Opioids
Tramadol (Ultram)
Street names: Ultram, Tramal, Trammies, Chill pills, Ultracet (with APAP)
Overdose? Act now. Call emergency services — say "unresponsive, not breathing". Give naloxone for opioid-like signs. Hotlines
⚡What it does
- Weak opioid pain relief plus SNRI effects: warmth, mood lift, energy at recreational doses
- Seizure risk is dose-dependent
⚠Key risks
- SEIZURES — tramadol lowers the seizure threshold; doses above 400 mg/day or combos (SSRIs, stimulants, antipsychotics) can trigger them
- Serotonin syndrome with antidepressants or MDMA
- Dependence and withdrawal (SNRI + opioid double withdrawal: brain zaps + flu)
- Africa's and the Middle East's most-abused opioid — Egypt, Nigeria, Saudi Arabia epidemics
- CYP2D6 ultrarapid metabolizers convert it to O-DSMT fast — accidental overdose
✚Overdose signs
- Seizures
- Pinpoint pupils with respiratory depression
- Serotonin-syndrome signs: agitation, clonus, fever
📋Quick facts
Also known asUltram, Tramal, Trammies, Chill pills, Ultracet (with APAP)
CategoryOpioids
Schedule / classSchedule IV (US); POM most places; heavily consumed Africa/Middle East/Asia
Appearance50–100 mg tablets/capsules; 50 mg/ml drops; IV ampoules
Street price~$0.10–$1 per tablet — the world's cheapest opioid
Legal statusSchedule IV US; Rx-only everywhere; some countries restrict sharply due to abuse epidemics
Last updated2026-09-18
Sources: WHO, NIDA, EMCDDA, FDA
Category comparison — Opioids
| Substance | Class | Top risks | Street price |
|---|---|---|---|
| Tramadol (Ultram) | Schedule IV | SEIZURES — tramadol lowers the seizure threshold; doses above 400 mg/day or combos (SSRIs, stimulants, antipsychotics) can trigger them; Serotonin syndrome with antidepressants or MDMA | ~$0.10–$1 per tablet — the world's cheapest opioid |
| Tapentadol (Nucynta) | Schedule II | Schedule II for a reason: full mu-opioid addiction profile; Seizure risk lower than tramadol but present at high doses | ~$1–$5 per tablet diverted |
| Codeine 30/500 mg (co-codamol) | Schedule V / Rx | Paracetamol component destroys the liver at high doses; Lean + alcohol risks fatal respiratory depression | ~$2–$10 per tablet |
Street prices are regional estimates. Potency and cuts vary constantly.
?Frequently asked questions
What does Tramadol (Ultram) look like?
50–100 mg tablets/capsules; 50 mg/ml drops; IV ampoules
What are the signs of a Tramadol (Ultram) overdose?
Seizures; Pinpoint pupils with respiratory depression; Serotonin-syndrome signs: agitation, clonus, fever Call emergency services immediately and give naloxone if available — it reverses opioid overdoses.
How addictive is it?
SEIZURES — tramadol lowers the seizure threshold; doses above 400 mg/day or combos (SSRIs, stimulants, antipsychotics) can trigger them Dependence can develop with regular use.