Barbiturates, or “barbs,” are a class of depressant drugs that produce sedative effects and have been used for more than a century in clinical applications 2. In the years that followed the synthesis of the precursor molecule—barbituric acid—more than 2500 varieties of barbiturates were engineered, with about 50 of them being utilized in clinical settings 6. In the mid-20th century, barbiturates were the preferred sedative/ hypnotic medications, which help manage sleep and anxiety disorders 6. Currently, only about 12 barbiturates are used in practice 5. Some common examples of barbiturates include 1,5:
In the past, these substances were widely prescribed and used for a range of conditions and symptoms, including as questionable pharmacologic agents for mental health states like catatonia and psychosis 6. They continue to be useful medications for some seizure disorders and for pre-operative or procedural sedation. With diminishing frequency, they are also still used to manage some headaches, insomnia, and anxiety disorders (although benzodiazepines have largely supplanted them for use in a sedative capacity) 4. With the exception of phenobarbital, most of the barbiturates are becoming increasingly rarely prescribed due to their abuse and addictive potential, rapid tolerance, high risk of overdose, and potentially fatal interaction with alcohol 2.
When barbiturates are abused, users may experience euphoria, or a feeling of pleasure and well-being.
Barbiturates, like other sedatives, slow down certain central nervous system (CNS) processes. These drugs create this effect by modulating certain receptor proteins throughout the CNS and, in doing so, increasing the effectiveness or activity levels of a neurotransmitter in the brain called gamma-aminobutyric acid (GABA). GABA is a substance that depresses the otherwise excitatory ‘background tone’ throughout the brain. More GABA effectively leads to increased inhibition and lower levels of neural activity. Similar responses are caused by other CNS depressants like benzodiazepines and sleep medications 8.
With its ability to slow the functioning of the body and the brain, a barbiturate can trigger a range of effects, such as 4,5:
People abuse barbiturates in a number of ways. They may take the drug in higher doses than directed, more frequently than prescribed, or combine it with other drugs to enhance the high. They may also take it in a way other than prescribed, such as crushing and dissolving a pill to inject it. When barbiturates are abused, users may experience euphoria or a feeling of pleasure and well-being 4. This high serves as positive reinforcement to continue abusing the substance. Chronic barbiturate abuse can lead to addiction, a maladaptive cycle of compulsive drug use despite negative consequences.
Many people abuse barbiturates for their euphoric and sedating effects, but they can also elicit harmful or dangerous side effects, such as 10,11,12:
If someone abuses large amounts of barbiturates, they are at risk of experiencing an overdose. Signs and symptoms of a barbiturate overdose include10:
If you suspect that someone has overdosed on barbiturates, call 911 immediately and do not leave the person until emergency responders arrive.
Chronic barbiturate abuse can have severe and detrimental effects on a person’s physical and mental health. Some long-term consequences include 9,10,11:
The longer you abuse barbiturates, the more difficult it can be to quit using. If you or someone you know abuses barbiturates, don’t hesitate to seek professional detox treatment. A detox program can help to ensure comfort and safety throughout the withdrawal process.
Barbiturate addiction is only one of the dangers associated with barbiturate abuse. As someone uses or abuses the substance over a period of time, the effects of the drug become diminished as the body adapts to the increased GABA activity caused by the barbiturate. Because of this developing tolerance to the medication, higher doses need to be used to experience the previous effects.
Continued abuse of barbiturates often leads to the body essentially relying on the presence of the drug to function at the optimal level. This is an indication of physical dependence on the substance. When the drug is not available, distressing effects will be experienced by the user. These are called withdrawal symptoms, and they can range from mild discomfort to extreme danger requiring immediate medical attention. These medical emergencies are more common with barbiturates than with other sedatives.
Barbiturate withdrawal symptoms include 3:
In many situations, there will be no way to completely predict the extent of the withdrawal symptoms for the individual. Factors that influence how withdrawal symptoms manifest include:
Someone that uses barbiturates with other depressants like alcohol or opioids is not only at an increased risk of overdose but could also experience more severe withdrawal symptoms. Someone that has a previous mental health history that includes anxiety disorders will likely experience exacerbated anxiety and panic during withdrawal.
Barbiturates are classified by their speed of action. Categories include 5:
This speed of action will have an impact on the onset of the desired effects of the substance, as well as the onset of withdrawal symptoms with cessation of use. People who abuse barbiturates may be more likely to abuse the varieties that act quickly so that the desired effects can be experienced more rapidly. In turn, these varieties will lead to a more exaggerated withdrawal syndrome that begins sooner after the last dose. Short-acting barbiturate withdrawal symptoms can emerge as early as a few hours since the most recent dose 3. Conversely, withdrawal symptoms for longer-acting barbiturates may not appear for a day or even a week 9.
Withdrawal symptoms are part of the detoxification process. Barbiturate detox is the process by which the body eliminates toxins from the system. The duration of withdrawal symptoms will depend on many of the same factors that dictate severity of withdrawal. Some symptoms will diminish on their own over time, but some symptoms, like increased anxiety and panic, may not resolve until they are treated directly by a mental health professional.
If you are addicted to or dependent on barbiturate medications, detox is an absolute necessity. Failure to receive treatment drastically increases the risk of life-threatening symptoms. Remember, even people that take barbiturates as directed by their physician can still develop a dependence over time, due to the body’s normal adaptation to the presence of the drug.
Dependence will be easy to note. If you start to experience any or all of the withdrawal symptoms listed after missing a dose of the substance or taking it later than usual, dependence is likely to have already developed. Also, dependence may be more likely if you have been using barbiturates for an extended period of time or have had to increase your dose to extend drug efficacy.
Addiction can be a more challenging issue to objectively identify in oneself or others. Because of this problem, consider these warning signs of addiction 9:
Detox is a beneficial intervention for anyone hoping to end barbiturate abuse, and the treatment can aid in reducing the negative behaviors associated with addiction.
When seeking treatment for barbiturate dependence and addiction, there will be two types of detox centers to consider: social detoxification and medically supervised detoxification. Social detox offers a range of treatments that will depend on the specific center. Some offer only a safe and hospitable setting to experience the withdrawal symptoms. Others will offer a trained, professional staff that provide encouragement and support to establish and grow a drug-free lifestyle. Social detox programs will be helpful for withdrawal from certain drugs, but they will not be sufficient in the case of barbiturate withdrawal and detox.
Due to the dangers associated with ending barbiturate use, medically supervised detox is the safest option. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), medically supervised detox is the best practice with sedative-hypnotic drugs, like barbiturates 2.
A medically supervised detox program will have a full treatment team made up of medical health and mental health professionals that can:
With barbiturates, ending use immediately is rarely part of the treatment plan. Instead, the treatment plan will involve 3:
This tapering process is favorable since it will diminish the intensity of the withdrawal symptoms by spreading them over time. The process can be lengthy, so it is rarely conducted entirely in an inpatient setting. Rather, inpatient care may be needed to establish stability before transferring to outpatient when the weaning process is started.
If you or someone you care about suffers from a barbiturate addiction and wants to quit, various detoxification options are available to help ensure safety and comfort throughout the withdrawal process. Detoxification can occur in different settings with varying levels of intensity. The selection of a program type will depend largely on individual needs and can be facilitated by undergoing a pre-rehab evaluation by a substance abuse treatment professional.
No matter what type of barbiturate detox program you choose, it’s important to remember that detoxification does not constitute comprehensive barbiturate addiction treatment. Once you are stabilized and complete your detox program, transitioning into a substance abuse treatment program can help you to build a foundation for long-term sobriety by providing you with coping strategies and sober social skills.