Plugging Tramadol: The Dangers Of Rectal Ultram Use

Tramadol is a synthetic opioid that was initially considered to have lower abuse potential than other opioids such as oxycodone or hydrocodone. This perception has since been revised as tramadol carries a real risk of dependence and misuse, and was rescheduled to Schedule IV in 2014 to reflect this.

Because it has fewer depressive effects on the respiratory system than oxycodone (OxyContin), fentanyl, or hydrocodone (Vicodin), it is seen as safer by many. However, it is still prone to misuse by methods like snorting or plugging. And it may still create dangerous overdose effects, including death.

Why Do People Plug Tramadol?

When tramadol is used in a capacity outside of prescribed pain relief, people may look for a way to increase or amplify non-analgesic effects. Plugging (rectal drug intake) increases the bioavailability of tramadol in the body and facilitates quick feelings of well-being.

Some people also plug tramadol because they believe, in error, that this method of ingestion prevents damage to organ systems like the liver. Plugging may reduce perceived feelings of opiate-induced nausea, or may be used to prevent negative side effects, despite evidence to the contrary.

Dangers Of Plugging Tramadol

Plugging drugs introduces the drug into the bloodstream through rectal blood vessels. Generally, plugging causes the effects of a drug to be felt immediately but may dissipate. The use of tramadol rectally may increase the risk of overdose, and may also physically impact the person that plugs the drug. Because tramadol is not prescribed for rectal use in the U.S., only pills meant for oral consumption are used for plugging.

Plugging drugs without sterile applicators, lubrication, or proper instruction may cause uncomfortable reactions like internal bleeding and damage to delicate rectal tissue.

Side Effects Of Plugging Tramadol

Tramadol is a prescription opioid painkiller used to treat moderate to severe pain. It’s sold under brand names like Ultram, Conzip, and Ultracet (which combines tramadol with ibuprofen). The drug works differently than many other opioids because it not only activates mu-opioid receptors in the brain but also affects serotonin and norepinephrine levels, similar to certain antidepressants.

Even when people take tramadol exactly as their doctor prescribes, the medication can cause a range of side effects. Some people experience feelings of euphoria, mood elevation, relaxation, and drowsiness. While these effects may seem pleasant at first, they’re warning signs of the drug’s impact on brain chemistry and can lead some people toward misuse or addiction.

Tramadol also lowers the seizure threshold independently of its opioid effects, meaning seizure risk exists even at prescribed doses. It then increases with high doses, misuse, or when taken in combination with other medications that lower seizure threshold. This risk is amplified when tramadol is plugged because of the rapid, high-concentration delivery to the bloodstream.

Common Side Effects Of Tramadol Include:

• euphoria and elevated mood
• relaxation and drowsiness
• swollen joints
• skin rash and severe itching
• excessive sweating
• constipation or diarrhea
• nausea and stomach discomfort
• severe cough
• anxiety and depression
• severe headaches
• confusion and mental fog
• muscle and bone aches

Abusing tramadol, especially at high doses or through unusual methods like plugging (rectal administration), significantly increases the risk of experiencing severe and unpleasant side effects. The body isn’t designed to absorb opioids through certain routes, and doing so can cause intense physical reactions and unpredictable effects.

What may start as an attempt to get a stronger high can quickly turn into a dangerous situation with extreme discomfort, health complications, or overdose.

Additionally, if tramadol withdrawal is accompanied by severe depression, suicidal thoughts, or hallucinations, call or text 988 to reach the Suicide and Crisis Lifeline immediately.

Risks Of Tramadol Abuse

Plugging tramadol is not a common method of substance abuse. People that use tramadol rectally may suffer from an overdose as a result of multiple drug use with tramadol.

Because the drug’s effects wear off sooner through rectal ingestion, there is a perception that more of the drug can be ingested safely when it is no longer “felt”. This is not true. The body may become overwhelmed by the drug’s presence, and an overdose may occur.

Opioid Overdose

Certain overdose symptoms may be worsened when tramadol is plugged alongside antidepressants, alcohol, or other opioids. The effects on the central nervous system (CNS) may compound.

Signs of a tramadol overdose include:

• stopped breathing
• seizures
• disrupted breathing (apnea)
• coma
• death
• dizziness
• nausea and vomiting
• drowsiness
• anxiety
• hallucinations

If opioid overdose is suspected, call 911 and administer naloxone immediately. Naloxone is available over the counter at most pharmacies without a prescription.

Because fentanyl contamination is increasingly common in counterfeit opioid pills, a single dose may not be sufficient. Administer additional doses every two to three minutes if the person does not respond. Most states have Good Samaritan laws that provide limited legal protection to people who call 911 during an overdose.

Serotonin Syndrome

Because of tramadol’s impact on serotonin neurotransmitter pathways, it is possible that a person may experience serotonin syndrome. This occurs when a person’s brain is flooded by serotonin.

The body will physically react with the following symptoms:

• diarrhea
• nausea
• restlessness
• vomiting
• high blood pressure (hypertension)
• high heart rate (tachycardia)
• poor coordination

Serotonin syndrome is a medical emergency that requires immediate attention. The condition is more likely to occur when tramadol is combined with other medications that affect serotonin levels, such as antidepressants, migraine medications, or certain supplements. If you experience these symptoms while taking tramadol, especially if they come on suddenly or worsen quickly, seek emergency medical care right away.

Tramadol Addiction And Withdrawal Symptoms

Although tramadol’s use in health care settings is intended to prevent addiction, misuse and abuse of tramadol can still occur.

Treatment for tramadol use disorder may include medications for opioid use disorder (MOUD) such as buprenorphine or methadone, which reduce cravings and withdrawal symptoms while the person engages in behavioral treatment.

Such withdrawal symptoms may include:

• nervousness
• panic and depression
• trouble sleeping
• fever symptoms like chills, nausea, diarrhea
• hallucinations
• excessive sweating

When a person is addicted to tramadol and does not take the drug for some time, they may experience withdrawal symptoms. Some of the symptoms may be a result of physical dependence on the drug, which results in physiological reactions to the drug’s absence.

Getting Help With Tramadol Addiction

If you or a loved one regularly uses opioids like tramadol, it may be time to seek help. Drug misuse through methods such as snorting or plugging opioids is a sign of addiction, and likely means that drug and alcohol addiction treatment is necessary.

Browse our directory or reach out to the Substance Abuse and Mental Health Services Administration (SAMHSA) for more information about addiction recovery.

Written by the Addiction Resource Editorial Staff