Does tramadol damage the liver? Tramadol is a narcotic that can treat moderate to severe pain. There have been reports that tramadol may damage the liver. People can reduce the risk of liver damage by avoiding taking tramadol alongside alcohol and certain other drugs.

Tramadol and Liver Damage: What You Need to Know

Tramadol is a prescription drug that can be effective in relieving moderate to severe pain. Healthcare professionals often use it to treat chronic pain or pain following surgery. Tramadol works by altering how the brain perceives and responds to painful stimuli.

However, there has been some debate about whether tramadol can damage the liver. While tramadol is generally safe to use, in certain cases, such as overdose or prolonged use, it may potentially cause liver damage. A 2015 study found a risk of increased liver and kidney damage due to the long-term use of tramadol. Additionally, research has shown that taking tramadol with acetaminophen may lead to complications, including acute liver failure.

Understanding the Risks of Tramadol

Tramadol is a type of opioid, and researchers have found that opioids, in general, have an association with higher incidences of adverse effects in people with existing liver damage. Therefore, individuals with liver damage should not use opioids unless other options are unsuitable.

While tramadol is mostly safe and rarely causes liver damage, in some cases, the drug has contributed to health problems such as seizures, high blood pressure, and heart problems. It is essential to be aware of the potential side effects of tramadol and to take steps to protect the liver when using this medication.

Protecting the Liver When Taking Tramadol

There are several ways in which a person can protect their liver from potential damage when using tramadol:

1. Dosage: Taking the lowest dose possible for the shortest period will reduce the risk of liver damage.
2. Alcohol: Avoiding alcohol while taking tramadol is crucial, as the combination can cause liver damage.
3. Other medications: Certain other medications should be avoided when taking tramadol, including any that may cause drowsiness.

Opioid Use and Associated Risks

Opioid use, including the use of tramadol, carries other associated risks that should be considered:

• Side effects: Common side effects of opioids include constipation, dry mouth, fatigue, headaches, sleepiness, sweating, and vomiting.
• Addiction and misuse: People who take opioids for too long can develop an addiction to the drug, and opioids also have the potential for misuse.
• Withdrawal symptoms: When a person stops taking opioids after prolonged use, they may experience withdrawal symptoms such as shaking and sweating.
• Overdose: Taking a dosage of tramadol that is too high can result in an overdose, which can lead to respiratory depression and potentially death.
• Drug interactions: Tramadol can interact with other medications and cause fatal side effects if not taken properly.
• Serotonin syndrome: Serotonin syndrome is a rare but potentially life-threatening condition that can occur when the body produces too much serotonin or there is an interaction with another medication or substance.

The Importance of Liver Health

The liver is one of the most important organs in the body, responsible for transforming nutrients in food into substances the body can use and filtering toxins from the blood. Many factors, including genetics, diet, alcohol consumption, and lifestyle choices, can affect the health of a person’s liver. Maintaining good liver health is crucial for the proper functioning of the whole body.

Conclusion

In summary, while tramadol is generally safe to use, there is a potential risk of liver damage, especially with long-term use or in cases of overdose. It is essential for individuals taking tramadol to be aware of the risks and take steps to protect their liver health, such as following the prescribed dosage, avoiding alcohol, and being mindful of potential drug interactions. Regularly consulting with a healthcare professional is also crucial when using this medication.

Does tramadol damage the liver?

Tramadol is a narcotic that can treat moderate to severe pain. There have been reports that tramadol may damage the liver. People can reduce the risk of liver damage by avoiding taking tramadol alongside alcohol and certain other drugs.

The reports state that taking this medication in high doses over an extended period may cause liver damage. People should not take tramadol without consulting a doctor.

This article looks at how tramadol affects the liver and the other risks of this medication. It also lists the steps that people can take to protect their liver health.

Tramadol is a prescription drug that can relieve moderate to severe pain. Healthcare professionals use it to treat chronic pain or pain following surgery. Tramadol works by changing how the brain perceives and responds to painful stimuli.

Tramadol is a controlled substance, and a person may only use it under the close supervision of a doctor. This is because tramadol has the potential to cause addiction, and people can misuse it.

