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Though not as readily available as they once were, some barbiturates continue to be abused for their sedating high that includes effects such as:
Barbiturates are sedative drugs once widely prescribed for their anxiolytic, sleep-inducing, and anticonvulsant properties. Though effective for managing seizures and anxiety, prescriptions for and use of barbiturates has significantly declined due to their dangers. These include their addictive potential, overdose risk, and narrow therapeutic range (which means there is a very narrow window between the amount needed to have a therapeutic effect and the amount that can result in coma or death).13 Medical professionals view other drugs, including benzodiazepines and sleep medications (e.g., Ambien), as safer and more effective options.4
Available under brand names like Seconal and Fiorinal, slang, or street, names include:2
- Block busters.
- Christmas trees.
- Goof balls.
- Red and blues.
- Yellow jackets.
What Are Barbiturates?
Barbiturates are a group of medications that have been used for numerous medical reasons for more than 100 years.1-4 At one point, there were about 2,500 barbiturate variations created, but now only about 10 variants are employed by medical professionals.3 Available as an oral pill or injection, barbiturates are known by generic and brand names like:1,3,4
- Mephobarbital (Mebaral).
- Phenobarbital (Luminal).
- Pentobarbital (Nembutal).
Today, the range of medical uses for barbiturates has markedly narrowed. With a similar range of effects, the benzodiazepines (e.g., Valium, Xanax) have largely replaced the barbiturates for a number of medical applications. However, they continue to be used, to a lesser extent, for preoperative sedation and as treatment for:1,3
- Seizure disorders.
- Anxiety and tension.
- Severe sleep problems.
Barbiturates, like other central nervous system (CNS) depressants, essentially work by inhibiting certain brain processes.1
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 452,000 people used barbiturates within the last year.5 This number is small when compared to benzodiazepine users (30 million in the last year) and reflects the significant reduction in prescribing.
Are They Addictive?
Most barbiturates are Schedule II controlled substances, indicating they have a high potential for abuse and dependence.2,4
When they are consumed, barbiturates trigger specific chemical changes in the brain. Barbiturates enhance the activity of GABA, a neurotransmitter that relays certain types of signaling between brain cells; this, in turn, leads to slowed brain activity and sedation.4
Barbiturates have certain desirable effects, including relief from anxiety and a mild euphoria.2 For some people, these positive feelings reinforce continued use, often with escalating frequency and dosing, as the body quickly becomes tolerant to the effects. This not only raises the risk of addiction development, but also of deadly overdose.
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Signs of Abuse and Addiction
Abuse and addiction to prescription medications isn’t always overtly obvious. Most would agree that anyone using heroin is unequivocally abusing it. On the other hand, the abuse of prescription medications often begins more subtly. Someone abusing prescription drugs may:1
- Use the drug more often than intended.
- Use higher doses than recommended/prescribed.
- Consume the medication in ways other than prescribed, like crushing and snorting the pills.
- Combine the medication with other drugs or alcohol to modify or intensify the effects.
The fact that someone is prescribed the medication does not mean they cannot abuse or become addicted to it. Barbiturate addiction is marked by the compulsive drive to use the drugs regardless of all of the negative things that happen as a result.
Someone who has developed a barbiturate addiction or a sedative use disorder may display certain signs and behaviors, as well as experience symptoms such as:7
- Consuming the drug without a prescription.
- Making unsuccessful attempts to end or reduce use.
- Expending more effort and money to acquire and use the substance.
- Spending a lot of time intoxicated and recovering from intoxication.
- Experiencing increased conflicts in relationships and social isolation.
- Failing to meet their expectations and responsibilities at home, work, or school.
- Changing interests and activities.
- Needing to use more of the drugs to feel the effects (tolerance).
- Feeling irritable, uncomfortable, or sick when use ends (withdrawal).
- Strong cravings for more of the drug when it is not immediately available.
- Continuing to use even if there is a meaningful risk to mental or physical health.
Someone using barbiturates who meets just two of these criteria may have a substance use disorder.7
Other Warning Signs
There are additional signs that point to a problem with barbiturate abuse. Someone misusing these drugs may:
- Hide pills or pill bottles around the house.
- Have prescriptions that do not belong to them.
- See more than one doctor to get multiple prescriptions.
- Often appear disoriented or very drowsy.
- Have tools used to crush pills and snort the powder.
Short- and Long-Term Effects
When consumed, barbiturates have short-term effects that are similar to those of other CNS depressants like:1,2,7
- Feeling physically and mentally calm.
- Slurred speech.
- Slowed or shallow breathing.
- Lack of motor coordination.
- Problems walking with a steady stride.
- Cognitive problems including poor attention and memory, as well as disorientation.
