drug intoxicated, then addiction develops within just a few doses.

Like any other opiates, tramadol causes depression of the respiratory center. Drug addicts for recreational purposes use doses 3-5 times higher than pharmaceutical doses. This often causes overdose and death.

Effect of tramadol

The main constituent substance is tramadol hydrochloride. Its amount depends on the form of release of the medicine. In addition, the composition contains magnesium stearate, sodium acetate, milk sugar, distilled water.

When taking the drug, pleasure receptors are stimulated, pain is reduced, and sensations are dulled. A person feels comfortable and cozy, all problems recede. Very often, tramadol is abused by people prone to increased anxiety and neuroses.

Tramadol as a narcotic is used for pain relief, and the effect is felt within a few minutes. Its effectiveness is less than that of morphine, so drug addicts often take it in large doses, remaining in a state of euphoria for up to 36 hours. The following signs are characteristic of drug intoxication:

• lack of aggression, goodwill towards everyone;
• cheerfulness;
• excessive impressionability and responsiveness;
• desire for communication, swagger.

Long-term use of tramadol causes fear of loneliness, persecution mania, nightmares at night, and hallucinations.

History of creation

The drug was invented by Kurt Flick. This German chemist was involved in research in the field of synthetic opiates. His goal was to create a drug with strong analgesic activity and minimal side effects.

Tramadol first appeared on the market in the early 60s of the last century. In many Asian countries, tramadol is sold without a prescription, so pharmacy drug addiction is very common there.

Over the entire history of the drug, the number of prescriptions written for tramadol exceeds 70 million.

About a third of the forms were issued for non-medical purposes. Sometimes patients deceive doctors in order to obtain a prescription.

Effect on the body

The effect of tramadol is similar to opiates, only less pronounced. In small doses, which are recommended by the pharmacological company and doctors, the drug has no special side effects and is rarely addictive. But if you increase the dose and frequency of administration, then along with drug intoxication, changes appear in the functioning of the central nervous system and internal organs. Tramadol is a toxic drug; it can destroy liver hepatocytes, disrupt creatinine clearance in the kidneys and lead to disruption of communication between brain neurons.

The action of Tramal is based on stimulation of opioid receptors. This leads to depression of the central nervous system, severe analgesia, and impaired perception of time and space. CNS depression leads to a slowdown in the transport of ions across neuronal membranes. The consequence of this is loss of pain sensitivity.

When used for recreational purposes, the changes in the body are completely different and can lead to death.

Physical symptoms

Consequences of taking high dosages of tramadol:

• breathing problems, slowing down and stopping completely;
• slow heart rate, persistent bradycardia;
• drop in blood pressure;
• arrhythmias;
• decreased strength of contractions of striated muscles;
• the appearance of vomiting;
• convulsions;
• tremors in the hands;
• profuse sweating, after which body temperature may decrease;
• the appearance of jaundice;
• slower peristalsis, constipation;
• decrease in the amount of urine per day;
• constriction of the pupils (only 2 small dots of very small diameter may remain).

Cognitive changes

What happens to a person after taking the substance:

• memory impairment;
• disturbance of sleep processes;
• the appearance of illusions or hallucinations;
• decreased intellectual abilities;
• disorientation;
• increased drowsiness;
• the appearance of incoherent speech;
• change in behavior during the period when the drug ends.

It should be understood that all effects are dose dependent. The higher the dose, the more pronounced the symptoms and the greater their number. Usually, few symptoms appear from the first doses of the drug, but with each subsequent use the dose of tramadol increases and, accordingly, the consequences for the body will be worse.

Tramadol: effect and side effects

Drug addicts use this drug to obtain the following effects of tramadol:

• improving mood, achieving a feeling of euphoria;
• eliminating the feeling of fatigue;
• relief of pain of varying intensity;
• elimination of anxiety syndrome, smoothing symptoms of depression;
• change in perception of reality.
• For obtaining a short-term narcotic effect, drug addicts have to pay with irreversible consequences for internal organs and serious illnesses, and sometimes with their own lives.

When using this drug for medical purposes, the side effects of tramadol are minimal.
As the dose increases, their number increases many times over. The following symptoms are typical for a tramadol overdose:

• decreased blood pressure;
• depression of the respiratory center;
• dizziness;
• drowsiness;
• nausea, vomiting;
• muscle hypotonia;
• decreased intelligence and memory;
• disorientation in space and time;
• constriction of the pupils;
• slow heartbeat;
• increased blood viscosity;
• toxic damage to hepatocytes, etc.

How to recognize a drug addict

The dose of tramadol is usually increased gradually until a person experiences an overdose or clear signs of toxic damage to organs and the central nervous system, requiring months of active use. This complicates the early diagnosis of tramadol addiction.

To suspect a person of abusing narcotic analgesics, you should always pay attention to his behavior and changes in mood over time. The fact is that such people are always in two states: under the influence of a drug and in a state of withdrawal.

In the first case, people experience lethargy, drowsiness, indifference to the world around them, and calmness. Sometimes on the contrary, they can be very active, sudden mood swings occur.

During the abstinence period, these are always aggressive and apathetic people. They are anxious, in search of a new dose, can be rude and even resort to physical force. They often take money from loved ones, steal jewelry, and take household appliances out of the house.

With tramadol addiction, without a new dose, withdrawal occurs. It manifests itself with convulsions and severe pain. Typically, such symptoms last from 2 to 7 days.

Detoxification

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Calling a narcologist to your home

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Another “bell” that your loved one may be abusing drugs is the appearance in his room or belongings of packages of medications, prescription forms and receipts from pharmacies.

The effect of the drug lasts approximately 120-180 minutes. But it all depends on the dose and method of use. If taken intravenously, the substance acts more intensely, but for less time. When using pills, the opposite is true.

All addicted people begin to experience difficulties with work or study. This is due to the fact that the volitional sphere is violated. A person cannot bring himself to go to class or show up at work on time. In addition, cognitive functions suffer, which makes such people poorly trained and slow workers.

Psycho-emotional symptoms

After using this narcotic analgesic, intoxication occurs with characteristic manifestations:

• feeling of euphoria;
• a good mood;
• emancipation in actions;
• ease of communication;
• disappearance of anxiety and restlessness;
• slowing down thinking and reaction.

The severity of all symptoms depends on the dose taken and duration of use. At first, the manifestations will be bright and pleasant, but as addiction develops, increased portions will be needed to obtain the desired pleasure. This creates a dependence in which the usual amount is no longer satisfactory and is only needed to improve well-being.

At this stage, excessive anxiety and nervousness, problems with memory and cognitive functions, lethargy and lack of concentration, depression and suicidal tendencies appear.

