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What is a Barbiturate Drug?

Barbiturates belong to a group of sedative-hypnotic drugs composed of synthetic substances. 

A medical professional may prescribe barbiturates to treat different medical conditions, including:

  • Seizure disorders (like epilepsy) 
  • Insomnia 
  • Anxiety before surgery 
  • Neonatal abstinence syndrome (when a newborn baby experiences withdrawal symptoms due to drug exposure while in the womb)
  • Induction of coma (for increased intracranial pressure due to head injury)
  • Anesthesia

Barbiturates are classified as central nervous system (CNS) depressants. This means that these types of medications can slow brain activity, affect an individual’s level of consciousness, and cause symptoms like sleepiness and more. 

The effects of barbiturates will vary in speed and time, depending on whether the medications are:

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

However, because barbiturates can build physical dependence and even result in substance misuse, health care providers do not often prescribe such medication outside of clinical practice. 

Instead, health care regimens tend to include another type of CNS depressants called benzodiazepines. Examples of benzodiazepines include:

  • Diazepam (Valium®)
  • Clonazepam (Klonopin®)
  • Alprazolam (Xanax®)
  • Triazolam (Halcion®)
  • Estazolam (Prosom®)
  • Secobarbital (Seconal®)
  • Butalbital

If individuals misuse barbiturates, there is a risk of barbiturate poisoning or drug overdose. In more severe cases, the improper use of barbiturates can lead to death.

Examples of Barbiturate Drugs

Barbiturate drugs are available in different forms, including:

  • Capsule
  • Tablet
  • Elixir (sweet-flavored liquid)
  • Solution

Some of the main barbiturate medications available in the United States are:

  • Mephobarbital (Mebaral®) —  this medication acts as an anticonvulsant and has low toxicity (meaning fewer side effects). It may also help treat anxiety or apprehension. Somnolence (or sleepiness) is one of the primary side effects caused by this medication. Other less common side effects include agitation, nightmares, ataxia (lack of muscle control or coordination). 
  • Phenobarbital (Luminal®) — this medication helps to treat medical conditions like seizures or anxiety. Medical professionals may also prescribe this drug for individuals experiencing withdrawal symptoms due to dependence on another type of barbiturate or alcohol. Its effects may last longer than 6 hours and cause symptoms like drowsiness or headaches. In severe cases, it may also cause a rash or shallow breathing. 
  • Pentobarbital sodium (Nembutal®) — this short-acting medication helps treat medical conditions like insomnia and anxiety. It also serves as a euthanasia drug for animals and humans. Due to the drug’s potency, the United States government has included pentobarbital sodium in lethal injections during executions. Symptoms of this drug include confusion, low blood pressure, and sleepiness. 

One of the most common prescription anticonvulsants in the world is phenobarbital. In the United States, this barbiturate medication is a second-line treatment for epilepsy. 

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Are Barbiturates Illegal?

Barbiturates are not illegal in the United States. 

Phenobarbital is a common antiepileptic drug in the country and elsewhere around the world. Low-resource countries may prescribe this type of barbiturate as a first-line treatment because of its low cost. 

However, because barbiturates can lead to abuse and physical dependence, these drugs are classified as Schedule II, III, and IV depressants under the Controlled Substances Act. Classification for barbiturates will vary according to the type of medication, its potential for abuse, and the severity of psychological or physical dependence. 

For example, Schedule II barbiturates have a high potential for substance abuse and severe physical dependence. Schedule IV barbiturates, however, have a low potential of abuse and low risk of dependency. 

Because barbiturates fall in this classification series, it is illegal to purchase or consume this type of drug without a doctor’s prescription. Selling barbiturates without proper documentation or misusing these drugs can result in criminal offenses or penalties imposed by state and federal authorities. 

Additionally, when individuals obtain and use barbiturates, primarily through online purchases, they run the risk of consuming contaminated or expired drugs. The risk of overdose is also high. 

Common street names of barbiturates include Barbs, Block Busters, Christmas Trees, Goof Balls, Pinks, Red Devils, Reds & Blues, and Yellow Jackets.

Barbiturates are habit-forming. As a result, medical professionals prescribe benzodiazepines more often for anti-anxiety or insomnia. Even in the operating room, the use of barbiturates is minimal due to the rise of other recommended alternatives such as propofol (an anesthetic drug with fewer side effects). 

Risks & Side Effects of Barbiturate Use

Using any type of barbiturate can cause side effects. Those effects can last from 2 to 6 hours, or more depending on the drug itself, dosage, etc. It is important to speak with a physician if any of the side effects mentioned below occur or worsen while under treatment. 

Some of the more common side effects of barbiturate use include:

  • Clumsiness or unsteadiness
  • Dizziness or lightheadedness
  • Drowsiness or sleepiness 
  • "Hangover" effect (when an individual feels drowsy the day after taking a regular dose)

Some of the less common side effects of barbiturate use include:

  • Anxiety or apprehension
  • Constipation
  • Fainting sensation
  • Headache
  • Irritability
  • Nausea or vomiting
  • Nightmares 

Some rare side effects of barbiturate use include:

  • Sores or ulcers in or around the mouth 
  • Breathing problems (wheezing or chest tightness)
  • Chest pain
  • Fever
  • Rash or hives

In incredibly ill individuals, symptoms such as confusion, mental depression, and unusual excitement are more common to appear. 

Equally important, because of the potency of barbiturates, the body may still experience some symptoms after quitting the drug. In individuals who take high doses or for an extended time, the effects of a barbiturate drug could remain up to 15 days after quitting. 

