Author Archives: Reflections Recovery Center

Dissociative Drugs

Dissociative drugs are a classification of hallucinogenic drugs which distort a user’s perceptions of sight and sound. The effect of these drugs causes the user to feel detached or a ‘dissociation’ from their mind and body. While for some, this experience can sound like an exciting way to view their world in a different lens, it does not come without its risks.

dissociative drugs

How do dissociative drugs work? 

Some dissociative drugs started off as general anesthetics such as PCP (phencyclidine) and Ketamine to be used during surgery but are now commonly used as party drugs. According to the National Institute of Drug Abuse (NIDA), these drugs “ cause their effects by disrupting the actions of the brain chemical glutamate at certain types of receptors—called N-methyl-D-aspartate (NMDA) receptors—on nerve cells throughout the brain.” Glutamate is a critical chemical which is responsible for cognition (such as learning and memory), emotion, and perceptions of pain (which explains its use as a surgical anesthetic).

What are the effects of dissociative drugs

Dissociative drugs can have varying effects on people and everyone’s experience seems to be different. However, generally, users can expect to experience:

  • Anxiety
  • Depression
  • Memory loss
  • Impaired motor function
  • Body tremors
  • Numbness 

In addition, individuals who take lower doses may experience:

  • Disorientation
  • Confusion
  • Changes in sensory perceptions (sight, sound, shapes)
  • Hallucinations
  • Feelings of detachment 
  • Increase in blood pressure, heart rate, respiration and body temperature

Those who take high doses of dissociative drugs may further experience:

  • Hallucinations
  • Physical distress
  • Extreme paranoia, panic, fear, anxiety, aggression
  • Overdose when mixed with other depressants such as alcohol

dissociative drugs

Dissociative drugs FAQ

What will I feel when taking a dissociative drug?

It is extremely difficult to accurately determine how individuals will react to dissociatives because everyone’s experience is different. While most people will feel a general sense of detachment, some will experience a more intense hallucinogenic effect whereas others may only feel a euphoric high.

What are the long-term effects of dissociative drugs?

Some long term effects of dissociative drugs such as PCP can be speech difficulties, memory loss, depression, suicidal thoughts, anxiety and social withdrawal. 

What is a ‘k hole’?

A k-hole is the name given to the dissociative and hallucinogenic effects felt when taking high doses of Ketamine. People have described a k-hole as being an immensely powerful out of body experience and as if they felt physically separated from their body. This feeling can be desirable for some but carries a lot of the negative effects as discussed above.

Are dissociative drugs illegal?

The US Drug Enforcement Agency (DEA) has a classification system it uses to ‘schedule’ certain drugs into tiers. If a substance falls under one of the DEA categories, it is a controlled substance. Most dissociative and hallucinogenic drugs are classified under this system. For example, DMT is a schedule I drug which means it has no accepted medical uses and a high risk for abuse. Its categorization makes DMT illegal. Likewise PCP falls under the schedule 2 drug category.

What is Mescaline?

Mescaline is a naturally occuring hallucinogenic drug which is known to have similar effects to that of LSD and psilocybin. It is  the main psychoactive ingredient found in the peyote cactus which is another popular hallucinogenic drug.

What is the difference between dissociative and hallucinogenic drugs?

Essentially, hallucinogens are also known as psychedelics and only cause visual, auditory and sensory hallucinations. Popular hallucinogenic drugs include LSD, psilocybin mushrooms, and peyote. Dissociative drugs will cause a sense of detachment from your body along with hallucinations. PCP, Ketamine, and DXM are the most popular dissociative drugs.

dissociative drugs

What is HPPD?

Hallucinogen persisting perception disorder (HPPD) is essentially a never ending ‘trip.’ Medical science still has not come to a conclusion about why this occurs and what the mechanics of this is. However, some people report using a hallucinogenic drug once and never fully recovering from its effects.

Getting treatment

Dealing with dissociative drug addiction can be a major issue. This category of drugs provides an easy escape from reality and some people may begin to rely on it just to get through their day. If you or a loved one is struggling with addiction, please contact us today.

DXM and Kratom

Popular culture and media is bringing the issue of cough medicine abuse to light. Unfortunately, rather than presenting the dangers of abusing or mixing cough medication, many forms of media tend to glorify the drug. It is reported that 1 in 20 teens have taken DXM to achieve a recreational high. Some users choose to take the stance that its a ‘better’ addiction than alcohol or opioids- however, abusing any medication carries serious risks and consequences. Increasingly, people are experimenting with a combination of DXM and kratom.

What is DXM?

Dextromethorphan or more commonly known as a DXM is an over-the-counter (OTC) cough and cold medication. DXM is from a derivative of morphine, a very powerful opioid, but is not technically an opioid. Due to the effects it can have, it behaves like an opioid without the painkilling effects. It is effective at suppressing the average cough and creates some sedation which can help sick individuals relax or fall asleep. Unfortunately, when taken in much higher doses, DXM sometimes causes individuals to experience a euphoric high which is then sought after. 

According to the Drug Enforcement Agency (DEA), DXM is an antitussive (a type of medication used to stop a cough) found in over 120 cold medications (such as Vicks 44, NyQuil, Robitussin). The typical dosage is 15-30mg taken 3-4 times a day. When abused however, individuals can end up taking 100-1500mg a day. The DEA provides a ranking of “plateaus” which describes how users can manipulate different doses to achieve different effects.

  1. 100-200mg → Mild stimulation
  2. 200-400mg → Euphoria and hallucinations
  3. 300-600mg → Distorted visual perceptions, loss of motor coordination
  4. 500-1500mg → Dissociative sedation

The DEA will schedule certain drugs it deems to be dangerous and hazardous to the public’s health under its own classification system. For example, Methamphetamine is considered a schedule 1 drug and therefore is very dangerous. DXM is not classified under this system. It is typically found in liquid form but illicit websites and users have begun selling the drug in capsule or powder form.

DXM Side Effects

Some side effects of DXM include:

  • Sweating
  • Rashes or red, blotchy skin (not an allergic reaction)
  • Dizziness
  • Lethargy
  • Nausea and vomiting
  • Loss of coordination
  • Slurred speech
  • Impaired judgment
  • Reduced cognitive ability
  • Nystagmus, or rapid eye movements
  • Visual disturbances
  • Liver damage
  • Disorentiation

In high doses, the effects of DXM mimic those of Ketamine and PCP. A DXM overdose is possible if an individual takes enough of it. Given its suppressive effects, it can cause slowed breathing and critical organ function. 