Share on PinterestFRED TANNEAU/AFP via Getty Images

There is some debate as to whether tramadol is harmful to the liver. Tramadol is generally safe to use, but in some cases — such as overdose or prolonged use — it may damage the liver.

A 2015 study found that there was a risk of increased liver and kidney damage due to the long-term use of tramadol. Other research has shown that taking tramadol with acetaminophen may cause complications, including acute liver failure.

Tramadol is a type of opioid. Researchers have found that opioids, in general, have an association with higher incidences of adverse effects in people with existing liver damage. Therefore, people with liver damage should not use opioids unless other options are unsuitable.

Tramadol is mostly safe and rarely causes liver damage. However, in some cases, the drug has contributed to health problems such as seizures, high blood pressure, and heart problems.

Learn more about the side effects of tramadol.

There are some ways in which a person can protect their liver from damage when using tramadol.

• Dosage: Taking the lowest dose possible for the shortest period will reduce the risk of liver damage.
• Alcohol: A person should avoid drinking alcohol while taking tramadol, as this can cause liver damage.
• Other medications: There are many other medications that people should avoid combining with tramadol, including any that may cause drowsiness.

Opioid use has other associated risks.

Side effects

Whenever a person takes any medication, there is a risk of side effects. For people taking opioids, these include:

• constipation
• dry mouth
• fatigue
• headaches
• sleepiness
• sweating
• vomiting

Addiction or misuse

People who take opioids for too long can develop an addiction to the drug. This means that they will start to experience a persistent urge to use the drug, despite any negative effects it may have.

Opioids also have the potential for misuse. Misuse happens if a person takes the drug to experience a high or does not follow the prescribed dosage.

It is also possible to develop a tolerance to the drug, meaning that a person needs more of it to feel its effects. This is why it is important for people to stop taking the drug before their tolerance increases.

Withdrawal symptoms

When a person stops taking opioids after taking them for a while, they might experience withdrawal symptoms, such as shaking and sweating.

Learn about the timeline for opioid withdrawal.

Overdose

Taking a dosage of tramadol that is too high can result in an overdose. An overdose can cause respiratory depression, which is when a person’s breathing becomes dangerously slow and shallow. This can lead to death.

Learn how to recognize the signs of an opioid overdose and what to do.

Drug interactions

Tramadol is a drug that interacts with other medications and can cause fatal side effects if people do not take it properly. It is important to know what drugs are compatible with tramadol to avoid any complications.

A person should speak with a doctor about any current medications before they start taking tramadol.

Serotonin syndrome

Serotonin syndrome is a rare but potentially life threatening condition that occurs when the body produces too much serotonin, there is an interaction with another medication or substance, or both.

Serotonin syndrome can cause symptoms such as:

• agitation
• confusion
• hallucinations
• high blood pressure
• irregular heartbeat
• nausea and vomiting
• seizures
• sweating
• tremors

The liver is one of the most important organs in the body. It is responsible for transforming nutrients in food into substances that the body can use and for filtering toxins from the blood.

Many factors can affect the health of a person’s liver, such as genetics, diet, alcohol consumption, and lifestyle choices.

Liver health is important for the proper functioning of the whole body. There are many things that people can do to keep the liver healthy.

These include:

• eating a balanced diet, including plenty of fresh fruits and vegetables
• avoiding alcohol
• avoiding excess sugar and salt
• exercising regularly
• quitting smoking, if applicable

If the damage to the liver is not severe and doctors find it early, it can be reversible. However, if the damage is severe enough, it may be permanent.

Most of the time, taking tramadol will not cause liver damage. Additionally, because healthcare professionals regularly monitor people taking tramadol, they may notice any signs of liver damage early.

Blood tests can help healthcare professionals determine how well a person’s liver works. If the liver shows signs of damage, the doctor may lower the dosage of tramadol or prescribe an alternative medication.

Tramadol can cause liver damage if a person does not take it according to the prescription.

People should always ensure that they take the proper dosage of tramadol and avoid taking other drugs that may interact with it.

A person should not take tramadol if they have any type of kidney or liver disease.

Tramadol – LiverTox – NCBI Bookshelf

Last Update: November 24, 2020.

