Tramadol and codeine: can you become dependent with a prescription?
Tramadol and codeine are prescribed to relieve real pain. They can be useful after surgery, during significant pain or in certain situations where other treatments are not enough. The fact that they were prescribed by a doctor does not, however, remove all risk of dependence.
A person can start their treatment by following the prescription, without seeking any particular effect, and then find that they have trouble cutting down or stopping. Symptoms can appear as soon as a dose is delayed. The fear of running out sets in, or the medicine begins to be used to sleep, to calm anxiety or to get through the day.
This situation is neither a fault nor a sign of weakness. Dependence on tramadol or codeine can develop in a medical setting. The issue is to recognize what is happening, then talk about it without shame to a professional.
Useful medicines, but not harmless
Tramadol and codeine belong to the family of opioid painkillers. They act on the perception of pain and can provide real relief when prescribed in an appropriate situation.
Calling them opioids does not mean they are always dangerous or that you should systematically distrust them. It means they also have effects that can lead to tolerance, physical dependence, misuse or overdose.
Tramadol is sometimes described as a « weak » opioid. This expression should not lead to minimizing its risks. The French national health insurance (Assurance Maladie) points out that it can cause severe dependence and that withdrawal difficulties can appear even at therapeutic doses.
Prescription rules have in fact been strengthened. Since 1 March 2025, medicines containing tramadol, codeine or dihydrocodeine must be prescribed on a secure prescription. The dosage, regimen and duration of treatment must be written out in full. The maximum validity of the prescription is set at three months.
These changes do not mean that the medicines have lost their value. They aim to better frame their use and reduce the risks of misuse, dependence, abuse and overdose.
The context justifies this vigilance. According to the French national health insurance, in 2022 France was the second largest consumer of painkillers among several large European countries studied. The French medicines agency (ANSM) also indicated, based on 2017 data, that tramadol was the first painkiller involved in deaths linked to painkiller use.
These figures should be read with measure. They do not mean that a prescribed treatment necessarily leads to a complication. They show, however, that these medicines deserve careful follow-up.
Physical dependence, tolerance, addiction: what these words mean
The terms are often confused. Yet they do not describe exactly the same situation.
Physical dependence
Physical dependence corresponds to the body’s adaptation to the medicine. When an opioid is taken regularly, the body can get used to its presence. If the treatment is stopped abruptly, withdrawal symptoms can appear.
This adaptation can occur while the person follows their prescription and uses the medicine only for pain. It does not automatically mean that an addiction is present.
Withdrawal symptoms can include anxiety, sleep problems, pain, sweating or irritability. With tramadol, psychological manifestations, especially anxiety, are described as more frequent than physical signs.
Tolerance
Tolerance means that the same treatment seems to produce less effect over time. The person may feel that the medicine no longer relieves as much as before, or that they would need to take more to achieve the same result.
An increase in doses should never be decided alone. Pain that is not sufficiently relieved, tolerance or a paradoxical increase in sensitivity to pain should be assessed by a doctor.
The French national health insurance describes in particular opioid-induced hyperalgesia: after prolonged exposure, sensitivity to pain can increase instead of decreasing. This phenomenon cannot be diagnosed by the person themselves, but it shows why increasing doses is not always the right answer.
Addiction or substance use disorder
Addiction involves loss of control and continuing use despite negative consequences.
The medicine can take an increasingly important place. The person anticipates doses, fears running out, exceeds the instructions or continues even though the initial pain has decreased. They may also use tramadol or codeine for reasons other than pain: to calm anxiety, promote sleep, improve mood or seek a particular effect.
Physical dependence, tolerance and addiction can overlap, but they are not interchangeable. Only a global assessment allows understanding the situation.
Can you become dependent even with a prescription? Yes
Dependence can develop without initial recreational use, without deliberate misuse and without obvious exceeding of prescribed doses.
According to the French national health insurance, more than 50% of reported tramadol withdrawal syndromes concern use at therapeutic doses. Some appeared after a treatment duration of less than a week.
This finding is important: the risk does not only concern people who use large amounts or seek a euphoric effect. A patient treated for pain can also face difficulties when reducing or stopping.
A study conducted in 2021 among 1,001 tramadol and codeine users, cited by the French national health insurance, provides other benchmarks. Among those surveyed, 47% said they had difficulty stopping or reducing their treatment.
In addition, 24% acknowledged having used these medicines for a purpose other than pain relief, for example for an anxiolytic, hypnotic or stimulant effect.
This shift in use can be gradual. A person first notices that the medicine also soothes their anxiety or helps them sleep. They then use it more in those moments, without always perceiving that its function has changed.
The risk of overdose also deserves to be known. Still according to this study, nine users out of ten did not know that an overdose could cause respiratory arrest. This information should not serve to worry unnecessarily, but to remind us of the importance of following the prescription and not changing the treatment alone.