Barbiturate intoxication can look very similar to alcohol intoxication, as both drugs are depressants and affect the body and brain in similar ways.7
The effects will increase proportionally to the dose of barbiturates. Higher doses lead to more significant signs and symptoms. For example, someone using small doses may have memory problems; someone using large amounts of barbiturates may experience gaps of memory comparable to blackouts produced from excessive alcohol consumption.7
People using barbiturates at high doses face risks that may include:1,2,7
- Irritability and aggression.
- Substantial mood changes.
- Impaired judgment.
- Reduced ability to relate with others.
- Depression and suicidal thoughts.
Another frightening risk is that of sexual assault.7 At high doses or in combination with other drugs like alcohol, barbiturates may be used to incapacitate someone to the point where they are unable to resist an attack.
Barbiturate use may also result in an impaired ability to drive and increase the risk of bodily injury.
Barbiturates and Other Drug Use
Some people that abuse barbiturates combine them with other substances—often, other sedatives.8,9 A person may combine barbiturates with other substances to:8
- Amplify the euphoric effect. Consuming barbiturates with benzodiazepines, sleep medications, and other drugs can intensify the high but also the danger of overdose and even death.
- Increase the anti-anxiety effects. Some will abuse barbiturates to experience a euphoric high while others will seek to self-medicate an anxiety disorder, whether it is diagnosed or not. This self-medication is sometimes called “chemical coping.” Though it might initially seem like an appealing option, abusing multiple prescriptions or combining barbiturates with other sedatives is a maladaptive coping mechanism and extremely dangerous to boot.
- Offset the unwanted effects of a stimulant substance. Someone may utilize barbiturates to take the edge off, or otherwise lessen some of the unpleasant effects of stimulants, as well as to ease the comedown off them.
Another tendency is for people to abuse barbiturates and alcohol concurrently.9 Alcohol and barbiturates work synergistically to amplify the inhibitory nature of GABA.8 Using alcohol with barbiturates can produce a more intense euphoria and temporarily relieve anxiety to an even greater extent, but this combination can produce unwanted effects that far outweigh the perceived benefits.
Can You Overdose on Barbiturates?
Overdosing on barbiturates is very possible.3 In fact, there is an enormous risk of overdose for anyone abusing barbiturates, especially if they are combining the substance with other CNS depressants. The high risk of overdose is a significant drawback related to barbiturates and one reason that benzodiazepines are currently prescribed at much higher rates.4
At the height of barbiturate use and abuse, many died from the substance. Notably, the two men that first introduced barbiturates are believed to have overdosed and died from the substance.3 Perhaps the most famous death related to barbiturates was actress Marilyn Monroe in 1962.3
People would take their recommended dose of the barbiturate, forget that they had taken a dose, and take another dose.
Other people would unintentionally overdose on their prescribed barbiturates due to a problem called the “automatism phenomenon.”3 These people would take a recommended dose of the barbiturate, forget that they had taken a dose (possibly due to memory and attention problems associated with the drug), and take another dose.3
Most barbiturate overdoses involve a cocktail of drugs, with alcohol and opioids being the most frequently observed additions.10
Signs and symptoms of barbiturate overdose include:2,10
- Cold, clammy skin.
- Shallow breathing.
- Dilated pupils.
- Weak but quick pulse.
- Fading in and out of alertness.
- Extreme drowsiness.
Additional adverse consequences of barbiturate overdose include:10
- Head, neck, and spine injuries from falls.
- Pneumonia from breathing in vomit or other liquids.
- Muscle damage from lying unconscious for long periods on a hard surface.
About 10% of barbiturate overdoses lead to death, mostly from heart and lung issues.10
Anytime someone appears very tired, confused, or has breathing problems after taking a dose of barbiturates, seek emergency medical assistance by calling 911 immediately.
Unfortunately, there are no medications or antidotes given to people that overdose on barbiturates, but quick treatment can prevent more serious complications.10 If the person consumed opioids along with barbiturates, medical professionals could administer an opioid antidote drug like naloxone (Narcan) to reverse those effects.10
Barbiturate Dependence and Withdrawal
Addiction and overdose are serious issues, but they are not the only negative developments associated with barbiturate abuse. Issues like tolerance and physical dependence are likely, even when the medication is used as prescribed.10 Tolerance is the need to use more of the substance to attain the same effects.4 Physical dependence is when the body and brain come to rely on the substance to achieve a feeling of normalcy.4
Once dependence has set in—as it quickly can for barbiturate users—withdrawal will occur if the drug is not consumed at the usual levels.6 The symptoms of withdrawal can range from mildly distressing to significantly dangerous depending on factors related to the substance, the severity of abuse, and the individual’s unique differences.
Sedatives, hypnotics, and anxiolytic (anti-anxiety) substance withdrawal symptoms will resemble alcohol withdrawal and include symptoms like:7
- Increased sweating.
