What happens if you snort amitriptyline

In addition, similar to bupropion, the United States regulatory approvals of amitriptyline and venlafaxine predate the existence of the two target Web forums, thus increasing the chances of seeing the discussions reflecting these drugs.

Summary statistics on numbers of posts, threads, and authors for 4 additional controlled substances methylphenidate, alprazolam, buprenorphine, and oxycodone were also collected and compared for contextualization.

Data were collected from two publicly available harm-reduction forums Bluelight and Opiophile from their launch dates and , respectively through July 29, The sites were chosen from pilot work suggesting that these were particularly rich databases for this type of information. Bluelight has been in operation continuously since , and is the largest global drug discussion website with over , members and nearly 7 million posts.

Opiophile, in contrast, has experienced several periods of downtime since its launch in , owing to server issues. At the time of data analysis, it had been offline since mid, and had only members and just fewer than , posts at study inception. That set of product names was then used to identify posts. Posts from Opiophile were gathered by identifying and downloading all posts with references to the products via customized software developed by Epidemico.

All posts containing references to the 3 antidepressants were subjected to customized natural language processing tools that identified formal and vernacular references to misuse-related Preferred Terms. The Preferred Terms were then associated with 1 of the 3 study drugs [ 38 ]. All posts mentioning the target antidepressants were reviewed by a coding team composed of pharmacists, a physician, epidemiologists, Web-based harm-reduction forum administrators, and providers of health and social services to people who use drugs nonmedically see Multimedia Appendix 2.

Each post was evaluated by a single coder, and challenging posts were further reviewed by 1 or more additional members of the coding team. In addition, the acquired data were stripped of personally identifiable identification PII and provided in a deidentified format. Complete alignment is not apparent among regulators, the pharmaceutical industry, and harm reductions practitioners regarding how to define the misuse or nonmedical use of prescription products [ 71 ].

Abuse is a term that is widely used but varies in meaning. In the United States, the term generally refers to problems of psychoactive substance use for both prescription and nonprescription compounds see Table 1. In this study the SMQ Drug abuse, dependence, and withdrawal was utilized. Due to inherent regulatory commitments, the authors of this publication also opted to utilize the FDA definitions of abuse and misuse [ 73 , 74 ]. In addition, the information and discussion presented here should not be viewed as suggesting or approving of the misuse or nonmedical use of these antidepressants.

Manual coding is the process of manually reviewing posts to extract medical insights, similar to chart abstraction in traditional studies. The coding team completed standardized training prior to evaluating posts for this project and met regularly to discuss challenging posts and determine standards.

All decisions and guidance were tracked and documented in a coding manual, with updates added as new situations occurred and team decisions were made. The FDA definitions of misuse and nonmedical use above were utilized to guide the coders.

Additionally, the source of the posts was blinded to the coders. If a coder had any concern about how to answer any question relating to an individual post, the software helped to facilitate collaboration among the reviewers by enabling them to send a request for secondary review to any of the other coders or the whole group.

The software takes advantage of contextually highlighting the post content through the use of RxNorm- and MedDRA-controlled vocabularies to help coders quickly identify those portions of the text that may be relevant to the review process.

RxNorm is a catalog of the standard names given to clinical drugs and drug delivery devices in the United States to enable efficient and accurate communication between electronic systems, independent of software and hardware capacity [ 77 ].

A screenshot of the coding tool is shown in Multimedia Appendix 4. All of the metadata collected about each post by manual coding is then recorded into a central database, which serves as the basis for results presented in this paper. A random sample of 10 posts was gathered from the dataset and evaluated by all members of the coding team using the same questions and response options available in the manual coding interface. Agreement between coder-applied tags was then evaluated by calculating Fleiss kappa metrics of interrater agreement [ 78 ].

The use of Fleiss kappa was justified by the number of raters being assessed 11 and the nominal-scale format of ratings that were applied. The analyses included responses to the first two questions in the coding protocol, which asked coders to identify whether the post included reference to misuse or nonmedical use of in-scope products and what type of reference was made where applicable.

Additional questions were omitted from analysis to reflect the coding protocol instruction to leave default answers unchanged if relevant information was not present in each post, thereby preventing artificial inflation of interrater agreement.

In this study, we analyzed the archives of two Web forums. Two main areas of ethical focus were considered for this work: informed consent from individuals and communities and the protection of PII. We drew from the heuristic approach provided by McKee and Porter [ 79 ] that charts 2 dimensions against each other: private to public communication and sensitive to nonsensitive information. Content that is deemed sensitive and is in the public domain sits in a gray zone from an ethical perspective, and the extent of protection for the individuals who write the content and the communities that host the content should be assessed on a case-by-case basis.

The community discussions demonstrate that contributors are aware of the public nature of the content that they post, and almost all contributors utilize pseudonyms to mask their identities. Although the subject matter may be seen as sensitive, these elements led the research authors to determine that consent from individual contributors was not necessary to conduct the research.

