Phenobarbital is an addictive drug that places users at high risk of developing dependence and experiencing severe withdrawal. Misuse of the drug, especially in combination with alcohol or other depressants, is associated with a range of short- and long-term effects and can increase the risk of a fatal overdose.
Phenobarbital users attempting to quit may face dangerous withdrawal symptoms. Because of the risks associated with phenobarbital dependence, users should consider seeking professional treatment.
What Is Phenobarbital?
Phenobarbital is a central nervous system depressant used to treat seizures, manage anxiety, alleviate withdrawal symptoms from other drugs, and, in rare cases, treat sleeping problems.1,2 Also known by the brand name Luminal and the street names “barbs” and “downers,” phenobarbital belongs to a class of drugs known as barbiturates.3 These types of drugs act on the brain’s GABA receptors to depress brain activity and produce a sense of calm and drowsiness.
Phenobarbital is the most commonly prescribed barbiturate.4 Its effects, including sedation and drowsiness, may last for up to 24 hours.4 People may misuse phenobarbital in order to experience the drug’s pleasurable effects by taking it without a prescription or taking more than prescribed.
Barbiturates like phenobarbital can be highly addictive, especially when misused.1,4 Addicted users may continue taking the drug despite serious negative consequences to their physical and mental health and lifestyle. Taking the drug without the supervision of a medical professional may increase the likelihood of developing an addiction.
Phenobarbital poses several dangers. It is not simply the risk of overdose that users need to be concerned about but also what can happen when you quit; the acute barbiturate withdrawal syndrome can put your health at risk if you don’t detox under medical supervision.2 Additionally, the drug has a number of serious side effects that may require professional medical treatment.1
Possible Side Effects
Consuming barbiturates like phenobarbital can cause an immediate “high” or intoxication. During a phenobarbital high, a user may experience a sense of calm, relaxation, anxiety relief, and drowsiness.2 However, not all of the short-term effects of barbiturates are positive. The high may be accompanied by: 1,3,45
- Nausea and vomiting.
- Difficulty breathing.
- Swelling of the face.
- Blistering or peeling skin.
It is important to contact your doctor or seek medical attention immediately if you experience breathing problems, swelling, rash, skin problems, fever, or confusion.1
In addition to the drug’s short-term effects, some chronic users may experience long-term physical and mental health issues.
Long-term physical and mental effects of barbiturates may include:4,6
- Memory loss.
- Changes in level of alertness.
- Dependence and addiction.
While medical professionals have been able to identify some of the long-term effects of using barbiturates, there may be other effects that remain unknown.4
Phenobarbital users may become physically dependent on the drug after a period of time.2 The main sign that you’ve become dependent is that you feel the symptoms of withdrawal when you cut down on or stop phenobarbital use.
Dependence and Addiction
Some users may also meet the criteria for a substance use disorder, a condition characterized by compulsive substance abuse behaviors and the potentially severe consequences of such problematic behaviors. Signs of a substance use disorder—commonly called addiction—include:7
- Taking more of the drug or taking the drug for a longer period of time than you set out to.
- Unsuccessfully attempting to quit or cut back.
- Spending long amounts of time acquiring, using, or recovering from the drug.
- Having cravings or urges to use the drug.
- Failing to carry out your responsibilities at home, work, or school because of drug use.
- Experiencing social or relationship problems caused or made worse by drug use.
- Giving up activities that were once important.
- Using the drug in dangerous situations.
- Using the drug despite physical or psychological problems caused or made worse by drug use.
- Needing to up your dose regularly to get the same effects.
- Going through withdrawal when you stop or cut down.
Chronic phenobarbital use can also negatively impact a person’s lifestyle and overall functioning, leading to situations such as:
- Financial problems.
- Arrests and other legal problems.
- Relationship problems, such as divorce or estrangement from loved ones.
- Job loss.