Tests for tramadol

There are two options for testing a person who has used tramadol or tramal: they can determine the amount of the drug used and the fact of its use. In the second case, the enzyme immunoassay method is used, which is the main one in rapid tests.

They sell tests that are specific to synthetic opiates. This means that they will be positive even if you take other drugs with a similar active substance and mechanism of action. Typically, such tests have more than 99% accuracy, but it is difficult to determine which drug gave a positive reaction.

Such tests cannot be used in legal proceedings as they are not certified. The average price of such a test is from 150 rubles. The second option for such tests is test plates. Such tablets, interacting with biological fluid, can help determine the use of 5-10 drugs. This makes sense, since drug addicts typically suffer from polydrug addiction and use whatever they can find or buy. A person who uses only tramadol for recreational purposes is rare.

Quantitative testing methods are laboratory studies using chromatography, gas-liquid spectrometry, gas chromatography-mass spectrometry. These tests can be used in legal proceedings. They show the amount of the drug used and the approximate time frame when the drug was last used.

Among the rapid tests there are few fakes and they are all relatively high quality. You can buy tests from such and “Wondfo”;

You can use saliva, blood, and urine for testing. Urine is the most optimal biological fluid because it can be easily and safely obtained from the patient. Blood and saliva testing are more expensive and take longer.

Comparison of the effectiveness of Tramadol and Tramal

Tramal is more effective than Tramadol - this means that the ability of the drug to provide the maximum possible effect is different.
For example, if the therapeutic effect of Tramal is more pronounced, then with Tramadol it is impossible to achieve this effect even in large doses.

Also, the speed of therapy is an indicator of the speed of the therapeutic action; Tramal and Tramadol are also different, as is bioavailability - the amount of a drug substance reaching the site of its action in the body. The higher the bioavailability, the less it will be lost during absorption and use by the body.

How long does it stay in the body?

On average, tramadol is cleared from the body within 72 hours. But you need to understand that everything depends on the patient’s age, weight, drug use experience, functional characteristics of the liver and kidneys. Because everything is very individual.

According to data, tramadol metabolites can be detected in the blood within 24-48 hours. But after 12-14 days you can try to find antibodies produced against antigens from tramadol metabolism.

The drug stays in the urine for about 3 days. In saliva for up to 6 hours. Parts of the metabolites may remain in the hair for several months. But in our realities, checking hair or nails is a very long (up to a month) and expensive process.

In practice, blood testing and conventional immunochromic urine tests are used. This makes it possible to identify drug addicts and, if necessary, remove them from work in order to begin treatment.

You can't cheat the test. An experienced doctor knows that urine collection must be done under control, and blood must be taken from the cubital vein in an amount of 10 to 20 ml.

Comparison of the safety of Tramadol and Tramal

The safety of a drug includes many factors.

At the same time, with Tramadol it is quite similar to Tramal. It is important where the drug is metabolized: drugs are excreted from the body either unchanged or in the form of products of their biochemical transformations. Metabolism occurs spontaneously, but most often involves major organs such as the liver, kidneys, lungs, skin, brain and others. When assessing the metabolism of Tramadol, as well as Tramal, we look at which organ is the metabolizing organ and how critical the effect on it is.

The risk-benefit ratio is when the prescription of a drug is undesirable, but justified under certain conditions and circumstances, with the obligatory observance of caution in use. At the same time, Tramadol does not have any risks when used, just like Tramal.

Also, when calculating safety, it is taken into account whether only allergic reactions occur or possible dysfunction of the main organs. In other matters, as well as the reversibility of the consequences of using Tramadol and Tramal.

How long do drug addicts live?

There are no exact data on life expectancy. Moreover, it is impossible to say whether the person died precisely from tramadol addiction or polydrug addiction, or due to a disruption in the functioning of internal organs.

But as soon as a person becomes dependent, his quality of life immediately deteriorates. All he thinks about and lives for is drugs. Consciousness and behavior change. For the sake of a new dose, drug addicts are ready to commit immoral acts, theft and even murder.

Along with tramadol, they often drink alcohol, other opiates, and smoke cannabis. All this greatly depletes the body, and the lifestyle increases the risk of premature death due to conflicts with other people, crimes and diseases that arise against the background of injections or suppressed immunity.

We can safely say that people who are dependent on opiates rarely live more than 10 years.

The usual cause of death is overdose. Death often occurs during drug-induced sleep. Opiates stimulate the autonomic nervous system and this often results in vomiting. Due to the anesthesia, a person does not feel this and may vomit while sleeping on his back. Vomit enters the respiratory tract and causes asphyxia.

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Dangers of different methods of application

The narcotic drug is used in various ways, on which the intoxicating effect and consequences of taking it depend:

1. When used orally, the oral cavity and gastrointestinal tract are primarily affected. The risk of inflammation of the mucous membranes, gastritis, ulcers, and malignant tumors increases.
2. The rectal method most often causes diseases of the rectum, obstruction and cancer.
3. After intramuscular injections, irritation, swelling, phlegmon and abscesses appear at the injection site.
4. Injections of Tramadol into a vein are considered the most dangerous, since this increases the risk of overdose several times. If sterility is not maintained, there is a high probability of contracting AIDS, hepatitis and other infectious diseases.

Regardless of the method of administration, the drug has a detrimental effect on the entire body and it will not be possible to get rid of the consequences in a short time. It will take a considerable amount of time and the help of a qualified narcologist.

Analogs

All drugs whose active ingredient is tramadol are its exact analogues. They have the same effect, but different trade names. The quality of the drug depends on the manufacturer. Sometimes another active ingredient is added to these drugs to expand its effect on the body.

There are analogues according to the mechanism of action, these are primarily: methadone, morphine, codeine, promedol, as well as other drugs from the group of narcotic analgesics.

Among drugs, analogues with similar effects are heroin, opium, and desomorphine.

Tramadol overdose

Exceeding the permissible amount of medication may be influenced by the following factors:

• inexperience of a novice drug addict;
• increased susceptibility to psychotropics;
• increasing the dose due to increased tolerance to the substance;
• deliberately taking large quantities for the purpose of suicide;
• using the drug together with other drugs, alcohol or medications.

Severe intoxication of the body, which occurs when consuming an excessive portion, is accompanied by shortness of breath, difficulty breathing, weak heartbeat, attacks of nausea and vomiting. The victim's vision sharply decreases, muscle cramps and epileptic seizures appear. In the most severe cases, the addict loses consciousness and may fall into a coma.

At this moment, it is useless to prove to a person that Tramadol is a drug. He needs urgent support to avoid death and minimize the negative impact of toxins on the body.

How to speed up elimination at home

You need to understand that it will not be possible to remove the drug in a couple of hours. The effect can be stopped using opioid receptor antagonists. But given the short-term effect of the drug, they should be used only in case of an overdose of tramadol.

