Guide to Fioricet Abuse and Treatment

Last updated on November 4th, 2019

Fioricet is a prescription medication used to manage frequent or uncontrolled tension headaches.Fioricet may be helpful for someone struggling with tension headaches (although evidence supporting its effectiveness for recurring headaches is lacking); however, it must be used cautiously. Fioricet is a known drug of abuse that has the potential to bring about serious physical and mental health complications.1

Anyone who is unable to control their Fioricet use should consider substance abuse treatment. By consulting with an addiction professional or attending substance abuse treatment, a person can quit Fioricet safely and learn to address the thoughts and behaviors that keep them using in spite of the harm that doing so causes.2


Is Fioricet an Addictive Substance?

Fioricet is a potentially addictive medication.1 Fioricet is comprised of 3 separate substances:1

  • Butalbital – a barbiturate that slows certain central nervous system (CNS) processes via its interaction with brain receptors for the inhibitory neurotransmitter GABA.
  • Acetaminophen – a commonly used pain reliever and fever reducer (an active ingredient in many Tylenol products).
  • Caffeine – a common CNS stimulant.

pile of blue pills portraying fioricet pillsFioricet users may develop significant dependence to this barbiturate-containing drug. The risk of barbiturate dependence and, ultimately, addiction development increases when people consume it at larger doses for longer periods of time.1 In fact, the drug is not recommended for long-term use specifically because of its abuse potential.1 A person abusing or addicted to barbiturates like butalbital may consume incredibly high levels of the drug each day – average daily Fioricet doses in those compulsively misusing the drug have been known to approach 1,500 mg in a single day.1 One Fioricet tablet contains just 50 mg of butalbital.1

When Fioricet enters the brain, it acts similarly to several other CNS depressants (e.g., alcohol, benzodiazepines) by enhancing the activity of a neurotransmitter called gamma-aminobutyric acid (GABA).3 GABA inhibits or slows certain processes in the brain and creates a relaxed feeling.3 For this reason, doctors frequently prescribe CNS depressants for their ability to promote sleep and reduce anxiety.3

Fioricet with Codeine is an opioid analgesic combination formulation of the drug. This combo contains the same medications at roughly the same doses as the other Fioricet formulation, with the addition of 30 mg of codeine.4 The added opioid component of Fioricet can further increase the reward associated with misuse and thereby increase the abuse liability.5

Because of its significant abuse potential, Fioricet with Codeine is listed as a Schedule III DEA-controlled substance.4 Fioricet alone is scheduled as a controlled substance in only a small number of states, not on a national level.

Is It Dangerous?

Yes. Fioricet and Fioricet with Codeine can both be dangerous, due to both their immediate drug effects and their addictive properties. They may be safe when used carefully as directed, but misuse of either drug may lead to physical and mental health hazards, such as addiction and overdose.1

Short-term Side Effects

Certain effects of Fioricet will come on right away. Some of these may occur even if you are taking the drug as directed. The most frequently reported side effects of Fioricet include:1

  • Drowsiness.
  • Lightheadedness and dizziness.
  • Sedation.
  • Nausea/vomiting.
  • Stomach pain.
  • Shortness of breath.

Additionally, there are more serious Fioricet side effects that occur less frequently like:1

  • Confusion.
  • Fainting.
  • Seizures.
  • Depression.

Someone using large amounts of Fioricet may experience the adverse effects of both caffeine and barbiturate intoxication.1

Effects of caffeine intoxication may include:6

  • Restlessness.
  • Nervousness.
  • Excitement.
  • Insomnia.
  • Agitation.
  • Rambling thought and speech patterns.
  • Changes to heart rhythm.

Barbiturate intoxication leads to symptoms comparable to alcohol intoxication, such as:6

  • Slurred speech.
  • Poor coordination.
  • Balance problems.
  • Poor attention and memory.
  • Aggressive behavior.
  • Mood changes.
  • Impaired judgment.

Someone using Fioricet with Codeine may additionally experience opioid intoxication, which might consist of an initial period of euphoria followed by: 4,6

  • Low mood.
  • Lack of interest.
  • Drowsiness.
  • Slurred speech.
  • Poor judgment.
  • Nausea.
  • Vomiting.
  • Constipation.

