Butorphanol (Stadol) Addiction

Butorphanol (Stadol) Addiction

Butorphanol (Stadol) Addiction

Butorphanol (Stadol) AddictionButorphanol nasal sprays were hailed as a breakthrough medical advance when they first came out in 1978. Relief would be just a puff away for people suffering from migraine headaches. They could not take a narcotic painkiller in a very small dose, and therefore they would not become addicted to it. Stadol and similar butorphanol nasal sprays were put on the market as non-addictive, non-regulated drugs.[i]

Within a few years, however, butorphanol nasal sprays were becoming problematic. The spray produced euphoria and a “high” that was hard to resist, even when you did not have a headache. Studies on laboratory animals were finding that they easily became addicted to butorphanol and would self-administer it.[ii] The drug was also more dangerous than believed. Research from the World Health Organization found that 13 died from butorphanol poisoning between 1979 and 1992, 60 had adverse reactions, and more were becoming addicted.[iii]

In the mid-1990s, a law student addicted to butorphanol committed suicide after his physician stopped filling his prescriptions. His father, Dr. Morris Fisher, led the fight to have butorphanol recognized as an addictive substance. In 1997, the United States Drug Enforcement Agency classified butorphanol as a Schedule IV Controlled Substance, which meant there were now penalties and fines for possessing or selling it without a prescription, and that pharmacies and doctors would have to keep careful records of its dispensing.

Today, as more people under 25 years old experiment with prescription narcotic drugs, butorphanol is in vogue but hard to obtain. The drug is increasingly used as an injection given in supervised situations during surgery or at doctors’ offices. Bristol-Myers has discontinued selling Stadol nasal spray in the United States.

What is Butorphanol?

Butorphanol is a narcotic painkiller that binds to kappa receptors in the brain and central nervous system, making it different from the majority of similar drugs that bind to sigma and mu receptors. “Mu” opiates are the gold standard of painkillers, and include drugs like morphine and codeine. Kappa opiates such as butorphanol are less well known and seem to work better in female patients than male.[iv]

Butorphanol comes as a white crystalline powder slightly soluble in water and methanol. Its chemical name is 17-cyclobutylmethyl-morphinan-3,14-diol, and its molecule looks like this:[v]

When compared to all opiate painkillers, butorphanol is most similar to Lexapro.

In 1997, the United States Drug Enforcement Agency classified butorphanol as a Schedule IV Controlled Substance, which means it is addictive but can be used for medical purposes. If you are caught selling, possessing or otherwise dealing in butorphanol, you will face penalties and fines under the Controlled Substance Act passed by Congress in 1970.[vi]

What are the Medical Uses of Butorphanol?

Butorphanol, like many drugs in the opium family, is a sedative and a painkiller. It is used as a pre-anesthesia before surgeries as well as a painkiller prescribed for labor pain and migraine headaches. One study of people in chronic pain from cancer or neuropathy found that butorphanol provided excellent relief in 51% of patients, but poor results in 19%.[vii] The reason may be that other studies have shown that butorphanol is twice as effective for females, when compared results for male patients.[viii]

Butorphanol is mostly used as an injection into a muscle or vein or through intravenous delivery systems.[ix] Nasal sprays containing butorphanol can deliver pain medication at a lower dose than when taken orally or as an injectable, and also have the advantage of rapid absorption.[x]

Doctors usually determine the dose of injectable butorphanol based on a patient’s age, weight, physical status, type of surgery involved, other drugs the patient is taking, and so forth.[xi] As a nasal spray, the usual dose if 1mg, or one spray in one nostril every 60 to 90 minutes at first, and then no more than 1mg every three to four hours. The usual intravenous dose is 1mg every three to four hours.[xii]

Butorphanol is used in veterinarian medicine as a painkiller or cough medication. The drug has made headlines in the sport of horse racing where its use is illegal.[xiii]

What are the Side Effects of Butorphanol?

Common side effects are drowsiness, constipation, nausea, vomiting, dry mouth, and red or itchy skin.[xiv]

In a study of 2446 patients taking butorphanol products, one percent or greater had at least one of the following side effects: lethargy, headache, feeling warm, heart palpitations, anorexia, constipation, confusion, dry mouth, nausea, vomiting, anxiety, confusion, blurred vision,  hostility, ringing in the ears, agitation, dizziness, lightheadedness, a feeling of floating, paresthesia, vertigo, sweating, euphoria, insomnia, nervousness, sleepiness, tremors, bronchitis, cough, dyspnea, epistaxis, nasal irritation, rhinitis, and nasal congestion.[xv]

The following side effects should be reported to a doctor as they may indicate that serious is wrong: pounding or uneven heartbeat, shallow breathing, slow heartbeat, tremors, confusion, fainting, and high blood pressure.[xvi]

What Drugs Interact with Butorphanol?