The signs that should alert
No single sign allows concluding an addiction to tramadol or codeine. Several changes can, however, justify a discussion with a professional.
Doses become difficult to respect
The person takes the medicine earlier than planned, brings certain doses closer together or regularly exceeds the instructions.
They may also find that they cannot follow a reduction agreed with their doctor. Each reduction causes such discomfort that they quickly return to the previous dose.
The fear of running out sets in
The treatment occupies more and more thoughts. The person counts their tablets, anticipates the renewal or worries a great deal when they risk not having enough.
This fear can be linked to pain, withdrawal symptoms or the sought-after effects of the medicine. In any case, it deserves to be expressed without shame.
The medicine is no longer taken only for pain
The dose is now intended to sleep, to get through a hard day, to calm anxiety or to regain a feeling of energy.
This change in use does not necessarily mean that severe addiction is present. It indicates, however, that the role of the medicine has widened and that a reassessment becomes useful.
Treatment continues even though the situation has changed
The initial pain has decreased, but stopping seems impossible. The person continues for fear of symptoms, out of habit or because the medicine brings them other effects.
They may also continue despite side effects, relationship difficulties or a feeling of loss of control.
Stopping causes bothersome symptoms
Anxiety, insomnia, pain, sweating or irritability can appear when a dose is delayed or removed.
These manifestations should not lead to changing the treatment alone. They show that the body has adapted and that stopping must be prepared.
What to do if you recognize yourself?
The first rule is not to stop tramadol or codeine abruptly.
The ANSM recommends a gradual reduction of doses before stopping in order to limit the risk of withdrawal syndrome. The pace and modalities of this reduction must be decided with a doctor.
The prescriber is often the first point of contact. They can reassess the pain, the duration of treatment, the effects felt and the difficulties encountered. A pharmacist can also answer certain questions and refer to the appropriate professional.
It is important to describe the facts simply: difficulty reducing, symptoms between doses, fear of running out, use to sleep or calm anxiety. This information makes it possible to understand the situation. It should not be hidden for fear of being judged.
An addiction specialist can also support dependence linked to a prescribed medicine. Addiction medicine does not only concern illicit drugs. It also deals with difficulties with opioid painkillers, anxiolytics or other treatments.
Outpatient care is possible, without systematic hospitalization. The goal is to organize a gradual reduction, to work on pain and to understand the functions the medicine has taken on in daily life.
It is also possible to see a general practitioner or a specialized addiction support service.
The rules have changed since March 2025
Since 1 March 2025:
- tramadol, codeine and dihydrocodeine must be prescribed on a secure prescription;
- the dosage, regimen and duration of treatment must be written out in full;
- the validity of the prescription is limited to three months;
- a new prescription is needed to continue treatment beyond this period.
Prescriptions written before 1 March 2025 remain valid until the end of the treatment indicated on them.
This regulation does not question the usefulness of these painkillers. It aims to secure their prescription and dispensing, while reducing the risks of misuse, dependence and overdose. If you want to continue with related reading, you can subscribe to the Adikto33 newsletter or request the free ebook.
Sources
- ANSM — « Tramadol and codeine: new prescription and dispensing rules come into force on 1 March 2025 »
- French national health insurance (Assurance Maladie) — « Prescribing tramadol: the anti-addiction reflex »
- ANSM — « Tramadol: a measure to limit misuse in France »
- French addiction vigilance network — CEIP-A
Can you become dependent on tramadol or codeine prescribed by a doctor?
Yes. Physical dependence and withdrawal symptoms can appear even at therapeutic doses. According to the French national health insurance, more than half of tramadol withdrawal syndromes concern use at prescribed doses, sometimes after a treatment duration of less than a week.
What is the difference between physical dependence and addiction?
Physical dependence corresponds to the body’s adaptation to the medicine and can cause withdrawal during an abrupt stop. Addiction additionally involves loss of control, a growing place given to the substance and continuing use despite negative consequences.
What to do if symptoms appear when stopping treatment?
Do not stop abruptly or change doses alone. Anxiety, sleep problems, pain or sweating can correspond to a withdrawal syndrome. It is recommended to talk to the doctor in order to prepare a gradual and adapted reduction.
Does the secure prescription change anything for the patient?
Since 1 March 2025, tramadol and codeine must be prescribed on a secure prescription. The dosage, regimen and duration are written out in full, and the prescription is valid for three months at most. Earlier prescriptions remain valid until their term.
Can an addiction specialist help if the problem comes from a prescribed medicine?
Yes. Dependencies linked to prescribed medicines are part of the field of addiction medicine. A specialist can help assess the situation, understand the place taken by the treatment and prepare adapted support, in connection with the prescribing doctor if necessary.
