Barbiturates are a sedative-hypnotic class of drugs once widely used as anesthetic agents as well as to treat insomnia, anxiety, and seizure disorders.1 They are synthetic drugs that act as central nervous system (CNS) depressants.2,3 Barbiturates have historically been available in a variety of formulations, including those that may be taken orally as a pill or elixir, or injected as a liquid solution.1,2 Currently approved therapeutic uses for barbiturates include preoperative sedation and seizure management, though they may be misused nonmedically for any number of reasons, such as to decrease inhibitions or to address the undesirable effects of other illicit drug use.1
Barbiturates still in use today include butalbital (Fiorinal), pentobarbital (Nembutal), phenobarbital (Luminal), and secobarbital (Seconal).3 As sedative-hypnotic drugs, the use of barbiturates has largely been supplanted by benzodiazepines, but they are still occasionally used.2
These drugs have become relatively infrequently used because of their generally unfavorable side effect profile and low therapeutic index; barbiturates have a high potential for abuse, can swiftly build tolerance, and can cause death from overdose—especially in a setting of concurrent alcohol use.4 Barbiturates are controlled substances; despite their approved medical uses, these drugs have known abuse potential.4-6
Effects of Use
The use of barbiturates can have both physical and psychological effects. Barbiturates slow down breathing, heartbeat, reflexes, and brain activity. Physically, the drugs may have an effect similar to that of alcohol, with small doses bringing about a relaxed body and calmness. At higher doses, barbiturates can lead to slurred speech, lack of balance, and bad judgement. Increasingly large doses can also lead to blackouts and even death.7
Barbiturates may give users feelings of euphoria, tranquility, and temporary anxiety relief.7 Continued use of barbiturates may lead to tolerance and dependence.2 As tolerance develops, a person begins to need higher doses of a drug to achieve the same effects experienced with initial use.8 Tolerance to the mood-altering effects can develop rapidly with repeated use, which often drives people to increase their doses; however, tolerance to some of the potentially-lethal physiological effects may not increase at the same rate—meaning the risk of barbiturate toxicity or overdose remains high.2,9
Signs and Symptoms
Barbiturate addiction is associated with several adverse physical, emotional, and behavioral consequences that addiction treatment can help to address. Some of the signs and symptoms of abuse and addiction to barbiturates may include the following:3,7
- Consistent drowsiness
- Altered levels of consciousness and confusion
- Problems with memory
- Impaired judgment
- Behavioral changes including excitement and irritability
- Slurred speech
- Breathing difficulties including shallow breathing
- Dangerous behavior such as driving when using barbiturates
- Neglect of routine responsibilities
- Social and family difficulties
Overdose Signs
In the event of suspected barbiturate overdose, which may result from some of the more dangerous effects of use, such as severe respiratory depression, immediate medical treatment is necessary. Without proper treatment, brain damage or even death can result from an overdose of barbiturate sedatives.
Signs of overdose may include the following:1,2,9
- Shallow breathing or respiratory arrest
- Low blood pressure and weak pulse (as a result of cardiovascular depression)
- Clammy skin
- Markedly altered mental status
- Confusion
- Severely slurred speech
- Loss of consciousness
- Coma
Withdrawal Symptoms
When physical dependence is a factor, immediately stopping the use of barbiturates can lead to severe withdrawal—which may be life threatening in some instances. Withdrawal symptoms may include the following:2,3,7
- Anxiety
- Agitation
- Insomnia
- Delirium
- Hallucinations
- Fever
- Sweating
- Abdominal cramps, nausea, vomiting
- Increased heart rate and blood pressure
- Tremors
- Seizures/convulsions
Detox and Rehab
Medical detoxification is often the first step in treating barbiturate addiction. Supervised detox protocols may involve a gradually tapered dose of the medication to best manage the discomfort and risks of withdrawal.3 Medical detox and withdrawal management allows the body to clear itself of the drug and, through the administration of medications, addresses troublesome withdrawal symptoms and lowers the risk of potentially dangerous physiological effects associated with abruptly quitting barbiturates.10
Though it is an important component of early recovery, detox is typically considered only the first stage of addiction treatment, with substance abuse rehabilitation as the next stage.10 Prior to transition into this longer period of rehabilitation, a thorough intake assessment of the patient will allow for an individualized treatment plan to be made for an optimal treatment strategy.
Counseling and other behavioral therapeutic techniques can help a patient recover by dealing with the root causes of their addictions and finding more constructive ways of responding to stresses and other triggers that contributed to their compulsive barbiturate use issues. Combining various forms of therapy, in either an inpatient or outpatient setting, patients can begin to work toward recovery.
Sources
- U.S. Department of Justice Drug Enforcement Administration. (2017). Drugs of Abuse: A DEA Resource Guide, 2017 Edition: Barbiturates.
- European Monitoring Centre for Drugs and Drug Addiction. (2015). Barbiturates drug profile.
- National Institute on Drug Abuse. (2018). DrugFacts: Prescription CNS Depressants.
- Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and Substance Abuse Treatment.
- Substance Abuse and Mental Health Services Administration. (2018). 2017 National Survey on Drug Use and Health: Methodological Summary and Definitions.
- United States Drug Enforcement Administration. (n.d.). Drug Scheduling.
- George Mason University. (n.d.). Barbiturates.
- National Institute on Drug Abuse. (2007). The Neurobiology of Drug Addiction: 6: Definition of tolerance.
- U.S. National Library of Medicine. (2019). MedlinePlus: Barbiturate intoxication and overdose.
- National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-based Guide (Third Edition): Types of Treatment Programs.