Butorphanol is a narcotic painkiller that slows down the central nervous system. If you combine it with other drugs that do the same thing, you can decrease your rate of breathing and heartbeat to the point where they stop and you die. Drugs that slow down the central nervous system that should not be combined with butorphanol are other narcotic painkillers, alcohol, illegal narcotics, barbiturates, tranquilizers, sedatives, muscle relaxers, certain antidepressants, sleeping pills, and most medications that cause drowsiness, such as antihistamines and cold and flu medications.

Which People Should not Take Butorphanol?

People who have any of the following medical conditions should not take butorphanol, unless directed by a medical doctor. These conditions are chronic obstructive pulmonary disorder, asthma, apnea, liver or kidney diseases, head injuries, tumors in the head, high blood pressure, mental illness, heart disease, and a history of alcoholism, substance abuse, or heart attacks.[xvii] Do not take butorphanol if you have myocardial infraction, ventricular dysfunction, coronary insufficiency, or hypotension.[xviii]

Pregnant or nursing women should not take butorphanol because it is classified as a Category C drug that could harm their unborn children. It is known to cause stillbirths in laboratory animals.[xix] Butorphanol is used with caution among the elderly because they can experience more severe side effects, and the drug’s sedative effect can cause them to fall more readily.[xx]

What are the Risks of Taking Butorphanol?

One of the main dangers of taking butorphanol is that you might become addicted to it. This means you will face withdrawal symptoms when you stop using it, and you will also experience drug cravings. You will build up a tolerance to the drug and have to take more to achieve the same effects, putting you at risk for an overdose.

Some people get extreme vertigo or a feeling that they cannot move or speak after taking butorphanol, but this is rare. Also on rare occasions, some people have severe, life-threatening reactions to the drug. They develop hives and rashes, even as their faces, lips and tongues swell to the point that they have difficulty breathing. This reaction called anaphylactic shock can be fatal if the person does not get immediate medical treatment.

Butorphanol depresses respiration and inhibits the motility of the gastrointestinal tract. This is why it is not usually prescribed on a long-term basis.

Because the drug causes sleepiness and drowsiness, you put yourself at risk for accidents if you drive under its influence.

Does Butorphanol Show up on Urine Tests?

Butorphanol is a narcotic, and narcotics can be detected on the kind of urine tests given at work or school. The half-life of Butorphanol is about 18 hours. A drug’s half-life is how long it takes for the body to metabolize half the drug. The usual rule of thumb is that you multiply the half-life of a drug by five to determine about how long it can be detected in the body. Using this rule, butorphanol can probably be detected for about four days after taking it.

What is a Butorphanol Overdose?

A butorphanol overdose occurs when a person takes the drug in too large an amount. This can be life-threatening if the person faints, goes into a coma, and then stops breathing. Symptoms can be extreme drowsiness, muscle twitching, pinpoint pupils, confusion, cold and clammy skin, weak pulse, and shallow breathing.  Some people have seizures or keep falling.

Emergency room doctors treat such a butorphanol overdose by opening the patient’s airway, administering oxygen, using a breathing machine if the patient is comatose, and administering naloxone as an antidote.[xxi] Often the person has combined butorphanol with alcohol or other opiate drugs.

In studies of laboratory monkeys given butorphanol, they can enter a severe stupor that can be reversed by using naloxone.[xxii]

What is Butorphanol Withdrawal?

Butorphanol withdrawal is a series of unpleasant symptoms that occur when a person physically dependent on the drug tries to stop using it. The syndrome is the same as that for other narcotic drugs. Butorphanol nasal spray can cause withdrawal syndromes as severe as any other narcotic.[xxiii]

These symptoms can feel like a terrible case of the flu, and might include nausea, vomiting, abdominal cramps, tremors, diarrhea, malaise, runny nose, chills, sweats, confusion, irregular heartbeat, dilated pupils, muscle pain, insomnia, and lack of coordination.[xxiv] Some people have mental symptoms such as severe anxiety, irritability, hallucinations, and insomnia.[xxv]

It is best to withdraw from butorphanol under medically supervised conditions because of the danger of hallucinations and other dangerous symptoms. A doctor can gradually withdraw the person from the drug by reducing the amount taken over time, or by using certain prescription medications.

