Tramadol (which is a narcotic), as formulated, is of very limited recreational use. It is however, definitively addictive, and is far less "safe" and "enjoyable" than other low-potency opiates such as codeine, DHC etc. Again, I speaking strictly in terms of recreational use (not clinical), but with tramadol I have found there to be mild-modest opioidergic properties in non-tolerant users, however tolerance grows quickly and eventually, it is difficult to even "feel" any MOR activity whatsoever (even in doses far above the 'seizure threshold'). Personally, I found the monoaminergic activity of tramadol to be an annoyance, as it reduces appetite, presents a very real risk for hypertensive crisis if taken in sufficient dosages and combined with other 5-HT modulating compounds (I have seen fatalities from high dose tramadol and SSRI's, as well as one case involving a modest dose of tramadol combined with a rather typical dose of MDMA).
Some will disagree, but from my perspective, the drug has anti-depressant properties which are generally unremarkable.
Clinically speaking, yes, the drug works for pain, but there are a multitude of superior and safer alternatives. Some physicians simply prefer to prescribe the drug due to the fact that is (in most states) an 'Rx only' compound, which is more of a reflection on the physicians personal liability concerns. It will be prescribed more and more, particularly since dextropropoxyphene is no longer available. The concern is that some physicians prefer to prescribe far more "dangerous" opioids such as dextropropoxyphene or tramadol over codeine/hydrocodone, simply to "protect" themselves, or under some misguided opioiphobic notion.
The catch is......O-desmethyltramadol, 'metabolite 1' of tramadol, is actually, a pretty enjoyable opioid when used in its pure state. O-desmethyltramadol lacks much of the monoaminergic properties of its parent drug, and has unmistakable and powerful MOR activity. I found it best injected (again I am not talking about tramadol, I am talking about pure O-desmethyltramadol), which produced an effect similar to pethidine, but more sedating. Intravenously, O-desmethyltramadol can easily induce full "narcosis", nodding, etc. Do to its fast acting nature, I recall nodding off after re-administering an IV dose, leaving the syringe half depressed in the catheter (in the rare event that I decide something is worth injecting, I use a catheter instead of poking holes in my arms). I have also, in the past, injected tramadol ampules, and it was nothing like the M1, in fact, it was actually unpleasant from what I recall.
The one way to make p.o. tramadol "worth it" is to take in a manner in that maximizes conversion to M1. I have toyed around with this, using ethanol and cimetidine (high dose), with zero to moderate success (the tramadol dose needs to be large,
personally 500mg or more). I am well aware of the literature and know the stated threshold, so I cannot recommend doing the things I personally attempt.
To optimize oral tramadol to M1 conversion one must understand the metabolic processes/phases, pharmacokinetic curves, pH dependence, p-gp-mediated efflux-take etc, etc. Its actually a bit of a headache and waste of time, but I have gotten it to work using agents such as ethanol, cimetidine, omperazole, quinidine gluconate ER tablets, etc. I have not been able to do it consistently, but I have a rough idea of ideal timing, doses etc. Why fuck with tramadol to begin with? Because its cheap, unscheduled, and not nearly as alluring as pure agonists (for example, methadone, is a drug I very much enjoy, which is why I cannot use it due to my susceptibility to opioid addiction). Tramadol is an experiment of sorts.....
This article is some rather heavy reading but it is interesting:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2774482/
