Barbiturates are a type of drug that acts to calm down or sedate the body. They’ve been around since the late 1800s and were originally used to help people relax and sleep better.
In the 1960s and 1970s, barbiturates became popular as recreational drugs, but this led to some cases of addiction and misuse.
Recently, their use has decreased significantly. This decline is primarily because newer drugs that are safer have been developed.
Barbiturates can be addictive, both physically and psychologically. They also pose a higher risk of a deadly overdose compared to other drugs because the difference between a safe amount and a lethal amount is small.
Nowadays, benzodiazepines are more commonly used instead of barbiturates for recreational and medical purposes. However, benzodiazepines also come with risks like physical dependence and other side effects. Examples of benzodiazepines include Ativan and Valium.
What is it?
Barbiturates are a set of drugs known for their calming results on the body, often compared to the effects of alcohol. These drugs were first developed in the 1860s by Bayer laboratories in Germany. They work by increasing the activity of gamma amino butyric acid, a chemical in the brain that helps spread signals.
Medically, barbiturates are used to alleviate anxiety, decrease muscle spasms, prevent seizures, and promote sleep. On the other hand, when used recreationally, they induce effects similar to alcohol, including euphoria, relaxation, reduced inhibition, impaired coordination, slurred speech, impaired judgment, and confusion.
Barbiturates vary in how rapidly they take effect and how long their effects last, classified as long-acting, intermediate-, short-, and ultra-short- types. When ingested orally, these drugs typically begin to take effect within about 30 minutes and can last anywhere from 4 – 16 hours depending on the specific type used.
Uses
Barbiturates, primarily phenobarbital, find occasional use in medical settings for specific conditions like epilepsy, increased intracranial pressure, severe head trauma, and certain kinds of convulsions. They are also employed as anesthetic agents.
In addition to their approved uses, barbiturates are sometimes prescribed off-label for conditions like alcohol and benzodiazepine withdrawal, migraines, jaundice, and trauma. Despite these applications, their use is limited due to concerns about adverse effects and poor outcomes.
Today, barbiturates are rarely prescribed for sleep disorders due to these risks. Phenobarbital remains a preferred choice for treating seizures, particularly in developing countries, endorsed by the World Health Organization for its affordability and established effectiveness.
Barbiturates are available in various forms including liquids, pills, rectal formulations, and injectables to accommodate different medical needs.
Commercial names of Barbiturates
Barbiturates used for medical purposes are sold under several brand names. These include well-known medications like Butabarbital (sold as Butisol), Phenobarbital, Seconal, and Nembutal. Butabital, found in Fioricet, is notable for not being classified as a controlled substance. Additionally, Primidone, which is used for medical purposes but not classified as a controlled substance, is also available.
However, Thiopental, marketed under the brand name Pendothal, is no longer available due to ethical concerns surrounding its use in lethal injections for capital punishment. This decision reflects broader ethical debates surrounding the pharmaceutical industry’s involvement in capital punishment procedures.
Side Effects
When taken as directed, barbiturates typically cause common side effects like relaxation, drowsiness, and occasional nausea.
However, more severe reactions can occur, including impaired coordination, headaches, throwing up, confusion, and difficulties with memory. In extreme cases, barbiturate use may lead to respiratory failure and even death.
One significant issue with barbiturates is their potential to induce tolerance and dependence. Tolerance means that higher doses are needed over time to achieve the same effect, while dependence refers to withdrawal symptoms arising if the drug is discontinued abruptly. These factors underscore the careful management required when using barbiturates in medical treatments.
Risks
Barbiturate use carries significant risks, with overdose being the most serious concern. Signs of an overdose can include impaired coordination, slurred speech, cognitive difficulties, impaired judgment, kidney failure, shallow breathing, drowsiness, coma, and death in severe cases.
Overdose incidents are more prevalent in developing countries, where the affordability of barbiturates has led to their widespread use in managing seizures.
Long-term use of barbiturates, due to their relaxing effects on various bodily functions, can lead to respiratory problems and an increased risk of pneumonia. Chronic use may also result in delayed reflexes, sexual dysfunction, shortened attention span, and memory impairment.
Frequent users of barbiturates may experience a chronic state akin to being intoxicated. Combining barbiturates with alcohol significantly heightens their effects and dangers.
Moreover, with continued use, the threshold between a dose that achieves the needed effect and one that causes a potentially fatal overdose narrows. This escalation in risk makes overdoses more likely, especially in cases of prolonged use exceeding two weeks.
Symptoms
Abrupt cessation of barbiturate use can trigger rapid onset of withdrawal symptoms, which range from restlessness, insomnia, and anxiety to more severe manifestations like stomach cramps, a sick feeling of stomach, vomiting, and even suicidal thoughts or hallucinations.
Barbiturate withdrawal poses serious risks, potentially leading to seizures in up to 75 % of individuals, accompanied by confusion and elevated body temperature. Delirium, affecting around 66 percent of people, can persist for several days, resembling the delirium tremens (DTs) seen in alcohol withdrawal. Symptoms may include disorientation, anxiety, and visual hallucinations, progressing untreated to complications such as high temperatures of the body, heart failure, and death.
Due to these dangers, medical intervention in a hospital setting is typically necessary to manage barbiturate withdrawal effectively.
Summary
Barbiturates are a class of drugs known for their calming effects, akin to alcohol. Used medicinally, they treat conditions like epilepsy and intracranial pressure, though their recreational use has declined due to serious risks including overdose and addiction.
Common side effects include drowsiness and coordination problems, while long-term use can lead to respiratory issues and cognitive impairments. Withdrawal from barbiturates is perilous, often causing seizures, delirium, and potentially fatal complications without proper medical care. Combining barbiturates with alcohol amplifies risks. Despite their historical use, newer, safer alternatives have largely replaced barbiturates in medical practice today.
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