You also need to understand that after all tramadol metabolites are eliminated, withdrawal symptoms may occur. The person will experience convulsions, vomiting, and severe pain in muscles and joints. This occurs because opioid receptors are not stimulated by endogenous opioids. Endogenous opiates are not produced, since exogenous ones (in the form of tramadol) are constantly supplied from the outside.

At home, you need to drink plenty of fluids. Better than sweets, this will feed the brain with glucose. Typically, people experience decreased appetite and exhaustion after using opiates. Sweet tea is a great choice. You can drink coffee, but provided that there are no more than 3 cups, and if there are no problems with the conductivity of the heart muscle.

Minimal activity helps speed up your metabolism. If you dress well while walking, your body temperature will rise, which can increase your metabolism.

You need to eat food that is high in fiber, low in fat and meat. Fried and salty foods negatively affect the liver and peristalsis. And tramadol itself can inhibit the secretion of gastric juice and intestinal motility. Tramadol has a toxic effect on the liver, so during the period of cleansing the body, it should be minimally loaded. Alcohol is strictly prohibited.

Tramadol (Tramal) in the treatment of acute and chronic pain syndromes

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The main method of treating acute and chronic pain syndromes in modern medicine is systemic pharmacotherapy. The latter can be carried out using different methods of introducing an analgesic into the body (oral, rectal, sublingual, transdermal, injection), but in any case, the drug, when absorbed, enters the systemic bloodstream, and then to the site of its action (unlike regional method of administration of the analgesic, for example, perineural, epidural).

To treat pain of low intensity, according to WHO recommendations [4], various non-opioid analgesics are used, and for pain of moderate and high intensity, opioid analgesics are used. Non-opioid painkillers have a predominantly peripheral effect at the level of the source of pain, have little analgesic potential and are therefore suitable only for the elimination of mild pain. Opioids are centrally acting analgesics, realized through the body's endogenous opioid system at the level of the spinal cord and brain by inhibiting the ascending flow of pain impulses. They differ from each other in their analgesic potential and ability to relieve moderate or severe pain. Due to their good analgesic properties, opioids are widely used in various fields of medicine dealing with intense pain, primarily in oncology and surgery [3,7].

A common feature of all opioids is the non-selective nature of their action, i.e., along with analgesia, they cause a number of other side effects and at the same time differ from each other in the degree of expression of certain properties, which is associated with the individual characteristics of their interaction with opioid receptors . An important condition for working correctly with opioids is knowledge of their mechanism of action.

Mechanism of action and classification of opioids

All known opioids are divided into four main classes depending on the nature of their interaction with receptors.

The main class consists of opioid agonists

or opioid m(mu) receptor agonists, including substances and drugs of varying analgesic power, including the powerful drug heroin, traditional strong opioid analgesics - morphine, fentanyl, piritramide, as well as less strong ones - promedol, prosidol, tramadol, codeine. This group of opioids is characterized by such side properties associated with depression of the stem structures and centers of the medulla oblongata, such as sedation (less often euphoria), general weakness, inhibition of the cough reflex, and in large doses - respiratory depression (bradypnea, apnea) and circulatory depression (hypotension, bradycardia) . Along with these inhibitory effects, opioid agonists have an activating effect on the vomiting centers with the possible development of nausea (vomiting), as well as on the smooth muscles of the hollow organs, which can result in motility disorders of the latter (constipation, urinary and bile retention, a tendency to bronchospasm). All of these serious side effects are most pronounced in the most powerful opioid analgesics (fentanyl, morphine) and are less common in drugs with less analgesic potential [3,7].

All opioid agonists, except tramadol, have a specific ability to cause dependence - physical and mental, therefore they are included in the category of controlled drugs by the International Narcotics Convention [17], and they are subject to special rules for prescription, prescription, recording, storage, transportation, reporting, determined by the relevant orders of the Ministry of Health of the Russian Federation [1]. Tramadol, which is an exception, is not a drug, since, according to extensive international and domestic experience, no clear data have been obtained for the development of dependence on tramadol. This drug is classified as a potent drug and is prescribed on a prescription form for potent substances [1,9]. A characteristic property of strong opioids is also tolerance, i.e., a decrease in the analgesic effect with increasing duration of administration of the opioid into the body, which requires a gradual increase in dose during long-term therapy to maintain pain relief [4,7]. Thus, the dose of morphine can increase tens of times compared to the initial one during treatment over several months, reaching or even exceeding 1000 mg/day.

The next class of opioids is partial agonists of opioid m receptors.

- represented by buprenorphine, which is similar in properties to morphine, but has a longer and somewhat less pronounced analgesic and other side effects.

Compared to other classical opioid agonists, buprenorphine has a lower narcotic potential, but in Russia it is also classified as a narcotic.

Unlike morphine, buprenorphine has a “ceiling” of analgesic dose, above which the analgesic effect ceases to increase. Different authors define this limit in the range of 2.4–5 mg/day [7,17], which may limit the continuation of buprenorphine therapy for chronic pain syndrome and is a signal for a transition to a more powerful opioid - morphine, which does not have a “ceiling” of analgesic dose .

Mixed opioid agonist–antagonist class

includes three drugs (pentazocine, butorphanol, nalbuphine), which are k(kappa) receptor agonists and m receptor antagonists. As k-receptor agonists, these opioids cause less pronounced analgesia than morphine and have a slightly different spectrum of side effects (sedation predominates, nausea, dizziness, and respiratory depression are less common). As m-receptor antagonists, opioids of this class can weaken or eliminate the effects of classical opioid agonists, including analgesia [3,7,17]. In this regard, the combined use of opioid agonists-antagonists and morphine analgesics is inappropriate.

Drugs of this class, like buprenorphine, are characterized by a “ceiling effect”. The latest generation agonists-antagonists butorphanol and nalbuphine (unlike pentazocine) are not included in the register of narcotic drugs and are classified as potent substances. They play an auxiliary role in the treatment of pain syndromes due to their antagonistic relationship with opioids of the main class of agonists.

Properties of s(sigma) receptor agonist

Ketamine has a moderate analgesic effect [7] and a whole complex of side activating effects (tachycardia, hypertension, psychomotor agitation).

The antagonist of opioids of all groups is naloxone, which quickly neutralizes all their effects, including analgesia.

Existing opioid analgesics differ not only in the nature of their interaction with certain opioid receptors, but also in the characteristics of their binding to them in terms of strength and duration. The higher the affinity of the opioid for the receptor, the stronger the analgesia; the longer the connection with the receptor, the longer the analgesia [7,17].