How Long Does DXM Stay In Your System?

Testing for DXM is rare because of its common use as a cough suppressant. However, the drug can trigger false positives for PCP. DXM has a half-life of around 4 hours. A substance’s half-life is the time it takes for the chemical to reduce to 50% of its original size. Given its half-life elimination time, it can be assumed that most users can get rid of the chemical around 16.5 and 33 hours. While the chemical itself may be gone, this does not mean that traces cannot be tested for. 

DXM can be detected in:

  • Urine 24-48 hours after ingestion
  • Blood 3-24 hours after ingestion
  • Saliva does not apply as most OTC medications are taken orally
  • Hair up to 90 days after ingestion

What is Kratom?

Kratom is a plant found in Southeast Asia which is beginning to find its way into U.S. markets. Its leaves contain a chemical which produces a psychotropic (mind-altering) effect. The use of kratom is still pretty minimal in the U.S. but as of now, there is no nationwide ban or enforcement of the drug. In fact, most users can buy it online, although some states have banned the substance. According to the National Poison Data System, between 2011-2017 there were 11 deaths associated with kratom use.

dmx and kratom

Kratom’s effects are unpredictable. It is possible to use as a stimulant in lower doses, but can also have a heavy sedative effect when taken in higher doses. The lack of research on the effects of kratom makes it difficult to fully understand the negative side-effects. However, users can expect to experience:

  • Disrupted sleep
  • Increased energy and alertness
  • Drowsiness
  • Cough suppression
  • Pain reduction
  • Psychosis
  • Weight loss

While not all of these effects are necessarily negative, some negative short-term effects include:

  • Tremors
  • Dizziness
  • Nausea and vomiting
  • Constipation 

How Long Does Kratom Stay In Your System?

There is currently no drug test for kratom. However, the duration of the chemicals presence in your body lasts due to:

  • Frequency of use
  • Age
  • Genetics
  • Body fat
  • Metabolic rate
dxm and kratom

Mixing DXM and Kratom

It is possible to abuse both DXM and kratom to provide a sedative effect on the mind and body. While DXM may do a better job at this than kratom, mixing the two substances can greatly enhance the suppression effects. If taken at the same time, bodily function and critical organs may slow down to a dangerously low point, putting the user at risk of an overdose. The use of Naloxone has been proven to work against a patient overdosing on DXM and may save their life. 

Treatment

Cough syrup addiction and the tendency to mix it with other drugs as seen in popular culture presents a serious risk to those who do not understand the dangers. If you or a loved one is struggling with cough syrup abuse or addiction, please contact us today so we can begin the journey to a sober life.

Percocet Addiction

Opioid drug addiction and abuse has been on the rise in the US for some years now and is responsible for more deaths than motor accidents. Opioids also account for a majority of overdoses and have become a major problem in the US. Opioid addiction is a very concerning issue which many people do not fully understand. However better knowledge of the effects and dangers of drugs may help prevent users from falling victim to the drug. It is important to recognize Percocet addiction and take it seriously.

What is Percocet?

Percocet is the brand name for the combination of oxycodone (an opioid) and acetaminophen (commonly seen in brand name Tylenol). The acetaminophen present in Percocet helps boost the effectiveness and potency of oxycodone. Percocet is prescribed to individuals who are dealing with moderate to severe pain and can also be prescribed to those who struggle with chronic pain. 

Percocet can have some severe side effects even if taken responsibly, such as:

  • Hypothermia
  • Vomiting
  • Visual disturbances
  • Insomnia
  • Anxiety
  • Hallucinations
  • Increased thirst
  • Hypo-tension or hypertension
  • Slowed/repressive breathing
  • Slowed heartbeat
  • Chest pain
  • Jaundice (yellowing of the skin)
percocet addiction

Why are opioids so dangerous?

Opioids relieve pain by binding to the opioid receptors in the brain which activates them. These receptors are a part of a system of proteins known as G protein-coupled receptors (GPCRs). They work great as painkillers but can be very dangerous given their addictive nature. When opioids are taken, most people will feel a slight euphoric high. It will calm them down and make them feel relaxed. The issue is that users will build a tolerance to opioids.

percocet addiction

A tolerance is when your body essentially gets accustomed to the chemical and will develop a resistance to its effects- prompting users to take more for the drug to be useful. If someone is abusing this drug just to achieve a high, they run the risk of developing a tolerance and continually increasing their dosage to achieve the same high. At a certain point, the drug will become overpowering and cause an overdose. Most overdoses will cause the complete suppression of the central nervous system which in turn causes critical bodily functions such as breathing to completely stop.

Abuse vs Addiction: What is an addiction?

In the world of drug use, abuse and addiction can mean different things and it is important to understand the differences as it can determine what kind of treatment you need.

 Abuse

Abuse is the misuse of any drug. Instances of abuse include:

  • Taking more than the prescribed amount of a drug
  • Taking someone else’s prescriptions
  • Using non prescribed drugs to alleviate stress or experience a euphoric high

Taking any drug in a manner inconsistent with its labeling can be considered abuse. However, you are usually able to stop your habits relatively easily which is one of the key differences between abuse and addiction.

Addiction

An addiction is considered to be a chronic disease which is characterized by compulsive drug use and the inability to stop using even when the negative effects are known. Given that addiction is a chronic disease, it is common to see former addicts relapse. In fact, addiction has similar relapse rates as other chronic diseases such as type II diabetes.

Percocet addiction is no different. Users who have become dependent on the opioid will find it difficult to effectively become sober- but that does not mean it is not possible. 

percocet addiction

How long does Percocet stay in your system?

Percocet has a half-life of around 3.5 hours. A substance’s half-life will determine how long it takes for the substance to reduce to half of the taken dose to eliminate from your system. However, the substances that make up Percocet and that are unique to the drug (also known as metabolites) can have a longer half-life. It takes around 19 hours for the drug to leave your system. However, it is possible to detect for some time after that. 

Generally, it is possible to detect Percocet in your system via:

  • Saliva 1-4 days after ingestion
  • Urine 3-4 days after ingestion
  • Hair upto 90 days after ingestion

Keep in mind that these figures are for Oxycodone and by extension all opioids. There are a lot of other factors which may affect how long Percocet can be detected in your body such your weight, usage history and metabolism. 

