Barbiturate Addiction: Signs, Symptoms, Risks, and Treatment Resources

Barbiturates are drugs with a sedative-hypnotic effect, meaning they cause both relaxation and sleepiness. Historically, barbiturates were used as anesthesia and for the treatment of a variety of conditions such as seizures, anxiety, intracranial hypertension, insomnia, and more. Due to their high potential for abuse and the emergence of safer options, barbiturate availability is more limited today.

What are Barbiturates?

Barbiturates are a class of central nervous system depressants derived from barbituric acid. They work by reducing neurotransmitter activity in the brain[1]. While barbiturates have been used to induce anesthesia and treat conditions such as certain forms of epilepsy and extreme cases of insomnia historically, their use today is more restricted due to the development of safer alternatives. Their classification under the Controlled Substances Act varies by specific drug and its potential for abuse, with some barbiturates classified as Schedule II, indicating a high potential for abuse and dependence, and others as Schedule III or IV, indicating a lower potential relative to Schedule II substances.

Abuse of barbiturates was prevalent in the 1970s but declined significantly when benzodiazepines were introduced as a safer alternative. However, the risk of barbiturate overdose has not been completely eradicated, with 405,000 people over the age of 12 having reported use or misuse of barbiturates in 2018[2]. Common alternative names for barbiturates include Barbs, Block Busters, Christmas Trees, Goof Balls, Pinks, Red Devils, Reds & Blues, and Yellow Jackets[3].

Side Effects of Barbiturates

Barbiturates enhance the effect of gamma-aminobutyric acid (GABA), the main inhibitory neurotransmitter of the central nervous system, by increasing GABA-induced chloride ion flux into neurons. This leads to hyperpolarization and decreased neuronal firing, which reduces neuronal activity, creating effects ranging from mild sedation to coma. Improper usage of barbiturates has severe implications, so it must be taken carefully.

Potential side effects of barbiturates when taken as prescribed include:

• Confusion
• Headache
• Dizziness
• Drowsiness
• Impaired memory
• Irritability
• Low blood pressure
• Nausea and vomiting
• Reduced self-control
• Vertigo
• Trouble breathing

How are Barbiturates Taken?

Barbiturates are most commonly consumed in the form of pills and tablets. They may also be administered as a liquid injection or sometimes rectally for pediatric patients. There are ultrashort, short, intermediate, and long-acting kinds of barbiturates. Barbiturates are a prescription-only drug.

Barbiturate Quick Reference

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Statistics on Barbiturate Use, Misuse, and Addiction

According to data from the 2018 National Survey on Drug Use and Health, about 405,000 individuals in the United States reported using barbiturates within the past year.[2] This statistic reflects both medical and non-medical use, underscoring the continued presence of barbiturates in some treatment protocols as well as their potential for misuse.

Before the introduction of benzodiazepines in the 1970s, barbiturates were the most commonly prescribed treatment for seizures and anxiety disorders in the US. Barbiturate prescriptions have dramatically decreased since then, and the reduced availability has helped curb abuse in recent years. Barbiturates are known to have a high potential for physical dependence after only a short time of use.

Effects of Barbiturate Abuse

As a central nervous system depressant, the effects of barbiturate abuse can look similar to those of alcohol abuse. In addition to the physical symptoms, those who misuse barbiturates may display risky behaviors, avoid responsibilities such as work and school, isolate themselves from loved ones, and lose interest in hobbies they once enjoyed.

Can You Overdose on Barbiturates?

Barbiturates carry a significant risk for addiction and the development of tolerance, where increasing doses are required to achieve the desired effects. The risk of overdose is heightened by the practice of combining barbiturates with other substances, which can unpredictably amplify their effects. This combination increases the danger of overdose, which is a critical concern due to the narrow therapeutic index of barbiturates.

Signs and Symptoms of Barbiturate Overdose

A barbiturate overdose should be treated as a medical emergency as it is extremely dangerous.

