Some people abuse tramadol by snorting the crushed tablets. This may be done by those seeking a rapid initial burst of euphoria by bypassing the steady release of medication that would otherwise result from its intended oral administration. This can result in a relatively rapid delivery of this drug to the brain but can also cause serious side effects.
What Is Tramadol?
Sold under a variety of commercial names—including ConZip, Ultram, and Ultram ER—this analgesic medication is prescribed to manage moderate to moderately severe pain. Tramadol is a synthetic opioid agonist that interacts with certain opioid receptors within the brain—modifying sensations of physical pain and discomfort. It is often prescribed for people with nerve damage, arthritis, or other painful chronic conditions.
Tramadol is sold in immediate-release and extended-release tablets, and it is meant to be taken orally. The extended-release version is intended to control symptoms for a longer period of time and is prescribed to adults who need around-the-clock pain control.
When tramadol is abused for recreational purposes, it can create a near-immediate sense of pleasure and happiness that’s often been compared to a morphine high. But like almost all opiate derivatives, this man-made opioid agonist can be addictive, and snorting the drug increases the risk of dependence.1
How do you know if you or a loved one may be addicted? Find out here.
What Happens When You Snort Tramadol?
When tramadol is taken orally as prescribed by a doctor, the drug is a generally safe alternative to other pain medications. Tramadol has more powerful painkiller properties than non-steroidal anti-inflammatory medications, and it was designed with the intention of providing a less addictive alternative to the stronger opioid analgesics.2,3
Crushing the medication, however, is unsafe. People who misuse tramadol may crush multiple tablets in order to snort the drug and get a euphoric high. While some side effects of snorting tramadol may be shorter-term and less harmful than others, other side effects—such as seizures and overdose—can be much riskier and even lethal.
How Tramadol Enters Your System
When tramadol is ingested orally, it is first processed through the liver before its effects are felt throughout your body. When tramadol is snorted, however, the drug dodges this intended “first-pass” process of liver metabolism. Instead, the mucous membranes of your nasal passages absorb the drug and delivers it across the blood-brain barrier directly to your brain.
How Tramadol Works in the Brain
Tramadol is a synthetic opioid, meaning that its chemical makeup has been man-made, rather than having been developed directly from opium poppy plant derivatives (“opiates”). Nonetheless, it works in the brain very similarly to natural opiates, as it attaches to opioid receptors and alters signaling throughout the body’s pain pathways.4 As a result, you perceive less pain in your body when there is tramadol in your system.
Tramadol is a somewhat unusual opioid analgesic in that it also increases the availability of norepinephrine and serotonin in your brain.
Tramadol is a somewhat unusual opioid analgesic in that it also increases the availability of norepinephrine and serotonin in your brain. The drug’s actions on these neurotransmitters may serve to bolster its pain-relieving capabilities, but is thought to also provide a mild antidepressant effect—elevating good feelings throughout the body.5
How Quickly You Feel Tramadol’s Effects
Orally administered tramadol pills (immediate release) are processed through the liver, and drug levels peak in the body in about 2 hours. Since snorting tramadol skips this liver metabolism process—delivering the drug directly to the neural circulation—the effects of tramadol are experienced in less than 10 minutes. Furthermore, animal studies have shown that the maximum bloodstream concentration of tramadol is 20 times higher when it is snorted then when it is taken orally, and snorting tramadol makes the drugs 500% more available to the body.6 Thus, snorting tramadol greatly intensifies both its desired and dangerous effects.
What Are the Side Effects of Snorting Tramadol?
When tramadol powder is snorted, the medication can cause severe irritation of the mucous lining of the nose. Some users report a painful burning sensation. In addition to causing discomfort and pain, snorting tramadol increases the risk of taking too much of this medication.1
Snorting tramadol can have serious consequences, such as:7
- Shaking and tremors.
- Nausea and vomiting.
When you snort tramadol while you’re drinking or taking other drugs that suppress breathing and heart rate (such as opioid pain relievers like methadone or opiates like heroin), the risk of central nervous system depression increases—as does the risk of accidental death.
Tramadol and Serotonin Syndrome
A 2010 study of tramadol overdose published in Clinical Toxicology indicates that 1.2 percent of all poisoning episodes in 2006 to 2007 were related to tramadol.7 Taking too much of this drug can result in what’s known as serotonin syndrome—a severe drug reaction that can occur when you take medications that alter the brain’s production of the neurotransmitter serotonin. Dangerous side effects of serotonin syndrome may include:7
- Accelerated heart rate.
- Elevated blood pressure.
- Elevated body temperature.
- Delusions and hallucinations.
- Loss of motor coordination.
Getting Treatment for Tramadol Addiction
If you feel that your tramadol abuse has taken over your life, you may have a physical or psychological dependence on this drug. Getting help for tramadol addiction may require intensive, professional substance abuse treatment, potentially one that specifically promotes recovery from tramadol addiction or other form of prescription drug abuse. Treatment strategies for tramadol abuse include:
- Enrollment in a residential treatment program.
- Individual therapy or counseling utilizing behavioral modification techniques.
- Group and family counseling.
- Participation in a 12-step addiction program.
- Stress management techniques to prevent relapse.
Types of Treatment Programs
Treatment program types can vary quite a bit, depending on what you’re looking for in a program. Most treatment programs will involve a period of detox—where the body gets rid of any residual substance of abuse—followed by some combination of individual, group therapy, and ongoing maintenance recovery.
- Luxury rehab centers provide residential rehabilitation treatment alongside a wide variety of plush, resort-like amenities to make your experience more comfortable.
- Executive rehabs also provide residential rehabilitation with many of the same luxurious amenities as luxury rehab. Executive rehab, however, also focuses on providing busy professionals with the resources and structure to maintain active involvement in the workplace throughout the recovery process.
- Standard or traditional rehab facilities also provide the same top-notch rehabilitation treatment as do luxury or executive programs—only without the extra amenities or high price tag.
- National Institute on Drug Abuse (2014). Drugs, Brains and Behavior: The Science of Addiction.
- Hur J, Ryou J, Kim (2013). Comparison of effectiveness and safety of tramadol/acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDS) for treatment of knee osteoarthritis in elderly patients. Annals of the Rheumatic Diseases 71, 694.
- Bravo L., Mico JA and Berrocoso E. (2017). Discovery and development of tramadol for the treatment of pain. Expert Opinion on Drug Discovery, 12(12), 1281-1291.
- Sansone RA, Sansone LA. (2009). Tramadol: seizures, serotonin syndrome, and coadministered antidepressants. Psychiatry (Edgmont). 6(4), 17–21.
- Yalcin I, Aksu F, Bodard S, et al. (2007). Antidepressant-like effect of tramadol in the unpredictable chronic mild stress procedure: possible involvement of the noradrenergic system. Behavioral Pharmacology, 18, 623–631.
- Zhang, H., Zhao, Y., Wang, X., and Zhang, Q. ( 2014). Bioavailability of tramadol hydrochloride after administration via different routes in rats, Biopharmaceutics and Drug Disposition, 35, pages 525– 531.
- Tashakori, A., Afshari, R. (2010). Tramadol overdose as a cause of serotonin syndrome: a care series. Clinical Toxicology, 48(4), 337-41.
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