Percocet Addiction Help and Treatment

As previously mentioned, addiction is a chronic disease which has a high potential for relapse. Therefore it is always recommended that anyone seeking treatment do so under the supervision of a professional who is trained to assist individuals who are on the road to recovery. Further, with the risk of withdrawals, it is never recommended that you try and go ‘cold turkey’ on your own. If you or a loved one is suffering from addiction, please contact us today so we may begin your path to a sober life, together. 

Ativan and Alcohol

Mixing alcohol with most drugs is likely to nearly always have a negative effect on the body. Many people are hoping to heighten the “positive” effects each drug. However, they do not realize that this also significantly heightens the negative and dangerous effects. Of course, there are ways to prevent the accidental mixing of drugs. However, it is the intentional mixing of two drugs which becomes a serious cause for concern. With the increase in anxiety disorders in the US, there is a correlating increase in the amount of drugs prescribed to treat such ailments. Ativan and Xanax are both drugs with a large number of prescriptions to patients who deal with issues such as anxiety. Further, some people use alcohol as a means to deal with anxiety. Ativan and alcohol are a common and dangerous combination.

What is Ativan?

Ativan is a benzodiazepine with use as a sedative, muscle relaxant or tranquilizer. It is also the brand name for the drug lorazepam. It is in the class of psychoactive drugs. Further, it is one of the most abused pharmaceutical drugs in the US. Other benzodiazepines (or ‘benzos’) include Xanax and Valium. Ativan may be prescribed to treat patients who suffer from:

  • Anxiety
  • Nervous tension
  • Psychological issues
  • Insomnia
  • Epilepsy

Ativan users develop a tolerance over time. A tolerance is the body’s way of getting used to a drug. Overtime, a user will need to continually up their dosage in order to feel the same effects. Thus, because Ativan is such a potent drug, it is rarely prescribed for periods over 4 months. 

Ativan, like most other benzos, works by blocking the gamma-aminobutyric acid (GABA) neurotransmitter to essentially slow down overactive mental processes. It is commonly sold in a tablet/pill form and takes around 45 minutes to start feeling the effects. Xanax operates much in the same way as Ativan, but Xanax is more popular in mainstream culture and on the streets. Given that Ativan is a depressant, the side effects will include drowsiness and tiredness. Some other side effects include:

  • Dizziness
  • Muscle weakness
  • Headache
  • Blurred vision
  • Insomnia
  • Nausea
  • Vomiting
  • Skin rash
ativan and alcohol

Ativan Abuse and Addiction

Ativan is considered to be a Schedule IV Controlled Substance by the Drug Enforcement Agency (DEA). According to the DEA, a Schedule IV substance is one which has “a low potential for abuse relative to substance in Schedule III.” DEA definitions are based on a relative scale where the drugs are essentially compared in their potential for abuse. While the definition for Schedule IV includes “low potential for abuse”, it is important to realize that it is in comparison to much more potent and dangerous drugs such as Ketamine or Codeine. So make no mistake, Ativan is still very dangerous. So, is Ativan addictive? Absolutely, because not only does Ativan create a physical dependence but it also creates a psychological one. Users who abuse Ativan will likely see the negative consequences in their life but will still continue to abuse the drug. 

According to the National Institute on Drug Abuse, benzo related overdoses have risen from 1,135 in 1999 to 11,537 in 2017- that is a 916% increase. As a central nervous system depressant, Ativan will slow and suppress the activity of crucial organs such as the lungs. In some cases, taking too much Ativan can completely stop your breathing. 

ativan and alcohol

Knowing the signs of an overdose can save your life or the life of someone else:

  • Pale, cool, bluish skin or lips
  • Very shallow, slow breathing
  • Over-sedation
  • Drowsiness
  • Loss of coordination/motor skills
  • Slurred speech
  • Memory loss
  • Confusion
  • Weakness
  • Loss of consciousness
  • Muscle weakness
  • Unresponsiveness

Any overdose is a serious medical emergency and requires immediate attention. 

How Long Does Ativan Stay In Your System?

The half-life of Ativan is around 12 hours. A chemical half-life is the determination of how long it takes for the chemical to reduce to half of its initial ingested amount. 10mg of Ativan will take 12 hours to effectively become 5mg in the body. However, an active metabolite of Ativan, glucuronide has a half life of 18 hours. It takes around 5 days for 95% of the lorazepam to leave your body. While the drug may have left your body, traces of it and its metabolites may remain longer in the body and can be detected with various tests.

Ativan can be detected in your system by:

  • Urine- up to 6-9 days after ingestion
  • Blood- up to 3 days
  • Saliva- around 8 hours
  • Hair follicle- up to 4 weeks
ativan and alcohol

While these figures can provide a good estimation of the effectiveness of drug tests, there are several other factors which must be considered when determining how long Ativan stays in your system.

  • Body composition- your build/composition will play a big factor in how long traces can be detected. Everything from your height and weight, genetics, metabolic rate, age and body fat percentage.
  • Frequency of use- your history with Ativan (essentially any benzodiazepine) will determine how well your body processes it. As previously mentioned, Ativan users will develop a tolerance which will then increase how long it takes for your body to process the drug. 

Mixing Ativan and Alcohol

Ativan and Alcohol are both central nervous system depressants. They both release GABA which decreases and slows bodily and nerve function. The effects of both drugs are quite similar. The biggest risk of mixing the drugs is the possibility of an overdose. Slowing down bodily function will lead to a drop in blood pressure and slowed breathing. In some cases, breathing can completely stop leading to a blackout and overdose. Taking the drugs together may also lead to engaging in dangerous behavior such as driving or taking other serious risks.

ativan and alcohol

How To Get Help

Dealing with alcohol or benzodiazepine addiction can be difficult. It can impact all aspects of your life and usually requires the help of trained professionals to help you along your journey to recovery. It is important to find treatment that addresses addiction issues as well as mental health. If you or a loved one needs help, please contact us today.

Melatonin and Alcohol

Melatonin is a naturally occurring hormone in humans. However, it is increasing in popularity as a supplement as a sleeping aid. When taken in its correct dose, melatonin is very effective. But what if you have been drinking and want to take melatonin? What are the risks? These are important questions to consider when taking any drug or combining drugs. Melatonin and alcohol are both common substances. While the combination is not deadly, there are potential risks to consider. It is important to consider this with any substances.

What is Melatonin?

