Butorphanol, also known by the brand name Stadol, is a synthetic opiate or narcotic drug.Other examples of drugs in this class of drugs include morphine, heroin, Vicodin, OxyContin, codeine, and a number of others. All opiate drugs are derived from elements of the poppy plant or synthesized from various compounds found in the poppy plant.
Opiate or narcotic drugs have their primary medicinal effects for use in the suppression of pain and are also sometimes used as cough suppressants, anti-diuretics, etc. Typically, butorphanol is used to treat migraine headaches, pain associated with surgery, and other types of pain. It is now only available in generic forms, and it is typically used as an injectable or nasal spray in humans. There is a tablet form that is used to control surgical pain in domestic animals; however, the tablet form is not readily broken down when taken by people and is not typically used in humans.
Butorphanol is a Schedule IV controlled substance, according the United States Drug Enforcement Administration, indicating that it does have potential medicinal uses but also carries a risk for abuse and the development of physical dependence. In this regard, it is very similar to other narcotic drugs.
Physical Dependence on Butorphanol
All narcotic or opiate drugs have the potential to produce physical dependence in individuals who use them for significant periods of time. The syndrome of physical dependence includes both tolerance (a decrease in the effects that a drug produces at a specific dose as a result of using it over time) and withdrawal (negative physical and psychological reactions as a result of abrupt discontinuation or significantly cutting down the dosage of a drug). While the symptoms of physical dependence may be a sign that perhaps an individual has developed a substance use disorder (substance abuse or an addiction), physical dependence alone is neither necessary nor sufficient to indicate that a person has developed a substance use disorder.
Substance use disorders result from the nonmedicinal use of drugs that lead to a number of negative ramifications in the individual’s functioning and issues with self-control. Any individual who uses or abuses butorphanol for a significant length of time is at a significant risk to develop physical dependence on the drug. If they wish to discontinue use of the drug, they will need to engage in some type of withdrawal management program.
Detox, or detoxification, is a term that defines the natural process that the body uses to eliminate waste products, foreign products in the system, and drugs. This process is ongoing and primarily accomplished by the liver. Withdrawal symptoms occur in individuals who have developed physical dependence on a drug. When one develops physical dependence on a drug, the person’s system has learned only to operate efficiently when certain levels of the drug are present in the tissues. Withdrawal symptoms are triggered as a result of this natural process of elimination of waste products from the body. Individuals who have developed physical dependence and discontinue their use of butorphanol, or any drug, will experience a natural detoxification process as the drug is metabolized and eliminated from their system. They may also experience a number of accompanying unpleasant emotional and physical symptoms during the withdrawal process.
Withdrawal symptoms can be dealt with in a number of different ways, including by simply taking the drug once the symptoms appear (thus, halting them by replenishing the drug in the system), using a “cold turkey” approach such that one suffers through the withdrawal syndrome, or by having a physician oversee the withdrawal process and minimizing the discomfort and any potential dangers associated with it. Withdrawal from opioid drugs is not considered to be potentially fatal unless the individual becomes confused and makes poor decisions that can be risky, has an accident, or becomes emotionally distraught and suicidal.
According to the majority of professional organizations that are focused on research, assessment, and treatment of substance use disorders, such as the American Society of Addiction Medicine, the correct term for medical management of the withdrawal syndrome is withdrawal management.Detox describes a natural process the body uses to cleanse itself, whereas withdrawal management describes a medical intervention to assist people in successfully discontinuing drug use.
Butorphanol is eliminated relatively quickly from the body (half-life of around 4-7 hours), and individuals who have used or abused the drug may begin to experience significant negative withdrawal symptoms rather quickly after their last use. The severity and duration of potential withdrawal symptoms depend on several factors
- Length of use: The period of time that the individual has regularly been using the drug will affect the severity and length of withdrawal syndrome, such that individuals using the drug for longer periods of time will most often experience lengthier and more severe withdrawal syndromes.
- Dose: The amount of the drug that the person typically used can affect the severity and length of withdrawal, such that people who use higher doses on a regular basis will have more severe withdrawal symptoms.