OVERVIEW

Introduction

Tramadol is an opioid analgesic used for the therapy of mild-to-moderate pain. Tramadol overdose can cause acute liver failure. Pharmacologic doses of tramadol has not been associated with cases of clinically apparent drug induced liver disease.

Background

Tramadol is a synthetic codeine analog that acts as a weak opioid agonist in addition to mildly inhibiting serotonin and norepinephrine reuptake. Tramadol is effective against mild-to-moderate pain, but is not as effective as standard opioids and not recommended for severe pain. Tramadol was approved for use in the United States in 1995 and is currently widely used, with more than 18 million prescriptions written yearly. Tramadol is available in 50 mg tablets in multiple generic forms and under the brand name Ultram. It is also available as tablets of 37.5 mg in combination with acetaminophen (325 mg) both generically and under the brand name Ultracet. The usual dose in adults is initially 25 mg daily, with titration based on effect and tolerance to 50 to 100 mg every 4 to 6 hours as needed for pain, but not to exceed 400 mg daily. Extended release formulations in capsules of 100, 200 and 300 mg are also available (ConZip and generics) and are given once daily. Physical dependence can occur, and while the potential for abuse is less than with more typical opioid analgesics, tramadol is classified as a schedule IV drug and is provided under a risk evaluation and mitigation strategy (REMS). Common side effects are nausea, dizziness, dry mouth, sedation and headache. Tramadol may increase the risk of seizures. It is considered contraindicated in children below the age of 12 because of risk of respiratory depression, and prolonged use should be avoided in pregnancy because of the risk of infant withdrawal syndrome. Rare but potentially severe adverse events include seizures, severe respiratory depression, serotonin syndrome, addiction, abuse and withdrawal syndrome.

Hepatotoxicity

Serum aminotransferase levels can be elevated in a small proportion of patients receiving tramadol, particularly with high doses. Intentional and accidental overdoses of tramadol can cause respiratory arrest as well as acute liver failure, several fatal instances of which have been reported. In these cases, however, the liver injury may have been caused by shock, hypoxia or ischemia secondary to the respiratory arrest. Liver injury attributed to tramadol overdose has also been associated with hyperammonemia, lactic acidosis and hepatic steatosis, suggestive of direct mitochondrial injury. In some situations, acute liver failure after tramadol overdose may be related to acetaminophen taken separately or in combination with tramadol. Clinically apparent idiosyncratic liver injury with recommended doses of tramadol has not been reported.

Likelihood score: E* (unproven cause of liver injury in therapeutic doses but reported to cause liver injury with overdose).

Mechanism of Injury

The mechanism of hepatotoxicity from overdoses of tramadol is not known, but is likely due to direct hepatocellular injury, either as a result of ischemia or mitochondrial toxicity. Tramadol is metabolized by the liver, predominantly by CYP 2D6 and 3A4 to its active form and it can result in troublesome drug-drug interactions.

Outcome and Management

The minor enzyme elevations that occur with tramadol use are usually mild, asymptomatic and self-limited, resolving even with continuation of therapy. Cases of acute liver failure due to tramadol overdose require intensive medical management and can be fatal. In acute overdoses, there may be interaction with other agents capable of causing liver injury (particularly acetaminophen).

Drug Class: Opioids

CHEMICAL FORMULA AND STRUCTURE

ANNOTATED BIBLIOGRAPHY

References updated: 24 November 2020

• Zimmerman HJ. Nonsteroidal anti-inflammatory drugs. Drugs used to treat rheumatic and musculospastic disease. In, Zimmerman HJ. Hepatotoxicity: the adverse effects of drugs and other chemicals on the liver. 2nd ed. Philadelphia: Lippincott, 1999, pp. 517-41.

  (Textbook of hepatotoxicity published in 1999; tramadol is not discussed).

• Yaksh T, Wallace M. Opioids, analgesia, and pain management. In, Brunton LL, Hilal-Dandan R, Knollman BC, eds. Goodman & Gilman’s the pharmacological basis of therapeutics. 13th ed. New York: McGraw-Hill, 2018, pp. 355-386.

  (Textbook of pharmacology and therapeutics).