Melatonin is a hormone responsible for regulating the sleep-wake cycles our bodies naturally develop. Melatonin releases during the night or evening as the light around us decreases. Long before the abundance of technology, there was no exposure to artificial light such as that produced by our cellphones and laptops. Historically, the setting sunlight and onset darkness were the only things to help the release of melatonin. Light stimulates the suprachiasmatic nucleus (SCN) which resides in the hypothalamus part of the brain. With light exosure, the SCN sends signals to the brain to release certain hormones such as cortisol, increase body temperature and prevent the release of melatonin. However, without light, the SCN essentially allows for the release of melatonin. 

Most of us know the news reports and medical journals advising us to avoid cell phone use before bed. It is because that artificial ‘blue’ light keeps the SCN active. This is preventing the release of melatonin and making sleep more difficult to achieve. Melatonin is also a very powerful antioxidant and is known to regulate fat cells in the body.

melatonin and alcohol

Melatonin is an over-the-counter drug found in most vitamin aisles in stores. There is no need for a prescription. It is usually sold in its pill form, although liquid melatonin is available.

Melatonin Abuse and Addiction

Most people use melatonin to help them fall asleep and there are no well known cases of melatonin abuse. Some individuals experience a decrease in natural melatonin production as they get older. Thus, they take melatonin pills to supplement what their body is already producing. In addition, the supplement is seen as a helpful aid in dealing with jet lag. Generally, melatonin supplements are considered to be safe for short and long term use. Currently, there is little risk of developing an addiction.

melatonin and alcohol

There are no well documented cases of melatonin abuse or addiction. There is no risk of developing a dangerous tolerance as there is with other substances. Subsequently, if you take the same dose everyday you feel essentially the same effects. Although, some feel it is less effective after long-term use. Still, anyone with a family history of addiction, or for themselves, should discuss with a doctor.

How Much Melatonin is Too Much?

While melatonin is a naturally occurring chemical, it is important to take the correct amount. Too little is not enough to help you fall asleep. Further, with too much there are potentially negative effects. It is also possible too much interferes with your sleep cycle. Melatonin does not work the same for everyone. If you are looking for ways to sleep, consider speaking with a medical professional to find solutions.

melatonin and alcohol

Can You Overdose on Melatonin?

While it is important find balance with anything, there are no known cases of melatonin overdose. It is possible that taking too much causes unwanted side-effects such as extreme drowsiness and can cause very vivid dreams. In some cases, taking excessive dosages have been reported to little effect and rather made it more difficult to fall asleep.

Other effects of melatonin include:

  • Headaches
  • Nausea
  • Dizziness
  • Tremors
  • Irritability
  • Low-blood Pressure
  • Tiredness the following day

Mixing Melatonin and Alcohol

Alcohol is a central nervous system depressant. It has sedative effects on the body after just a few drinks. Even though alcohol seems to do essentially the same job as melatonin, mixing the two substances is never recommended. For some, alcohol helps with sleeping. However, it also promotes the release of stress hormones in the body that causes restlessness during sleep. Also, some studies show that alcohol inhibits the natural release of melatonin in the body. It potentially therefore interferes with any supplementation of the hormone. If you need to take melatonin, it is recommended that you wait around 2-3 hours after your last drink to consume melatonin. It is best not to combine another sedative with alcohol, a substance with potentially deadly sedative effects.

The Bottom Line

Melatonin is a rather harmless but useful supplement. Many people rely on it to have a good night’s rest. Some also rely on alcohol to achieve the same effects. Some refer to this as a ‘nightcap’. However, they frequently find that their sleep is more restless. Mixing the two substances is not likely to have deadly consequences as seen when mixing other drugs with alcohol. However, there are still potential negative side effects. Both are sedatives which is where some of the danger is.

Generally, mixing various substance with alcohol is a bad idea. Alcohol is the most abused drug in the world. Yet, the common usage makes it difficult to recognize when it is abuse or addiction. Few also recognize the dangers of alcohol. Further, its interactions with other drugs are potentially deadly. It is always best to discuss interactions of any substances with a medical professional if possible. Someone dealing with alcohol abuse or addiction is at risk. They likely do not realize the danger though of mixing something like melatonin with alcohol. If you or a loved one struggles with alcohol abuse, please contact us today.

Resources:

Suprachiasmatic nucleus and melatonin – Neurology
Blue light has a dark side – Harvard Health Publishing
Significance and application of melatonin – NIH
Alcohol and Fatigue – Harvard Health Publishing
Alcohol and Sleep: What you need to know – Psychology Today

Ambien and Alcohol

Americans are now more distracted than ever. Since the end of the 20th century, more and more screens have been introduced into the average household. Smartphones, tablets, laptops, massive TVs- all contribute to the increase in sleeping disorders. Many people turn to options like Ambien to help. A lot of people in America also drink alcohol, sometimes even with the thought that it helps sleep. Subsequently, the increasing risk of mixing Ambien and alcohol is a real danger.

ambien and alcohol

What is Ambien?

Ambien is the brand name for Zolpidem Tartrate, which is a sedative and falls under the hypnotic class of medication. In general, the purpose is to treat insomnia in patients and is seen as a better alternative to benzodiazepines or barbiturates. Ambien’s design is to provide the same sleep relief as other drugs but without the dangerous side-effects commonly associated with drugs such as Valium. It was approved by the FDA in 1992 during a time where the prevailing sleep-aid, Halcion, was being linked with psychosis, suicide and addiction and was welcomed with open arms. 

ambien and alcohol

Ambien works by binding and activating GABA (gamma-aminobutyric acid) receptors in the brain. GABA is a neurotransmitter which is responsible for blocking impulses between nerve cells in the brain. Ambien binds to the same receptors as benzodiazepines. By binding to the receptors, the chemical essentially slows down brain function, making it easier to fall asleep. While Ambien became popular because it was believed to have less of the harmful side effects of other sleep-aids available at the time, it comes with its own risks:

  • Daytime drowsiness
  • Dizziness
  • Weakness
  • Nausea
  • “Drugged” feeling
  • Insomnia
  • Confusion
  • Headache

Some of the serious side effects of Ambien include:

  • Memory loss
  • New or worsening depression
  • Abnormal thoughts
  • Thoughts of suicide
  • Hallucinations
  • Confusion
  • Agitation
  • Aggressive behavior
  • Anxiety

Ambien Addiction and Abuse

A chemical tolerance is when a higher dose is required to get the same desired results while taking a drug. Essentially, the body gets used to the drug and more of it is required to feel the effects. Unfortunately, Ambien tolerance develops quickly in some patients. Ambien was never designed to be a long-term use drug. However, some patients require their physician to increase the dosage to get the same relief. Increasing the dosage may cause users to develop a dependency to the drug. Some may find that they are unable to fall asleep without it.

ambien and alcohol

In high doses, it is possible for Ambien to provide a euphoric high, which is then be sought after by some. At this point, normal use begins to turn to abuse. According to SAMHSA, Ambien abuse is rare with those who are have a prescription. It is more likely to be with those who acquire it illicitly.