Long-Term Side Effects

With prolonged use of Fioricet, the individual is more likely to experience tolerance, the need to consume more of the substance to achieve the wanted effects.1 Continuous use of higher and higher doses can lead to serious problems, including possible overdose (see below) and substance use disorder, which manifests with symptoms like:6

Man sitting on bed with head down portraying an individual experiencing Fioricet side effects
  • A strong desire/craving to use more of the substance.
  • Spending a lot of time getting, using, and recovering from Fioricet.
  • Failed attempts to cut back or end use.
  • Problems living up to expectations at home, work, and school.
  • Emerging issues with relationships.
  • Declining interest in social activities or once-enjoyed habits.
  • Continuing to use Fioricet even when faced with harmful outcomes including:
    • Poor physical health.
    • Worsening mental health.
    • Legal problems, such as from drug-seeking, driving under the influence, etc.
  • Going through withdrawal when trying to cut back (a sign of physical dependence).

It takes a much lower dose of a barbiturate to kill a user when they’ve added alcohol to the mix.It is common for abusers of barbiturates to abuse other substances as well, which may lead to eventual polysubstance addiction and additional physical and mental health dangers.7 For example, it takes a much lower dose of a barbiturate to kill a user when they’ve added alcohol to the mix.1

What Are the Signs of Overdose?

As tolerance builds and the individual consumes more Fioricet, the distance between an intoxicating dose and a dangerous dose shrinks, which makes an overdose more likely.1 Excessive use of both Fioricet and Fioricet with Codeine can result in:4

  • Barbiturate poisoning.
    • Drowsiness.
    • Slowed breathing.
    • Confusion.
    • Low blood pressure
  • Codeine poisoning.
    • Opioid overdose triad:
      • Depressed respiration (slowed or stopped breathing).
      • Pinpoint pupils.
      • Loss of consciousness.
    • Convulsions.
  • Acetaminophen overdose.
    • Serious liver damage.
    • Nausea/vomiting.
  • Caffeine poisoning.
    • Inability to sleep.
    • Severe restlessness.
    • Tremors.
    • Irregular heart rate.

While overdose may occur with any misuse of Fioricet or Fioricet with Codeine, the greatest risks come when someone combines this substance with other CNS depressants and alcohol.3,5 In the case of Fioricet with Codeine, it already combines two substances which have depressant effects on the CNS (butalbital and codeine), so adding another into the mix is a big—and possibly deadly—risk.

If you or someone you know is in danger from a Fioricet overdose, seek professional medical treatment immediately by calling 911 or going to the nearest emergency room. Medical treatment will focus on:4

  • Breathing support and airway management, if needed.
  • Cardiovascular support.
  • Decreasing toxic absorption with activated charcoal.
  • Administering naloxone, an opioid blocker, in the case of overdose from Fioricet with Codeine.

What Are the Withdrawal Symptoms?

Chronic excessive use of Fioricet may result in the development of significant physiological dependence. The unpleasant withdrawal syndrome that arises when a dependent person tries to quit can inhibit them from seeking the help they need to get off the drug. Symptoms can range from mild to very serious.

woman holding head down and holding neck portraying someone experiencing anxiety from fioricet withdrawalFioricet withdrawal often begins with headaches, which people may see as a common headache instead of a withdrawal symptom. Unknowingly, they may use more Fioricet to manage the headache and restart the cycle of abuse.7 Someone who makes it past the initial headache stage of Fioricet withdrawal may have additional symptoms like:6

  • Hand tremors.
  • Fast or jerky movements.
  • Anxiety.
  • Rapid pulse.
  • Hallucinations.
  • Nausea/vomiting.
  • Grand mal seizures.

Severe butalbital withdrawal symptoms may begin about 16 hours after the last dose.1 The symptoms will then peak on the second day and will typically show a noteworthy improvement by day 5 and then gradually improve over the course of about 2 weeks.1

Seeking professional treatment for Fioricet withdrawal is crucial, not only because it will alleviate your discomfort to prevent you from relapsing, but also because withdrawal from this drug is associated with sometimes-lethal complications. As many as 30% of those who attempt withdrawal from drugs like Fioricet without treatment will experience a seizure.6

Additionally, withdrawal can spark intense depression, leading to suicidal thoughts and attempts. Depression may be worse among people stuck in patterns of frequent intoxication and repeated withdrawal attempts.6

Where Can I Get Help?

