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Barbiturates

Barbiturates are powerful depressants that slow down the central nervous system (CNS). Classified as sedative/hypnotics, they include amobarbital (e.g. Amytal), pen obarbital (e.g. Nembutal), phenobarbital (e.g. Luminal), secobarbital (e.g. Seconal), and the combination amobarbital-secobarbital (e.g. Tuinal). (Note that where a drug name is capitalized, it is a registered trade name of the manufacturer.)

What is discussed in this paper are most of the sedative/hypnotics that are not benzodiazepines. (For a discussion of benzodiazepines, see Facts About Tranquillizers.)

Barbiturates and other sedative/hypnotics are medically prescribed to treat sleeplessness, anxiety, and tension, and to help prevent or mitigate epileptic seizures. Certain barbiturates are also used to induce anesthesia for short surgical procedures or at the beginning of longer ones.

Because of the risks associated with barbiturate abuse, and because new and safer drugs such as the benzodiazepines are now available, barbiturates are less frequently prescribed than in the past. Nonetheless, they are still available both on prescription and illegally.

Besides having therapeutic uses, barbiturates are often used for their pleasurably intoxicating effects. Some people take them in addition to alcohol, or as a substitute. Heavy users of other drugs sometimes turn to them if their usual drugs are not available, or to counteract the effects of large doses of stimulants such as amphetamines or cocaine.

Barbiturates are known generally on the street as "downers" or "barbs." Many are named for the colors of their brand name versions - blues or blue heavens (Amytal), yellow jackets (Nembutal), red birds or red devils (Seconal). and rainbows or reds and blues (Tuinal).

Effects

The effects of any drug depend on several factors:

the amount taken at one time
the user's past drug experience
the manner in which the drug is taken
the circumstances under which the drug is taken (the place, the user's psychological and emotional stability, the presence of other people, the simultaneous use of alcohol or other drugs, etc.).

Short-term effects are those that appear rapidly after a single dose and disappear within a few hours or days. With barbiturates, a small dose (e.g. 50 mg or less) may relieve anxiety and tension. A somewhat larger dose (e.g. 100 to 200 mg) will, in a tranquil setting, usually induce sleep. An equivalent dose in a social setting, however, may produce effects similar to those of drunkenness - a "high" feeling, slurred speech, staggering, slowed reactions, loss of inhibition, and intense emotions often expressed in an extreme and unpredictable manner. High doses characteristically produce slow, shallow, and irregular breathing, and can result in death from respiratory arrest.

Non-medical users often start taking barbiturates at doses within a safe therapeutic range. As tolerance develops, however, they progressively increase their daily dose to many times the original. It is extremely important to note that in spite of acquiring tolerance to the intoxicating effects of barbiturates, the user develops no tolerance to the lethal action of the drug Therefore, high doses could produce fatal results even for tolerant abusers.

Taking barbiturates with other CNS depressants - e.g. tranquillizers; such opioids as heroin, morphine, meperidine (Demerol), codeine, or methadone; and antihistamines (found in cold, cough, and allergy remedies) - can be extremely dangerous, even lethal.

No one should operate a motor vehicle or engage in tasks requiring concentration and coordination while under the influence of any CNS depressant.

The long-term effect of barbiturates - particularly of protracted high-dose abuse - is not unlike a state of chronic inebriation. Symptoms include the impairment of memory and judgment; hostility, depression, or mood swings; chronic fatigue; and stimulation of preexisting emotional disorders, which may result in paranoia or thoughts of suicide. Although the prescribing of barbiturates has declined notably since the safer benzodiazepine tranquillizers were introduced, this group of drugs remains a significant contributor to drug- related deaths. They remain easily available to abusers through both licit and illicit sources.

Other sedative/hypnothics

Such drugs as glutethimide (Doriden), methyprylon (Noludar), ethchlorvynol (Placidyl), and methaqualone (found in Mandrax) were introduced as barbiturate substitutes, in the belief they would be safer. It was soon found, however, that they shared problems similar to those of barbiturates, including abuse leading to overdose and interaction with other CNS depressants. The same caution necessary in using barbiturates thus applies to these other sedative/hypnotics as well.

Tolerance and dependence

Because tolerance to the intoxicating effects of sedative/ hypnotics can develop rapidly with regular use, higher daily doses become necessary to achieve the desired effects. Taking more of the drug to compensate for tolerance, however, can lead to life-threatening complications. On one hand, there is the risk of death from overdose. On the other, when chronic and regular high-dose abuse has resulted in serious physical dependence, abrupt withdrawal can cause symptoms severe enough to cause death. For this reason, barbiturates are among the most dangerous of the widely abused drugs.

People who use these drugs daily for prolonged periods may become both psychologically and physically dependent upon them.

Psychological dependence exists when a drug is so central to a person's thoughts, emotions, and activities that the need to continue its use becomes a craving or compulsion. Psychological dependence is most likely to occur with the fast-acting barbiturates, which can produce euphoria within minutes of being taken.

Physical dependence exists when the body has adapted to the presence of the drug, and withdrawal symptoms occur when its use is abruptly ended. These symptoms range in intensity from progressive restlessness, anxiety, insomnia, and irritability to delirium and convulsions in severe cases. Again, it must be stressed that physical dependence on barbiturates can be one of the most dangerous of all drug dependencies.

Barbiturates are commonly and heavily used by heroin addicts; they inject a mixture of both drugs to obtain a pleasurable "high" - a hazardous practice, because both drugs depress respiratory control centres in the brain. Some methamphetamine ("speed") abusers take barbiturates to combat severe hyperactivity following a "run" of methamphetamine use over several days.

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