It is no secret that the opioid epidemic has swept the United States and the world. But how much do they know about prescription drug abuse in sports? Do they know that seemingly innocent prescriptions of oxycodone and Tramadol may become full-blown drug addictions? Addiction can cause an overdose or death. It can happen to anyone – even athletes. Particularly athletes?
USADA believes that physicians should be the ones to provide medical advice, but we can bring attention to issues of health and safety that affect athletes. As such, USADA has publicly provided education and guidance on substances and methods on the World Anti-Doping Agency (WADA) Prohibited List while pushing for other substances to be added to the List because of associated health risks and performance-enhancing capabilities.
Tramadol is a powerful yet dangerous narcotic drug still legal in sports. USADA and many other sports organizations believe it is time for WADA to finally move Tramadol from the Monitoring Program to the Prohibited List.
WADA has yet to add the drug, even though it is being abused by at least one sport. WADA Monitoring Program shows that 71-82 percent of tramadol abuse in global sports was monitored between 2012 and 2015. It was in cycling.
Tramadol is a drug that has clinical use and abuse potential. However, when an anesthetic is closely associated with one sport, the debate is made more complex.
The danger of this drug is made more evident when athletes share their stories about the painkiller.
The Reality of an Athlete
Ian Mullins is an elite mountain bike racer who says that Tramadol, despite the drug’s reputation for abuse, is the painkiller of choice for many athletes. He says that Tramadol, a powerful painkiller, can provide noticeable pain relief for athletes before, during, and after intense training or competitions. Furthermore, it is without the risk of a positive drug test. Tramadol is a powerful painkiller that athletes can take whenever they feel pain without risking a positive test.
It is, in part, the reason Mullins became addicted to the drug.
His doctor prescribed Tramadol to relieve chronic pancreatitis pain. He soon discovered that the drug helped him train and race more effectively.
Mullins says that Tramadol is as good for athletes as a blood transfusion. You can take a tramadol pill up to 18 hours before a 24-hour endurance event and get an instant boost. Then, it will help you finish the race.
Knowing that his doctor had never seen tramadol addiction, Mullins began to obtain Tramadol from other sources when his prescription was no longer valid. He wanted pain relief, but he didn’t want to become addicted. Instead, he was soon consumed with watching the clock and counting the minutes until his next dose.
Both he and others around him were disturbed by his addiction. His addiction destroyed a relationship and made him wonder how someone could be both an addict and a body-conscious elite athlete.
He avoided taking the drug to overcome his addiction, only to be overcome with the crippling symptoms of withdrawal – from nausea to cold sweats. Then, the cycle of regret and need was interrupted by a series of overdoses, which left Mullins bleeding and disoriented.
His left him wondering how something so powerful and addictive could be permitted in sport. He saw significant benefits on the bike thanks to Tramadol’s performance-enhancing properties while also being crushed by its addictive nature and side effects, making it a seemingly obvious candidate for the WADA Prohibited List.
Mullins says, “I’m not going to let other athletes go through the same thing I did because they believe it’s okay to use tramadol because it isn’t banned in sports.” “My most significant error, aside from taking Tramadol, was not seeking help to stop using it. Asking for help can save your own life.
Mullins saw enough of his fellow cyclists go through the highs and lows of tramadol abuse to realize he was not the only one fighting opioid addiction. So he contacted USADA to share his story and spread awareness of the opioid abuse plaguing cyclists and his sport.
The Big Picture
When athletes push their bodies beyond the limit, it’s easy to understand why they might become addicted to pain medication like Tramadol. USADA’s Matthew Fedoruk says, “We often hear from athletes and other people that tramadol abuse is taking place in sport.” Of course, we want to ensure that athletes can compete and win without Tramadol. But, like other drugs on the WADA Prohibited List, tramadol misuse threatens athletes’ rights to equal playing fields and health.
Loraschi and colleagues conducted a study that supports this claim. 2014 showed that cyclists regarded Tramadol to be a doping substance, indicating that they understand Tramadol’s ability to improve performance. Eyewitnesses have reported that Tramadol was given out with water bottles at cycling races to ease the pain.
In Cycling Tips, an elite cyclist, Taylor Phinney, says: “You need to ask yourself why you are taking a painkiller. You’re doing it to mask the effects of riding a bicycle on your body…basically, you’re taking a painkiller to improve your performance. The whole point of sport is to push our bodies to their limits. “If you take something to improve your performance, it is not being true to yourself or your sport.”
The 2015 Cycling Independent Reform Commission Report echoes riders’ concerns that cyclists widely use Tramadol because it’s not banned and has potent PED properties.
More Evidence Against Tramadol
In addition to performance-enhancing benefits, research suggests that Tramadol can have serious side effects, including the potential for decreased alertness, seizures, and addiction. For example, a Washington Post/Kaiser Family Foundation survey revealed that regarding addiction: “One-third of Americans taking prescription opioids for two months or more say they have become physically dependent on the powerful painkillers.”
The U.S. has only recently deemed Tramadol a Schedule IV controlled drug. Drug Enforcement Administration (DEA), citing the addictive properties of Tramadol, cited the fact that it would be “diverted away from legitimate sources and used without medical supervision and therefore become a safety issue for individuals and the community.” They also cited that tramadol addiction symptoms are similar to other opiates, including serotonin-induced syndrome, seizures, and stopped breathing. In addition, Tramadol is toxic and can cause overdose. The effects of tramadol range from neurologic toxicity, such as coma, to cardiovascular toxicity, such as tachycardia. Tramadol may also interact negatively with other products. The DEA, for example, explains that Tramadol can fatally interact with alcohol. Tramadol-related deaths have also been documented in medical textbooks.
Dr. Fedoruk notes that Tramadol’s pharmacological effect and metabolism vary between people, even when they use the same dose. It’s important to know that if an overdose occurs, medications such as Naloxone, which is often used to reverse opioid overdoses in emergencies, are not effective for treating Tramadol. , according to, only changes 30 percent of the effects of Tramadol.
According to anecdotal reports, Tramadol is also suspected to be a factor in crashes involving pro pelotons. Phinney, for example, was quoted by CyclingTips as saying that “You see so many late-race stupid crashes that it’s almost not surprising if some or all of them are caused by people who take these hard-hitting drugs at the end races.” The tramadol inserts in the U.S. warns that “While taking [Ultram], do not: drive or operate heavy equipment until you understand how [Ultram] will affect you.” [Ultram] may make you feel sleepy, lightheaded, or dizzy.
A study by Johns Hopkins, cited in the Wall Street Journal, supports this idea. Dr. Ibrahima Amadou found that 80 percent of traffic accidents in sub-Saharan Africa involved Tramadol.
USADA urges WADA to include Tramadol on the Prohibited List due to its serious health effects and potential abuse. There are also safer alternatives to opioid analgesics. In addition, Tramadol is prohibited in sports to protect athletes and ensure an even playing field.
