Rectal administration of medications

Dear Diego,

Plugging, as you mentioned, is the act of inserting drugs (usually in liquid or powder form) into the rectum to achieve stronger and quicker effects. For some people who can't take medication orally or via injection, rectal administration through enemas or suppositories can be a helpful option. However, plugging isn't recommended by most medical professionals due to the health complications that can occur. Plugging lisdexamfetamine, known more commonly by its brand name, Vyvanse, can lead to rectal bleeding, infection, and even overdose. Due to these potential consequences, it’s recommended that you only take lisdexamfetamine (and all other medications) as prescribed by your health care provider.

Though less advertised and less convenient than oral administration, rectal administration of medication is a common form of treatment. For people with chronic or fatal conditions, many patients are unable to take drugs orally or intravenously due to their health conditions. Therefore, rectal drug delivery can serve as an alternative form of addressing pain. Some of the most common devices used to plug medication are enemas, suppositories, and catheters.

You are correct in bringing up avoidance of the liver. For many drugs, rectal administration means that the liver is at least partially bypassed. As a result, the substance doesn’t experience the same reduction of concentration that happens through oral consumption, meaning that its effects are often stronger. Similarly, the environment of the rectum is generally stable and has low enzymatic activity in comparison to other parts of the gastrointestinal (GI) tract. Therefore, there's a higher likelihood that the drug will be fully absorbed. Depending on the drug, plugging can often result in a more intense high. As a result, some people use rectal administration as a way to abuse substances.

Lisdexamfetamine is a prescription medication commonly used to treat attention-deficit/hyperactivity disorder (ADHD) and binge eating disorder (BED). Unlike some other drugs that are used to treat ADHD, lisdexamfetamine can only work as a central nervous system stimulant after oral ingestion. Therefore, it’s unlikely that you’ll experience any of the benefits of the medication through plugging. While taking lisdexamfetamine can reduce ADHD and BED symptoms, some people may also experience side effects such as insomnia, decreased appetite, nausea, and dizziness.

So if some drugs can be administered through the rectum, is it safe to do the same with lisdexamfetamine? Current research suggests otherwise. When drugs are plugged, the lining of the colon can sometimes become irritated, which can result in bleeding or infection. If you share your plugging equipment with others, you may also be exposed to sexually transmitted infections. Finally, because the high from plugging peaks and fades quicker than highs from other forms of consumption, there’s an increased risk of overdose as some people will use more of the drug prior to it being cleared from the body.

If you want to get the benefits of lisdexamfetamine while simultaneously avoiding potential harm to your rectum, taking the medication as prescribed by a health care provider is the best option. With that being said, if you’re having difficulty quitting plugging, it may be a good idea to speak to both a health care provider and a mental health professional. Together, you can work as a team to establish a healthy relationship with medication and ensure that you feel well both physically and mentally.

Wishing you well,