Nalbuphine (Nubain) is a synthetic opioid drug that has chemical similarities to opioid antagonist drugs, as it blocks the effects on opiate receptors in the brain, and opioid agonist drugs, as it attaches to opioid receptors and results in specific effects, such as pain suppression.
Nalbuphine is the only opioid narcotic drug of this type that is not currently listed as a controlled substance by the US Drug Enforcement Administration. Nonetheless, it is a drug that has significant risks associated with use.
Use and Abuse of Nalbuphine
Nalbuphine is used for the treatment of moderate to severe pain. It is not a drug that is often prescribed by physicians compared to other narcotic medications used for pain control, such as Vicodin and OxyContin. Its primary use occurs in clinical settings, such as a hospital or medical clinic, where it is often administered by injection. There is an oral form of nalbuphine that is prescribed to some individuals, and this is the most likely form of nalbuphine that is abused.
The DEA and a number of other sources report that nalbuphine is not considered to be a primary drug of abuse. Part of the reason for this is that individuals who have an opioid use disorder are very likely to suffer an immediate withdrawal syndrome if they use nalbuphine. This is due to nalbuphine’s very powerful opioid antagonist effects.
The drug is abused in some cases by bodybuilders who also abuse steroids because it can help to burn fat and relieve fatigue and pain associated with heavy training. It may be abused by some healthcare professionals and others, as there are also a number of anecdotal reports of people claiming to abuse nalbuphine.
Despite being considered a drug that does not have a high potential for abuse, nalbuphine users may develop physical dependence on the drug.
Risks of Using Nalbuphine
Nalbuphine is considered to be a relatively safe drug when it is used for medicinal purposes, but there are several risks to using nalbuphine.
- Taking nalbuphine with other drugs that have central nervous system depressant effects, such as alcohol, other narcotic pain medications, sedatives, or tranquilizers like benzodiazepines, will increase the suppression of central nervous system functions. This can be potentially dangerous and even potentially life-threatening due to significantly decreased breathing.
- Nalbuphine often causes sedation that can include drowsiness, blurred vision, and even dizziness. Individuals using nalbuphine should not operate machinery of any type.
- All drugs have the potential to produce side effects. Common side effects of using nalbuphine include drowsiness, dizziness, dry mouth, nausea, vomiting, constipation, headache, sweating, and cold clammy skin.
- Rarer and more severe side effects may occur with nalbuphine, such as an allergic reaction, difficulty urinating, numbness in the arms or legs, severe headaches, changes in vision, dangerously reduced heartbeat, chest pain, hallucinations, anxiety, depression, hypertension or hypotension, fluid in the lungs, and/or seizures. Anyone taking nalbuphine and experiencing any of these reactions should immediately seek medical attention.
- Pregnant or nursing women should only use nalbuphine under the strict supervision of a physician. There is the possibility that the fetus could be exposed to the drug in these instances. Pregnant or nursing mothers engaging in prolonged use of nalbuphine risk the development of physical dependence on the drug in their children (e.g., neonatal opioid withdrawal syndrome).
- Long-term use of nalbuphine can result in the development of physical dependence on the drug. Physical dependence includes the syndromes of tolerance (needing a higher dose of the drug to achieve the effects that were once achieved at a lower dose) and withdrawal (the development of negative physical and emotional symptoms when one stops using the drug). The withdrawal syndrome associated with nalbuphine is similar to withdrawal syndromes associated with other opioid drugs, and the symptoms are not considered to be potentially life-threatening; however, some individuals may become extremely distraught or confused when they are undergoing withdrawal and may be at a higher risk for accidents or self-harm.
- Individuals who abuse nalbuphine and take extremely high doses may be at risk for a number of potentially long-term damaging effects to the liver, kidneys, lungs, and cardiovascular system. The most salient of these is the drug’s effect on the respiratory system. Typically, opioid drug use of nearly any type has the effect of suppressing the respiratory system. This can result in a number of potential issues over the long-term in individuals who use these drugs for lengthy periods of time, including reduced oxygen delivery to the brain and other organs and/or the development of serious respiratory conditions or exacerbation of existing conditions, such as chronic obstructive pulmonary disease or other issues (COPD).
In the short-term, individuals who overdose on nalbuphine may experience life-threatening suppression of the respiratory system. This can result in significant damage to organs, such as the brain, heart, and other tissues due to a lack of oxygen and/or can potentially be fatal.
- Even though this drug is not considered to be a drug that has a high potential for abuse or the development of a substance use disorder as mentioned above, there are reported cases of individuals abusing the drug. Individuals who use the drug for reasons other than its intended use and/or use the drug without having a prescription are at risk for the development of a substance use disorder.
- Individuals abusing nalbuphine in conjunction with other drugs of abuse run the serious risk of experiencing severe drug interactions. The specific type of interaction that can occur depends on the individual and the drug being abused; however, as mentioned above, combining nalbuphine with other drugs that have central nervous system depressant effects can be potentially dangerous and even fatal.
Treatment for Abuse
Individuals who have developed a substance use disorder as a result of abusing nalbuphine will most likely require a structured treatment approach. This will generally include some form of withdrawal management program to assist the individual through the withdrawal process, intensive counseling to help the individual understand the reasons for their substance abuse, the development of positive coping skills, the implementation of a long-term relapse management program, and a number of support mechanisms. For many individuals with substance use disorders, community support groups and 12-Step groups provide a positive method of social support that assists in staying sober.