• Lewis KS, Han NH. Tramadol: a new centrally acting analgesic. Am J Health Syst Pharm. 1997;54:643–52. [PubMed: 9075493]

  (Review of pharmacology, efficacy and side effects of tramadol in management of pain; extensively metabolized in the liver, largely through CYP 2D6; adverse events in 15%, but no mention of hepatic effects).

• Cossmann M, Kohnen C, Langford R, McCartney C. Drugs. 1997;53 Suppl 2:50–62. [Tolerance and safety of tramadol use. Results of international studies and data from drug surveillance] [PubMed: 9190325]

  (Extensive review of side effects of tramadol from phase II-IV studies in 21,000 patients from 1977-93; little evidence of respiratory depression or dependence with oral administration; no mention of hepatotoxicity).

• Bamigbade TA, Langford RM. Tramadol hydrochloride: an overview of current use. Hosp Med. 1998;59:373–6. [PubMed: 9722388]

  (Review of mechanism of action, pharmacology and uses of tramadol).

• Tolman KG. Hepatotoxicity of non-narcotic analgesics. Am J Med. 1998;105:13S–19S. [PubMed: 9715830]

  (Review of liver injury due to analgesics; states that tramadol has not been reported to cause hepatic injury).

• Musshoff F, Madea B. Fatality due to ingestion of tramadol alone. Forensic Sci Int. 2001;116:197–9. [PubMed: 11182272]

  (26 year old man found dead after tramadol overdose; autopsy showed brain edema, no mention of liver).

• Highlights of the 22nd French pharmacovigilance meeting. Prescrire Int. 2002;11:21–3. [PubMed: 11985373]

  (Tramadol reported to interact with warfarin leading to marked increases in INR and bleeding).

• Loughrey MB, Loughrey CM, Johnston S, O’Rourke D. Fatal hepatic failure following accidental tramadol overdose. Forensic Sci Int. 2003;134:232–3. [PubMed: 12850423]

  (Accidental tramadol overdose in 67 year old man taking ~1000 mg daily for 8 days, presenting with respiratory failure, stupor and liver injury [bilirubin 3. 3 mg/dL, ALT 1739 U/L, Alk P 89 U/L, lactic acidosis and hypoglycemia], dying after cardiopulmonary arrest and possibly ischemic hepatic injury).

• Chalasani N, Fontana RJ, Bonkovsky HL, Watkins PB, Davern T, Serrano J, Yang H, Rochon J., Drug Induced Liver Injury Network (DILIN). Causes, clinical features, and outcomes from a prospective study of drug-induced liver injury in the United States. Gastroenterology. 2008;135:1924–34. [PMC free article: PMC3654244] [PubMed: 18955056]

  (Among 300 cases of drug induced liver disease in the US collected between 2004 and 2008, none were attributed to tramadol).

• De Decker K, Cordonnier J, Jacobs W, Coucke V, Schepens P, Jorens PG. Fatal intoxication due to tramadol alone: case report and review of the literature. Forensic Sci Int. 2008;175:79–82. [PubMed: 17875377]

  (28 year old man with acute tramadol overdose suffered cardiopulmonary arrest, was resuscitated, but died two days later with acute liver and renal failure and hyperammonemia; liver biopsy showed steatosis and centrolobular ischemic necrosis).

• Leppert W. Tramadol as an analgesic for mild to moderate cancer pain. Pharmacol Rep. 2009;61:978–92. [PubMed: 20081232]

  (Review of mechanism of action, pharmacology, efficacy and safety of tramadol in mild-to-moderate cancer pain; side effects occur in 1-6% of patients, but serious adverse effects are very rare; hepatotoxicity and ALT abnormalities are not discussed).

• Reuben A, Koch DG, Lee WM., Acute Liver Failure Study Group. Drug-induced acute liver failure: results of a U.S. multicenter, prospective study. Hepatology. 2010;52:2065–76. [PMC free article: PMC3992250] [PubMed: 20949552]

  (Among 1198 patients with acute liver failure enrolled in a US prospective study between 1998 and 2007, 133 were attributed to drug induced liver injury, none of which were attributed to tramadol).

