Oyekanmi Oyeyimika, Kissel-Smith Hannah, Melmer Monica N, Wills Brandon
J Addict Med. 2025 Aug 8. doi: 10.1097/ADM.0000000000001567.
Precipitated opioid withdrawal due to partial opioid agonists other than buprenorphine is rarely reported. We present a case of severe precipitated opioid withdrawal and stress cardiomyopathy after butorphanol use in the setting of chronic fentanyl use.
Emergency medical services responded to a 61-year-old female with opioid use disorder (OUD) who was severely agitated requiring multiple doses of sedatives. Emergency department examination was notable for extreme agitation and restlessness. An electrocardiogram showed sinus tachycardia without ischemic changes. Urine drug immunoassay was positive for benzodiazepines and fentanyl, despite no fentanyl administration by providers. A transthoracic echocardiogram showed evidence of stress cardiomyopathy. A subsequent comprehensive urine drug analysis was positive for norfentanyl and butorphanol. The patient confirmed using butorphanol immediately before the onset of symptoms. The patient's goals were to resume treatment of OUD with buprenorphine. She stabilized on buprenorphine 16 mg/4 mg sublingual film daily, then transitioned to buprenorphine long-acting injectable 96 mg subcutaneous monthly.
Butorphanol is a synthetic partial agonist at the μ-opioid receptor and full agonist at the κ-opioid receptor. It is available in several formulations and is frequently used as a veterinary analgesic. Precipitated opioid withdrawal from butorphanol has been demonstrated in experimental settings but has not been described in clinical practice.
This case emphasizes the importance of recognizing butorphanol as a partial opioid agonist capable of causing precipitated opioid withdrawal in the setting of chronic opioid agonist exposure, and underscores potential medical consequences of precipitated opioid withdrawal including stress cardiomyopathy.
除丁丙诺啡外，其他部分阿片类激动剂导致的阿片类药物戒断反应鲜有报道。我们报告一例在长期使用芬太尼的情况下使用布托啡诺后出现严重的阿片类药物戒断反应和应激性心肌病的病例。
急救医疗服务机构接到一名患有阿片类药物使用障碍（OUD）的61岁女性的求助，该女性极度烦躁不安，需要多次使用镇静剂。急诊科检查发现其极度烦躁和不安。心电图显示窦性心动过速，无缺血性改变。尿液药物免疫分析显示苯二氮䓬类药物和芬太尼呈阳性，尽管医护人员未给患者使用芬太尼。经胸超声心动图显示有应激性心肌病的迹象。随后的综合尿液药物分析显示去甲芬太尼和布托啡诺呈阳性。患者确认在症状出现前立即使用了布托啡诺。患者的目标是恢复使用丁丙诺啡治疗OUD。她每天舌下含服16毫克/4毫克丁丙诺啡薄膜片后病情稳定，随后转为每月皮下注射96毫克长效丁丙诺啡。
布托啡诺是一种μ-阿片受体的合成部分激动剂和κ-阿片受体的完全激动剂。它有多种剂型，常被用作兽医镇痛药。在实验环境中已证实布托啡诺可引发阿片类药物戒断反应，但在临床实践中尚未有相关描述。
该病例强调了认识到布托啡诺是一种在慢性阿片类激动剂暴露情况下能够导致阿片类药物戒断反应的部分阿片类激动剂的重要性，并强调了阿片类药物戒断反应的潜在医学后果，包括应激性心肌病。
