Tramadol Withdrawal – Think Twice before Considering an Ultra Rapid Detox

A few hours under anesthesia followed by a few days of light recovery – the discontinuation promised by clinics selling ultra rapid opiate detox (UROD) packages sounds a lot more inviting than a lengthy and difficult tramadol home tapering regimen…but is ultra rapid detox for tramadol really a good idea?

Well, when it sounds too good to be true, maybe it is. For a few reasons, UROD for tramadol probably doesn’t make sense. Read on to learn:

1. Why the American Society of Addiction Medicine (and other experts) doesn’t endorse the procedure – even for single mode full opiates.
2. Why tramadol’s dual mechanism of action - opiate-like and antidepressant-like – complicates recovery.
3. How drugs used in the procedure may be uniquely dangerous for tramadol withdrawal.

Though UROD clinics advertise their services to the tramadol-dependent, due to tramadol’s dual mode of action and antidepressant-like qualities, ultra rapid detox isn’t likely a good choice.

Is UROD Ever a Good Idea?

How does UROD work?

1. In an ultra rapid detox, doctors induce anesthesia and then inject an opiate antagonist – usually naloxone – to flush out all opiates from opiate receptors in the brain, thus inducing an immediate state of full opiate withdrawal.
2. This would be agonizing for a conscious person, but not for a person held under anesthesia, and after a few hours under anesthesia, you wake up already past the worst of the detox discomforts.

Sounds good, right – so what’s the drawback?

• The procedure, while legal, is controversial, even for normal – single mode of action opiates.
• It is more expensive and dangerous than a conventional opiate detoxification.
• Some patients report still significant discomfort with the UROD procedure.

What Do The Experts Say?

• The American Society for Addiction Medicine doesn’t currently support UROD, citing insufficient evidence that the benefits of the procedure outweigh the risks.¹
• A Cochrane review study from 2010 reported that heavy sedation during withdrawal confers no additional benefits but increases the risks of life-threatening adverse events. The study authors recommend against pursuing this treatment, due to its high cost, lack of benefits and additional dangers.²
  
• An UptoDate review from this year found that anesthesia-assisted detoxification was not superior to conventional detoxification and that given the high costs and risk of serious adverse consequences, UROD could not be considered a medically sound therapy.³

Is UROD Appropriate for Tramadol?

Well, if you search online you can find UROD clinics advertising their services to tramadol-addicted patients. There is scant research evidence in favor or against UROD for tramadol, however, tramadol doesn’t seem a logical fit for this procedure, since:

1. The UROD procedure focuses exclusively on the opiate systems of the brain – theoretically accelerating neural adaption to a state of opiate abstinence.
2. The procedure does not target the serotonin or norepinephrine systems or other systems targeted by the atypical opiate tramadol.
3. Switching from chronic high-dose use to abstinence would likely cause intense typical and atypical withdrawal symptoms. Even if UROD reduced opiate withdrawal symptoms, you'd still face intense atypical withdrawal symptoms, such as depression, anxiety, paranoia, panic, tingling, etc.

If considering UROD for tramadol withdrawal, make sure you ask and feel satisfied with your doctor’s plans for managing the atypical withdrawal symptoms you’d face after UROD. Your doctor might, for example, suggest managing these symptoms with a short course of an SSRI after the UROD procedure.

Potential Tramadol-Specific Risks

Tramadol has a dangerous propensity for inducing seizures – and the drug normally used in the UROD procedure – naloxone – increases this seizure risk.

• Since UROD protocols use naloxone to precipitate withdrawals, the naloxone-tramadol seizure association is worrisome.⁴
• If experts do not endorse UROD for conventional opiates without a naloxone-seizure risk, should you consider this procedure for tramadol detox, given its increased risks?

Make sure to ask your doctor about the potential risks of seizure when combining these two medications.

Tapering – Safer and Gentler

Given the high risks and high costs, in most cases, there is little to gain with UROD over a slow and steady program of tapered reductions combined with effective tramadol withdrawal coping strategies.