• Björnsson ES, Bergmann OM, Björnsson HK, Kvaran RB, Olafsson S. Incidence, presentation and outcomes in patients with drug-induced liver injury in the general population of Iceland. Gastroenterology. 2013;144:1419–25. [PubMed: 23419359]

  (In a population based study of drug induced liver injury from Iceland, 96 cases were identified over a 2 year period, but none were attributed to tramadol).

• Chalasani N, Bonkovsky HL, Fontana R, Lee W, Stolz A, Talwalkar J, Reddy KR, et al. United States Drug Induced Liver Injury Network. Features and outcomes of 899 patients with drug-induced liver injury: The DILIN Prospective Study. Gastroenterology. 2015;148:1340–52.e7. [PMC free article: PMC4446235] [PubMed: 25754159]

  (Among 899 cases of drug induced liver injury enrolled in a US prospective study between 2004 and 2013, none were attributed to tramadol, other opiates or opiate antagonists).

• FDA warns against use of codeine and tramadol in children and breastfeeding women. Med Lett Drugs Ther. 2017;59(1521):86–8. [PubMed: 28520700]

  (Concise summary of revised FDA recommendations on use of tramadol in children listing it as contraindicated in those below the age of 12 because of risk of severe respiratory depression, cautioning its use in adolescents because of addiction and abuse, and avoidance of prolonged use in pregnant women because of potential of withdrawal syndrome in newborns; no mention of ALT elevations or hepatotoxicity).

• Opioids for pain. Med Lett Drugs Ther. 2018;60(1544):57–64. [PubMed: 29664446]

  (Concise review of the mechanism of action, efficacy, safety and costs of opioids used for pain relief, discusses adverse events or short and long term use of tramadol, but makes no mention of ALT elevations or hepatotoxicity).

New safety data for tramadol

PUBLICATIONS

Relevance

Analgesic
Tramadol has a large number
side effects. However, the results
new French study
talk about the presence of previously unknown
severe disorders of the liver and biliary
ways.

Necessary
note that tramadol is under
pharmacovigilance supervision
in France since 2012 due to reports
on the development of side effects
gastrointestinal tract, and
dizziness, neurological and
psychiatric disorders and
drug addiction. But the situation
is complicated by new damage data
liver, which were obtained in
University research
Medical Center of Toulouse and published
in Therapie magazine.

Methods

Researchers
analyzed all serious
adverse events occurring in
against the background of the use of tramadol in adults,
which were registered in
pharmacovigilance between 1
August 2011 and December 31, 2015.

Results

Average
the age of the patients was 61 years.

• Behind
  the analyzed period of 4.5 years were
  identified 1512 reports of the development of severe
  side effects. Most of
  side effects were neurological
  character (29.4% (of which 13.2% violations
  consciousness, 6.7% convulsions)), psychiatric
  nature (22.8%, of which 14.6% were
  confusion, hallucinations
  (7.3%)) and from the gastrointestinal
  tract (17.0%, of which nausea and vomiting
  were 9.6%).
• unexpected side effects
  effects – hyponatremia, cholestatic
  hepatitis and serotonergic syndromes.
  There was also one case of fulminant
  hepatitis and cases of cytolysis
  (when tramadol was given in combination
  with paracetamol).
• B
  1.5% of cases were reported episodes
  hypoglycemia and 2.3% reported an increase
  INR level, which reflects the process
  coagulation.

Conclusion

Analysis
the safety profile of tramadol has shown
what is the most commonly identified severe
side effects are
neuropsychiatric and gastrointestinal.
However, unexpected
metabolic and hepatic adverse
phenomena. In addition, when exceeding
dose may develop serotoneric
syndromes.

Sources:

Tramadol : nouvelle alerte sur ses risques notamment pour le
foie medisite.fr

Florence Moulis,
Vanessa Rousseau, Delphine Abadie.Effets
indésirables “graves” du tramadol: bilan
2011–2015 de pharmacovigilance en France.

Phenazepam, clozapine, tramadol. Why the police did not notice the serial poisoner in the center of Moscow

Over the past month, at least 24 people have been poisoned in the center of Moscow. On a series of incidents on June 24, the city edition of The Village told. The scenario in all cases was similar: a certain young man treated Muscovites having a rest with a drink, in which he mixed strong drugs. When the victims fainted, he robbed them. NV found out how these substances work and why the police paid attention to these cases only after a wave of publications.

