Is Tramadol a 'true' narcotic or just a pain reliever?

FWIW, we had a patient who was taking Tramadol regularly and his toxicology screen came back positive for opiates, so perhaps even though it's created synthetically, it is close enough in structure to opioids to be considered one?

Tamadol is a crappy pain killer with tons of abuse potential. It is classified as a controlled substance, but is not considered a narcotic. ie, to prescribe it, I do not have to use my DEA #.

Tramadol (Ultram, Tramal (see below)) is a centrally-acting analgesic, used for treating moderate to moderately severe pain. The drug has a wide range of applications, including treatment for restless leg syndrome, acid reflux, and fibermyosis.
Tramadol was developed by the German pharmaceutical company Grünenthal GmbH in the late 1970s.[1][2]
Tramadol possesses weak agonist actions at the μ-opioid receptor, releases serotonin, and inhibits the reuptake of norepinephrine.[3][4][5][6][7][8][9]
Tramadol is a synthetic stripped-down piperidine-analog of the phenantherane alkaloid codeine and, as such, is an opioid and also a pro-drug (codeine is metabolized to morphine, tramadol is converted to M-1 aka O-desmethyltramadol). Opioids are chemical compounds which act upon one or more of the human opiate receptors (the euphoria, addictive nature and respiratory depression are mainly caused by the Mu(μ) 1 and 2 receptor. The opioid agonistic effect of Tramadol and its major metabolite(s) are almost exclusively mediated by the substance's action at the μ-opioid receptor. This characteristic distinguishes tramadol from many other substances (including morphine) of the opioid drug class, which generally do not possess tramadol's degree of subtype selectivity.

Tramadol is synthetic opioid so it is a narcotic per say(fentanyl, sufenta, alfentanil etc are all synthetic opioids), but is highly receptor specific so there is very little problem with respiratory depression, dependence etc. It also has increases the levels of serotonin and norepi in the body, so the patient gets the added effect of taking a low dose TCA or SSNRI which have both been shown to help with pain control. http://www.rxlist.com/ultram-drug.htm

Pharmacodynamics

ULTRAM® contains tramadol, a centrally acting synthetic opioid analgesic. Although its mode of action is not completely understood, from animal tests, at least two complementary mechanisms appear applicable: binding of parent and M1 metabolite to μ-opioid receptors and weak inhibition of reuptake of norepinephrine and serotonin.

Opioid activity is due to both low affinity binding of the parent compound and higher affinity binding of the O-demethylated metabolite M1 to μ-opioid receptors. In animal models, M1 is up to 6 times more potent than tramadol in producing analgesia and 200 times more potent in μ-opioid binding. Tramadol-induced analgesia is only partially antagonized by the opiate antagonist naloxone in several animal tests. The relative contribution of both tramadol and M1 to human analgesia is dependent upon the plasma concentrations of each compound (see CLINICAL PHARMACOLOGY, Pharmacokinetics).

Tramadol has been shown to inhibit reuptake of norepinephrine and serotonin in vitro, as have some other opioid analgesics. These mechanisms may contribute independently to the overall analgesic profile of ULTRAM®. Analgesia in humans begins approximately within one hour after administration and reaches a peak in approximately two to three hours.

For what it's worth:
Ultram is not allowed to be taken if you are in a monitoring program (ie Fl IPN).
It does have potiential for abuse and dependancy.

It's not technically a narcotic, but depending on where you live it may be a schedule substance.

However, it has a high abuse potential, so if it's not a schedule medication, many facilities treat it like one and keep it with the narcs/other schedule meds.

At my job we do not count tramadol as part of the narcotic count it is on the side as a PRN.

we count ours in narcs. I know that tolerance builds up very quickly for some patients.

wow I have been going on FALSE info then!
My 18 yr old daughter and I have both been given Tramadol in the hospital and I was given a script for it and we BOTH were told by more than one health care pro that it is NOT narcotic. Kind of scary.