- Quickened heart rate – greater than 100 beats per minute.
- Quickened breathing rate.
- Raised blood pressure.
- Increased body temperature.
- Inability to sleep.
- Nausea and vomiting.
- Sped-up movements.
- Shaky hands.
- Grand mal seizures.
The onset, intensity, and duration of these symptoms will be affected by:2,7
- The action of the barbiturate (time of onset and duration of effects). Short-acting barbiturates (e.g., Seconal), will trigger withdrawal symptoms that begin just a few hours after the last dose.
- The dose and frequency of use.
- The total duration of use.
- The use of other substances with the barbiturates.
As mentioned, people often abuse other substances with barbiturates, which means that withdrawal will be more complicated and potentially more difficult to treat effectively.
People may be unaware of the risks associated with suddenly quitting sedating drugs such as the barbiturates. As many as 30% of people withdrawing from sedatives will have a seizure.7 A person dependent on barbiturates should always seek professional treatment to safely and effectively manage their withdrawal.9
A person dependent on barbiturates should always seek professional treatment to safely and effectively manage their withdrawal.
A helpful way to begin the recovery process is a professional detoxification program. Detoxification is the process in which drugs are allowed to safely and gradually clear from the system.11 Medically supervised or medically managed detox is the use of specific strategies and medical intervention to manage the process of withdrawal to limit discomfort and minimize threats to the individual’s physical and mental health.9
Detox programs will work to gradually reduce and slowly taper the dose of barbiturates over a length of time, or they will end use completely while providing medical assistance to ensure comfort and safety.9
Detox is a critical step in treatment, but it is not usually enough to help people achieve long-term recovery from barbiturate abuse.12 People interested in maintaining lasting abstinence should receive follow-up care that is offered at two broad levels:9,11,12
- Inpatient/residential treatment. These programs benefit people with more significant addictions, failed attempts at recovery in the past, or inadequate supports at home. The different inpatient/residential program varieties can focus on relatively short-term, acute care, or provide longer-term care that can last up to a year, in some cases. All inpatient/residential programs are quite structured and require the individual to live at the treatment center for the duration of their stay. Different programs operate within a range of treatment settings, including hospital-based locations or more home-like, residential environments.
- Outpatient treatment. Many people that complete an inpatient/residential program will follow up that care with outpatient treatment to continue their recovery efforts. Others may seek outpatient care from the start. This option is more appropriate for people with less severe addictions, previous treatment success, or strong support at home. Outpatient programs permit the individual to live at home and attend treatment during the day. Outpatient program options include:
- Partial hospitalization programs (PHPs) – The highest intensity outpatient program offering individual, group, and family sessions for most of the day.
- Intensive outpatient programs (IOPs) – A lower intensity option that offers some combination of individual, group, and family sessions for about 3 hours per session, 3 days per week.
During inpatient/residential or outpatient treatment programs, the individual will receive behavioral therapy with the goal of: 11
- Changing thoughts and feelings regarding drug use.
- Improving positive coping skills to achieve a healthier life.
These options represent some of the professional addiction treatment options. Support groups like Narcotics Anonymous (NA) and non-12-step groups like SMART Recovery offer a complementary way to maintain recovery.12 Support groups are group meetings led by peers that have first-hand experience with addiction and recovery. Support groups are helpful during any stage of recovery.
If you’ve noticed a problem in yourself or someone that you love, don’t hesitate to reach out for help. People recover from addiction every day—it’s possible to live a life that doesn’t include substance abuse.
- National Institute on Drug Abuse for Teens. (2017). Prescription Depressants.
- Drug Enforcement Administration. (2015). Drugs of Abuse..
- López-Muñoz, F., Ucha-Udabe, R., & Alamo, C. (2005). The history of barbiturates a century after their clinical introduction.. Neuropsychiatric Disease and Treatment, 1(4), 329–343.
- National Institute on Drug Abuse. (2016). Research Report Series: Misuse of Prescription Drugs.
- Substance Abuse and Mental Health Services Administration. (2016). Prescription Drug Use and Misuse in the United States: Results from the 2015 National Survey on Drug Use and Health.
- Medscape. (2016). Withdrawal Syndromes.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- Weaver, M. F. (2015). Prescription Sedative Misuse and Abuse. The Yale Journal of Biology and Medicine, 88(3), 247–256.
- Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.
- U.S. National Library of Medicine: MedlinePlus. (2015). Barbiturate Intoxication and Overdose.
- National Institute on Drug Abuse. (2016). Drug Facts: Treatment Approaches for Drug Addiction.
- National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide.
- Coupey, S. M. (1997). Barbiturates. Pediatrics in Review, 18(8).