Overdose of Ambien is possible. According to SAMHSA, there were 64,175 Ambien related emergency room visits (ER) and of those 20,793 were related to over-medication. While your risk of overdose will depend on various factors such as body composition, tolerance level and history of use, it is generally considered that taking more than 150mg per kilogram of body weight is lethal. An individual weighing 50 kilograms will need to take 7,500mg of Ambien to experience a fatal overdose. While that may seem like a lot of medication, the 150mg can be greatly reduced when taken with other drugs, especially alcohol. 

How Long Does Ambien Stay in Your System?

Once Ambien enters the body, it takes around 30 minutes for the drug to reach peak potential blood concentration meaning that the full effects are felt around this mark. Compared to other drugs, this is quite fast. However, Ambien has a short half-life of around 1.5 hours. A chemicals half-life is a determination of the time it takes for the chemical to reduce to half of its ingested dose. In other words, after 1.5 hours, the 10mg dose of Ambien is essentially reduces to 5mg. However, it’s possible to feel the effects of the drug for 8 hours and the chemicals will be completely out of the body in about 14 hours. 

It is possible to detect Ambien in the body after the 14 hour mark in various tests:

  • Urine – 72 hours after use
  • Hair – 3 to 5 weeks after use
  • Saliva – 8 hours after use

Drug testing for Ambien is quite rare however circumstances such as traffic incidents may call for testing.

Mixing Ambien and Alcohol

Alcohol is a central nervous system (CNS) depressant. A CNS depressant will slow brain and nerve function thus having an effect on motor and cognitive function. Ambien has very similar CNS depressant effects by binding to the GABA receptors in the brain. Two depressants or drugs mixed together (also referred to as polysubstance abuse) will amplify the overall effects and can pose serious overdose risks. According to the National Institute of Alcohol Abuse and Alcoholism (NIAAA), mixing alcohol with other depressants such as Ambien can cause drowsiness, slowed or difficulty breathing, impaired motor skills, and memory problems. With two powerful depressants working, it can cause breathing to slow to a dangerously low level or stop completely. Death can also occur by engaging in dangerous behavior often associated with alcohol use. 

Getting Help

Getting off Ambien may seem difficult. Especially if the user has been using it for an extended period and believes it is necessary for a good night’s sleep. Someone with a problem with ambien and alcohol needs specialized help. However, with the proper attention and guidance, recovery is possible. If you or a loved one is struggling with addiction, please contact us today to see how we can help.

*Resources:
Hypnotic medications and suicide – NIH
Emergency Department Visits – SAMHSA
Harmful Interactions – NIAAA

Prozac and Alcohol

Alcohol is one of the most widely misused drugs in the world. Given its high popularity and presence in modern culture, it is no surprise that some people experiment and mix alcohol with other drugs. Unfortunately, the dangers of mixing alcohol with other drugs will almost always cause a negative reaction. Prozac and alcohol is a common combination with many people not realizing the dangers.

What is Prozac?

Prozac (brand name fluoxetine) is a selective serotonin reuptake inhibitor (SSRI) antidepressant. It is used to treat major depressive disorder, bulimia, nervosa, obsessive-compulsive disorder (OCD) and panic disorder. It is taken daily in pill or in liquid form and is typically taken for weeks at a time as a long-term treatment option. Fluoxetine works by binding to neurotransmitters in the brain and preventing the release of serotonin. By preventing the release of the chemical, it begins to build up in the brain which improves the transmission of neurons. Ultimately this causes a temporary elevation in mood and can cause euphoric effects. SSRIs are considered selective because they do not affect the release of any other neurotransmitters and are the most common type of antidepressants. Other types of SSRIs used to treat depression include Lexapro, Paxil and Celexa.

In 2017, the National Institute of Mental Health reported that 17.3 million Americans reported dealing with at least one major depressive episode. Further, the National Alliance on Mental Illness reported that 1 in 5 US adults will experience a mental illness at some point in their life. With mental illness on the rise, it is not surprising to see an increasing number of people getting prescriptions for antidepressants such as Prozac. More access to antidepressants may encourage the mixed use with alcohol which can be dangerous.

prozac and alcohol - major depressive episode

Common side effects of Prozac are:

  • Headache
  • Nausea
  • Diarrhea
  • Dry mouth
  • Nervousness
  • Restlessness
  • Fatigue
  • Insomnia

How long does Prozac stay in your system?

Prozac is a long-term drug. Its main chemical, Fluoxetine has a half-life of around 2-4 days whereas its metabolite (norfluoxetine) has a half-life of 7-15 days. A half-life is the determination of how long it takes for a chemical to breakdown into half of its original strength. Therefore, it can take around 4 weeks to completely remove Prozac from the body. 


One main advantage of a longer half-life is that it covers individuals who miss a daily dose and prevents them from developing SSRI Discontinuation Syndrome.