Therefore, to protect the identity of all post authors, PII was removed from all posts by a third-party vendor before receipt of the posts for coding.

The types of PII removed included screen names, user names, first and last names, and addresses. Because our research did not involve intervention or interaction with the individuals, nor is the information individually identifiable, our study did not meet the criteria of the Office for Human Research Protections OHRP framework that guides institutional review board IRB status.

As such, IRB approval was not pursued. Some researchers anonymize the names of the Web forums that they utilize as data in order to further assure confidentiality of the individual contributors or because the group had neither been actively involved in the research nor given consent to be involved [ 80 , 81 ]. Here, we took a participatory or partnership approach [ 82 ]. The researchers contacted Bluelight to initiate discussions regarding this project, resulting in a partnership approach involving regular contact and contribution of Bluelight representatives to this study.

We contacted Opiophile via email to request consent and terms of access for gathering data from that forum. Opiophile forum posts were gathered using customized Web-crawling software that stored the primary body of text included in each post. We contacted a third potential data source, Erowid, to request consent and terms of access for gathering samples from their database of user-reported experiences with drugs.

No response was received from Erowid, and their usage agreement explicitly prohibited data gathering or publishing of analyses without prior permission. In light of those policies and in the absence of response from site administrators, Erowid was excluded as a data source for this study. A total of posts were reviewed, containing references to at least one of the chosen products ie, about posts referenced more than 1 antidepressant. For purposes of simplicity, we refer to the as the denominator for proportion calculations.

Of the total posts, contain reference to misuse or nonmedical use of the product as defined above. This was 8.

The remainder of the posts made reference to in-scope products and drug use, but did not describe specific acts, intentions, or effects of nonmedical consumption.

A breakdown across the 3 in-scope products is shown in Table 2. In total, To better contextualize the overall numbers of these posts, the numbers of posts for controlled substances with nonmedical use potential are available for comparison in Table 3. Discussions for the noncontrolled substances first 3 in Table 3 were considerably fewer than for controlled substances. Additional characteristics of each post were examined by the coding team. The results from each characteristic or data point extracted are shown in Multimedia Appendix 6 , with paraphrased example posts for illustration.

Information about the desired effect of a drug was deduced from total posts Figure 1 shows that although all 3 pharmaceuticals have the same antidepressant indications, their desired effects in nonmedical use are quite different. Bupropion seems to be most desired as a stimulant, whereas amitriptyline most desired as a sedative, and venlafaxine as a dissociative.

Of note, 21 bupropion posts mentioned more than 1 route to equal route mentions within the bupropion posts. Figure 2 shows that the preferred nonmedical route of administration for bupropion is intranasal followed by intravenous or injection.

The means of procurement of the drug are shown in Figure 3. Overall, procurement method was mentioned in 62 9. Although they have similar licensed indications, the 3 drugs show some differences in most common route of procurement, with amitriptyline showing a higher propensity for procurement via stealing or illegal purchase than bupropion or venlafaxine, which were most commonly acquired via prescription from a health care provider.

This paper makes 2 contributions. First, we were able to design a methodology that detects misuse and nonmedical use of noncontrolled substances in harm-reduction Web forums, a novel pharmacovigilance process.

Second, we were able to validate this methodology by confirming the formerly sparse literature and spontaneous adverse reports regarding the nonmedical use of bupropion, previously unconfirmed by the DAWN database study. The evidence from these forums suggests that despite being noncontrolled substances, these 3 antidepressants have properties sought out by those seeking positive psychoactive effects.

Collectively, the data reveal that nonmedical use of the 3 antidepressants differs markedly. The most commonly discussed types of effects were stimulant for bupropion, sedative for amitriptyline, and dissociative for venlafaxine.

This is consistent with what is seen in literature reports for each drug, respectively. The data also indicate that amitriptyline was sought most frequently in combination with other usually controlled substances for euphoric effect; such a combination was reported much less frequently for bupropion and venlafaxine. Nasal insufflation was the most popular route for abuse of bupropion, seen nearly twice as often as with either comparator drug.

One of the most interesting findings overall was the high percentage of posts in these forums which actually discouraged the nonmedical use of bupropion, whereas posts encouraging nonmedical use were relatively constant across the 3 drugs. Nonmedical use was discouraged either owing to side effect profile nasal burning , danger risk of seizure , or failure to achieve the desired effect by various post authors. These data also provide a rare glimpse into the combinations of antidepressants and other substances that are used outside of a medical context, providing a basis for harm-reduction messaging.

This novel methodology allows for the differentiation between misuse and nonmedical use patterns among 3 commonly prescribed antidepressants, all of which are noncontrolled substances according to international treaties. This study reveals that the posted experiences of antidepressants when misused or used nonmedically are heterogeneous. Whereas animal studies have suggested some of these differences, rodent models are limited in their ability to discern certain mammalian effects, such as dissociative effects, sought out by nonmedical users.

