Tapentadol (Nucynta) is a Schedule II opioid that’s been quietly growing in prescription and misuse rates, and most people have no idea what it is. While it is an opioid medicine that’s only available with a prescription, it’s not uncommon to be able to purchase it online from other countries like India. Learn more about the dangers of tapentadol abuse and how you or your loved one can begin the path to recovery.
What Is Tapentadol?
Tapentadol is a prescription opioid medication that is used to treat moderate to severe pain. It’s also sold under the brand name Nucynta.
How Tapentadol Works
What makes it unusual is that it has a dual mechanism of action.1 It is a mu-opioid receptor agonist. Similar to oxycodone,2 it activates the opioid receptors in your brain to relieve pain. It is also one of the norepinephrine reuptake inhibitors, meaning it increases the levels of norepinephrine in your nervous system. Tapentadol extended-release tablets are used to treat chronic pain conditions including neuropathic pain, while immediate-release forms are used for acute pain relief.
How Does Tapentadol Compare to Other Pain Medications?
Tramadol is a powerful pain medication used to treat moderate to severe pain3 and is often compared to tapentadol because both medications have a dual mechanism of action. However, there are important differences between the two drugs. Tramadol is considered a weak opioid on its own and depends heavily on liver metabolism to convert it into stronger opioid metabolites. It also works by inhibiting the reuptake of serotonin and norepinephrine.
Key differences and misconceptions about tapentadol:
- Tapentadol is often perceived as safer than other opioid pain medications.
- Many patients experience fewer common opioid side effects, including:
- Constipation
- Nausea
- Vomiting
- Some individuals can achieve pain relief with less direct opioid receptor activation.
- Physicians may view tapentadol as more predictable because its mechanism of action is simpler than tramadol’s and does not rely as heavily on metabolism.
Despite these perceived advantages, tapentadol still carries significant risks. Because it works differently from traditional opioids, some people mistakenly assume it is not a true opioid. However, tapentadol can still lead to physical dependence and serious opioid-related complications, including withdrawal symptoms, respiratory depression, and overdose.
Related: Isotonitazene (“ISO”): The Dangerous Synthetic Opioid Affecting Young Adults
Tapentadol Addiction and Online Purchases
While few have heard about tapentadol, it is becoming a major problem, specifically because it is readily available for purchase from countries like India. According to U.S. Customs and Border Protection, officers have seen a dramatic rise in the amount of prescription pills confiscated from the mail system.4
A large amount of these opioids seized is tapentadol. Some users have reported crushing or injecting tapentadol to intensify its effects, which significantly increases the risk of overdose and other life-threatening complications. Not only is purchasing tapentadol without a prescription illegal, but it also carries numerous risks. Many of these pills may be laced with more dangerous substances like fentanyl, which puts you at an increased risk of overdose.
Related: Cychlorphine: A New Threat to the Opioid Drug Supply and Recovery
What Are the Signs of Tapentadol Misuse and Dependence?
Tapentadol misuse or abuse doesn’t always look like the stereotypical image of a person who is out of control or intoxicated. Many people appear to be functional for quite a while. You may notice some subtle signs at first. These signs become more noticeable as opioid dependence grows.5
Some signs to look out for include changes in:
- Energy and alertness – They may seem unusually sleepy at odd times or appear to “nod off.”
- Eyes – Look for pinpoint pupils, heavy eyelids, and a glazed or distant appearance.
- Coordination – Common clues include clumsiness, slurred speech and slowed reaction time.
A person who is misusing tapentadol may frequently complain about symptoms that don’t add up. These include nausea, dizziness, constipation and headaches. Although these symptoms alone can’t prove misuse, they may be indicative of a problem.
Related: Signs of Drug Use in Your Child
Why Tapentadol Withdrawal Can Be Particularly Challenging
Many people find tapentadol withdrawal very difficult for a couple of reasons. First, it combines the features of opioid withdrawal with the effects related to its ability to inhibit norepinephrine reuptake. This means that a person with a tapentadol dependence isn’t only dealing with the physical effects of coming off an opioid. They also experience significant anxiety, agitation, and central nervous system overactivity.
Tapentadol withdrawal symptoms include:6
- Agitation
- Anxiety
- Achy muscles
- Watery eyes
- Runny nose
- Restlessness
- Sweating
- Yawning
- Diarrhea
- Vomiting
- Stomach cramps
- Intense cravings
Withdrawal symptoms can develop fast, which can overpower the motivation you have to quit. Sleep becomes difficult, and anxiety and physical discomfort grow stronger. As willpower fades, you may take another dose just to find relief.
When withdrawing from a traditional opioid, the symptoms are primarily due to the body trying to adapt to the loss of opioid receptor stimulation. Over time, your brain and nervous system adapt to tapentadol. When you suddenly stop taking it, both systems must adjust, and it’s an uncomfortable experience. This is why cold turkey attempts to quit at home often fail, regardless of how much you may want to quit.
