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

[GLORIAmunchkin72]

Every now and then that question comes up at work and everyone seems to have their own definition. I was thinking it was a true opioid even though synthetic. Drugs.com classifies it as 'narcotic-like'. What is it, really?:)

[canned_bread]

Very interesting... We had a patient who had a long history of an active heroin addiction and he kept complaining of a headache that he couldn't specify location, intensity etc. Doctor decided patient was drug seeking and gave him Tramadol (in our narc cupboard as pharmacist said "drug seekers think it's good and we pretend it is so we can give it to them") as it was a "weak" drug according to doc, and hopefully would act as placebo effect.

So I've always assumed it was something like...codeine with paracetemol... for mild pain but has a name on the streets for being a "good drug".

[needaprn]

It is an opioid (what I think of when someone says "narcotic"), just a weak one with a low dose ceiling, and even that is mostly through its active metabolite M1, making it somewhat of a prodrug. The SNRI action is responsible for some of its effects. The 50-100 mg usual dose is probably too low for effective pain relief in many cases, but cannot be raised much higher because of dose-dependent side effects (myoclonus, seizures, etc.)

If you mean narcotic as in controlled substance, then no (except in a few states, where it is Schedule IV...same as Ativan or Valium)

If you mean narcotic as in special storage requirements, then no (can't speak for those few states where it is scheduled)

IMO, its only advantage is that is it not a controlled substance, and thus less red tape involved. Why not use codeine instead if you want a not-so-strong opioid analgesic? Would work just as well (if not better) with way fewer side effects and interactions (especially if the pt is taking SSRI's).