Laboratory dogs, physically dependent on butorphanol go through withdrawal syndromes that include crying, teeth chattering, severe scratching, vocalizations, shaking, and drooping eyelids.[xxvi]

What is Butorphanol Addiction?

When butorphanol first came out as a nasal spray, no one thought that it would become an addictive substance. Within a few years, however, pharmacists and other healthcare professionals were noticing that patients taking butorphanol tended to refill their prescriptions more often than necessary. Hospital staff members were becoming addicted to it.[xxvii] Post-marketing studies of butorphanol products found that people were more likely to abuse the nasal sprays than the injected products.[xxviii]

Patients used to have prescriptions for the butorphanol nasal spray to be used “as needed” for migraines, and then discover they liked the effect of the drug. Some people have described it as a “warm jello sensation,” “pretty incredible,” or “something I love to do when I have nothing better to do that day.”[xxix] The effects of butorphanol are usually described as feeling drunk, floating, and feeling high.

In one study of 8,114 patients, four percent experienced a severe withdrawal syndrome when they stopped using butorphanol and up to 43% developed a physical or psychological dependence on the drug.[xxx] The 2004 National Survey on Drug Abuse found that one percent of the American population has experimented with butorphanol in a recreational way.

What Treatments are Available for Butorphanol Addiction?

If you have become addicted to butorphanol after using it under medical supervision, your best course of action is to talk to your doctor about how you can gradually decrease your dosage to avoid withdrawal syndrome. If this is not possible or if you are heavily addicted to butorphanol or using it with other drugs, you need to enter a residential treatment center where you can undergo an intense program of chemical detoxification and psychotherapy individually designed for you to treat your drug addiction.

The first step upon entering rehabilitation is to undergo a complete physical and psychological examination by a medical professional who can determine whether you have any psychiatric comorbidities besides drug addiction. Most drug addicts have undiagnosed problems such as depression or bipolar disorders that need to be treated in a separate protocol. If a comorbidity is not treated, your chances of recovering from drug addiction are slim.  The staff of the drug rehabilitation center will meet with you to create an individualized program for you.

The next step is to enter a detoxification unit where you can safely withdraw from butorphanol under medically supervised conditions. Health professionals can monitor your situation and make you more comfortable by employing certain relaxation techniques and prescribing medications.

Once your body is clear of butorphanol, you move into the residential center, where you can work for your program with others facing similar challenges. Your day will be highly structured, as you participate in individual psychotherapy, group therapy, and many different classes in subjects, such as the chemical basis of drug addiction, how to use yoga and meditation as healthy substitutes for drugs, how to deal with triggers in the environment that will cause you to relapse back into drug use, and many more. You will have seminars in art, music, journaling and drama to help you get in touch with your emotions, as well as career counseling. Your friends and family members may participate in your program through family therapy or couples therapy. You may also attend self-help support meetings such as Narcotics Anonymous. Your residential treatment program should have elements of fun and recreation, such as active sports, sightseeing, parties, and exploring new hobbies and interests.

When you return home, you continue in one-on-one psychotherapy and family therapy, and you may participate in support meetings in your local community.

How Can I Tell if I am Addicted to Butorphanol?

If you can answer yes to any of the following questions, it is time to speak with your family physician or an addiction specialist at a drug rehabilitation center about your problem with butorphanol.

  • If you have been prescribed butorphanol for migraines, are you using it for relaxation and other purposes?
  • Do you experience cravings for butorphanol when you don’t use it?
  • Is butorphanol just one of many substances you use to relax, such as other sedatives or alcohol?
  • When you try to stop using butorphanol, do you experience a withdrawal syndrome?
  • Do you find that you have to use more butorphanol to achieve the effects you want?
  • Have you ever driven a car under the influence of butorphanol or otherwise endangered yourself physically because of this drug?
  • Do your family members or friends criticize you for using drugs?
  • Do you find it difficult to go more than a day or two without using drugs?
  • Have you tried to stop using butorphanol on your own but failed?
  • Do you worry about troublesome side effects that butorphanol causes, such as constipation?
  • Has your drug use caused you financial or legal problems?
  • Do you feel guilty or ashamed about your use of drugs?
  • If money were no object, which you enter a drug rehabilitation center and get help for your drug addiction?

