Suboxone is a safe and effective medication used to treat opioid use disorder, however, like other prescription medications, Suboxone may interact negatively with other medications. One medication that can have potentially severe interactions with Suboxone is tramadol.

Tramadol is a weak opioid drug used to treat pain, but because it is an opioid, it cannot be mixed with other opioids. You should never take tramadol while on Suboxone unless directed to do so by your doctor. There are safer, alternative ways to manage your pain while you’re trying to recover from opioid addiction without having to take tramadol.

What is Tramadol?

Tramadol is a weak opioid medication that was approved by the FDA in 1995 and is prescribed to treat moderate to severe pain. It is available under the brand names Ultram, Ultram ER, and Conzip.[1]

Unlike other opioids, tramadol is considered a mixed-mechanism opioid drug, meaning its effects are a little different from full opioid agonists like oxycodone, morphine, heroin, or methadone. It still activates opioid receptors in the brain but to a lesser degree. This leads medical professionals to believe that it relieves pain through additional mechanisms besides just binding to the opioid receptors.

When tramadol was originally approved by the FDA, it was not considered addictive so it wasn’t labeled a controlled substance. However, reports of tramadol abuse, diversion, and dependence proved otherwise, and the FDA classified tramadol as a Schedule IV controlled substance in 2014. As a Schedule IV controlled substance, tramadol is believed to have medicinal use but also has a low potential for misuse.

While tramadol is considered less addictive than other opioids like oxycodone or heroin, abuse and dependence can occur. One study even found that people who abuse tramadol are more likely to engage in long-term substance abuse when compared to other stronger opioid medications.[2]

Tramadol abuse can be dangerous. Tramadol abuse is associated with double the risk of death compared to anti-inflammatory pain medications like naproxen. But when taken as prescribed, tramadol can be a safe and effective pain management mechanism.

What is Suboxone?

Suboxone is a combination medication that contains buprenorphine, a partial opioid agonist, and naloxone, an opioid antagonist. Buprenorphine partially binds to and activates opioid receptors but to a lesser degree than full opioid agonists. Naloxone blocks the effects of other opioids, so if you take an opioid while on Suboxone, naloxone will displace opioid molecules from opioid receptors and prevent you from being able to get high. Naloxone is also the reason why people experience withdrawal symptoms if they take Suboxone too early or while opioids are still in their system.

Suboxone is available for prescription only. It was approved by the FDA in 2002 for the treatment of opioid dependence and addiction.[3] People may start taking Suboxone 12-24 hours after their last dose of opioids to alleviate symptoms of withdrawal. Suboxone can also be used after detox to keep drug cravings under control. Suboxone is most effective when combined with a comprehensive addiction treatment program involving behavioral therapy, counseling, and peer support.

Can You Take Tramadol and Suboxone at the Same Time?

No, you should not take tramadol while you are on Suboxone. The two drugs are known to have numerous drug interactions, the first of which deals with the combination of tramadol and naloxone.

Since tramadol is an opioid and naloxone’s job is to displace opioids so that people don’t get high, naloxone can knock tramadol off of opioid receptors in the brain and body. This can result in a condition called precipitated withdrawal.

Precipitated withdrawal occurs when medication-assisted treatment (MAT) medications, such as Suboxone, trigger withdrawal symptoms. These symptoms include:

• Severe muscle aches and pains
• Fever
• Chills
• Cramping
• Sweating
• Dilated pupils
• Insomnia
• Nausea
• Vomiting
• Diarrhea
• Depression
• High blood pressure
• Rapid heartbeat
• Suicidal thoughts

In severe cases, precipitated withdrawal can be worse than regular opioid withdrawal. It can also be life-threatening without medical treatment.

If you are taking tramadol, you should wait at least 24 hours before starting Suboxone. Be sure to tell your health provider about any medications you have taken recently. Do not start taking Suboxone until your healthcare provider has directed you to do so.

Dangers of Mixing Tramadol and Suboxone

Research has shown that taking tramadol while on Suboxone produces an additive analgesic effect, which means pain symptoms are further reduced.[4] Pain reduction is helpful in people who suffer from chronic pain, however, the benefits outweigh the risks. But in some people, Suboxone completely blocks the effects of tramadol.

In addition to the risk of precipitated withdrawal, other dangers of mixing tramadol and Suboxone are:

• Increased risk of overdose because tramadol and buprenorphine are both opioids
• Increased risk of seizures
• Potential sedation and respiratory depression
• Withdrawal symptoms can make it harder to stay in recovery

Although you should never mix tramadol and Suboxone, research has found that up to 6.4% of patients taking buprenorphine/naloxone received at least one overlapping prescription for tramadol.[5] This highlights the importance of communicating with your doctor about the medications you are taking and collaborating with your different healthcare providers.

Other Ways to Manage Pain While Taking Suboxone

Many people who suffer from chronic pain and get addicted to opioids must find alternative ways to manage their pain in recovery. While the buprenorphine in Suboxone can alleviate pain, it isn’t fully effective for everyone. As a result, if you have chronic pain and are taking Suboxone, you must talk to your doctor about safe ways to manage it. Mixing tramadol or other opioids with Suboxone is not an option.

A few ways you may be able to manage your pain while taking Suboxone include:

• Yoga
• Stretching
• Massage
• Physical therapy
• Light exercise
• Neurostimulation
• Chiropractic
• Non-narcotic medications (such as ibuprofen or acetaminophen)

Find Help Today

If you or someone you love are struggling with opioid addiction, our team at Moving Mountains Recovery is here to help. We offer clients a safe and supportive environment where they can start their recovery and improve their lives. Whether you’re interested in Suboxone treatment or would like to learn more about your holistic treatment options, please call now to speak with a trusted admissions counselor.

References:

1. U.S. Food & Drug Administration (FDA): Tramadol Information, Retrieved May 2023 from
2. Science Daily: Historically ‘safer’ tramadol more likely than other opioids to result in prolonged use, Retrieved May 2023 from https://www.sciencedaily.com/releases/2019/05/190514090953.htm
3. U.S. Drug Enforcement Agency (DEA): Buprenorphine, Retrieved May 2023 from https://www.deadiversion.usdoj.gov/drug_chem_info/buprenorphine.pdf
4. National Library of Medicine: The problem of pain: Additive analgesic effect of tramadol and buprenorphine in a patient with opioid use disorder, Retrieved May 2023 from https://pubmed.ncbi.nlm.nih.gov/30835647/
5. National Library of Medicine: A Claims Analysis of the Utilization of Tramadol for Acute Pain in Patients Prescribed Buprenorphine/Naloxone for Opioid Use Disorder, Retrieved May 2023 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6476537/