Choice of opioid for the treatment of moderate to severe pain

An important consequence of the above analysis of the mechanism of action of opioids is the generally accepted position about the main role in opioid therapy of pain of analgesics belonging to the class of opioid agonists [4], since drugs of all other groups have certain limitations (the “ceiling” effect of the analgesic dose, antagonism in relation to the most powerful analgesics of the morphine group, undesirable side properties). This situation is especially important to consider when treating chronic pain syndrome in order to obtain optimal pain relief results and avoid possible failures.

The range of existing opioid agonists is quite wide and includes, as mentioned above, analgesics of various potencies that can eliminate moderate and severe pain, and indications for the treatment of such pain exist in different areas of medicine.

In what cases is the prescription of an opioid analgesic for pain relief indicated and how to choose the right opioid? To do this, first of all, you must be guided by certain general rules.

• Indications for the prescription of an opioid arise when treatment with non-opioid analgesics does not eliminate pain, i.e. the pain is more than mild. When treating chronic pain syndrome in cancer patients, preference should be given to opioid agonists.
• When determining the intensity of pain, you should be guided by a simple verbal pain rating scale (VPS): 0 - no pain, 1 point - weak, 2 points - moderate, 3 points - severe, 4 points - the worst pain. For the treatment of pain of moderate and high intensity in Russia, the instructions of the Ministry of Health of the Russian Federation recommend: tramadol, prosidol for moderate pain, buprenorphine for severe pain and morphine or fentanyl (including in transdermal form) for the most severe pain [10[.
• Doctors authorized to work with drugs (most often in oncology and surgical institutions) have the right to prescribe opioid analgesics, which are classified as narcotic drugs.
• Opioids - non-narcotics classified as potent drugs (tramadol, butorphanol, nalbuphine) can be prescribed on a prescription form for potent drugs by any doctor in agreement with the head of the department if it is necessary to relieve pain in the patient that is not eliminated by non-opioid analgesics (articular, neurogenic and other non-oncological pain). Among opioid agonists, the only non-narcotic drug is tramadol.

Clinical pharmacology of tramadol

Tramadol (Tramal) is an opioid agonist that stands apart among all representatives of this class of opioids, primarily because, unlike them, it does not belong to narcotic drugs [1]. This is confirmed by extensive clinical experience of its use around the world and special scientific studies of its narcotic potential [7,12, 15,16, etc.].

Volunteers receiving maximum doses of tramadol (Tramal, hereafter referred to as “T”) and cancer patients treated long-term with this drug for pain were tested for drug dependence using the opioid antagonist naloxone. It is known that in heroin and other drug addicts, the introduction of naloxone into the body immediately causes the development of drug withdrawal syndrome (withdrawal syndrome), manifested by severe mental and physical symptoms: severe psychomotor agitation, fear of death, panic, acute cramping abdominal pain, vomiting, chills, trembling , tachycardia, etc. In the people studied, as in the animal experiment, against the background of long-term use of “T”, naloxone did not cause these symptoms or their manifestations were unclear and did not reach the “mild withdrawal syndrome” gradation. The likelihood of mental dependence on “T” is minimal; In the above studies, the drug did not reveal any euphoric or dysphoric effects. It has been established that in patients with opiate addiction, “T,” like placebo, does not lead to the elimination of subjective discomfort during abstinence [11], i.e., it does not have a drug-substituting effect (unlike other opioids studied - promedol, butorphanol, nalbuphine , buprenorphine).

Unlike other opioid agonists, T has a dual mechanism of action. It has been established that analgesia caused by “T” is not completely eliminated by the opioid antagonist naloxone and, along with the opioid mechanism, is realized through additional inhibition of pain impulses with the participation of the serotonin and adrenergic systems [13]. That is, according to the mechanism of analgesic action, “T” is not completely identical to other opioid agonists.

Recently, reports have appeared in the Russian media about the use of “T” by drug addicts as a substitute for heroin and other hard drugs. As a professional, I consider it necessary to provide clarification in connection with the erroneous interpretation of the properties of “T” by journalists. The television showed in detail the case of the death of a drug addict recorded by a video camera after the intravenous administration of retard “T” tablets, melted over a fire and somehow diluted, intended for oral administration. Such a mixture could contain any substances toxic to the body when introduced into the blood, so it is unlikely that “T” can be considered the root cause in this case.

In an article published by the newspaper “Moskovsky Komsomolets” on August 28, 2002, “T” is characterized as “a potent narcotic drug from the group of heroin synthetics, its action is very similar to methadone.” This characterization is absolutely untrue, so experts consider this publication as “unprofessional and biased.” “T” has nothing to do with either heroin or methadone, both in terms of pharmacological properties and clinical effects. It differs fundamentally from them and from other narcotic analgesics in that it has a milder effect and minimal narcotic potential, which is described in detail above. At the same time, uncontrolled use of “T”, like any other drug, can lead to serious consequences, since all medications without exception, when exceeding therapeutic doses, cause a variety of side effects and exhibit toxic properties. This also applies to a wide range of over-the-counter drugs, including analgesics. “T”, according to the order of the Ministry of Health of the Russian Federation dated August 23, 1999 No. 328 “On the rational prescribing of medicines, the rules for writing prescriptions for them and the procedure for their dispensing by pharmacies,” must be dispensed according to a doctor’s prescription written out on a form for potent drugs.

Below is a description of the main clinical effects of “T”, which are similar in nature to the effects of other opioid agonists, but are much less pronounced. This applies to both analgesia and side effects.

The analgesic potential “T”, according to various authors, ranges from 0.1 to 0.2 of the potential of morphine [4,7], it is equal to or slightly exceeds the potential of codeine; the effectiveness of 50 mg of “T” is equivalent to 1000 mg of metamizole [13], i.e. “T” belongs to analgesics intended for pain of moderate intensity.

The most important criterion for the safety of any opioid is the severity of its central depressive effect on breathing and circulation. Numerous studies have not established significant respiratory depression in postoperative patients under the influence of “T” in the range of therapeutic doses from 0.5 to 2 mg per 1 kg of body weight, even with intravenous bolus administration, while morphine at a therapeutic dose of 0.14 mg/kg statistically significantly and significantly reduces the respiratory rate and increases the CO2 tension in the exhaled air [13]. That is, in recommended doses, “T” does not cause respiratory depression, but it cannot be ruled out that it is possible if these doses are exceeded. “T” does not have a depressing effect on blood circulation. In contrast, when administered intravenously at 0.75–1.5 mg/kg, it can increase systolic and diastolic blood pressure by 10–15 mmHg. and slightly increase the heart rate with a rapid return to initial values, which is explained by the sympathomimetic component of its action [13]. It does not affect the level of histamine in the blood or mental functions [13]. "T" is metabolized in the liver. Only one of its metabolites is active. The half-life of “T” when administered orally or intravenously is 5–6 hours; it may increase in patients with impaired liver and kidney function. About 90% of the oral dose of T is excreted by the kidneys [14]. "T" has favorable pharmacokinetic characteristics. Its absolute availability with intramuscular administration approaches 100%, with rectal administration - 78%, with oral administration - 68% (with a subsequent increase with continued therapy). These figures are significantly higher than those of morphine and pethidine. Peak plasma concentrations when administered orally [14] are achieved within 1.6–2 hours.

