Barbiturate Addiction: Signs, Symptoms, Risks, and Treatment Resources
Barbiturates are a class of sedative-hypnotic drugs that were historically used for conditions such as sleeping disorders and seizure disorders. However, their use has significantly declined due to safer alternatives.[1]. Barbiturates were once heavily utilized in medical settings for their ability to induce drowsiness and deep sleep but have largely been replaced as a tool for pre-anesthesia and anxiety reduction. However, they are still prescribed for specific medical conditions.
Key Points
- Barbiturates depress the CNS by enhancing the activity of gamma-aminobutyric acid (GABA), inducing relaxation and sedation.
- Barbiturates are dangerous and addictive; even a slight overdose is potentially fatal.
- Misuse of barbiturates leads to varied effects: euphoria, impaired coordination, respiratory depression, memory loss, and death risk.
- Barbiturates are commonly known as barbs, downers, and red devils in various forms.
What Are Barbiturates?
Barbiturates act as a sedative by depressing the activity of the central nervous system (CNS). They work by enhancing the activity of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits brain activity, leading to relaxation, drowsiness, and a reduction in perceived anxiety. These CNS depressants are also dangerous, addictive, and potentially fatal when misused, with even a slight overdose able to result in a coma or death[2].
Also known as barbs, downers, tranquilizers, and red devils, barbiturates can come in various forms, including tablets, capsules, and liquid injectables. They can be short, immediate, or long-acting and are classified as Schedule II, III, and IV depressants under the current Controlled Substances Act[3], depending on their potential for abuse and medical use.
According to statistics released from a national survey in 2018, more than six million Americans over the age of 12 reported misusing sedative-based drugs, per the Substance Abuse and Mental Health Services Administration (SAMHSA)[4]
Side Effects of Barbiturates
Barbiturate misuse produces varied effects on the body and mind, which may include temporary euphoria, impaired coordination, judgment impairment, and respiratory depression. Higher doses may cause impairment of memory, paranoia, and loss of coordination, along with potential death.
Chronic use can lead to tolerance and severe withdrawal symptoms, as barbiturates have a high potential for abuse.[5]. Additional concerns may also arise from concurrent use of other depressants (such as alcohol), substances, or prescribed medications, as this can dangerously slow the CNS or cause the liver to process other medicines more quickly.
How Are Barbiturates Taken?
Barbiturates are typically taken orally as a pill or injected into veins or muscles in their liquid form. Prescriptions are available in both forms, though injections for short-acting barbiturates are usually administered into large muscles to minimize the risk of necrosis at the injection site.[6] Barbiturates remain in the system for an extended period when injected, increasing the potential for abuse and dependence.
Misusing short-acting barbiturates in any form is particularly dangerous, as they can rapidly slow the CNS and brain activity, causing heart and brain disruptions.
Barbiturate Quick Reference
Drug Category
Sedative/hypnotic
Commercial & Street Names
Barbs, BlockBusters, Christmas Trees, Goof Balls, Pinks, Red Devils, Reds & Blues, Yellow Jackets
DEA Schedule
Schedules II, III, and IV
Administration
Pill, injection
Learn About Other Substances
Statistics on Barbiturate Use, Misuse, and Addiction
Among people aged 12 or older in 2020, 2.2 percent (or 6.2 million people) misused tranquilizers or sedatives that year. The percentage was found to be highest among young adults aged 18 to 25 (3.7 percent, or 1.2 million people), followed by adults aged 26 or older (2.2 percent, or 4.7 million people), and then by adolescents aged 12 to 17 (0.9 percent, or 226,000 people)[7].
Around 1 in 10 people who overdose on barbiturates or a mixture that contains barbiturates will die[8].
Effects of Barbiturate Abuse
The mechanism and time frame for the effects of barbiturate abuse vary depending on whether the substance is classified as short, intermediate, or long-acting.
- Short-acting barbiturates can produce an anesthetic effect and depress the CNS within minutes after intravenous use.
- Barbiturates classified as intermediate-acting can take effect in 15-30 minutes and last up to 6-8 hours, while long-acting barbiturates can take longer to take effect and last up to 12 hours.
All barbiturates can produce slurred speech, a loss of motor coordination, impaired judgment, and feelings of euphoria and lightness.
Can You Overdose on Barbiturates?
Yes, and the consequences can be deadly. Barbiturate overdose can present similar to alcohol intoxication and can include the following symptoms:
- Nausea and vomiting
- Dizziness
- Unfocused eyes
- Fainting
- Confused thought patterns, delirium
- Psychosis
- Trouble with respiration
- A bluish tint to the lips and fingernails
Barbiturates can result in coma or death due to their ability to suppress the CNS, along with the difficulty of adequately measuring a safe dose.
If you suspect someone of having an overdose, call 911 for immediate medical attention.
Dangers of Long-Term Barbiturate Use
Taken over the long term, barbiturates can lead to several complications, which include[9]:
- Chronic breathing difficulties
- Memory loss
- Cardiac issues
- Liver and kidney problems
- Sexual dysfunction
- Twitching and issues with motor function
Mixing Barbiturates with Other Drugs
As stated above, mixing any sedative-based substance with other drugs can be fatal. Combining barbiturates with alcohol, for example, can cause a synergistic effect, resulting in acute toxicity and a high potential for mortality. What’s more, drugs in the sedative-hypnotic class are known to affect how the body processes several other prescription medications, increasing the risk for overdose and other drug-drug interactions.