Why Drinking on Barbiturates Is Deadly
A barbiturate overdose can occur if a person takes more of the drug than the body can handle, either accidentally or intentionally. 6
Barbiturates and alcohol are both central nervous system depressants that slow down breathing. As a result, when they’re consumed together, the risk of fatal respiratory depression increases significantly.2,4,6 So if you take a little more phenobarbital than you should and you decide to have a few glasses of wine, you could be putting your life at risk.
Approximately 1 in 10 phenobarbital overdoses is fatal.
To reduce the risk of an overdose, barbiturates should be taken exactly as prescribed under the supervision of a medical professional. These drugs should not be combined with other drugs, especially other CNS depressants like benzodiazepines and opioids. It is also important to disclose any over-the-counter or prescription drugs you are taking to your doctor, as some antihistamines may also compound the risk for overdose when combined with barbiturates.2
What Happens During Overdose?
A phenobarbital overdose can be deadly if not identified and treated properly.4 Approximately 1 in 10 phenobarbital overdoses is fatal.6 Death from an overdose is typically caused by heart- and lung-related issues that occur during the overdose.6 Knowing the signs and symptoms of an overdose and how to respond can help increase the chance of survival.
Barbiturate overdose can lead to severe impairment—both physical and mental. Physical signs and symptoms of a barbiturate overdose may include:1,3,6
- Loss of control of bodily movements.
- Lethargy and very slurred speech.
- Low body temperature.
- Decreased pupil response to light.
- Uncontrollable eye movements.
- Poor eye muscle control.
- Heavy sweating.
- Changes in heart rate.
- Extremely slowed or stopped breathing.
Psychological symptoms of a phenobarbital overdose can include:3,6
- Severe irritability and aggression.
- Memory loss.
- Poor judgment.
- Poor attention.
- Altered consciousness.
- Delirium, a state of severe confusion.
In some cases, a phenobarbital overdose can lead to dangerous complications such as:3,6
- Head, neck, or spinal injury and/or concussion from falling.
- Muscle damage.
- Pneumonia due to aspiration of vomit into the lungs.
If you suspect that you or someone else is experiencing a barbiturate overdose, call 911. Compared to overdoses of other shorter-acting barbiturates, phenobarbital overdoses may require more intensive medical interventions.3 The faster you initiate emergency care, the better the chance of recovery.
Emergency medical professionals may work to restore breathing and circulation and perform necessary tests before taking the overdose victim to the hospital where they may be then admitted for extended care and monitoring.3 If a barbiturate overdose involves opioids, Narcan (naloxone) may be administered in an attempt to restore breathing and consciousness. However, there is no antidote medication for barbiturate toxicity itself. During hospitalization, doctors may need to provide ventilation assistance, monitor body temperature, and administer IV fluids. Activated charcoal may also be used to absorb any drug remaining in the stomach.
Famous People Who Overdosed on Barbiturates
Barbiturates like phenobarbital have been involved in the overdoses of many famous people, including Marilyn Monroe, Jimi Hendrix, and Judy Garland:4
- Marilyn Monroe tragically died of an overdose at age 36 in her Los Angeles home.8 Prior to her death, Monroe had been struggling with depression, mood swings, and physical health issues. Despite her success, the celebrated movie star had been using a cocktail of barbiturates, amphetamines, opioids, sedatives, and alcohol before her death.
- Judy Garland died of a barbiturate overdose shortly after her 47th birthday.9 Garland was introduced to prescription drugs early in her Hollywood career. During the taping of The Wizard of Oz, she turned to amphetamines and barbiturates to manage her weight and cope with long hours on set. Her drug use resulted in a lifelong addiction and untimely death.
- Jimi Hendrix died of a fatal barbiturate overdose at the young age of 27.10 His death was caused by inhaling vomit during the overdose. Known as much for his drug use as his musical talent, his rock-and-roll lifestyle ultimately cost him his life.
Barbiturate users may experience dangerous and possibly life-threatening withdrawal symptoms when trying to quit. Symptoms of phenobarbital withdrawal may include:1
- Muscle twitching.
- Uncontrollable shaking.
- Vision problems.
- Nausea and vomiting.