Experience of clinical use of Tramal

The first publications on the use of “T” in the clinic date back to the early 80s of the twentieth century, i.e. its medical use already has a 20-year history. During this time, indications for treatment “T” for various acute and chronic pain syndromes were determined, its analgesic and side properties, optimal methods and methods of its use in various fields of medicine were determined: in oncology, surgery, traumatology, rheumatology, neurology, cardiology, etc. .

In the practice of the Moscow Research Institute of Orthopedics named after. P. A. Herzen “T” is widely used for the treatment of both acute (postoperative - p/o BS) and chronic (CHP) pain syndrome in cancer patients. The overall experience of its use at the institute exceeds 6,000 observations, and the duration of therapy ranged from several days to many months for chronic heart disease.

When prescribing “T” we are guided by the general principles of drug treatment of pain syndromes [10]. The main criterion is the intensity of pain, assessed according to the above scale (SVO). The indication for prescribing “T” for both chronic heart disease and p/o heart disease is pain of moderate intensity (2 points according to the ShVO). There is no need to prescribe “T” for mild pain (1 point according to the ShVO), where pain relief can be achieved with the help of non-opioid analgesics (various NSAIDs, paracetamol). “T” is also not indicated for severe pain (3–4 points according to the ShVO), since it is not sufficient to eliminate it, and in these cases more powerful opioids should be used to avoid further intensification of the pain syndrome.

Most often, when conducting opioid therapy, including “T”, it is advisable to combine an opioid with non-opioid components in order to increase the effectiveness and tolerability of pain relief, although monotherapy is also quite acceptable.

It is pathogenetically justified to supplement “T” with one of the non-opioid analgesics of peripheral action, suppressing the production of the pain mediator prostaglandin at the site of pain (ketoprofen, lornoxicam, diclofenac, etc.) and/or central action, inhibiting this mediator at the level of pain structures of the spinal cord (paracetamol). This allows you to get complete pain relief while reducing the need for opioids, i.e. when using it in reduced doses and with less likelihood of side effects. Clinical confirmation of the advisability of such tactics for working with opioids is contained in numerous publications, including the works of employees of our institute [3,5,8,10, etc.].

The choice of dosage form, dose of “T” and drugs for combination with it depends on the nature of the pain syndrome, its localization, and the individual characteristics of the patient.

Dosage forms and dosages of Tramal

. Tramal is presented in various forms:

Solution for injection (ampoules 1 and 2 ml), 50 mg in 1 ml.

Capsules 50 mg

Suppositories 100 mg

Retard tablets 100 mg, 150 mg.

Recommended single dose 50–100 mg; daily up to 400 mg. The drug is administered 4 times a day. Tramal in the indicated forms is produced and available in Russia.

Tramal for chronic pain syndrome

of different origins is widely and successfully used. In this article we look at this using the example of chronic pain syndrome (CPS) of oncological origin, which we constantly deal with in our work.

Taking into account the institute’s experience in the use of “T” for the treatment of CHD in more than 1000 patients, it is advisable to prescribe it for uncomplicated moderate (2 points) somatic CHD (damage by a tumor or its metastases to the skeletal bones, soft tissues, muscles, skin, external lymph nodes) or visceral (damage to internal organs and/or membranes - pleura, peritoneum, internal lymph nodes) type. All incurable cancer patients go through this phase of CHD, and the duration of moderate-intensity CHD varies widely, which is determined by individual tumor growth rates.

Practice shows that the use of “T” is not indicated for severe chronic heart disease complicated by a neuropathic component caused by the involvement of nerve formations. In these cases, stronger opioid analgesics are required in combination with complex special therapy.

“T” is prescribed when the initial non-opioid therapy (NSAIDs, paracetamol preparations) becomes insufficiently effective, while maintaining this therapy, which has its own pathogenetic focus, complementing the action of the opioid.

The presence of different dosage forms makes it possible to choose the optimal one for a particular patient. In most cases, the usual oral forms are applicable (capsules, retard tablets), and in the absence of this possibility (patients with dysphagia due to cancer of the esophagus, stomach), another non-invasive method of administration can be used - rectal. In the form of a “T” injection for long-term treatment of CHD, it is usually not used due to its invasiveness.

For long-term therapy, the most convenient are retard tablets, which should be taken twice a day: 100 – 150 – 200 mg every 12 hours. The duration of action of all other forms of “T” is 5–6 hours, so they are taken 4 times a day.

Selection of the optimal dose “T” begins with a minimum single dose of 50 mg (1 capsule) in order to assess both the analgesic effect and tolerability of the drug. With good analgesia and tolerability, this single dose is maintained, administered 3-4 times a day (taking into account the duration of analgesia). If pain relief is insufficient, after 40–60 minutes you should take a second similar dose and evaluate its effect. If after 1 hour sufficient pain relief is achieved, then therapy is carried out in single doses of 100 mg up to 4 times a day (capsules or suppositories), but it is more advisable to recommend that the patient take long-term retard tablets 150–200 mg 2 times a day, which is much more convenient (the first dose in the morning after sleep, the second dose in the evening before bed). Additional non-opioid analgesics are prescribed according to your own regimen.

A clinical study “T” in cancer patients with chronic heart disease [6,7,8] showed that with initial moderate pain (2 points), the drug always eliminates it, but with more severe pain, pain relief with the above therapeutic doses is not achieved, so if a single a dose of “T” 100 mg in non-retarded form is insufficient to relieve pain, which means that the intensity of pain has been underestimated and it is necessary to intensify analgesic therapy. This can be achieved either by switching from T to a stronger opioid while maintaining the same non-opioid therapy, or by additionally prescribing another non-narcotic analgesic that has not previously been used. For example, if after prescribing “T” against the background of previous therapy with diclofenac, ketoprofen or other NSAIDs, the pain has decreased, but has not stopped (mild pain remains), it is advisable to add one of the paracetamol drugs: Panadol 500–1000 mg 4 times a day or Solpadeine ( contains, in addition to paracetamol, small doses of codeine and caffeine) in the same doses as paracetamol. Solpadeine, despite the presence of codeine, is not a registered drug due to the minimal dose of codeine, which, however, well complements the “T” effect, as an opioid of the same class [9]. A similar combination of “T” with non-narcotic analgesics can be effective for a more or less long period, depending on the course of the oncological process.

Such therapy (as long as it is effective) is more accessible to patients than drug treatment, given the not yet formed system of fully providing cancer patients with narcotic analgesics in our country.