What happened?

In May and June, at least 24 people were poisoned in the center of Moscow. While the victims were unconscious, they were robbed, sometimes beaten. According to The Village, the attacks took place in squares near Chistye Prudy, as well as in the Pit (Khokhlovskaya Square), Gorka Park and the Zinziver bar.

At the beginning of June, passers-by saw a young man who was searching the bags of people lying on the ground. He tried to explain that his friends got sick, so he collects their things “so as not to be stolen.” Passers-by did not believe and called the police. The police, after initiating a theft case, released the alleged offender on bail. After this, the attacks continued, with some victims so severely affected that they lay in a coma for about two weeks. The case received a response when it became clear that the victims of the attacks were journalists – for example, the photo editor of The Village, Lyudmila Chizhova.

The next day after the publication in the media, the young man was detained again.

Who is accused of the attacks?

Murat Sabanov, a 26-year-old native of Kabardino-Balkaria, was detained on suspicion of attacks. Police searched him and found phenazepam, clozapine and tramadol. In the criminal case of the suspect, which was initially initiated under the article on theft (Article 158 of the Criminal Code of the Russian Federation), then an article on robbery was added (Article 162 of the Criminal Code of the Russian Federation).

At the trial, while under restraint, Sabanov said that in Moscow he “worked unofficially” – “was engaged in cargo transportation. ” The defendant’s profile on the profi.ru website indicates that he worked as a loader.

“Open media” found pages in social networks, possibly belonging to Sabanov: he served in the internal troops (now the Russian Guard) until at least 2014. In one of the photos on VKontakte, Sabanov is in military uniform against the backdrop of a shopping center in the city of Sosnovy Bor: not far from there is the military unit of the Russian Guard No. 3705. Moreover, in one of the photos Sabanov has epaulettes of a junior lieutenant.

During the trial, Sabanov said that he had lived in Moscow for five years in a hostel on Basmannaya Street. According to the interrogation protocols, the suspect did not deny that he had mixed phenazepam into the water. The Tagansky District Court of Moscow sent Sabanov to a pre-trial detention center for two months.

Later, the Investigative Committee announced the arrest of a suspect in a similar case. According to investigators, a resident of Tver poisoned a fellow traveler in the Podsolnechnaya-Moscow train with clozapine, who died a few hours later. The criminal case is being investigated under Part 4 of Article 111 of the Criminal Code of the Russian Federation (“Intentional infliction of grievous bodily harm resulting in death”) and Part 4 of Article 162 of the Criminal Code of the Russian Federation (“Robbery”). The investigation believes that the accused is involved in the commission of other crimes on the territory of Moscow, Moscow and Tver regions .

What do we know about the substances found at Sabanov’s?

Most often, such poisoning in the post-Soviet space is associated with clonidine – this is a common medicine for high blood pressure, but in case of an overdose it leads to fainting or even death. Judging by the court verdicts published on the aggregator website sudact.ru, in recent years, clonidine has been used less and less – but such drugs as phenazepam and clozapine have appeared in the prosecution materials.

During a search in Sabanov’s hostel, the police found exactly this set – phenazepam and clozapine, as well as tramadol.

Toxicologist Alexei Vodovozov and psychiatrist-narcologist Oleg Toytman told NV what you need to know about these drugs.

It is easy to explain why these drugs were used. “Of course, I can’t know, but I think that this guy consulted either with a familiar pharmacist or with some medical student. And for medical purposes we have not been using clonidine for a long time, there are newer and more sensible drugs for pressure, here no one remembered him,” says Vodovozov.

Clozapine is a neuroleptic, it has “an unpleasant side effect – orthostatic hypotension: that is, a person tries to stand up, his pressure drops sharply, and after the pressure the person himself falls.” It’s a strong drug used in so-called “big psychiatry” — in cases of schizophrenia or bipolar disorder, Vodovozov says.

