Barbiturates fall under the category of sedative-hypnotics. Though they were originally made to treat disorders such as anxiety and insomnia, they have been largely replaced by newer drugs that have fewer toxic side effects. Illicit barbiturate use can produce feelings of calmness and relaxation and even mild euphoria at high doses.
What are barbiturates?
Barbiturates are nervous system depressants, which mean they slow down activity in the central nervous system including breathing and heart rate. This depressant mechanism is why barbiturates are effective in treating anxiety and seizure disorders, in which the nervous system is working too fast.
Over time, barbiturate use has largely been phased out because of the potential for toxicity. Long-acting barbiturates, such as Luminal, are particularly dangerous because the drug is slow to be eliminated from the body so taking further doses can compound its effects. Even short and medium-acting barbiturates have been replaced by safer drugs such as benzodiazepines. However, barbiturates are still sometimes used medically to treat seizures and as general anesthetics.
Despite its potential for adverse side effects, barbiturates have a high risk of abuse and addiction. They are classified as Schedule II, III, and IV depressant substances by the US DEA, depending on their specific properties.
Well-known barbiturates
Amytal
Amytal, or amobarbital sodium, is used as an anesthetic or sleep aid. However, it functions in such a way that sleep is not as restful because it prevents individuals from entering REM sleep. Because of this, Amytal is no longer used as frequently in favor of more effective sleep aids. Amytal may be referred to as blue heaven or blue velvet because it comes in a blue pill.
Luminal
Luminal, also known as phenobarbital, is commonly used to treat seizures, anxiety, as well as during barbiturate withdrawal. Its popularity also makes it one of the most abused barbiturates since it is so widely available. It is known illicitly as purple hearts or goof balls.
Nembutal
Nembutal, or pentobarbital sodium, is no longer prescribed because of its potential for abuse. It is known by the street name yellowjackets or nembies. It was once designed for use as a surgical sedative and sleep aid. It is one of the drugs that is used for euthanasia where the practice is legal.
Seconal
Seconal, or secobarbital sodium, was also designed to treat seizures, insomnia, and to serve as an anesthetic, but is now used medically only for euthanasia. Seconal use is associated with a high likelihood of developing tolerance, requiring higher doses to achieve the same effect. This is part of why it is so addictive.
Because barbiturates affect the nervous system, many essential bodily functions can be altered through barbiturate abuse. Thus, signs and symptoms of barbiturate abuse are wide-ranging, affecting physiological systems, cognition, mood, and normal daily functioning.
Some short-term physiological signs of barbiturate use include:
- Drowsiness
- Imbalance
- Nausea
- Vomiting
- Slowed breathing
- Depressed heart rate
- Low blood pressure
- Impaired motor function
- Excessive sweating
- Low temperature
- Insomnia
- Coma
Barbiturates can also cause severe psychological effects. These may occur as a response to short-term use but are more likely and severe with prolonged barbiturate use. They include:
- Memory impairment
- Disorientation
- Confusion
- Difficulty concentrating
- Agitation
- Paranoia
- Anxiety
- Mood swings
- Depression
- Delusions
- Hallucinations
- Suicidal ideation
Behavioral signs of barbiturate abuse
Barbiturate abuse and addiction may be evident to loved ones because prolonged use can change how you interact with the people around you.
Some behavioral signs of barbiturate abuse include:
- Decreased interest in hobbies and activities that you used to find enjoyable
- Becoming isolated from family and friends
- Engaging in barbiturate use despite the interpersonal problems it causes
- Increased concern with getting, using, or recovering from barbiturate use to the detriment of other aspects of your life
Barbiturate intoxication
Barbiturate toxicity is common because the effect of long-acting barbiturates tends to wear out long before the drug is eliminated from the body. Subsequent repeated use can lead to toxic barbiturate levels that can dangerously depress vital functions like breathing and heart rate.
This also increases the risk of developing tolerance as the body quickly adjusts to having higher and higher doses, and the same amount stops having such a powerful effect. Tolerance is one important component in the development of addiction. With high tolerance and increased use, withdrawal symptoms can also make it difficult for individuals to quit using.
Barbiturate intoxication occurs when unsafe levels of barbiturates are present in the body. Some symptoms of intoxication include:
- Difficulty concentrating
- Nausea
- Muscle weakness
- Depressed heart rate
- Depressed breathing
- Decrease in urination
- Slurred speech
- Impaired balance
Barbiturate overdose
As a powerful and extremely toxic sedative, barbiturates have a high risk of lethal overdose. Potential barbiturate overdose is a medical emergency and should immediately be treated by medical professionals. Signs of barbiturate overdose include:
- Cold and clammy skin
- Dilated pupils
- Weak pulse
- Shallow breathing
- Respiratory depression or respiratory failure
- Loss of consciousness
- Coma
Overdose is more likely when barbiturates are combined with other substances which can exacerbate its effects. For example, alcohol and opiates can have a synergistic effect when combined with barbiturates because they also depress the nervous system. In the event of barbiturate overdose, it’s important to consult with paramedics and, if possible, inform them of any other drugs that may have been taken with barbiturates for the most effective treatment.
Barbiturate withdrawal
When the body becomes physically dependent on barbiturates, suddenly stopping their use can lead to unpleasant withdrawal symptoms. The more severe the addiction, the worse withdrawal symptoms typically are. These include:
- Nausea
- Vomiting
- Irritability
- Increased sweating
- Fever
- Chills
- Anxiety
- Low blood pressure
- Irregularities in the heartbeat
- Hallucinations
- Depression
- Suicidal ideation
- Seizures
Medical detox from barbiturates
Barbiturate withdrawal can cause distressing and intense symptoms, which makes it more difficult for individuals to safely discontinue their drug use without support. Medical detox is recommended to help patients safely eliminate barbiturates from their system under close medical supervision. Doctors and nurses can monitor the individual and provide treatment for the most severe side effects to make detox more comfortable.
Barbiturate addiction treatment
Addiction treatment for barbiturates is designed on an individual basis according to the severity of the abuse, duration of addiction, physical and mental health, and other personal factors. Treatment is typically tailored to the individual’s needs and goals for recovery to ensure maximum effectiveness. Addiction treatment is holistic and emphasizes overall well-being.
Beginning with detox, barbiturate addiction treatment progresses to therapeutic intervention once the drug has been fully removed from the body. During this phase of treatment, individuals are more open and physically ready to explore underlying issues that are linked to their substance abuse. Therapy is held in individual and peer group sessions, where the focus is learning to overcome triggers and cravings.
Barbiturate FAQs
Can barbiturate withdrawal be life-threatening?
Since barbiturate withdrawal can affect important functions such as blood pressure, it’s possible for withdrawal to be lethal. Psychologically, severe depression induced by withdrawal can result in suicide.
Why are barbiturates still used despite their side effects?
Though barbiturates have largely stopped being prescribed, they are still indicated in the treatment of seizures or as an anesthetic. This may occur because of allergic reactions to other anesthetics or because certain conditions are not responsive to newer alternatives.
Can long-term effects of barbiturate use persist after recovery?
Unfortunately, certain long-term effects are irreversible after prolonged barbiturate use. These include cognitive impairments that can affect learning and memory, heart and liver damage, and neurological damage to the central nervous system.
How do barbiturates affect the body?
Barbiturates exert their effects on the central nervous system by enhancing the activity of a neurotransmitter called gamma-aminobutyric acid (GABA). This results in a depression of brain activity, leading to effects such as sedation, relaxation of muscles, and reduction of anxiety. However, these effects can also lead to risks such as respiratory depression, lowered blood pressure, and impaired cognitive function.