- Frequency of use: How often an individual took the drug during a typical day affects the individual’s tolerance to the drug and will affect the withdrawal syndrome.
- Route of administration: The method the individual used to typically take the drug can affect the length and severity of the withdrawal process. Individuals who inject or snort drugs will more likely have more severe and lengthier withdrawal symptoms than individuals who take them orally.
- Personal factors: Individual differences in emotional makeup and metabolism affect the withdrawal process.
- Withdrawal management programs: People who enroll in physician-supervised withdrawal management programs will often take longer to totally discontinue their use of the drug; however, they will experience few or no withdrawal symptoms.
Timeline for Butorphanol Withdrawal
The following timeline is based on a general estimation of detoxification from butorphanol in individuals who do not use some form of medical management. Typically, there are three phases:
- Phase I: The initial phase will begin within a day or two after discontinuing butorphanol, although some individuals with severe abuse issues may experience withdrawal symptoms less than 24 hours following discontinuation. The most salient symptoms in the initial phase include flulike symptoms, such as nausea, vomiting, diarrhea, headache, fever, chills, heavy perspiring, pain, muscle cramps, muscle aches; emotional symptoms that can include confusion, agitation, irritability, significant anxiety that may present as panic attacks, and depression; and intense cravings to find and use butorphanol. For most individuals, the initial phase will peak within 48 hours.
- Phase II: Beginning around the third to fifth day after discontinuation of use, symptoms will begin to subside. The most common symptoms during this phase will be mild nausea, muscle pains, muscle cramps, muscle spasms, mild or anxiety, and issues with cravings, depression, and irritability.
- Phase III: A week after discontinuation, most individuals will still experience very low-level nausea, anxiety, depression, and potentially cravings. This phase may last for some length of time, and some sources report a potential for this phase to last for months to even years.
There still remain a number of sources that refer to a lengthy additional period of withdrawal following the acute withdrawal process that is often termed post-acute withdrawal syndrome or protracted withdrawal syndrome. This phase is primarily described as consisting of emotional and psychological symptoms that are chronic and include issues with depression, apathy, increased vulnerability to stress, intermittent anxiety, intermittent cravings, and a potential for relapse. Despite a number of sources referring to this as a formal syndrome, it has never been accepted in any professional diagnostic manual or described as such by any medical manual or organization. While it is certainly possible that many individuals who recover from a substance use disorder are vulnerable to mood swings, issues with motivation, stress, and cravings for some time after withdrawal, it is doubtful that this represents a formal withdrawal syndrome.
Withdrawal Management for Butorphanol
A physician-assisted withdrawal management program consists of a number of phases that are designed to help individuals negotiate the withdrawal process without significant complications and without relapsing. The general process consists of:
- Medications: Often, opiate replacement medications are used to control withdrawal symptoms as the individual naturally detoxifies from the drug. For butorphanol, this would typically include a drug such as Suboxone, which is an opioid replacement drug, that can both minimize withdrawal symptoms and control other issues. Other drugs can also be used, such as naloxone, to control cravings for butorphanol as well as additional drugs to manage specific symptoms, such as nausea or headaches.
- Tapering: This is a strategic method of tapering down the dosage of the opioid replacement medication or the original drug of abuse such that the person receives decreasing dosages of the drug at specific intervals to allow them to get used to the slow removal of the drug from their system. This minimizes the withdrawal process and at the same time helps the individual to wean off the drug. Because the tapering strategy allows the individual to gradually adjust to different levels of the drug in their system without negative withdrawal affects, a tapering strategy takes a longer period of time than just discontinuing the drug itself without any assistance.
- Other support: This can include a substance abuse recovery program that utilizes therapy and counseling, social support groups, family therapy, and other interventions as required on a case-by-case basis. These interventions can include behavioral interventions for relaxation, the management of pain, and the management of stress.
- Aftercare: Once the withdrawal management process and intensive treatment are complete, the individual needs to become engaged in a long-term aftercare program. Individuals who just go through withdrawal or withdrawal management and do not address the issues that contributed to their substance use disorder, learn stress management skills, and acquire proactive relapse prevention skills are at a significantly higher risk for relapse than individuals who complete and engage in such a program.