T-based treatment for CHD is usually well tolerated by patients. When analgesia is achieved, the quality of life improves - night sleep, mood, physical activity. This “T” compares favorably with more powerful opioids (morphine, buprenorphine), which, while causing analgesia, simultaneously lead to depression of physical and mental activity and other significant side effects. Assessing the tolerability of "T", it should be said that the nature of its side properties is not fundamentally different from those inherent in morphine and its derivatives, however, the frequency and degree of their severity in "T" is much less. It is a much milder opioid than morphine, both in analgesic and side effects.

According to the literature and our own experience [2,3,7,8], side symptoms during treatment with “T” are observed in approximately half of the patients and are most often manifested by transient drowsiness, less often by nausea (very rarely vomiting), dry mouth. Constipation, which complicates therapy with codeine or morphine, is not characteristic of T, nor is urinary retention. Transient dizziness may occur. Drowsiness and nausea that appear at the beginning of treatment with T usually stop within 1–2 weeks and in most cases do not require correction. If such symptoms are present, patients are advised to lie down after taking “T” for 30–40 minutes. For persistent nausea, the use of an antiemetic is indicated (metoclopramide 10–20 mg 3–4 times a day with gradual cessation as the nausea subsides). The frequency and severity of these side symptoms are similar when using different dosage forms of “T”. When using suppositories, symptoms of irritation of the rectal mucosa (pain and tenesmus) are possible. To avoid these phenomena, the suppository should be inserted as deep as possible - beyond the sphincter, into the cavity of the rectal ampulla.

We did not observe any cases of respiratory and circulatory depression under the influence of “T” at the indicated therapeutic doses, and they are also not described in the literature [2,3,5,6,7,13].

Our data on the effectiveness and safety of “T” in cancer patients with chronic heart disease are confirmed by the results of a multicenter study of “T” in Russia for various pain syndromes in 2000 outpatients [2].

In our practice, Tramal is the drug of choice among opioids of medium analgesic potency for the treatment of moderate-intensity chronic heart disease.

. Its advantages:

• effectiveness combined with good tolerability and the absence of dangerous side effects;
• status of a non-narcotic drug, which increases its availability for patients, facilitates the work of medical personnel in prescribing and recording it.

Tramal in the treatment of postoperative pain

. The majority of surgical interventions in various fields of surgery, including oncology, are moderately traumatic operations. In oncology, these are such widespread operations as radical mastectomy, thyroidectomy, transvaginal amputation of the cervix, removal of soft tissue tumors, etc. Compared to radical intracavitary operations, these operations are less traumatic, but quite extensive and are accompanied by significant postoperative pain syndrome, requiring the use of opioids. analgesics. However, traditional opioids (morphine, promedol, etc.) are not suitable for patients after such operations, since their use, especially in the early period after general anesthesia, is dangerous for the development of central respiratory depression and requires monitoring the patient in an intensive care unit. Meanwhile, due to their condition, patients after such operations do not require hospitalization in the intensive care unit, but they require good and safe pain relief.

Our institute has developed and over the past years has been constantly using the optimal tactics of p/o anesthesia for operations of this type. It consists of combining “T” with peripheral analgesics from a number of NSAIDs or metamizole. We consider it preferable to use one of the NSAIDs on the principle of preventive analgesia, i.e., with the administration of the first dose before the start of surgery and with continued therapy with this drug after surgery in combination with “T”. This tactic has been successfully used in more than 5000 patients [5,8,10].

Prophylactic preoperative doses of NSAIDs are 30 mg for ketorolac, 100 mg for ketoprofen, and 8 mg for lornoxicam; dose of metamizole – 1000 mg. Postoperative analgesia is supported by the planned use of one of the indicated peripheral analgesics in the recommended daily dose in combination with “T”, the average analgesic daily dose of which, according to our data, ranges from 345±29 mg on the 1st day after surgery to 205±16 mg (4th day). In this case, good analgesia is achieved in the active state of operated patients without serious side symptoms characteristic of morphine and promedol (drowsiness, lethargy, hypoventilation of the lungs).

The developed method of postoperative pain relief based on “T” in combination with one of the peripherally acting analgesics is effective, safe, and allows pain relief to be provided to the patient in the general ward, without special intensive observation.

Conclusion

Tramadol (Tramal) occupies a special place among all opioid analgesics, which is determined by the unique mechanism of central action and clinical pharmacology. It differs from traditional morphine-type narcotic analgesics by having a less pronounced analgesic effect, but at the same time by less pronounced side properties. In analgesic doses, it is devoid of the main dangerous properties of morphine and its analogues - a depressive effect on vital functions and the ability to cause opioid addiction. Therefore, it is safer than other opioids and is classified not as a narcotic, but as a potent drug. Tramadol also has advantages over the traditional opioid of similar analgesic potency - codeine, which belongs to a number of drugs and does not have so many different non-invasive and injectable forms.

All these features of tramadol make it possible to successfully and widely use it for the treatment of acute and chronic pain syndromes of moderate intensity in various fields of medicine, including oncology and surgery, where its role is especially great.
Literature:
1. Babayan E. A., Gaevsky A. V., Bardin E. V. Legal aspects of the circulation of narcotic, psychotropic, potent, toxic substances and precursors. M. MCFR, 2000, 438 p.

2. Bunyatyan A. A., Trekova N. A., Osipova N. A., Manukyan L. M., Folomeev M. Yu. Analgesic Tramal in the treatment of acute and chronic pain in 2000 outpatients. New drugs. 1997, Vol. 7, pp. 3 – 11.

3. Lebedeva R. N., Nikoda V. V. Pharmacotherapy of acute pain. M. AIR ART, 1998, p. 7 – 39.

4. Cancer pain relief and palliative treatment. WHO, Geneva, 1992, 76 p.

5. Osipova N. A., Petrova V. V., Dolgopolova T. V., Vetsheva M. S., Andrianova K. Yu., Beresnev V. A. Synthetic opioids of the latest generation in oncology surgery. Russian Medical Journal, 1995, No. 1, p. 35 – 39.

6. Osipova N. A., Novikov G. A., Prokhorov B. M., Loseva N. A., Sokolenov A. S., Abuzarova G. R. Tramal in outpatient treatment of chronic pain in cancer patients. New drugs, 1997, Vol. 7, p. 3 – 11.

7. Osipova N. A., Novikov G. A., Prokhorov B. M. Chronic pain syndrome in oncology. M. Medicine, 1998, 178 p.

8. Osipova N. A., Novikov G. A. Pain syndromes in the oncology clinic. In the book. “Selected lectures on clinical oncology”, M. 2000, p. 213 – 226.