The Risk of Tapentadol Overdose
Tapentadol overdose is a serious and potentially life-threatening situation that requires immediate medical attention. Because many people underestimate tapentadol’s potency as an opioid analgesic, they may take more than intended or combine it with other pain medicines, alcohol, or sedatives, dramatically increasing the risk.
One of the most dangerous signs of overdose is trouble breathing or life-threatening breathing problems, which occur when the drug suppresses the central nervous system to the point where it can no longer regulate normal respiratory function. Other warning signs include chest pain, extreme drowsiness, limpness, and loss of consciousness. If you suspect someone is overdosing on tapentadol, call 911 immediately.
Opioid Recovery: What Comes Next After Detox or Inpatient Treatment?
Completing detox or an inpatient program for Nucynta addiction is a milestone, and you should be proud of the work you’ve put in to get sober. But your recovery after addiction treatment doesn’t end there. Recovery should be viewed as a longer process that takes time.
One of the most vulnerable times after completing detox or an inpatient recovery program comes right after discharge. Detox and inpatient programs are highly structured. However, once you leave the facility, the pressures of daily life creep in again. Many people struggle with triggers, isolation, or the overconfidence that they are able to manage recovery on their own.
While you may physically feel better after detox, you still haven’t developed the coping skills, healthy habits and emotional regulation that are necessary to deal with cravings. That is why the time between discharge and stability is often called the “gap.”
To increase your chances of achieving long-term sobriety, this gap needs to be filled with structure, substance abuse treatment, therapy work, and a positive, supportive community who understands what you’re going through.
Related: What to do After Rehab: Navigating Your New Beginning
How Does Sober Living Help Fill This Gap?
Sober living communities provide an extra layer of support and accountability during opioid recovery.7 While they provide a great deal of structure, you also get to maintain your independence and freedom as you work the program. A sober living facility helps minimize the distractions and temptations you may encounter while helping to keep you focused on the recovery process.
Loneliness is a trigger for many who struggle with prescription opioid abuse. However, if you choose a sober living home, you’ll create meaningful friendships with peers and staff members who understand exactly what you’re going through. You’ll also have the opportunity to participate in sober support groups and learn valuable life skills that will support your sobriety.
Discover a Sober Living Community That Can Support Your Recovery After Opioid Addiction Treatment
Looking for a community that provides continued support after you complete detox or rehab for prescription opioid abuse? Our program provides a safe and comfortable substance-free living environment. Through daily routines, peer support, and guidance from staff who understand, we can help you build the confidence and life skills you need to achieve lasting recovery.
At our sober living in Los Angeles, you can expect:
- Home-like residential housing
- Structured routines to help you create healthy habits
- Individual, family and group therapy
- Life skills training to help you succeed as you move forward
You’ve done the hard work of becoming sober. Let us help you as you navigate the next steps in your sobriety journey. By building the stability you need at our sober living facility, you’ll develop the tools and skills that will carry you through to a healthy, independent life free from addiction.
References
- Alshehri FS. Tapentadol: A Review of Experimental Pharmacology Studies, Clinical Trials, and Recent Findings. Drug Des Devel Ther. 2023 Mar 21;17:851-861. doi: 10.2147/DDDT.S402362. PMID: 36974332; PMCID: PMC10039632. https://pmc.ncbi.nlm.nih.gov/articles/PMC10039632/
- Sadiq NM, Dice TJ, Mead T. Oxycodone. [Updated 2024 Feb 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482226/
- Dhesi M, Maldonado KA, Patel P, et al. Tramadol. [Updated 2024 Feb 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537060/
- U.S. Customs and Border Protection. (n.d.). Opioids, pain pills flood international mail facility at O’Hare. U.S. Department of Homeland Security. https://www.cbp.gov/newsroom/local-media-release/opioids-pain-pills-flood-international-mail-facility-o-hare
- Praveen KT, Law F, O’Shea J, Melichar J. Opioid dependence. BMJ Clin Evid. 2011 Sep 20;2011:1015. PMID: 21929827; PMCID: PMC3275107.https://pmc.ncbi.nlm.nih.gov/articles/PMC3275107/
- Collegium Pharmaceutical, Inc. (n.d.). NUCYNTA (tapentadol hydrochloride) tablets prescribing information. DailyMed. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e35e8385-db1f-41a8-8307-20979569ac72
- Mericle AA, Slaymaker V, Gliske K, Ngo Q, Subbaraman MS. The role of recovery housing during outpatient substance use treatment. J Subst Abuse Treat. 2022 Feb;133:108638. doi: 10.1016/j.jsat.2021.108638. Epub 2021 Oct 8. PMID: 34657785; PMCID: PMC8748296. https://pmc.ncbi.nlm.nih.gov/articles/PMC8748296/