“After all, in Russia it is better known under the name Azaleptin, it was he who caused the main toxic effect of these three drugs,” says Oleg Toitman, a psychiatrist and narcologist. Clozapine is used to treat schizophrenia and similar diseases, as a behavior corrector and a typical antipsychotic It is with its overdose that excessive drowsiness, weakness, confusion, muscle relaxation occur, and at high doses – depression, up to coma.0003

Phenazepam is “almost the first” benzodiazepine, quite heavy, “hitting the head and the entire nervous system.” This remedy inhibits the action of brain neurons, it may well be used as a sleeping pill. In large doses, it leads to stunning, confusion and coma, says Vodovozov.

“In principle, this is a very good tranquilizer, although it is quite “old”. At the same time, its effectiveness is much higher than any modern drugs. It is not a very potent drug, but at the same time it has a depressing effect on the nervous system,” adds Toytman .

Acute poisoning can lead to death, especially in combination with alcohol, specifies Vodovozov.

“About tramadol – I’m very surprised why it is needed. It is a synthetic opioid analgesic, a drug. Like any opioid, it has a euphoria-forming effect, however, none of the victims described this,” the toxicologist notes.

Indeed, none of the victims described euphoria, but they complained of shortness of breath. “The first thing a toxicologist might think of when they are told they are having difficulty breathing is opioids. And the second is a benzodiazepine, in our case, phenazepam.”

“This is the safest of the three because it is mainly used as an analgesic. It is quite strong in action, but in principle it can be prescribed to neurologists and therapists and oncologists and a bunch of other doctors. I must say right away that there can be no oppression of consciousness from it, but … when interacting with phenazepam and azaleptin, they enhance each other’s action and the toxic effect on the nervous system is significantly enhanced, ”explains Toytman.

“Why they put it all together is a mystery to me. Maybe, for reliability, they consulted with someone, they were given several different tips, and they combined them for reliability. In fact, each of these drugs separately is more than enough, given that they were given in horse doses, if people immediately fell from one sip,” continues Vodovozov. The toxicologist is sure that the dose was powerful.

Phenazepam, clozapine and tramadol are strictly forbidden to mix with alcohol, but even without alcohol, an overdose of these substances is extremely dangerous and entails not only damage to the nervous system, but also multiple organ failure – that is, damage to the liver (where these substances are activated) and others internal organs. And for each of these drugs, the instructions say: in case of an overdose, coma or death is possible.

Therefore, all three drugs must be dispensed strictly by prescription. “In our country since 9In the early 1900s, there were so-called “station pharmacies” – strange establishments where you can buy almost everything you need. Pharmacy drug addicts have not gone anywhere, there are some pharmacies that almost specialize in this, the main turnover is made precisely at the expense of such clients, “explains Vodovozov.

I decided to try out the method I heard earlier on Chistoprudny Boulevard in Moscow. In this regard, I needed to purchase Phenozipam, which I purchased at the Strogino pharmacy, which was located on the street [address hidden], this pharmacy is not official, and has no signs, this pharmacy sells many medications without asking a prescription for their purchase,” Sabanov said during interrogation (the page of the protocol was published by the “Pravozaschita Otkryki”, spelling and punctuation as in the original).

It is now difficult to understand why these drugs could not be detected during tests during hospitalization. The toxicologist claims that benzodiazepines, like opioids, are routinely tested because they can be used as drugs. It is not always possible to name the exact drug, but the drug class is easy to identify.

“Perhaps the fact is that patients were not delivered to special toxicological hospitals. Our toxicological service was badly damaged during the cuts, there are practically only one department left in large cities. But you need to understand each specific case,” says Water carriers.

Old scheme

The terms “clofelinist” or “clofeliner” came into common use in the 80s and 90s, when poisoning was mainly practiced by sex workers who mixed a client with a sedative and then took away valuables from him . In the “zero” they were joined by taxi drivers, who treated lonely drunken customers to coffee from a thermos, after which the passenger lost consciousness.

After the publication of the incidents of recent weeks, two more people wrote to the NV correspondent who became victims of similar robberies over the past year. So, a young man, who wished to remain anonymous, said that back in September he was robbed when he was drinking in a bar in the evening. “The last thing I remember is how they spilled my cocktail and bought a new one. Then everything, emptiness,” he told NV.