The best and most effective options for your Fioricet treatment will largely depend on several factors, including:8

  • The duration and intensity of your use.
  • If you abuse multiple substances.
  • Your environmental stressors and supports.
  • Existence of any mental health disorders.
  • Prior detox and treatment history.

Because withdrawal from this substance has the potential to be very serious, treatment should begin with a detox program in which you can receive professional medical supervision and care.8

Detox treatment may take place in a variety of settings with options ranging from intensive hospital care to programs that allow more freedom and less monitoring like scheduled visits to a doctor’s office.8 Programs can vary in length from a few days to a few weeks based on your needs.

There are several methods of detox, but the most common method involves stabilizing the individual on their current Fioricet dose before gradually reducing the dose amount and frequency over time.1 Other options involve:8

  • Ending all Fioricet use and prescribing other medications to treat withdrawal symptoms.
  • Switching from Fioricet to a longer-acting barbiturate or another sedating medication like a benzodiazepine and subsequently tapering the dose.

Detoxification is a necessary part of treatment, but someone seeking addiction recovery will require much more to remain drug-free.2 There is more to addiction than just physiological dependence, so addressing only this aspect is insufficient. For long-term abstinence, you should always seek additional treatment to discover ways to change the maladaptive thinking and behaviors that contribute to your substance abuse.

If you’re suffering from a particularly severe addiction, you may require additional inpatient or residential treatment after detox. These options involve you living in the treatment center and having limited contact with the outside world.2 Here, the goal is to spend as much time as possible working with staff on your recovery. Inpatient and residential options can last anywhere from a few days to a year (in the case of therapeutic communities).2

If your addiction is mild, outpatient treatment could be a good fit for you. Compared to inpatient or residential programs, outpatient treatment interventions are generally less time intensive. Outpatient treatment allows those in recovery to return home each night, to continue with work or school responsibilities, and to freely visit with loved ones and other sources of support.8  Outpatient treatments range from several hours each day to only a few hours each month and can include individual, group, and family sessions.8 Unlike their inpatient treatment counterparts, outpatient programs are unable to provide 24/7 supervision. However, they have no requirements for on-site living and are often significantly more affordable.

Better outcomes are associated with longer durations of care.As you move from one stage of treatment to the next, your treatment professionals will recommend and link you to other levels of care to suit your needs.8  This process is referred to as aftercare planning. For some, it will include 12-step or other recovery groups for continued support after treatment.2  It may also include moving to a sober living house where residents can practice new abstinence-supporting life skills in a sober environment. Better outcomes are associated with longer durations of care, so receiving ongoing treatment is the best way to maintain a life of abstinence.2

Alternative Methods of Treating Headaches

Someone who finds themselves abusing Fioricet may have begun taking it as a therapeutic remedy for headache, so when attempting to stop using, this underlying condition may still be a factor that needs to be addressed. Many treatment programs will initiate a process of non-pharmacological headache management, including:9

  • Mind and body approaches including:
    • Acupuncture.
    • Massage.
    • Relaxation.
    • Chiropractic care.
    • Tai chi.
  • Dietary supplements.

With natural approaches, finding an effective treatment or combination of treatments may take some time and several tries. You may wish to speak with your doctor about new ways to address the pain without returning to Fioricet or another potentially addictive medication.


References

  1. DailyMed: U.S. National Library of Medicine. (2016). Fioricet.
  2. National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide.
  3. National Institute on Drug Abuse for Teens. (2016). Prescription Depressants.
  4. DailyMed: U.S. National Library of Medicine. (2016). Fioricet with Codeine.
  5. National Institute on Drug Abuse for Teens. (2017). Prescription Pain Medications (Opioids).
  6. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  7. Weaver, M. F. (2015). Prescription Sedative Misuse and AbuseThe Yale Journal of Biology and Medicine88(3), 247–256.
  8. Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.
  9. National Center for Complementary and Integrative Health. (2016). Headaches: In Depth.
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