In terms of other health risks, regular, even therapeutic use of barbiturates can lead to tolerance (when a drug is not as effective due to repeated use) and physical dependence. Continued misuse could result in barbiturate intoxication (poisoning) and, in some cases, death.

For individuals who are hypersensitive to barbiturates, there is the additional risk of a life-threatening syndrome called drug rash with eosinophilia and systemic symptoms (DRESS). Some of the symptoms include rash, fever, organ inflammation, lymphadenopathy (abnormal size or inconsistency of lymph nodes), and hematological problems.  The mortality rate of individuals with DRESS is 10%. 

Finally, pregnant women and their fetuses face a high risk of health problems. Barbiturate toxicity during pregnancy increases the likelihood of congenital disabilities (malformations) and can cause neonatal abstinence syndrome (NAS). Despite these risks, though, medical professionals may prescribe this type of drug for either serious diseases or during a medical emergency, in which the mother’s life is at stake. 

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Symptoms of Barbiturate Abuse

Certain barbiturate drugs can have a much higher potential for abuse than other drugs of the same group. That said, when individuals abuse this type of drug, they may experience the following symptoms:

  • Drowsiness
  • Sedation
  • Ataxia (incoordination) 
  • Respiratory depression (slow, ineffective breathing)
  • Headache
  • Gastrointestinal problems 
  • Confusion 
  • Memory, judgment, and motor skill impairment

Individuals who abuse barbiturates may seem like they drank too much alcohol. This is because of the excitement or euphoric effects paradoxically caused by the drug. 

A “hangover” effect, in which judgment and fine motor skills are impaired, can occur up to 22 hours after an individual takes a hypnotic barbiturate drug.  

Individuals misusing barbiturates shouldn’t stop drug use suddenly. Abrupt barbiturate withdrawal can be dangerous and result in death.

Barbiturate withdrawal is similar to alcohol withdrawal, with individuals experiencing the following symptoms:

  • Restlessness
  • Anxiety or apprehensive
  • Stomach pain
  • Nausea and vomiting
  • Seizures 
  • Delirium tremens (disorientation, visual hallucinations, hyperthermia)

Symptoms of barbiturate withdrawal tend to disappear after eight days or so. 

Symptoms of Barbiturate Overdose

Because tolerance to the lethal effects of barbiturates can occur little by little, an overdose is a considerable health risk. 

Lethal overdoses will vary from one barbiturate drug to the next. For example, the lethal dose for amobarbital is 2 to 3 grams, while the lethal dose for phenobarbital is 6 to 10 grams.

Similarly, if alcohol, opiates, or other CNS depressants are taken with a barbiturate substance, the risk of overdose and death increases much more. 

Here is a list of some overdose symptoms:

  • Incoordination
  • Slurred speech
  • Trouble thinking 
  • Clammy skin
  • Coma
  • Respiratory depression (slowed, ineffective breathing)
  • Changes in vital signs (slowed heart rate, low blood pressure, less oxygen circulation) 
  • Shock

There is also the additional risk of hypoxia (a decreased amount of oxygen to the brain). Individuals with hypoxia may suffer both short- and long-term health problems, including coma and permanent brain damage. Severe muscle damage from a result of falling and lying on a hard surface is also a risk.

If you or someone you know experiences any overdose symptoms, contact medical authorities immediately. It is best to provide them with full information regarding the substances consumed, as it may affect their treatment. If opiates were involved in the dose, they may use the emergency medicine called naloxone (Narcan) to treat the overdose.

Treatment Options for Barbiturate Addiction

Those with a barbiturate addiction do have health care options, including:

  • Rehab treatment program — inpatient or outpatient treatment centers are available and can help individuals through detox. 
  • Medications — addiction treatments may include tapering dosage or substituting one barbiturate for another.
  • Interventions from health professionals — it is recommended to consult a medical practitioner before stopping barbiturates. Withdrawal symptoms may be severe and result in death. A medical practitioner can also explain the different therapies available, like cognitive-behavioral therapy, to address underlying problems affecting the addiction. 

If you or your loved one is suffering from a barbiturate addiction, please seek medical attention to design a treatment plan that can accompany you to a path of recovery and relief. 

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Resources

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“Barbiturate (Oral Route, Parenteral Route, Rectal Route) Side Effects.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 1 Sept. 2020, www.mayoclinic.org/drugs-supplements/barbiturate-oral-route-parenteral-route-rectal-route/side-effects/drg-20069290.

“Barbiturate Intoxication and Overdose: MedlinePlus Medical Encyclopedia.” MedlinePlus, U.S. National Library of Medicine, June 2019, www.medlineplus.gov/ency/article/000951.htm.

“Barbiturates Drug Profile.” Drug Profiles, European Monitoring Centre for Drugs and Drug Addiction, www.emcdda.europa.eu/publications/drug-profiles/barbiturates_en.

“Barbiturates.” DEA, www.dea.gov/factsheets/barbiturates.

Nobay, F., and N.M. Acquisto. “Barbiturates.” Encyclopedia of Toxicology (Third Edition), Academic Press, 14 Apr. 2014, www.sciencedirect.com/science/article/pii/B9780123864543006965.

“Phenobarbital: MedlinePlus Drug Information.” MedlinePlus, U.S. National Library of Medicine, 15 May 2020, www.medlineplus.gov/druginfo/meds/a682007.html.

Prescription CNS Depressants DrugFacts. National Institute on Drug Abuse, 24 July 2020, www.drugabuse.gov/publications/drugfacts/prescription-cns-depressants.

Skibiski, Jeanie. “Barbiturates.” StatPearls [Internet]., U.S. National Library of Medicine, 10 July 2020, www.ncbi.nlm.nih.gov/books/NBK539731/.

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