Butorphanol Dependence in a Woman With No Prior Substance Use
Citation: Muhammed JK, Mandal P, Ambekar A. Prim Care Companion CNS Disord 2026;28(5):26cr04253. Published 20 October 2026.
Link: https://www.psychiatrist.com/pcc/butorphanol-dependence-no-prior-substance-use/
Note: This summary is built from the indexed excerpts of the article, not the full text. Peak dose, withdrawal details and the treatment used are not covered here; see the article for those.
The case
- "Ms A", 39, a widowed graduate homemaker, presented to a tertiary addiction treatment centre after 3 years of butorphanol use. The authors' other work places them at AIIMS in Delhi, so this is almost certainly an Indian case.
- She had no history of any psychoactive substance use. She was first given butorphanol for acute pain.
- She found the injections relaxing and kept using them. Within 2 months she was at two injections (2 mg/1 mL) a week.
- She later managed a significant period of abstinence. After surgery, butorphanol was given again for pain and she relapsed quickly into her old pattern.
What the authors make of it
- The relapse after abstinence is their evidence that this behaves like any other opioid dependence, not mere neuroadaptation (i.e. not just a body that got used to the drug).
- Published reports of butorphanol misuse are rare, especially in women.
- Their takeaway: starting butorphanol for acute pain carries a risk of iatrogenic (doctor-caused) dependence even in someone with no drug history, so prescribing needs monitoring.
Background (not from the article)
- Butorphanol is a morphinan mixed agonist-antagonist: kappa agonist, partial agonist/antagonist at mu.
- The WHO Expert Committee on Drug Dependence groups it with buprenorphine and pentazocine. Its review found dependence is infrequent in humans, yet withdrawal looks much like that of morphine or buprenorphine.
- Earlier Indian reports exist, including a 2019 case of a health-care professional who injected it intramuscularly for euphoria.
Sources