Barbiturate overdose symptoms include:

• Incoordination or staggering
• Impaired judgment
• Slurred speech or other speech impediments
• Slowed or shallow breathing
• Increased heart rate
• Decreased blood pressure
• Reduced urine output
• Weak and rapid pulse
• Clammy skin
• Dilated pupils
• Coma and death

What to do if you suspect someone is overdosing on barbiturates:

If you suspect someone is suffering from barbiturate poisoning, treatment must be administered quickly. There is no antidote for overdose, but prompt treatment often results in positive outcomes for those who are otherwise healthy.

Dangers of Long-Term Barbiturate Use

Barbiturates come with a high risk for physical and psychological dependence with prolonged use. Those who take barbiturates even just for two weeks can develop a need for its relaxing and euphoric effects. One can build up their tolerance to the drug after two weeks, causing them to need a higher dose to feel the same effects.

Mixing Barbiturates with Other Drugs

Barbiturate abuse is most common among young adults who often use the drug to counteract the side effects of other stimulants such as cocaine and methamphetamines. Mixing barbiturates with other drugs can lead to potentially severe outcomes when taken inappropriately.

Barbiturate Addiction and Abuse

Barbiturate abuse today is less common than it was in the 1960s and 1970s when it was a commonly prescribed medication for an array of medical conditions. However, when it’s used, there is a high risk of addiction. Any form of misuse can lead to physical dependence, tolerance (leading to further abuse), intense withdrawal symptoms, and overdose.

Are Barbiturates Addictive?

Yes, barbiturates are an addictive drug with a high risk for abuse. They are often misused to reduce anxiety and inhibitions or treat unwanted side effects of other illicit drugs. Barbiturate addiction is a serious condition as it can easily lead to a lethal overdose.

Signs of Addiction to Barbiturates

The most telling sign of an addiction to barbiturates is experiencing physical withdrawal symptoms when usage has stopped. However, there are many behavioral and social signs that one has become dependent on barbiturates, including mood swings, attempting to gain more prescriptions than are needed, isolation from family and friends, loss of interest, perpetual drowsiness, new financial obstacles, and relationship issues.

Barbiturate Withdrawal

It doesn’t take long after stopping the drug for withdrawal symptoms to set in. As soon as 8-12 hours after the last dose, one can experience the following symptoms:

• Nausea
• Vomiting
• Restlessness
• Insomnia
• Muscle cramps
• Fatigue
• Anxiety
• Tremors
• Seizures
• Hallucinations

Barbiturate Withdrawal Management and Addiction Treatment

Barbiturate treatment often involves severe withdrawal symptoms in those who have misused the drug or taken it for a prolonged period of time. It is possible to safely overcome barbiturate dependence, though, in a reputable detox facility or rehab center.

The first step is detoxing. This is the process of ridding the body of the drug. Typically, this is done gradually to lessen the severity of withdrawal symptoms. Because withdrawal can cause life-threatening symptoms like seizures, it’s recommended to get help from professionals. This is especially true if the patient has been taking a high dose.

Withdrawal symptoms peak around the 72-hour mark, which is when the risk is highest for severe symptoms like seizures. Other dangerous withdrawal symptoms are psychosis, aggression, and self-inflicted injury. The withdrawal period can last for up to a week.

Detox is often followed by participation in a Partial Care rehabilitation program, from intensive to standard outpatient. Aftercare is another component often involved in rehabilitation to ensure long-term recovery.

The cost of treatment varies depending on the program and the individual’s needs. However, insurance often allows people to seek the professional help they need regardless of their financial situation.

Therapies Used in Barbiturate Addiction Treatment

There is a wide range of potentially useful therapies for barbiturate treatment, largely dependent on the individual and their circumstances. Some include Cognitive Behavioral Therapy (CBT), Motivational Interviewing (MI), Dialectical Behavior Therapy (DBT), and Trauma-focused approaches.

Drugs Used in Barbiturate Addiction Treatment or Withdrawal Management

The abrupt discontinuation of barbiturate use poses significant health risks due to the potential for severe withdrawal symptoms. A common medical strategy to mitigate these risks involves a gradual tapering of the dosage or employing a medically supervised detoxification process using a long-acting barbiturate like phenobarbital. This approach helps manage withdrawal symptoms more effectively and reduces the risk of severe complications such as seizures. Other medications, such as sleep aids and anti-nausea substances, can also help ease withdrawal symptoms.