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Correspondence
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Volume 345:469 August 9, 2001 Number 6
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"Invisible" Synthetic Opiates and Acute Psychosis

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To the Editor: Many acute psychotic episodes encountered in emergency situations are related to addictive substances. Nalbuphine is a synthetic opiate agonist–antagonist, chemically related to both the opioid antagonist naloxone and the analgesic oxymorphone.1 It has been widely prescribed in Mexico for palliative care and in the United States for obstetrical analgesia.1,2,3 Nalbuphine is a low-priced analgesic and is not a tightly controlled substance.

We wish to report the case of a 53-year-old man with no known psychiatric or substance-abuse history. Police found him walking public streets unclothed and apparently responding to internal stimuli. He was taken to the emergency . . . [Full Text of this Article]

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