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Dossier · medication trap · Opioid painkiller

Tramadol: the "mild" opioid that isn't always

Often seen as a lighter step than oxycodone or morphine. Yet tramadol is an opioid with a real risk of habituation and dependence, and that risk is easily underestimated with this drug.

The figures

318.000people received a prescription for tramadol in the fourth quarter of 2024, 3.35% of all drug users.Source: IVM/SFK, Monitor Prescription GPs, 2025
Decreasing since 2022the percentage of tramadol users decreased from 4.22% (2022) to 3.90% (2023) to 3.35% (2024).Source: IVM/SFK, 2025
100.000+patients under GP treatment used an opioid painkiller for more than three months in 2022 (figure for strong opioids as a group, not tramadol-specific).Source: IVM, 2023

The last figure is from 2022 and concerns strong opioids as a group. We were unable to find a tramadol-specific, recent figure on long-term use from a primary source; We prefer to state this honestly rather than make up a figure.

The tramadol trap

Tramadol belongs to the opioids, the same group as oxycodone and morphine, although the effect is milder. It is precisely this reputation of "mild" that can be a pitfall.

1

A doctor prescribes tramadol for moderate to severe pain, for example after an operation or for chronic symptoms.

2

Because it is seen as "lighter" than other opioids, alertness is sometimes lower than with, for example, oxycodone.

3

With longer use, tolerance may develop. This does not mean increasing the dose yourself; effects and side effects should be reviewed.

4

When repeat prescriptions continue, regular reviews remain important to discuss the goal, effect and risks.

5

Stopping can cause fear, nausea and restlessness, which feels like proof that the drug is still needed.

6

Reducing the dose without support may lead to renewed use when withdrawal symptoms become difficult.

Tramadol is not the care trap. A prescription that is called "mild" and is therefore never viewed critically again. That is the care trap.

Tapering requires an individual plan

The Dutch NHG Pain Standard advises planning tapering together, taking account of dose, duration of use, symptoms, available strengths and previous experience. The pace can be adjusted if withdrawal symptoms or pain return.

Whether gradual tapering is needed depends on the individual situation. Do not stop or change tramadol based on a general schedule on this website; discuss it with the prescriber and pharmacist.

Do you recognise this pattern?

Have you or someone around you been using tramadol for longer than intended, without having had a discussion about tapering? Share your experience. Not to appoint a doctor, but to make the pattern visible.

Share your experienceBack to medication trap

Justification and sources

  • IVM (Institute for Responsible Use of Medicines) in collaboration with SFK, Prescription Monitor for General Practitioners, Thematic Report on Opioids 2025: 318,000 tramadol users in Q4 2024 (3.35%), decreasing since 2022 (4.22%) through 2023 (3.90%).
  • IVM, "Increased use of tramadol in 2022": 100,000+ patients longer than 3 months of opioids at the GP (group figure for strong opioids, not tramadol specific).
  • Dutch NHG Pain Standard: shared decisions on an individual tapering plan, with the pace adjusted to use and symptoms.
  • Pharmacotherapeutic Compass: dosage advice and risk profile of tramadol.
This file was created on the basis of public information sources. Zorgfuik does not make diagnoses and does not provide medical advice. Never stop taking tramadol abruptly after longer use; this can cause serious withdrawal symptoms. If you have any doubts about your use or if you wish to reduce it, always consult your GP.