O-Desmethyltramadol Facts
Opioid;
Description
O-DSMT (O-desmethyltramadol) is a synthetic opioid of the aminocyclohexanol class. It activates opioid receptors in the brain, suppressing pain and producing sedation and euphoria.
Subjective effects include pain suppression, sedation, warmth, emotional calm, and reduced anxiety. The experience is a quiet, enveloping opioid effect — cleaner than tramadol, without the stimulating and serotonergic coloring of the parent compound.
O-DSMT produces physical dependence with repeated use, and slowed or stopped breathing is the mechanism of fatal overdose.[1] The compound remains active far longer than naloxone — the reversal agent — meaning overdose can return after an apparent rescue.
Dose and durationby route · individual sensitivity varies
Starts in 20 – 40 minLasts 6 – 10 hoursAfter-effects 1 – 3 hours
Body and dependence
- Acute toxicity
- High
- Chronic toxicity
- High
- Physical dependence
- Moderate
- Psychological dependence
- Moderate
- Withdrawal
- Moderate · medical supervision
- Compulsive redosing
- Moderate
Tolerance
- Builds
- Moderate
- Fully resets after
- 10.5 days
- Carries over to
- morphine;
oxycodone; fentanyl; heroin; tramadol; codeine; hydrocodone; methadone; buprenorphine
Effectslikely at a common dose
- Perception
- none likely · 1 possible
- Body
- Pain suppression;
Sedation; Pupil constriction; Constipation; Body high; +15 possible, including Nausea, Dizziness, Motor control impairment - Thinking
- none likely · 6 possible, including Cognitive impairment, Compulsive redosing urge, Confusion
- Feeling
- none likely · 3 possible
- Self
- none likely · 1 possible, including Craving
Who shouldn't take it
Combinations62 recorded
Seek help immediately if
- Unresponsive / can't be woken, even to a firm sternal rub
- Slow, shallow, or stopped breathing
- Pinpoint pupils
- Blue/grey lips, fingertips, or skin (cyanosis)
- Limp body; pale, clammy skin
- Choking or gurgling sounds ("death rattle")
- Slow, erratic, or absent pulse
What to do
- Try to wake them — shout their name, firm sternal rub
- Call emergency services immediately
- Administer naloxone if available
- Give rescue breaths (or CPR if there is no pulse)
- Place them in the recovery position
- Stay with them; re-dose naloxone every 2–3 minutes if there is no response
- Reversal agent
- Naloxone (Narcan) — opioid antagonist. May require repeated doses; its effect can wear off before the opioid does.
With prompt naloxone and rescue breathing, reversal is usually rapid. Because naloxone can wear off before the opioid — especially with long-acting opioids (methadone) or high-potency ones (fentanyl) — a period of monitoring is needed even after the person revives.
988 Suicide & Crisis LifelineFireside Project: 62-FIRESIDE
References
- [1]^Kronstrand R, Roman M, Thelander G, Eriksson A (2011) Unintentional fatal intoxications with mitragynine and O-desmethyltramadol from the herbal blend Krypton — Journal of Analytical Toxicology PMID:21513619