In addition, epidemiologic surveillance systems have not had the product-level resolution to discern the subjective differences, often combining all medications in this therapeutic area into 1 category.

The methodology provided herein suggests that Web forums may be able to fill this key information gap. The medications selected for this evaluation are antidepressants, noncontrolled substances that have limited epidemiologic surveillance for misuse and nonmedical use.

However, abuse in the usage of Elavil and other antidepressant drugs can cause tolerance which may lead to addiction over time. Elavil is a medication that has been approved for use in the United States since Amitriptyline hydrochloride is FDA approved for treating depression , so long as that depression is not associated with bipolar disorder.

It also has numerous off-label uses, and Elavil for pain is the most common of them. Numerous studies have found Elavil to be safe , or at least as safe as other antidepressants, in most cases. With that said, Amitriptyline HCl does come with certain risks.

Like all antidepressants, it can cause suicidal thoughts in the user, and the side effects of the medication are numerous. There are also interactions to consider.

Due to the risks associated with the drug, it is available by prescription only, meaning that users are only meant to access it through a doctor. Amitriptyline class of drugs falls under tricyclic antidepressants or TCA. Currently, there are nine generics for this drug class, and the FDA approves them for use in the United States.

These drugs get their name from a distinct three-ring structure, and they have two mechanisms of action. First, they increase norepinephrine and serotonin levels in the brain. Second, they block acetylcholine. Amitriptyline uses this exact mechanism of action to treat depression, which means the correct Amitriptyline class is a tricyclic antidepressant, which is considered relatively safe.

However, this does not mean it is safe to use this drug without doctor approval. Even with careful supervision, the side effects of this drug are numerous: diarrhea, dry mouth, dizziness, and even decreased sex drive. Also, Amitriptyline causes weight gain. Drugs may be sold under their generic names or brand names. Aside from the brand Elavil, there are also many companies that market Amitriptyline under other names, as well as generics that are simply called Amitriptyline HCl.

Brand names may differ from one country to another. Aside from the brand names mentioned above, there are also other brand names available in other countries.

There is not a problem when it comes to buying alternative brand names as long as the generic name and dosage strength are the same. However, it is important to always choose the recommended brand by the prescriber especially when the dosage form is noted to be important. Amitriptyline dosage is available in six strengths: 10mg, 25mg, 50mg, 75mg, mg, and mg.

Also, this drug comes in the form of a tablet and capsule with distinctive colors depending on the strength. All tablets are film-coated with a specific imprint on one side and plain on the other side.

Both tablets and capsules are available in bottles of 30, , and units. Doses of this drug should be taken around the same time each day at about 2 hours before bedtime and as instructed by a doctor. The maximum dose of Elavil is mg on average. Taking more than the recommended dosage may be fatal. Therefore, in case of an overdose of this drug, emergency overdose treatment should be administered to the patient by a qualified medical professional.

The safety of this drug is not approved for children under the age of 12 years. Amitriptyline hydrochloride for depression is the main utilization of the medication that is presently endorsed for use in the United States by the Food and Drug Administration. Elavil is an antidepressant with sedation effects on the body, and as such, inhibits the uptake of norepinephrine and serotonin adrenergic neurons. Long-term use of Elavil has been believed to ease the side effects of depression.

Amitriptyline hydrochloride can also be prescribed off-label for the treatment of several health conditions such as sleep disturbances, migraine, anxiety, and irritable bowel syndrome IBS. These side effects include fast heart rate, difficulty urinating, constipation, dry mouth , and blurred vision. For children: It has not been confirmed that this drug is safe and effective for use in children younger than 12 years.

Use of this drug in children must balance the potential risks with the clinical need. Amitriptyline oral tablet is used for long-term treatment. If you stop taking this medication suddenly you may have withdrawal side effects such as nausea, headache, and tiredness. For this drug to work well, a certain amount needs to be in your body at all times. If you take too much: You could have dangerous levels of the drug in your body.

Symptoms of an overdose of this drug can include:. But if your symptoms are severe, call or go to the nearest emergency room right away. What to do if you miss a dose: Take your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects. How to tell if the drug is working: Over time you should notice an improvement in your symptoms of depression.

This can take more than a month. A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription. Your doctor will monitor your mental health while you take this drug. Be sure to tell your doctor about any unusual changes in your behavior and mood.

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk with your doctor about other drug options that may work for you. Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date.

However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects.

The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses. I think this question violates the Community Guidelines. Inaugurationa large group of ones at Phong Nh where they agreed to at Ha. Can you snort amitriptyline hydrochloride Can you snort amitriptyline hydrochloride. Yes, you can. If you are on parole or probation, you may need to get the approval of a probation officer or a judge.

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