9. Osipova N. A., Abuzarova G. R. Treatment of chronic pain in incurable cancer patients at home. Doctor, 2002, No. 4, p. 7 – 9.

10. The procedure and timing of the use of narcotic analgesics. Guidelines of the Ministry of Health of the Russian Federation., M. 2001, 23 p.

11. Pchelintsev M.V., Solovyov S.L., Safronov A.G., Zvartau E.E. Clinical and psychological studies of the psychotropic effect of opiate receptor agonists-antagonists. In the book. “Pharmacodynamics of painkillers in experiment and clinic”, L., 1990, p. 130 – 136.

12. Barth H., Durra S., Giertz H., Goroll D., Flohe L. Long – term administration of the centrally acting analgesic Tramadol did not induce dependence of tolerance. Pain, 1987b, suppl. 4, Abstract No. 439, p. 231.

13. Drugs. Reprint, (Focusion Tramadol). Aug. 1993, V. 46, No. 2, p. 313 – 340.

14. Liao S., Hill JF, Nayak RK Pharmacokinetics of tramadol following single and multiple oral doses in man. Pharmaceutical. Research, 1992, 9 Suppl., p. 308, Abstract No. PPDM 8206.

15. Preston KL, Jasinski DR, Testa M. Abuse potential and pharmacological comparison of Tramadol, Morphine and Pethidine. Drug and Alcohol Dependence, 1991, 27, p. 7 – 17.

16. Richter W., Barth H., Flohe L., Giertz H. Clinical investigation on the development of dependence during oral therapy with Tramadol. Arzneimittel–Forchung / Drug Research 1985, 35, p. 1742 – 1744.

17. WHO Expert Committee on Drug Dependence: Twenty-fifth Report. Series 775. WHO, Geneva, 1989.

Detoxification in hospital

In the hospital, infusion is carried out using colloid and crystalloid solutions. The blood is saturated with 5% glucose. This reduces the concentration of drug metabolites and stimulates the kidneys to work.

In order to improve kidney function, loop diuretics are added to treatment. This method of removing toxins is called forced diuresis.

Symptomatic treatment is carried out in the hospital. And in cases of severe withdrawal syndrome, the patient may be put into an artificial coma. This helps to survive withdrawal without consequences. If necessary, antioxidants and hepatoprotectors are prescribed. Hemodialysis and other hardware methods of cleansing the body of drugs are carried out.

Medical assistance for addicts

In acute conditions, you should immediately call an ambulance. If the patient can move independently and agrees to visit the clinic, then you need to make an appointment with a narcologist.

Therapeutic measures for eliminating cravings for opiate analgesics include:

• consultation and diagnostics;
• detoxification by pharmacological or hardware method;
• relief of withdrawal symptoms;
• a medication course to restore the functioning of damaged organs and systems;
• methods of psychological correction;
• rehabilitation and social adaptation.

To remove toxic compounds, infusion-drip therapy, forced diuresis, and plasmapheresis are used. The choice of medications for symptomatic treatment depends on the diagnosed concomitant and chronic ailments. In modern narcology, nootropics, hepatoprotectors, benzodiazepines, diuretics, antidepressants, tranquilizers, sedatives, hypnotics and other medications are used.

Normalization of the psycho-emotional background is achieved by various methods: individual and group sessions, hypnosis, cognitive-behavioral and creative methods, introspection.

It is better for the patient to spend the rehabilitation period in a specialized center under the supervision of medical staff. A reasonable combination of medical procedures, occupational therapy, sports and creativity shows excellent results. This will not allow him to doubt whether Tramadol is a drug, and will not provide a single chance to return to his addiction.

Overdose

To get drug intoxication, the drug addict needs to increase the dose each time. This is due to the development of tolerance. The body produces enzymes for every foreign substance. And the more often this substance is supplied, the more resources appear in the body to fight this substance.

Therefore, the same dose of the drug the second time has a weaker effect. Because of this, drug addicts endlessly increase the number of tramadol tablets. As a result, the dose becomes too large for the body to cope with, and rapid dysfunction of all organs and systems occurs.

Often, the combination of tramadol with alcohol or other drugs is an aggravating factor. This increases the risk of overdose several times.

The main manifestations of a tramadol overdose will be the following symptoms:

• disturbance of consciousness in the form of stupor or coma;
• the appearance of frequent vomiting, which does not bring relief;
• convulsions;
• breathing and heartbeat disturbances;
• constriction of the pupils;
• profuse sweating;
• involuntary defecation and urination;
• hallucinations and illusions.

Without help, a patient with an overdose may die.

What to do

Before you begin to provide assistance, you must be sure that you are not in danger. That there are no other people around under the influence of drugs who could harm you. Then call an ambulance, and while it is driving, begin providing first aid.

• Warm the patient if it is cold. Throw a jacket and blanket over him and bring him into the room. If it’s hot, on the contrary, undress him, open the windows, provide fresh air.
• Make sure that the patient does not lie on his back while vomiting. The patient's head should always be turned to the side to prevent vomit from entering the respiratory tract.
• If the patient is conscious, give him sweet tea or coffee. He should drink plenty of fluids. If it's hot outside, you can give cold drinks (alcohol is prohibited).
• If convulsions occur, do not hold the patient or hold his tongue with any objects. Try to place a soft pillow or blanket near the person's head so that he does not injure himself during convulsions.
• If there is no pulse or breathing, perform chest compressions. You need to press firmly on the chest above the solar plexus. You need to press 2 times in 1 second, every 30 presses you need to inhale mouth-to-mouth. Before inhaling, make sure that there is no vomit in the person’s mouth; if there is, clean it with a handkerchief or napkin.

When the ambulance arrives, they can administer an antidote. Usually, doctors do not determine which opiate caused the overdose; they simply administer naloxone. Then symptomatic treatment is carried out and the patient is hospitalized in a hospital for detoxification and maintenance therapy.

