To      : Debra
Re      : Nubain(Nalbupine) and Stadol(butorphanol)

Nalbupine and butorphanol are sometimes used by some anesthesiologists as an
analgesic due to the fact that they do not suppress respiration like
morphine.    Nalbupine belongs to the family of opioid drugs which interact
at the Kappa opiate receptor site, and only weakly at the Mu-1 receptor
site. They are also called "Ceiling Opioids", in that they only produce
minimal to modest respiratory depression with increasing doses.

Morphine interacts primarily at the Mu-1 Mu-2 receptor sites and less so at
the Kappa site.

As such Nubain and the other Kappa analgesics can occasionally produce an
unusual psychologic effect,  so called a "psychotomimetic effect".  This
includes a floating sensation, and other hallucinogenic-like responses.
This is rather rare, but it is a well known phenomenon of this family.
Further,  if this product is added on after the use of other
opioids(morphine, demerol),  it can displace the more potent original
opioids and greatly increase the pain sensation in the patient. So we never
mix kappa opiods with Mu opioids.

As to whether it reduces or inhibits an infants' latch-on,  we actually have
no data, although I have heard this numerous times before.  Infants appear
awake, but don't seem to respond to normal stimuli.  Is this the
psychotomimetic effect?  Who knows.

Regards

Tom Hale, Ph.D.