The slang term ‘plugging’ is used to describe abusing a drug or substance by administering the substance rectally (in the rectum). Plugging causes the drug to be absorbed through the thin membrane in the anal cavity, entering the bloodstream, causing the drug to take effect quickly.
On the street, plugging is believed to be ‘less dangerous’ than intravenous drugs, with a lower risk of infection, transmission of hepatitis, or HIV. However, putting substances up inside the anal cavity can result in bowel dysfunction, ulcers, diarrhea, and damage to the membranes in that area. In addition, damaging the inside of the rectum actually increases the risk of contracting a sexually transmitted disease.
The common opinion among drug users is plugging will make the effects of the drug last longer and feel stronger than snorting, swallowing, or smoking.
The limited research regarding rectal administration of methadone does not agree with that opinion. In fact, research has shown that the absorption rate of rectally administered methadone is about the same as taking it orally. There is no data to support a more intense or longer-lasting ‘high’ with plugging, other than self-report.
Other research shows that drugs introduced into the rectum may take effect quickly, but those effects decrease quickly as well. Plugging has also been referred to as: boofing, shafting, shelving, or butt-chugging.
Methadone is an opioid agonist and one of three prescription drugs approved to treat opioid use disorders. Clinical pharmacology research also supports using methadone as a second option for individuals in need of pain management, if first-line opioids are not effective.
Methadone, like other opioid agonists, attaches to pain receptors in the brain. What sets methadone apart from other opioids is methadone prevents the euphoria typically associated with opioid addiction and has fewer unwanted side effects in pain management.
Methadone clinics provide outpatient services to people who are addicted to heroin, oxycodone (OxyContin), hydromorphone (Dilaudid), fentanyl, or hydrocodone (Vicodin). There are also inpatient treatment options for opioid addictions.
Although methadone maintenance can be part of a treatment program for opiate addiction, methadone itself is habit-forming and addictive. Abusing methadone only increases the risk of developing an addiction.
Dangers And Risks Of Plugging Methadone
The compulsion component of addiction may factor in when a person addicted to methadone decides to attempt plugging, usually in an attempt to increase euphoria.
Some of the dangers associated with plugging methadone are:
- infection of the lining of the anal cavity
- colon tears
- loss of bowel control
- pain in rectum or surrounding areas
- rectal bleeding
- reduced blood flow in the lower intestinal area (small intestine, bowel, rectum)
- tissue necrosis (tissue death)
- require a colostomy bag
- opioid overdose
Overdose Risks Of Plugging Methadone
There is a significantly higher risk of overdose when plugging methadone. Administering methadone rectally can result in the drug taking effect faster because there is a higher bioavailability through that route.
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However, the intense effects fade just as quickly. To someone who is ‘chasing a high’, they may believe that because they don’t feel the intense effects, the drug has left their body. This is not always the case and an overdose may occur if a person abuses more methadone before the previous dose has left their body.
A person experiencing a methadone overdose may show some or all of the following:
- falling asleep at strange times
- respiratory depression
- extreme confusion
- slow heart rate
- poor circulation (blue-like tint to skin or lips)
- drop in blood pressure
- throwing up
Seeking emergency medical treatment for a methadone overdose can save a life. Many emergency responders have access to Narcan (naloxone) to counter the symptoms of a methadone overdose.
Methadone Abuse Side Effects
The intensified effects of plugging methadone can also cause heightened unwanted side effects. It is important to know that methadone use at its appropriate dose does not cause intoxication. If a person displays these side effects, the dosage is either too high, or they may be abusing the medication.
The following are some side effects of methadone abuse that can intensify with plugging:
- impaired thinking
- itchy or flushed skin
When the methadone high starts to fade, they may experience irritability, depression, anxiety, or muscle pain.
Severe Effects Of Methadone And Plugging
The brain can be severely impaired by opioid addiction and some of those impairments can be permanent. Abusing opiate drugs like methadone change how the brain communicates within itself and the body. Blocking neurotransmitter receptor sites to manage pain can result in permanent malfunctions in the brain.
Taking more than one central nervous system (CNS) depressant can fast track these unwanted effects, and increases the probability of developing an addiction. Drinking alcohol and taking sleep medications or benzodiazepines is discouraged during methadone treatment, and absolutely should not be combined with methadone addiction.
Severe constipation is a side effect of long-term opioid abuse. Chronic constipation can damage the bowels and rectal cavity. Regularly introducing methadone into the rectum can irritate and erode the tissue, resulting in bleeding, ulcers, and infections. Plugging methadone can compound the individual unwanted effects of both methadone and plugging.
Research suggests that plugging can also lead to perforations in the colon, fecal incontinence, and vomiting blood.
Plugging opioids can also negatively impact fertility in men and women. Pregnant women and fetuses are also at risk of complications, and even death, if the mother-to-be is plugging methadone.
Treatment For Methadone Abuse
Someone who is addicted to methadone will likely benefit from an opioid addiction treatment program that offers detox and medication-assisted treatment (MAT) using Subutex (buprenorphine), Suboxone (a buprenorphine/|naloxone combination drug), or Vivitrol (naltrexone).
These medications can help manage opioid withdrawal symptoms, which can prevent early relapse and encourage the individual to continue on to a drug abuse treatment program.
Plugging methadone is a sign of an opioid use disorder. Finding addiction treatment providers can help you or your loved one start the path to sobriety. Contact our professional staff as soon as you are ready.
Addiction Resource aims to provide only the most current, accurate information in regards to addiction and addiction treatment, which means we only reference the most credible sources available.
These include peer-reviewed journals, government entities and academic institutions, and leaders in addiction healthcare and advocacy. Learn more about how we safeguard our content by viewing our editorial policy.
- American Journal of Psychiatry — Strange Routes of Administration for Substances of Abuse
- Michigan Medicine (University of Michigan) — Hydromorphone (rectal)
- National Library of Medicine — Clinical Pharmacology of methadone for pain