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Barbiturates Withdrawal and Treatment

What Are Barbiturates?

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

  • Phenobarbital (Luminal Sodium).
  • Pentobarbital sodium (Nembutal).
  • Amobarbital (Amytal).
  • Secobarbital (Seconal).
  • Butalbital (Fiorinal, Fioricet).

What are Barbiturates Used for?

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 barbiturates are becoming increasingly rare as prescriptions because of their abuse and addictive potential, rapid tolerance, high risk of overdose, and potentially fatal interaction with alcohol.2

Barbiturates, like other sedatives, calm down the central nervous system (CNS). 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 calms down the otherwise excitatory ‘background tone’ throughout the brain. When CNS depressants interact with GABA it leads to increased inhibition and lower levels of neural activity. Similar responses are caused by other CNS depressants like benzodiazepines and sleep medications.1

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

  • Increased relaxation.
  • Relief from muscle spasms.
  • Increased drowsiness.
  • Seizure prevention.

People misuse 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 misused, users may experience euphoria or a feeling of pleasure and well-being.4 This high serves as positive reinforcement to continue misusing the substance. Chronic barbiturate abuse can lead to addiction, a maladaptive cycle of compulsive drug use despite negative consequences.

Short-Term Effects of Barbiturates

Many people abuse barbiturates for their euphoric and sedating effects, but they can also elicit harmful or dangerous side effects, such as:9, 10

  • Memory and judgment impairment.
  • Changes in consciousness.
  • Coordination problems.
  • Irritability.
  • Paranoia.
  • Suicidal thoughts.
  • Lack of inhibition.
  • Extreme drowsiness.
  • Sluggishness.
  • Slurred speech.
  • Slowed reflexes and thinking.
  • Nausea.
  • Dizziness.

If someone abuses large amounts of barbiturates, they are at risk of experiencing an overdose. Signs and symptoms of a barbiturate overdose include:9

  • Clammy skin.
  • Dilated pupils.
  • Shallow breathing.
  • Weak pulse.
  • Coma.
  • Death.

If you suspect that someone has overdosed on barbiturates, call 911 immediately and do not leave the person until emergency responders arrive.

Long-Term Effects of Barbiturates

Chronic barbiturate abuse can have severe and detrimental effects on a person’s physical and mental health. Some long-term consequences may include:8, 9 10

  • Tolerance, which develops rather quickly.
  • Increased risk of overdose due to the need for larger doses.
  • Physical dependence, leading to potentially fatal withdrawal symptoms.
  • Addiction, which is characterized by an inability to control use despite harmful consequences.
  • Memory loss.
  • Changes in alertness.

The longer you misuse barbiturates, the more difficult it can be to quit using them. If you or someone you know misuses barbiturates, don’t hesitate to seek professional detox treatment. A detox program can help to ensure comfort and safety throughout the withdrawal process.

Barbiturate Withdrawal Symptoms

Barbiturate addiction is only one of the dangers associated with barbiturate abuse. As someone uses or misuses 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 misuse 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

  • Nausea.
  • Lack of appetite.
  • Diarrhea.
  • Increased blood pressure and heart rate.
  • Fever.
  • Irritability.
  • Insomnia.
  • Restlessness.
  • Depression.
  • Hallucinations.
  • Anxiety and panic attacks.
  • Severe agitation.
  • Shakiness or tremors.
  • Seizures.

In many situations, you may not be able to predict the extent of the withdrawal symptoms for the individual. Factors that influence how withdrawal symptoms manifest include:

  • The barbiturate dose.
  • The frequency of use.
  • The duration of use.
  • The existence of co-occurring mental health issues.
  • The use of other substances in combination with barbiturates.

Someone that uses barbiturates with other depressants like alcohol or opioids is not only at an increased risk of an 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.

Detoxing from Barbiturates

Barbiturates are classified by their speed of action. Categories include:5

  • Ultra-short.
  • Short.
  • Intermediate.
  • Long-acting.

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 after the most recent dose.3 Conversely, withdrawal symptoms for longer-acting barbiturates may not appear for a day or even a week.8

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 the 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.

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Benefits of Barbiturate Detox

If you are addicted to or dependent on barbiturate medications, detox can be an important first step in the treatment process. Remember, even people that take barbiturates as directed by their physician can still develop dependence over time, due to the body’s normal adaptation to the presence of the drug.

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 may 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.

Substance use disorders like barbiturate addiction can only be diagnosed by a medical professional. If you or a loved one are struggling with barbiturate misuse, it may be helpful to know some of the signs so you know when to seek support. Warning signs of addiction can include:8

  • Failing to cut down or quit using barbiturates despite efforts to do so.
  • Spending a large amount of your time obtaining and using barbiturates, as well as recovering from their effects.
  • Having increased problems at work or school as a result of barbiturate use.
  • Experiencing psychological or physical problems as a result of barbiturate use.
  • Having strong cravings for barbiturates.
  • Continuing to use barbiturates despite interpersonal or social problems resulting from use.
  • Abandoning previously enjoyed activities in favor of barbiturate use.
  • Using barbiturates in hazardous situations, such as while driving.

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.

How Does Supervised Detox Help?

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 withdrawal symptoms. Others will offer a trained, professional staff that provides 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 offers physical health and health professionals who can:

  • Accurately assess a person’s substance misuse, mental health status, and physical health condition.
  • Monitor and track vital signs related to withdrawal.
  • Treat physical health and mental health complications that are exacerbated or triggered by withdrawal symptoms.
  • Administer medications to increase comfort and maintain safety.
  • Provide support, compassion, and helpful strategies throughout the process.
  • Refer and arrange for substance abuse treatment when detox ends.

With barbiturates, ending use immediately is rarely part of the treatment plan. Instead, the treatment plan will involve:3

  • When applicable, switching to a long-acting barbiturate like phenobarbital.
  • Establishing a period of stability with the new medication.
  • Tapering the dose according to the needs of the individual.

This tapering process may be used to diminish the intensity of the withdrawal symptoms by spreading doses 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.

Barbiturate Detox Programs

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.

  • Hospital setting: People with a history of severe withdrawal symptoms, such as seizures and delirium tremens, may be safer in a hospital setting. Additionally, people with co-occurring disorders such as heart problems or major depression might be best served by ICU staff.
  • Inpatient detox program: Specialized inpatient programs are often useful because patients live at the facility and are constantly monitored by professionals. They may receive medically-assisted detox support in conjunction with psychological counseling.
  • Outpatient detox program: Specialized detox and outpatient recovery programs are also available on an outpatient basis. Good candidates for outpatient detox have:
    • No co-occurring disorders, which could interfere with withdrawal.
    • A sober support system at home.
    • An assessment by a medical professional during which it has been ascertained that there is little to no risk of having complicated withdrawal.
  • Doctor’s office: Many people benefit from outpatient detox assistance from their primary care doctor with daily visits to the physician’s office.

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.

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