Dependence on Tramadol - development and signs

In order to figure out whether Tramadol is a drug or not, you need to know only one thing: after using just one dose of the drug, a person will want to repeat it. To do this, the addict simply needs to eat an additional dose. After this, addiction progresses rapidly and has serious consequences. And the withdrawal period is manifested by terrible side effects:

• First day. After the end of the narcotic effect, a person is tormented by terrible dreams, he feels tired and insatiable, and experiences a fear of loneliness. During this period, psychological dependence begins, when the drug addict needs to take a new dose in order to get rid of the state of panic and discomfort.
• After 7 days, the addict experiences auditory and visual hallucinations, talks with non-existent people, animals, characters from films and books. With all this, hallucinations appear as an interesting, new experience. Because of this, the development of physiological dependence begins.
• After 30 days, psychological dependence becomes more stable, and without pills the addict experiences apathy, anger, dislike for life, panic attacks and other psychological attacks. Physiological signs begin in which the addict does not want to eat, he is thirsty and suffers from constipation. This happens because opioids disrupt the gastrointestinal tract.
• After 90 days, early syndromes also appear and at the same time seriously intensify, but new ones are also added. These include frequent mood swings, crying, regular migraines, high blood pressure, chills. The influence of the psychotropic substance affects the brain - serious problems begin with remembering ordinary things and concentrating.
• At this stage, a person can no longer cope with addiction without outside help. Withdrawal after using Tramadol lasts about a month and occurs with attacks of paranoia, hallucinations, tachycardia and is accompanied by serious headaches.
• 365 days of using tramadol, which is a drug, does not pass without serious problems and consequences. Bones and joints are destroyed. They become weak and the risk of injury increases. The teeth crumble and the bite deteriorates. Constant use of opiates increases the load on the liver, and the development of diseases up to cirrhosis begins. A decrease in immunity manifests itself in such a way that wounds take longer to heal, and the risk of viral and infectious diseases increases. Diseases of the heart and blood vessels begin. Impact on the heart and frequent intravenous administration of the drug develops serious heart failure and vascular inflammation. Serious mental problems also occur. Regular use causes paranoid attacks, hallucinations, severe depression and suicidal thoughts.

Rehabilitation

Rehabilitation of opiate addicts (including narcotic analgesics) requires inpatient treatment. This is primarily due to the appearance of withdrawal symptoms. Only in a hospital can adequate support and pain relief be provided so that the patient survives withdrawal and does not break down.

It should be understood that drug addiction cannot be cured. The task of a narcologist is long-term and stable remission of the patient. The word “remission” refers not only to the absence of drug use, but also to the person’s moral state. He must understand for himself that he is on the right path and he should not have the desire to use the drug again. This is precisely the condition that is the prerogative of professional drug treatment centers.

To achieve such an effect, it is not enough just to survive withdrawal. It is necessary to carry out regular psychological work with the patient. Include his loved ones in the program, help the patient recover in society and completely change his destructive behavior pattern.

Ambulatory treatment

Outpatient treatment is possible only after completing the basic course. This format is possible if the patient attends group classes and is constantly busy or interested. In other cases, such treatment will not bring results, and a relapse of the disease may occur.

Patients at home often ignore working with a psychologist. They begin to deliberately conflict with roommates and relatives, subconsciously looking for a reason to justify new drug use.

That is why outpatient treatment can be done only after completing a basic course of inpatient treatment.

Literature:

1. Prokhorov, Boris Mikhailovich. Synthetic analgesic tramadol in the treatment of chronic pain in cancer patients: abstract of thesis. ... candidate of medical sciences: 14.00.14. – Moscow, 2004. – 26 p.
2. Synthetic opioids in oncology surgery (tramadol, buprenorphine, butorphanol, nalbuphine) [Text]: a manual for doctors / Ministry of Health of the Russian Federation; prof. N. A. Osipova and others - Moscow, 1997. - 21 p.
3. Pankova, Olga Fedorovna. Modern psychotropic drugs used in psychiatry: educational and methodological manual / [Olga Fedorovna Pankova, Artem Vyacheslavovich Alekseev, Alexander Viktorovich Abramov]; Russian National Research Medical University named after N. I. Pirogov” (FSAOU HE RNRMU named after N. I. Pirogov of the Ministry of Health of Russia), Department of Psychiatry and Medical Psychology. – Moscow: Federal State Autonomous Educational Institution of Russian National Research Medical University named after. N.I. Pirogova Ministry of Health of Russia, 2021. – 135 p.

Working with codependents and resocialization

Drug addicts often hurt their loved ones, and after they quit using substances, they cannot find a common language with them. In addition, trust is lost between people, tension increases, and sometimes there is not even an opportunity to share their experiences. In such an atmosphere it is difficult to maintain long-term remission and a breakdown occurs.

To eliminate such situations, codependent people who have been harmed by the addiction of their loved one undergo special psychological training. There they learn to resolve conflicts and work through various situations with their possible participation. They are helped to find a common language with the patient and become his support in the fight against addiction.

Resocialization begins at the end of treatment. This is the introduction of the patient into an active social life. Returning the patient to his social significance so that he understands who he is. To feel part of society and not think about new breakdowns. It is important for patients to find new interests or hobbies. Keep them busy so that they become as immersed in their new field of activity as possible. Help them find their calling and, perhaps, themselves.

Consequences of tramadol use and addiction treatment

Tramodol addiction is not difficult to detect; the main thing is to immediately take appropriate measures. Every parent of a teenager should know the main signs of drug addiction in order to detect them in time and try to help their child. Teenagers prefer tramadol mainly due to its affordable cost and prefer the tablet form. They want to experience unknown and new sensations, without even thinking about the consequences of using tramadol. The main task of relatives is to try to inform the drug addict about all the terrible consequences of his entertainment and persuade him to undergo appropriate treatment in a specialized clinic. It’s not even worth hoping that an addict will be able to give up his hobby on his own; it will only be a waste of time, and the degree of drug addiction will be even more severe.

Our rehabilitation center provides specialized and professional treatment for the physical and psychological consequences of taking tramadol. We have the best specialists with many years of experience in this field with similar patients. Treatment is carried out in several stages: detoxification, treatment of physical and mental addiction, social rehabilitation. Psychologists have been professionally doing their job for a long time so that the patient does not return to taking drugs again.

Often, expired tramadol goes on sale on the black market, the consequences of which are even worse. Our specialists will do everything possible to save the life of a drug addict and teach him to live without drugs.

How to quit on your own

This is difficult, only a few can do it, and given that withdrawal symptoms can occur during the abstinence period, it can even be dangerous to quit on your own. But if there is no way out, then you need to really want to be cured. If you quit, then immediately without postponing until next time.

The brain works in such a way that in order to receive a new dose of something, it will convince a person by all means, deceiving itself. You need to learn to say no to yourself. Then you need to cut off all ties with friends who use any drugs. Even if they suggest leaving together, stop dating and being friends with them. If your friend can't quit, he will try to persuade you to start using again.

Do not substitute one drug for another. It doesn't make sense and it doesn't stop you from being addicted. It is best to give up drugs and alcohol completely. Cases have been described when, due to alcohol, a person began to use opiates again, since alcohol weakens the volitional sphere.

Tramadol - medical use

Tramadol is a pharmaceutical drug that was originally synthesized by a German pharmacist in 1962. Selling the drug in pharmacies has become a new milestone in the life of the pharmaceutical company. Since this drug began to be prescribed, most often as an analgesic, not only in Germany, but also throughout the world. The drug Tramadol

Often used at the moment, when a person has acute and chronic diseases. It is often used after surgery or to minimize the suffering of cancer patients.