The perils of a potent painkiller: my stupid run-in with Tramadol

    30 September 2016

    Prescription painkillers are now more widely used in the United States than tobacco, the Washington Post reported this month. Thirty-five per cent of Americans were given prescriptions for them last year – and the total rises to 38 per cent ‘when you factor in the number of adults who obtained painkillers for misuse via other means, from friends or relatives, or via drug dealers’.

    Or your kind-hearted Polish cleaner, in my case. Zofia is a lovely girl who vacuums briskly and gossips at leisure. From her I’ve learned many things about immigrant life in London (‘there was these women in Muslim black clothes [niqabs] on the bus and they speak to each other… in Polish!’).

    And I’ve also learned from her why the junkies on internet discussion boards rhapsodise over the painkiller Tramadol – yet shudder at the mention of its withdrawal symptoms.

    A few weeks ago I did my back in attempting to fix a leaky pipe underneath my sink – divine punishment, I decided, for masquerading as a normal middle-aged bloke who can do normal middle-aged things like DIY.

    ‘Here, try these,’ said kind-hearted Zofia, explaining that they always work for her mum. Whereupon, after a little interlude of chemical bliss, the real punishment began.

    I’ve known about pill-poppers’ online forums since I was researching The Fix, my book about addiction. They attract people for whom ‘recreational’ use of prescription drugs really is a recreation, albeit riskier than needlepoint or hill-walking. In these circles, ‘potential for abuse’ means ‘potential for fun’.

    I was looking for fast pain relief, not fun. I didn’t check the junkies’ threads but instead Googled Tramadol and read – too hastily – the Wikipedia entry for the drug.

    This notes that ‘in a recent German study … the low abuse and low dependence potential of Tramadol were re-confirmed’. And it isn’t, strictly speaking, an opiate. It tends not to be grouped with the notorious painkillers such as OxyContin, Vicodin and Percocet, whose abuse has killed more than 150,000 Americans since the start of the millennium.

    This bit I really didn’t check carefully enough.

    So I took the pills. Unprescribed. If you want to shop me to the police, go right ahead, but a hospital consultant friend tells me that being lent a ‘legally obtained’ drug isn’t likely to interest the authorities.

    The Tramadol pills did the trick for the pain. But they also played another trick, one I encountered years ago when I was given zopiclone as a sleeping pill. They gave me a high that I didn’t recognise as a high until the third or fourth time I’d taken them.

    We’re talking about a pleasant but insidious bonhomie, similar to the high produced by codeine, which is the furthest I’ve ventured into opiates. (I did once suck on a pipe of heroin, ages ago in California, but genuinely ‘didn’t inhale’ because I was frightened of throwing up or having a bad trip.)

    However, it took three or four doses of Tramadol before I recognised what was happening. That’s not as implausible as it sounds. In his 1963 cult classic Outsiders, the sociologist and jazz musician Howard Becker studied users of ‘marihuana’; he argued that ‘no one becomes a user without learning to recognise the effects and connect them with drug use (learning, in other words, to get high)’.

    In my case the Tramadol high didn’t materialise until at least an hour after I’d taken the medication. That’s unusual, so at first I didn’t make the connection between the blister pack and the genial buzz in my head.

    As Becker says, you need to ‘learn’ to recognise the effects of a drug. You can be drunk or high without realising it. Victorian temperance advocates were fond of ‘medicinal tonics’ containing alcohol or opiates that led them to campaign against the demon drink with special fervour.

    So it was a couple of days before I noticed just how damn good I was feeling post-Tramadol. Only then was I able to examine the sensation while it was still going on – and work out that this genial buzz was much stronger than the one produced by Nurofen Max or Solpadeine Max, both of which codeine painkillers you can buy over the counter in the UK, to the astonishment of foreigners.

    Having ‘learned’ to get high from Tramadol, I’d become what Becker calls a user. Once I’d noticed its mood-altering effect, I was interested to compare it with other highs with which (for reasons we needn’t go into) I’m familiar. So I dipped in to the ‘recreational’ threads.

    Pill-poppers love pontificating on the merits of psychotropic drugs; they bicker and show off like wine connoisseurs, though less coherently. Tramadol got the thumbs-up, with some users recommending its consumption in near-suicidal quantities. This was a bit worrying because Zofia had given me a whole box of the stuff and I have an addictive personality.

    Then nasty things started happening. I can’t pinpoint a moment: withdrawal symptoms are often as elusive as the original high.

    There was the night I was seized with exactly the same urge to vomit that I used to get when I was brutally hungover. Since I haven’t touched alcohol since 1994 the sense of being transported back to my 20s was overpowering.

    Between doses I lost the will to live. There’s a thriving cottage industry of hacks writing about their depression, so I’ll spare you the details. The onset was sudden enough to make me suspicious.

    And the fake colds: sniffles and a creeping virusey feeling that normally means you’ll wake up the next day properly stricken. Only I didn’t. Now that is classic opiate withdrawal. But I thought Tramadol wasn’t an opiate – and what about ‘the low dependence potential’ found by that German study?

    Finally, I did what I should have done before I swallowed the pills that work so well for Zofia’s mum. I Googled ‘Tramadol withdrawal’ and – well, try it yourself. ‘The worst feeling in the world’ … ‘horrific, and I mean horrific’ … ‘The headache is horrendous, throwing up and diarrhoea’ … ‘this is so scary’.

    Panicking, I rang a doctor friend (not the hospital consultant) who specialises in treating addicts. He groaned at the word ‘Tramadol’. It’s an opiate in all but name, he explained — it works on the same receptor sites in the brain. And it also has anti-depressant qualities, so the withdrawal can be psychological as well as physical. So you’re kicked from two directions.

    He’d been given it himself as a painkiller, he said, ‘so I know it feels nice’. But it’s horrendously addictive. Many doctors try to avoid prescribing it ‘because they don’t want little old ladies kicking down their door when you take them off it’.

    Yet other doctors seem unaware of the dangers of Tramadol; you don’t have to search for long on the internet to find patients who are bitterly angry with their GPs for assuming that it’s less addictive than ‘hillbilly heroin’ (ie, opiates).

    The truth is, though, that apportioning blame is difficult now people all over the world have quick access to drugs – including rigorously tested ones – whose effects vary so much depending on your brain chemistry.

    I was obviously stupid to take the Tramadol and some symptoms, such as the fake cold, have got ‘withdrawal’ written all over them. But the depression has continued long past any reasonable recovery period, so maybe it was coming anyway.

    It sometimes seems that the more we discover about the brain, the less we really know, because researchers keep stumbling across new area of ignorance. Likewise, as the number of painkillers, antidepressants and ‘smart drugs’ multiplies, so do the uncertainties about what they’re doing to us. But I won’t be taking Tramadol again, that’s for sure.