According to the young man, he “was recovering for two days”, and only then discovered that not only had his bank card been stolen, but also a “decent amount” had been withdrawn from it. “There are cameras from an ATM where a person withdraws money. There is card data where the remaining money was transferred, but the case is still suspended, they are not looking for anyone,” the young man complains.

25-year-old Anastasia says that in December a similar story happened to her: “I was sitting at the bar, a man sat next to me and knocked my glass with his elbow. He was very apologetic and convinced that he would buy me a new drink.” After the first sip, the girl became very dizzy, and she went outside to recover in the cold.

“I remember that he came out after me and tried to hug me by the shoulders, took the purse from his hands. Then I immediately realized that there was something wrong in my new glass and, stumbling, ran,” Anastasia said. She was afraid that the man had slipped something into the glass to rape the girl, so she ran “as fast as she could.”

At home, she immediately fell asleep, woke up the next evening and realized that the purse remained in the man’s hands. Anastasia could not remember his signs. “I didn’t go to the police, because I know what they would have answered me there,” the girl summed up.

What do the police say about it?

Artem Fayzulin, a former police captain from the Perm Territory, explained to an NV correspondent the complexity of such cases. According to Fayzulin, the “clofelinist” can walk free for quite a long time.

On the one hand, in most cases, the investigation has at least one victim, since the victims of “clofelins” rarely die, and it is impossible to calculate the dose in such a way as to accurately bring a person to memory loss. Moreover, the investigation often even has fingerprints of the criminal – on dishes or bottles.

“Unfortunately, an identikit is an extremely ineffective measure, making a recognizable portrait is more difficult than it seems. And fingerprints are good either as a reserve for the future, or if the person has already committed a crime and is in the police database,” says the former police officer.

The most effective and common method of catching is the investigation from criminal to crime, says Faizulin. “First (for example, with the help of agents) they find people who they decide to hire, and then they look at what exactly they have done.

Even when the police know exactly which card the stolen money was transferred to, the chain often breaks here: the cardholder is usually a figurehead, a poor student or a marginal element who does not fully understand what he is involved in.

“They only come to him to take money, and they can come once a month, and once every six months – no one will sit in ambush for so long, if, again, it’s not about the series,” explains Faizulin. There is also a more complicated scheme: when a card is ordered through an online bank for false documents. “These cards are brought by a courier who rarely realizes that he has stolen or fake documents in front of him,” says the former police officer.

Articles of accusation for “klonelinschikov” are chosen based on the decision of the Plenum of the Supreme Court “On judicial practice in cases of theft, robbery and robbery. ” “The essence of this explanation of the Armed Forces, roughly speaking, is that if they tore off your hat from your head and ran away, this is robbery, and if you took out a knife and ordered to give your hat back, this is robbery.” That is, if violence dangerous to health is used, the Supreme Court defines this crime as robbery. Accordingly, if the “clofelinschik” deliberately used a dose of a substance dangerous to health or the victim’s health was seriously affected (for example, if the victim fell into a coma), the case qualifies as robbery.

“I assume that this Moscow guy of yours was released on bail so easily, because it didn’t occur to the police that he had used some kind of psychotropic substances. They decided that he simply turned the pockets of drunk people inside out,” Faizulin said. The former policeman explains the inability of the Moscow police to combine such a number of similar poisonings with the poor work of the analytical department, which does not work “in the field”, but is engaged in comparing and identifying a series of crimes in the city.

“I have seen such people: they bring more green ones and sort out papers right away – they haven’t been in the field, they haven’t sniffed the earth, they haven’t seen corpses. They would have sorted through the papers at least wisely,” says Fayzulin. In his opinion, the questions are for analysts, and not for grassroots operatives.

An active member of the Moscow police agreed to talk to the NV correspondent on condition of anonymity. According to him, it is very difficult to work, since Moscow is a big city, “a lot is happening here,” but there is less and less trust in the police.

“A boy of about ten saw me on the street and ran away from me in the other direction! Was it like that in the Soviet Union?” – the 37-year-old policeman is indignant.

There is a lot of work and one has to “set priorities” – which things are more important, he complains. “Of course, you will excuse us, but drunken youth constantly get into some kind of story, we can’t flock to every sneeze all over the city.