Seizures during phenobarbital withdrawal may persist for several weeks.11 Other symptoms, such as visual changes or distortions, may last for months. In some cases, barbiturate withdrawal may result in death.2
Because of the risks associated with the phenobarbital withdrawal syndrome, users should seek medical help when detoxing.1,2 Medical detox is a procedure supervised by doctors and nurses who monitor withdrawal symptoms and treat physical and psychological symptoms that arise. Barbiturate users may be slowly tapered off of the drug to prevent seizures. Sedative and/or anticonvulsant medications may need to be used, should severe agitation or seizure activity arise. Throughout detox, medical professionals carefully watch for seizures, ensure that the person is getting enough fluids, and encourage rest and a healthy diet. Medical detox may take place in a hospital or treatment facility.
Options for Treatment
Detox is typically the first step in barbiturate addiction treatment. However, detox is only one step on a longer road to recovery. Detox is typically brief and focuses on helping people safely withdraw from drugs. Once the body is cleared of toxic influences, it’s time to address the mind. Treatment utilizes therapeutic interventions to help you address the underlying reasons for your drug use and develop healthier, substance-free ways of coping.
Upon completion of detox, barbiturate users may benefit from enrolling in some form of substance abuse treatment:
- Inpatient treatment programs offer 24-hour care in a hospital environment. Treatment is typically brief and the focus is on stabilizing symptoms to prepare a person for a less intensive level of care. Inpatient programs offer therapy sessions and also provide medical care for physical health issues, such as prolonged withdrawal symptoms.
- Residential treatment programs provide 24-hour care in a more home-like treatment facility. Treatment includes group, individual, and family therapy sessions, recovery meetings, and exposure to healthy activities, such as meditation and exercise. The duration of treatment may range from a few weeks to several months or more depending upon the particular program.
- Outpatient treatment programs offer therapy in a relatively less intensive manner than inpatient or residential programs. Participants reside outside of the treatment facility and come to the facility once or more per week. Partial hospitalization programs are the most intensive form of outpatient treatment and typically offer services 5 days per week for up to 6 hours per day. Intensive outpatient programs typically offer services 2-4 days per week for 2 or more hours per day. Other forms of outpatient treatment also exist, such as weekly group, individual, or family therapy sessions.
- Aftercare programs in their various forms allow continued recovery from addiction even after the initial phase of treatment has ended. A solid and diligently followed aftercare plan can help a person to better prevent relapse. Following an initial period of rehabilitation, an aftercare plan may include participating in a relatively lower level of treatment (e.g., ongoing outpatient therapy following completion of a residential rehab program), regularly attending recovery meetings such as Narcotics Anonymous and/or SMART Recovery, and securing residence in a stable, drug-free living environment (e.g., sober living home, therapeutic communities).
Quitting barbiturates like phenobarbital carries serious risks, but the dangers of continued use are far greater. If you or someone you know struggles with barbiturate dependence, recovery is possible. Seeking help for phenobarbital addiction can allow for a safer withdrawal and reduce the chances of a future overdose and long-term complications.
- U.S. National Library of Medicine. (2017). Phenobarbital.
- National Institute on Drug Abuse. (2016). Misuse of prescription drugs.
- Lafferty, K.A., & Bonhomme, K. (2017). Barbiturate toxicity. Medscape.
- Fisher, G.L., & Roget, N.A. (2009). Encyclopedia of substance abuse prevention, treatment, and recovery. London: SAGE.
- National Institute on Drug Abuse. (2012). Commonly abused drugs chart.
- U.S. National Library of Medicine. (2015). Barbiturate intoxication and overdose.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- Markel, H. (2016). Marilyn Monroe and the prescription drugs that killed her. PBS News Hour.
- Mapes, J. (2012). Judy Garland: Troubles from the end of the rainbow. Biography.
- Saunders, W. (2010). Jimi Hendrix: London. Berkeley, CA: Roaring Forties.
- Bidlack, J. M., & Morris, H. H. (2009). Phenobarbital withdrawal seizures may occur over several weeks before remitting: Human data and hypothetical mechanism. Seizure, 18(1), 79-81.