What is Alcohol

Alcohol is a very common drug so naturally, most people know what it is. However, it can still be beneficial to understand what kind of effects it has on the body as it can inform you on how it will interact with a drug. What people most commonly refer to as alcohol is actually ethanol. It is a central nervous system (CNS) depressant which works to slow breathing, heart rate and cognitive function. Some believe that in low doses, alcohol works as a stimulant. This is because it can make people feel more relaxed or can take the edge off in social situations. However, this is not entirely true as those feelings of relaxation and calm are created by the depressive effects of the alcohol. How much the alcohol affects you really depends on various body composition factors such as how much you have eaten, body weight and drinking history. 

prozac and alcohol

Some common side effects of alcohol include:

  • Slurred speech
  • Drowsiness
  • Vomiting 
  • Diarrhea
  • Upset stomach
  • Headaches
  • Breathing difficulties 
  • Distorted vision and hearing 
  • Impaired judgment 
  • Decreased perception and coordination 
  • Unconsciousness 

Mixing Prozac and Alcohol

The purpose of Prozac is to provide a calming effect and elevate mood. However, similarly to alcohol, Prozac can cause motor coordination and movement to worsen and can also affect alertness. The synergistic effects of mixing two drugs that affect movement and attention can cause an overall powerful depressive effect on your body’s nervous system. Further, the combination of the two can cause extreme drowsiness which can in turn lead to dangerous behavior. If you take Prozac and drink a light amount of alcohol- one you are usually comfortable driving with, you may not notice the overpowering effects until it is too late. The abuse of multiple drugs is polysubstance abuse.

prozac and alcohol

Effects of Mixing

An important tip to keep in mind is that alcohol tends to enhance the effects of any other drugs combined and vice versa. So in general, mixing alcohol with any sort of drug should always be avoided. Mixing Prozac and alcohol can also lead to suicidal thoughts and feelings of hopelessness. It is possible for alcohol to be a catalyst for depressive thoughts and feelings. Thus, drinking alcohol while dealing with symptoms of depression is not advised.

Even though Prozac should help reduce your symptoms of depression, the alcohol will likely be overpowering. One study even found that the “level of baseline alcohol consumption was significantly related to poorer response to Fluoxetine in a sample of depressed outpatients who did not abuse substances” and that alcohol use in general causes individuals to stop taking antidepressants for treatment.

It is also possible that the loss of effectiveness with Prozac can lead to less effective treatment with other drugs such as Lexapro.

Other side effects of mixing Prozac and Alcohol include:

  • Worsening depressive condition
  • The effectiveness of Prozac decreases
  • Drowsiness
  • Decreased alertness
  • Increase risk of alcohol addition

You do not need to take Prozac and alcohol at the same time to feel their mixed effects. Prozac is a long-term medication. Its main chemical Fluoxetine and the other metabolites/chemicals will last in your body for some time. Subsequently, taking alcohol at any point during that period can cause a mixed reaction.

Treatment

Prozac is meant to help a number of conditions, and for many it does. However, it should only be taken under a doctor’s supervision. Mixing two substances can be very dangerous. Further, it can be made even worse if you are dealing with depression or alcohol abuse. If you or a loved one is dealing with depression or drug abuse, please contact us today.

Kratom and Alcohol

Kratom is a plant native to Southeast Asia. It is typically used for recreational purposes and has slowly made its way into the US market. Its leaves contain chemicals which produce a psychotropic (mind-altering) effect when ingested. While there is a lack of any known medical properties, there is currently no federal widespread ban on the drug. In fact, it is pretty easy to buy online in various forms. While it is not illegal in most states, that does not mean it can not be deadly or harmful. As many people consume alcohol, they will possibly mix Kratom and alcohol without realizing the potential risks.

Kratom 101

Kratom is the name given to the Mitragyna speciosa species of trees. It goes by several other names such as Biak, Ketum, Kakuam or Thom. In its native regions, Kratom is used as a painkiller and stomach medicine but has no legitimate medical use. It is typically found online in its powdered or capsule form, but the leaves can be eaten raw or crushed. 


The Drug Enforcement Agency (DEA) classifies drugs in the US under several schedules. A schedule 1 drug for example is considered to have a very high risk for abuse and has no accepted medical purposes. Drugs such as marijuana and heroin are considered schedule 1 drugs. The DEA however has not scheduled Kratom under any of its classifications. Still, the DEA has listed Kratom as a ‘Drug of Concern.’ There is a push to make the drug illegal in the U.S. and in fact, 7 states have so far made it illegal to possess or use.


In 2016, the DEA announced that it was going to place Kratom under a schedule 1 classification. However, later in the year, the agency withdrew their notice of intent and began “soliciting comments from the public regarding the scheduling of mitragynine and 7-hydroxymitragynine under the Controlled Substances Act”. There have been no significant updates since then.

kratom and alcohol

Kratom Side Effects

Kratom effects on the body can be unpredictable. In low doses, the drug acts as a stimulant, causing users to feel an increase in energy and alertness, but can also have sedative-like effects when taken in high enough doses. The two main compounds in the leaves, mitragynine and 7-a-hydroxymitragynine, bind to the opioid receptors in the brain which can cause sedation, a euphoric high and pain killing effects. 

Kratom presents similar properties as some opioids. One of the cases for making Kratom a controlled substance rather than outright banning it is because some believe it can be used to treat opioid addiction. While there still needs to be more clinical trials to prove this, there is a push to keep it legal in the U.S.

Significant research is still necessary on Kratom, and it is difficult to say with certainty what effects Kratom will have on users. In general, users can expect to experience:

  • Disrupted sleep
  • Increased energy and alertness
  • Drowsiness
  • Cough suppression
  • Pain reduction
  • Psychosis
  • Weight loss

While not all of these effects are necessarily negative, some negative short-term effects include:

  • Tremors
  • Dizziness
  • Nausea and vomiting
  • Constipation 
kratom side effects

Mixing Kratom and Alcohol

It is difficult to predict what the effects of mixing kratom and alcohol might be. Generally, mixing alcohol with anything is inherently dangerous. Mixing two or more drugs (also known as polysubstance abuse) will generally cause the effects of the one drug to enhance the effects of each other, in particular the negative effects. Kratom can present sedative or stimulant properties while alcohol is a central nervous system depressant.

Given that Kratom can enhance the effects of alcohol, mixing the two drugs can cause the depressive effects of alcohol to be enhanced and as a result lead to alcohol poisoning or death. According to the National Poison Data System, between 2011-2017 there were 11 deaths associated with Kratom use. Nine of those deaths involved other drugs such as alcohol, fentanyl, cocaine, benzodiazepines and even caffeine.

Additionally, substance use often lowers inhibitions and causes impaired judgement. The more substances are added, the more at risk someone might be for potentially serious consequences.

kratom and alcohol

Is Kratom Addictive?

There are two different types of addiction: chemical and psychological dependence. Given the similar effects to opioid drugs, it is very possible for an individual to become addicted to Kratom. It is still yet to be seen how severe Kratom addictions can be, as there lacks any clinical trials or an abundance of data to draw a conclusion from. Some users have reported becoming addicted to Kratom and have even experience Kratom withdrawal symptoms such as:

  • Muscle aches
  • Irritability
  • Hostility
  • Aggression
  • Emotional changes
  • Involuntary movements
  • Runny nose
  • Insomnia

You can also develop a tolerance to Kratom, where you will need to take more of the drug to feel the same effects.

