ABSTRACT Catatonia is a complex neuropsychiatric syndrome characterized by disturbances in motor, behavioral, and autonomic functioning. While traditionally associated with mood and psychotic disorders, it is increasingly recognized in the context of medical and substance-related conditions. However, catatonia related to opioid withdrawal remains infrequently reported and often under-recognized. We present a case series of three male patients with long-standing dependence on brown sugar (heroin) who developed catatonic features during the opioid withdrawal phase. All patients presented within four to seven days of opioid cessation, exhibiting symptoms, such as mutism, posturing, rigidity, waxy flexibility, and psychomotor excitement. Neurological and metabolic evaluations were noncontributory. The Bush–Francis Catatonia Rating Scale (BFCRS) scores ranged from 16 to 20. All patients demonstrated partial to marked improvement following a lorazepam challenge and were subsequently managed with benzodiazepines, opioid withdrawal support, and low-dose antipsychotics when indicated. Full remission of catatonic symptoms occurred within five to ten days. These cases highlight the neurochemical dysregulation associated with abrupt opioid cessation—particularly GABAergic deficit and glutamatergic overactivity—as a potential mechanism. Early identification and treatment are crucial, as catatonia is highly responsive to benzodiazepines and often resolves rapidly with appropriate intervention. Increased clinical awareness is necessary to avoid misdiagnosis and ensure effective treatment in opioid-dependent individuals during withdrawal.
Sandhu et al. (2026) studied this question.