Ecco la traduzione in inglese, mantenendo il contenuto e il registro del testo originale.
Scrittura
Tramadol
Tramadol is an opioid substance usually described as a “weak” opioid, whose prescription is easier to obtain than that of other opioids (standard non-repeatable prescription). It is used as a painkiller, often when other analgesics have failed. It is available both on its own and in combination with paracetamol*.
(Trade names: Contramal, Patrol, Adamon, Fortradol, Tradonal, Bizytram, Dotran, Prontalgin, Traflash, Tramamed, Tramalin, Unitrana, Unitramarim, Dextra, Lenizak, Kolibri.)
Like other opioids used medically, tramadol also carries a risk of inducing dependence. Inducing dependence means that a person who uses it, regardless of the reason why they initially started taking it, may, if they use it frequently or continuously, develop a genuine “appetite” for the substance beyond any potentially useful effects. Once this appetite develops, the person tends to use it continuously, even if at varying doses, and therefore inevitably develops tolerance. This in turn leads them to increase the dose in order to reproduce the desired effect, while experiencing opposite symptoms (withdrawal) when the effect of the dose wears off.
These characteristics are common to all forms of dependence. The point is that medicinal opioids are often considered safer. It should be remembered that opioids that later became “notorious” were originally used medically, and that their subsequent exclusion or restriction was precisely the result of the recognition that inappropriate channels of prescription and use could develop, capable of inducing or sustaining dependence. In recent years there have been several cases of dependence on prescription opioids, ranging from the Russian “krokodil” (used mostly by people with drug dependence because it is easier to obtain and effective) to the oxycodone epidemic in the United States, which is displacing dependence on traditional opioids such as heroin. The “weakness” of an opioid should therefore not be misleading when considering its potential to induce dependence. The characteristic that promotes dependence is not pharmacological potency as such, but rather speed of action, which depends both on the lipophilicity of the compound and on the route of administration. When an opioid, even one with a weak effect at the receptor level, becomes concentrated rapidly in certain areas of the brain, it can trigger the mechanism of progressively increasing “appetite,” thereby leading to dependence. Heroin, for example, is not among the most potent opioids, but it is among the fastest-acting ones.
Compared with classical opioids (μ-agonists), tramadol also has properties similar to those of an antidepressant (a dual-action agent affecting serotonin and noradrenaline reuptake). Consequently, overdose may produce excitatory phenomena, while withdrawal may cause effects similar to those associated with abrupt discontinuation of antidepressants. The molecule resembles venlafaxine, and withdrawal therefore includes both opioid withdrawal symptoms and symptoms such as electric-shock sensations, tingling, and dizziness, which are typical of the discontinuation of certain antidepressants.
Cases of dependence on this substance involve uncontrolled and disorganized consumption of the product, accompanied by increasing anxiety and low mood, as well as fear of running out and an urgent search for supplies through doctors. Typically, patients change doctors, or doctors eventually refuse to prescribe it, or the person resorts to multiple sources. Some people forge prescriptions or use other means to obtain it.
“Legal” opioids can represent a form of relapse or an endpoint for people who have previously used heroin, because they initially solve the problems of cost, illegal status, and contact with clandestine environments. In reality, however, the problem eventually becomes equivalent, because addictive behaviors produce similar harms. The same applies to people who begin using tramadol without having previously tried other opioids. In these cases, they are more often women, including people of relatively advanced age.
With regard to treatment, it is important to clarify a general principle concerning the management of opioid dependence. A diagnosis of opioid dependence has two implications:
a tendency toward a relapsing course;
the fact that the reason for continued use is not withdrawal discomfort—or, more precisely, the relationship is the opposite: withdrawal is a complication caused by the drive to take the opioid frequently and the inability to gradually disengage from it.
Once the diagnosis has been established, dependence therefore requires treatment analogous to that normally used for opioid dependence in general, namely treatment with opioid agonists such as buprenorphine and methadone.
The methodological errors commonly made in the treatment of heroin dependence risk being repeated when dealing with “new” opioids, especially when they are considered “weak” and therefore harmless or easy to discontinue.
Some cases indicate good outcomes with buprenorphine-naloxone treatment. As with other forms of opioid dependence, this intervention should be conceived as anti-craving treatment rather than simply as “detoxification.” This is also important because simply stopping tramadol without establishing any treatment for the underlying dependence exposes the person to a risk of overdose, particularly because people who abuse painkillers often also abuse tranquilizers, and the combination of these two types of substances can be dangerous and produce unpredictable effects.
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