How long does kratom stay in your system?

There are currently no specific drug tests to detect the presence of Kratom in the body, most likely due to the obscurity of the drug. However, like most other substances, the duration of the chemical traces in your body will depend on the following factors:

  • Frequency of use
  • Age
  • Genetics
  • Body fat
  • Metabolic rate

There is no known half-life for Kratom but one the primary alkaloids found in Kratom, mitragynine, has a half-life of around 24 hours. Essentially, it would take a person a full day to remove 50% of the alkaloid and the alkaloid can be detected in some drug tests. 

kratom and alcohol

Treatment

With the lack of research on Kratom, it may be easy to believe that the drug cannot be dangerous. Its lack of popularity is not due to medical acceptance as the drug can still be very dangerous when misused. Alcohol is legal and widely used, but also presents serious risk of misuse, abuse and addiction. More research is necessary on Kratom and alcohol, but it is better not to mix at all. Staying informed on the dangers can help keep you safe against abuse, addiction, or overdosing. If you or a loved one are struggling with addiction, please do not hesitate to contact us

Sober Living


Sober home living can be beneficial to anyone who is looking for a stable environment to assist them in transitioning from an inpatient program to living a free, independent and sober life. Sober living homes offer the flexibility and freedom of living on your own while still reinforcing lessons learned in rehab. Most sober homes require individuals to have successfully completed some inpatient recovery program in order to live at the residence.

What is a sober living home?

Sober living homes are group homes which are completely free of drugs or alcohol. It is essentially like renting a home with roommates- except with more rules. The residents are there to adjust to daily life outside of an inpatient rehab program. They do so while being surrounded by a supportive community of people also recovering from addiction. Residents will typically pay rent and pull their fair share of work by cleaning and maintaining the property. Individuals will also likely have to actively participate in regular meetings and some homes may require random drug testing. Homes may also have a resident manager who supervises the house and enforces the rules.

However, for the most part, residents are in complete control of their own recovery. This allows them to develop strong life management skills and increases their chances at long-term sobriety. They are free to come and go as they please whether that be for work, family or leisure activities.

sober livingOften times, someone in recovery will relapse and go back to their old life where they are surrounded by negative influences. Addiction is considered a chronic disease which means it has the same relapse rates as other chronic illnesses such as hypertension and asthma. Therefore, relapse is not only possible, but likely. Sober living homes, however, can take some of that pressure off by placing individuals in a highly supportive but monitored environment. At Reflections, we offer an Aftercare Plan for individuals who are looking for continued support in their journey to life-long sobriety.

sober living - aftercare plan

What is the difference between a sober house and halfway house?

It can be easy to confuse sober homes and halfway homes as they essentially provide the same service. However, halfway homes are typically associated with government housing which is provided as a transition for those recovering from addiction. In some cases, halfway homes are reserved for formerly incarcerated individuals (though this is not always the case). Halfway homes also tend to be cheaper than sober living homes as they are more crowded, state funded and provide less amenities. 

According to a study published in the Journal of Psychoactive Drugs, the essential characteristics of a sober living home which distinguished itself from a halfway home are:

1) An alcohol and drug free living environment for individuals attempting to abstain from alcohol and drugs.

2) Members are either mandated or strongly encouraged to attend 12-step self-help groups such as Alcoholics Anonymous (AA).

3) Required compliance with house rules such as maintaining abstinence, paying rent and other fees, participating in household chores and attending house meetings.

4) Resident responsibility for financing rent and other costs.

5) Residents are able to stay in the house as long as they wish if they comply with house rules.

How much do sober living homes cost?

Sober homes will typically cost the same as an apartment in the area you are looking at. Locations such as San Francisco or New York will cost more than our locations in Prescott. They can range from $300/mo to $2000/mo.

sober living - financingSome homes will accept insurance however it is up to your insurance company to determine how much they will cover. Reach out to the home and work directly with them and your insurance to see how you can cover costs. 

It is possible your insurance will not cover any of the costs or you do not have insurance. However, you still have some options to pay for your sober living:

  • Scholarships: Some homes will offer its residents scholarships if they have shown commitment and dedication to staying sober.
  • Finance the cost: Using your personal savings, bank loans or credit cards can help you pay for a sober house.
  • Earn an Income: Sober homes allow you to come and go as you please which provides the opportunity to work and earn an income.
  • Payment Plan: Some homes will allow you to set up a payment plan which will break down the overall cost of living into bite size chunks.

How long can I stay in a sober home?

The duration of your stay will differ depending on your needs. However, people can spend anywhere from 3-24 months at a sober home. Generally speaking, this will allow you adequate time to situate yourself with a job and develop confidence in your sobriety.

As stated above, often those in recovery face challenges to their sobriety when they return to the same life. Often, though not always, people were in situations that contributed to substance abuse and addiction. It is important to seek help for as long as needed. Further, a good treatment center will help patients figure out the best plan after completing treatment. Sober living is important to recovery and should not be discounted. In recovery, the initial few months and even year are often the most vulnerable.

Continue Your Journey With Us

Time at a sober living home is limited. Therefore it is important that you develop skills, relationships and resources to maintain sobriety when you eventually leave. Here at Reflections we emphasize the necessary skills to best prevent or manage relapse and continued sobriety. However, in order to reside in a sober home, you must successfully complete an inpatient rehab program such as the ones we offer at our Prescott location. We are here to help you on your journey, contact us today if you or a loved one is in need of assistance.

 

 

Tramadol and Alcohol

Tramadol and Alcohol

Tramadol is an opiate analgesic (or narcotic). To this end, its purpose is to treat moderate to severe pain. As an opiate, there’s a significant risk of addiction and this increases with long-term use.* For the most part, it’s meant to help people that need 24/7 help for their pain. The need for continuous pain management contributes to the potential for long-term use – something medical professionals should monitor. Tramadol, like any opiate, should only be used under medical supervision. Likewise, it should not be stopped without medical supervision. Of course, someone taking tramadol might not always disclose use of other substances. In spite of the danger of mixing substances, a somewhat common combination is tramadol and alcohol. 


