Objectives: Nalbuphine (Nubain) is a synthetic opioid analgesic with agonist-antagonist properties. This study describes a characteristic patient profile, pattern of use and treatment outcome for a series of nalbuphine dependent subjects.

Method: Retrospective systematic case-note review of uniformly collected clinical data on 11 cases of nalbuphine dependence presenting to a substance misuse service.

Results: There were nine males and two females with a mean age of 31 years of whom nine were currently employed. At presentation the mean duration of nalbuphine use was three years, the average daily dosage was 60mg (range lOmg-lOOmg) and all subjects reported injecting between two and eight times daily (mean five times daily). All subjects met opioid dependence criteria (ICD-10). Drug-related problems were multiple and varied while forensic history was uncommon. Exposure to nalbuphine occurred exclusively within the gymnasium environment and was used by bodybuilders to enhance weight training and bodybuilding. Eight subjects admitted previous anabolic steroid use, and seven current cocaine use. Eleven subjects represented 14 separate treatment episodes of which 11 treatment episodes involved the use of methadone substitution therapy. The mean stabilisation dose of methadone was 29mg (range 15mg-40mg) and in eight episodes (73%) patients were successfully retained in treatment to completion of detoxification.

Conclusions: Dependence on nalbuphine, an agonist-antagonist opioid previously believed to have low abuse potential, does occur and may be particularly associated with bodybuilders who use its analgesic properties to facilitate pain free training. Its use appears linked not only with other performance enhancing drugs (viz. anabolic steroids) but may also be associated with other psychoactive drugs such as cocaine. Methadone substitution therapy appears to be a viable treatment option.