Taking Tramadol If You Cannot Metabolize Opiates

My husband was prescribed oxycodone and morphine sulfate for daily use after an accident that resulted in incomplete quadriplegia. Over the course of four months, the EMT's were here six times to address opiate overdose. After more strenuous physical therapy sessions, he would become completely gray in pallor and we could not wake him up. Twice he stopped breathing prior to help arriving. I administered CPR until their arrival, at which time they would inj. narcan, and boom! He's back. The first episode resulted in my totally monitoring his medication, documenting dose/times in a prescription diary and posting current status of his medications on a white board. He was not even taking two-thirds of what he was prescribed, because it was too strong, and we had yet to adjust his dose down. I personally handled all of his medications and they were stored in a room that is inaccessible to Danny. Each time the EMTs came, narcon was used effectively to bring him around. Each time it was documented as an overdose. On the sixth time, I refused to allow Danny to come home and though the staff at the hospital was displeased, they DID do further investigation and a nephrologist determined that Danny was unable to metabolize opiates. They were laying dormant in his system until extreme physical activity brought them to life, thus creating the overdose. Now, when he experiences high pain levels, he is given 100mg of tramodol. Between Danny's four physicians, two say tramadol is not a "real" opiate, but instead a synthetic opiate, so it's not a problem. The other two say it IS a mild opiate and could be a problem. When Danny tried the tramadol, it seemed okay, but it seemed okay with the oxycodone and morphine sulfate until it wasn't. Would you consider weighing in on this for us? Thank you.

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Hello, Dillpixel! How are you and your husband? I am so very sorry about what he's been through.

The FDA classifies Tramadol as a mild opioid, it was synthetically derived from other opiates, but isn't the same as them. When Tramadol came into being, what they were trying to do was create an opiate that would relieve pain like the others, but not cause the same side effects or have the same addictive tendencies, however, they ended up with the opposite, a medication that is much milder, but still causes the same side effects and has the same addictive tendencies. Overall, if he's had issues with other opiate narcotics, it is reasonable to assume that he may also have problems with this one, so both you and his doctors should watch him very closely.

Its typical side effects are listed as being the same as other narcotics and may include nausea, dizziness, drowsiness, headache, dry mouth and constipation.

That said, when someone is undergoing some sort of strain, such as physical therapy and begin to get hot, sweat, and/or overheat, it is known that they may metabolize opiates faster than normal, which has been known to result in overdose. Were any of them time released medications, perchance? Was he on Fentanyl patches, at any point?

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Thank you for taking the time to help. It's greatly appreciated. To answer your question, the oxycodone was not time release, and Danny has never used the Fentanyl patch. I also noticed that he is developing a tolerance for the tramadol much more quickly than with his previous prescription. That's disturbing. Again, thanks!

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