The mixture of tramadol and alcohol might not result in overdose every single time, but there is always the risk. Indeed, excessive alcohol intake significantly increases the risk, according to the Centers for Disease Control and Prevention (CDC). Further, they state there is no safe use of alcohol and opioids. Additionally, most people likely do not realize how few drinks it takes to reach excessive or binge-drinking levels. Increased consumption of alcohol heightens the effects of alcohol increasing the risk when combined with tramadol. To this end, excessive alcohol use can depress the central nervous system, impairing breathing. Likewise, a side effect of opioids is also suppressed respiratory function. As stated by the CDC, there is really no safe combination of tramadol and alcohol, and the risk increases the more either substance is used.

How long does tramadol stay in your system?

Tramadol comes in different forms (tablets, capsules, drops, injections, etc.) as well as slow-acting and fast-acting forms. According to the National Health Service (NHS-UK), fast-acting will work within 30 to 60 minutes. This is better for pain that is expected to only last for a short term. Slow-acting will be released into the body over 12 to 24 hours and will take longer to work, but will last longer. Thus, this is better for long-term pain management. What is more, it’s important to take Tramadol only under medical supervision. 


Depending on the dose and length of time, someone might have different reactions with tramadol and other substances. Above all, it’s important to communicate consumption of any other substances with medical professionals. According to the Mayo Clinic, tramadol and Tylenol (acetaminophen), is a safe combination. However, it is still best for anyone taking tramadol to communicate with their doctor if they are taking any other type of medication.

Tramadol Side Effects

Some common side effects of tramadol can include:

  • Headaches
  • Dizziness
  • Fatigue, low energy
  • Trouble concentrating
  • Sweating

These symptoms are common and not immediate cause for concern. However, anyone should always communicate with their doctor any concerns. 

Tramadol Withdrawal Symptoms

Under proper medical supervision, tramadol should not cause serious issues or withdrawal. However, it is possible for someone to mistakenly take an extra dosage, miss one or more doses, mix with other substances that cause issues, or even of course be using tramadol illegally. Ultimately, any of these possibilities, and many others, can cause someone to experience tramadol withdrawal symptoms. Equally important, sudden disuse of tramadol is more likely to cause withdrawal, so when possible it’s best to taper off with the help of a medical professional.

Tramadol withdrawal symptoms may set in 12-20 hours after the last dose. Symptoms can include:*

  • Numbness
  • Tingling
  • Tinnitus

Psychiatric withdrawal symptoms might include:

  • Hallucinations
  • Paranoia
  • Panic attacks
  • Confusion

With this in mind, it’s important for anyone experiencing tramadol withdrawal symptoms to seek medical help right away. Moreover, it’s important to call 911 if anyone’s in immediate danger or in fear of overdose.

Tramadol Overdose

Under proper medical supervision overdose is not common. However, even someone using under supervision may accidentally take too much tramadol. As a result of tramadol misuse, from 2005 to 2011, emergency-room visits from tramadol misuse tripled to 21,469. In regards to what tramadol overdose looks like, the a Wall Street Journal article states, “Excess tramadol intake tends to cause seizures and a fast collapse.” 

According to a U.S. National Library of Medicine resource, other symptoms of overdose include:

  • Difficulty breathing
  • Extreme drowsiness
  • Unconsciousness 
  • Slowed heartbeat
  • Muscle weakness

Again, under proper medical supervision the chance of overdose should be extremely low. However, mistakes happen as well as abuse being a common reality. It’s important for anyone using tramadol to be aware of the signs, as well as those with loved one’s using tramadol. Should you or anyone experience these symptoms as a result of tramadol use, it is important to call 911 as soon as possible.

Treatment

Most resources affirm that low-dosage, short-term use of tramadol under medical supervision shouldn’t result in addiction or serious health problems like withdrawal or overdose. Nonetheless, many people react differently and it’s always important to watch out for side effects and other problems. In many countries, this has led to a lack of oversight over the usage of tramadol. Moreover, in the United States, it was not controlled at a federal level until a few years ago. This allowed (and continues to allow) widespread use and abuse around much of the world. While it’s not as strong as morphine, it’s still an opioid and has the potential for abuse and addiction. 

If you or a loved one are struggling with tramadol abuse or addiction, we can help at Reflections Recovery Center. We can provide help and resources for intervention, if needed. Initially, each client goes through an assessment, which will help us determine if detox is necessary. We offer a 5-day detox program. Throughout treatment, we will help our clients improve their physical and mental health as well as providing the skills to maintain sobriety long after treatment. In addition to this, each client goes through an assessment so that we can determine what exactly they need. No person is the same, nor is their experience with addiction the same. Therefore, we form a treatment plan around each person’s unique needs. If you or a loved one needs help, please reach out today.

*Resources:
Tramadol: MedlinePlus Drug Information. (2019, June 17). Retrieved July 23, 2019, from https://medlineplus.gov/druginfo/meds/a695011.html

Alcohol Screening and Brief Intervention for People Who Consume Alcohol and Use Opioids. Retrieved July 23, 2019, from https://www.cdc.gov/drugoverdose/pdf/prescribing/AlcoholToolFactSheet-508.pdf

Tramadol. (2018, November 26). Retrieved July 23, 2019, from https://www.nhs.uk/medicines/tramadol/

Tramadol And Acetaminophen (Oral Route) Description and Brand Names. (2019, May 01). Retrieved July 23, 2019, from https://www.mayoclinic.org/drugs-supplements/tramadol-and-acetaminophen-oral-route/description/drg-20062870

Epstein, D. H., Preston, K. L., & Jasinski, D. R. (2010, September 22). Abuse liability, behavioral pharmacology, and physical-dependence potential of opioids in humans and laboratory animals: Lessons from tramadol. Retrieved July 23, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2943845/


Epstein, D. H., Preston, K. L., & Jasinski, D. R. (2010, September 22). Abuse liability, behavioral pharmacology, and physical-dependence potential of opioids in humans and laboratory animals: Lessons from tramadol. Retrieved July 23, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2943845/

Scheck, J. (2016, October 20). Tramadol: The Opioid Crisis for the Rest of the World. Retrieved July 23, 2019, from https://www.wsj.com/articles/tramadol-the-opioid-crisis-for-the-rest-of-the-world-1476887401

Schedules of Controlled Substances: Placement of Tramadol Into Schedule IV. (2014, July 02). Retrieved July 23, 2019, from https://www.federalregister.gov/documents/2014/07/02/2014-15548/schedules-of-controlled-substances-placement-of-tramadol-into-schedule-iv