Two years ago, my Swedish morning paper had an article about the increased use of tramadol by criminal gang members. When an investigator asked if there was anything special about tramadol, she was again and again told that this drug made it easier to commit crimes. Maria Almazidou, quoted in the article, said “the chemical has a double effect. You can get turned on and feel more focused, while at the same time it blunts your emotions. That is one reason it fits in with the criminal lifestyle”.
I was intrigued, but not surprised. After all, tramadol hits the opioid mu receptor and also has serotonergic properties, making it reduce anxiety as well as blunting affect.
Although I don’t think I have come across tramadol addiction here, I realize its potential to destabilize mood in bipolar disorder. I have seen florid psychosis and tremors in combination with duloxetine. But I have never seen it cause full blown serotonin syndrome.
There are many case reports and news articles, like this one, of people with tramadol addiction and overdoses committing violent crimes. But then, there are also FDA black box warnings about traditional serotonergic drugs causing suicidal ideation.
I started looking for more information on the link between tramadol and murders. The connections are all there, in many countries.
First of all, it is a more common drug of abuse in many countries, especially in Africa, and as such, the trade of it is linked with crime. But its use by criminals to enhance their unscrupulousness is actually well documented.
Here are some quotes I ran across:
“Tramadol is regularly found in the pockets of suspects arrested for terrorism in the Sahel, or who have committed suicidal attacks.” – The United Nations Office of Drugs and Crime
“One woman said children stumble down the streets, high on the opioid; parents add it to tea to dull the ache of hunger. Nigerian officials said at a United Nations meeting on tramadol trafficking that the number of people there living with addiction is now far higher than the number with AIDS or HIV.
Tramadol is so pervasive in Cameroon scientists a few years ago believed they’d discovered a natural version in tree roots. But it was not natural at all: Farmers bought pills and fed them to their cattle to ward off the effects of debilitating heat. Their waste contaminated the soil, and the chemical seeped into the trees.
Police began finding pills on terrorists, who traffic it to fund their networks and take it to bolster their capacity for violence.”
So, by now I have even more respect than I used to for the dark side of this unique (next to tapentadol/Nucynta) analgesic and all other drugs that work on so many neuroreceptors at the same time.
The World Health Organization has a comprehensive summary on Tramadol here.