Barbiturate Addiction and Abuse
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), addiction to barbiturates falls under the category of sedative, hypnotic, and anxiolytic use disorder, a category of substance use disorders[10].
An individual may be diagnosed with sedative, hypnotic, or anxiolytic use disorder if they meet at least 2 of the following criteria within a 12-month period:
- Sedatives, hypnotics, or anxiolytics are often taken in larger amounts or over a longer period than was intended.
- There is a persistent desire or unsuccessful efforts to cut down or control sedative, hypnotic, or anxiolytic use.
- A great deal of time is spent in activities necessary to obtain, use, or recover from the effects of the sedative, hypnotic, or anxiolytic.
- Craving, or a strong desire or urge to use the sedative, hypnotic, or anxiolytic.
- Recurrent sedative, hypnotic, or anxiolytic use failing to fulfill major role obligations at work, school, or home (e.g. repeated absences from work or poor work performance related to sedative, hypnotic, or anxiolytic use; sedative-, hypnotic-, or anxiolytic-related absences, suspensions, or expulsions from school; neglect of children or household).
- Continued sedative, hypnotic, or anxiolytic use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of sedatives, hypnotics, or anxiolytics (e.g. arguments with a spouse about consequences of intoxication; physical fights).
- Important social, occupational, or recreational activities are given up or reduced because of sedative, hypnotic, or anxiolytic use.
- Recurrent sedative, hypnotic, or anxiolytic use in situations in which it is physically hazardous (e.g. driving an automobile or operating a machine when impaired by sedative, hypnotic, or anxiolytic use).
- Sedative, hypnotic, or anxiolytic use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the sedative, hypnotic, or anxiolytic.
- Tolerance, as defined by either of the following;
- A need for markedly increased amounts of the sedative, hypnotic, or anxiolytic to achieve intoxication or desired effect.
- Withdrawal, as manifested by either of the following:
- The characteristic withdrawal syndrome for the stimulant (refer to Criteria A and B of the criteria set for withdrawal).
- The stimulant (or a closely related substance) is taken to relieve or avoid withdrawal symptoms.
Are Barbiturates Addictive?
While barbiturate use, misuse, and deaths have been on the decline in recent decades, largely in part due to the medical field now prescribing benzodiazepines for anxiety and utilizing other sedative agents for purposes, drugs in this class are nevertheless extremely addictive. Tolerance develops to barbiturates, making cessation difficult without appropriate medical treatment and support.
Barbiturate Addiction Treatment Levels of Care
Rehab treatment for barbiturate addiction can include:
Supervised medical detox
A supervised period of medical monitoring to ensure there are no complications surrounding cessation.
Residential treatment
A structured treatment environment including individual therapy, group therapy, medication management, and assessment for co-occurring issues. This typically lasts at least 30 days and provides new insights and coping strategies for long-term sobriety.
Intensive outpatient (IOP)/Partial Hospitalization Program (PHP)
Both IOP and PHP are programs that do not require an individual to be on-site at all times. They allow for a mix of in-person treatment services while still being delivered on an outpatient basis.
Aftercare
Ongoing therapy, support groups, and potential supportive living environments can help further integrate the learning and changes undergone during prior phases of treatment in the recovery process.
Therapies Used in Barbiturate Addiction Treatment
Several treatment modalities may be utilized to assist in the recovery process from sedative-based addiction, including:
Cognitive-Behavioral Therapy (CBT)
CBT works to assist individuals in learning more about negative thought patterns, developing new coping strategies, and re-evaluating their behaviors.
Motivational Interviewing
This client-centered approach invokes collaboration and curiosity to explore the motivations for change, build rapport, and identify goals and motivations for ongoing sobriety.
Group therapy
Group therapy allows individuals to process their experiences and gain new insights in the supportive environment of their peers, facilitated by a licensed professional.
Eye movement desensitization and reprocessing (EMDR)
EMDR helps to resolve traumatic memories and replace negative emotions with positive beliefs, reducing distress and increasing self-efficacy.
Co-Occurring Disorders
Individuals struggling with substance use disorders are also at risk for developing one or more concurrent mental health conditions or chronic diseases[12]. According to SAMHSA’s 2021 National Survey on Drug Use and Health, over 19 million adults in the United States have a co-occurring disorder, many of which involve both substances and other mental health disorders.
Some of the more common co-occurring disorders seen in individuals with a diagnosed substance use disorder include:
- Anxiety disorders
- Mood disorders (such as depression or bipolar disorder)
- Posttraumatic stress disorder (PTSD)
- Attention deficit hyperactivity disorder (ADHD)
Frequently Asked Questions
What are some of the most commonly prescribed barbiturates?
Some of the most commonly prescribed barbiturates include:
- Amobarbital
- Butalbital
- Methohexital
- Pentobarbital
- Phenobarbital
- Primidone
- Secobarbital
What are some of the benefits of appropriately-prescribed barbiturates?
Barbiturates are considered older medications, which means they have decades of research supporting their efficacy in the appropriate circumstances. They can also serve as a clinical backup when the intended, first-line medications don’t work or can’t be used.
Are barbiturates commonly prescribed?
Barbiturate prescriptions are not as common as they used to be, as other medications have typically taken their place as first-line treatments.
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