[i] Steinberg, Carol. “Ballyhoo on Nasal Drugs Meets Reality,” The New York Times, October 27, 1991.

[ii] Stadol,” The RX List, see http://www.rxlist.com/stadol-drug.htm, see also “Butorphanol, A Report from the World Health Organization,” WHO, see http://www.who.int/medicines/areas/quality_safety/4.1ButhorphanolCritReview.pdf

[iii] Ibid.

[iv] Angier, Natalie. “Yet Another Sex Difference Found: Gaining Relief From a Painkiller,” New York Times, October 30, 1996.

[v] “Butorphanol Indications and Dosage,” Medscape, see http://reference.medscape.com/drug/butorphanol-343327

[vi] “Placing of Butorphanol on Controlled Substance List,” The U.S. Drug Enforcement Agency, the U.S. Department of Justice, see http://www.deadiversion.usdoj.gov/fed_regs/rules/prior_1998/fr1001_1997.htm

[vii] “Butorphanol, A Report from the World Health Organization,” WHO, see http://www.who.int/medicines/areas/quality_safety/4.1ButhorphanolCritReview.pdf

[viii] Angier, Natalie. “Yet Another Sex Difference Found: Gaining Relief From a Painkiller,” New York Times, October 30, 1996.

[ix] “Stadol, Butorphanol Injection,” Official Information from the United States Food and Drug Administration, Drugs.com, see http://www.drugs.com/mtm/stadol-injection.html;

[x] Steinberg, Carol. “Ballyhoo on Nasal Drugs Meets Reality,” The New York Times, October 27, 1991.

[xi] “Butorphanol Indications and Dosage,” Medscape, see http://reference.medscape.com/drug/butorphanol-343327; see also “Stadol, Indication and Dosage,” the RX List, see http://www.rxlist.com/stadol-drug/indications-dosage.htm

[xii] “Butorphanol Indications and Dosage,” Medscape, see http://reference.medscape.com/drug/butorphanol-343327

[xiii] “Dutrow Loses Appeal on 10-Year Horse Racing Ban,” The New York Times, January 8, 2013.

[xiv] “Stadol, Butorphanol Injection,” Official Information from the United States Food and Drug Administration, Drugs.com, see http://www.drugs.com/mtm/stadol-injection.html; and “Stadol Nasal Spray,” Official Information from the United States Food and Drug Administration, Drugs.com, see http://www.drugs.com/mtm/stadol-ns-nasal.html

[xv] “Stadol, Side Effects and Interactions,” the RX List, see http://www.rxlist.com/stadol-drug/side-effects-interactions.htm

[xvi] “Stadol, Butorphanol Injection,” Official Information from the United States Food and Drug Administration, Drugs.com, see http://www.drugs.com/mtm/stadol-injection.html; and “Stadol Nasal Spray,” Official Information from the United States Food and Drug Administration, Drugs.com, see http://www.drugs.com/mtm/stadol-ns-nasal.html

[xvii] Ibid.

[xviii] “Stadol, Side Effects and Interactions,” the RX List, see http://www.rxlist.com/stadol-drug/side-effects-interactions.htm

[xix] Ibid.

[xx] Ibid.

[xxi] “Stadol, Butorphanol Injection,” Official Information from the United States Food and Drug Administration, Drugs.com, see http://www.drugs.com/mtm/stadol-injection.html

[xxii] “Butorphanol, A Report from the World Health Organization,” WHO, see http://www.who.int/medicines/areas/quality_safety/4.1ButhorphanolCritReview.pdf

[xxiii] “Butorphanol, A Report from the World Health Organization,” WHO, see http://www.who.int/medicines/areas/quality_safety/4.1ButhorphanolCritReview.pdf

[xxiv] “Stadol,” The RX List, see http://www.rxlist.com/stadol-drug.htm

[xxv] Ibid, see also “Butorphanol, A Report from the World Health Organization,” WHO, see http://www.who.int/medicines/areas/quality_safety/4.1ButhorphanolCritReview.pdf

[xxvi] Ibid.

[xxvii] Ibid.

[xxviii] “Stadol, Warnings and Precautions,” the RX List, see http://www.rxlist.com/stadol-drug/warnings-precautions.htm

[xxix] Quotes taken from various websites where drug addicts can post their experiences anonymously.

[xxx] “Butorphanol, A Report from the World Health Organization,” WHO, see http://www.who.int/medicines/areas/quality_safety/4.1ButhorphanolCritReview.pdf

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