Barbiturates Abuse: Signs and Symptoms

Barbiturates are central nervous system depressant drugs. These substances have the effect of suppressing (or depressing) the firing of the neurons in the central nervous system as well as the actions of other nerves outside the central nervous system. This is accomplished by the drug’s affinity to increase the efficacy of the primary inhibitory neurotransmitter in the central nervous system, gamma-aminobutyric acid (GABA). These drugs were originally prescribed to treat issues with anxiety (particularly anxiety disorders), for use during withdrawal from alcohol, as agents to control seizures, to initiate and maintain sleep, and to control issues with rigidity or muscle spasms.

These drugs were significant drugs of abuse, and many of their formal medicinal uses have been taken over by other classes of drugs, such as benzodiazepines, which are also central nervous system depressants. Barbiturates can only be legally obtained via a prescription from a physician. Depending on the particular barbiturate, they are classified as a Schedule II, Schedule III, or Schedule IV controlled substance by the United States Drug Enforcement Administration (DEA).

The Different Types of Barbiturates

There are literally thousands of different compounds that chemically qualify as barbiturates; however, only about 12 formal barbiturate medications are used in clinical practice. Barbiturates are commonly classified by their half-life or their duration of action, such that barbiturates can be classified as very short-acting, shorter- or medium-acting, and long-acting.

Very short-acting barbiturates have a quick onset of action, and their effects do not last very long. These drugs are often used as pre-anesthetics to relax a person before they are given a formal anesthetic before surgery. Short-acting or medium-acting barbiturates are often used for the initiation of sleep, whereas longer-acting barbiturates are more commonly used for issues with seizure control, anxiety, and withdrawal from alcohol.

Some of the better-known barbiturates include:

• Amytal (amobarbital)
• Pentothal (thiopental)
• Seconal (secobarbital)
• Luminal (phenobarbital)
• Soneryl (butobarbital)

These drugs are not used as extensively as they once were due to their propensity for abuse, and since 1970, the government has restricted access to them. As a result of this government action, these drugs are no longer as commonly available as they once were. According to the Substance Abuse and Mental Health Services Administration (SAMHSA):

• The use of barbiturates has significantly declined.
• Barbiturates may still be used in hospitals as anesthetics and pre-anesthetics.
• Some barbiturates, such as phenobarbital, are still commonly prescribed for the control of seizures.
• Women and elderly people are more likely to be prescribed barbiturates than men or younger individuals. In these cases, barbiturates are typically prescribed for their sedative effects.

SAMHSA also reports that most individuals who have prescriptions for drugs do not abuse them. The majority of people who abuse these drugs typically obtain them from others who have a prescription, steal them, or get them illegally on the street.

Other Indications of Abuse of Barbiturates

According to the current clinical diagnostic criteria, an individual who has a formal abuse issue with barbiturates would be diagnosed under the formal diagnostic label of a sedative, hypnotic, or anxiolytic use disorder. The formal signs and symptoms of this substance use disorder as a result of barbiturate abuse include:

• Frequent barbiturate use that results in significant impairment of the person’s functioning or significant distress in life
• Frequent strong desires or cravings to use barbiturates
• Giving up important activities or reducing involvement in them because of use of barbiturates (e.g., work activities, social activities, recreational activities, or even other important activities that the individual typically engaged in)
• Issues with controlling use of barbiturates that may occur in one or more domains
• Failing to fulfill important role obligations as a result of substance use, such as marital obligations, childcare obligations, financial obligations, work obligations, etc.
• The development of significant tolerance to barbiturates
• The development of withdrawal symptoms when one has either cut down or stopped use of barbiturates

Individuals who satisfy two or more formal diagnostic criteria would be formally diagnosed with a substance use disorder by a licensed mental health professional. Only a licensed mental health professional can formally diagnose a substance use disorder in anyone.

Deciding whether a loved one meets the formal diagnostic criteria for a substance use disorder is impractical and often difficult. Individuals who are concerned that their loved one is abusing barbiturates should consider the concern alone a valid indicator that there may be a problem and seek professional help. Outside of the diagnostic criteria, there are number of other potential signs that an individual has been abusing barbiturates. These include:

• Physical signs, such as appearing intoxicated without the smell of alcohol (e.g., slurred speech, difficulty with balance, difficulty with coordination, etc.).
• Finding empty prescription bottles in an individual’s room, clothing, car, etc.
• Cognitive signs, such as issues with confusion, slowed thinking, bouts of lethargy, severe sleepiness, poor memory, etc.
• Psychological signs, such as periodic issues with anxiety (often a side effect of not having been able to use a barbiturate for a while), isolation from others, development of disruptive or irritable behavior that is uncharacteristic for the individual, apathy, depression, etc.

Effects of Barbiturate Abuse

SAMHSA reports that both benzodiazepines and barbiturates are more commonly used in conjunction with other drugs of abuse, such as alcohol, other central nervous system depressants (e.g., other benzodiazepines, barbiturates, or narcotic medications or drugs), cannabis products, and stimulants, as opposed to being the sole substance of abuse. Obviously, both the short-term and long-term effects of barbiturate abuse are significantly exacerbated when an individual regularly abuses barbiturates with any of the drugs in these classes.

According to the book Barbiturates: Advances in Research and Application, there are short-term and long-term effects of barbiturate abuse. The short-term effects of barbiturate abuse include:

• Increased sensitivity to pain or sounds
• Issues with forming new memories
• Issues with respiration as a result of suppressed breathing
• Impotence in men and irregular menstrual cycles in women
• Issues with insomnia
• In rare cases, psychotic behaviors (e.g., hallucinations or delusions)

Long-term use or abuse of barbiturates may result in:

• Respiratory issues, including bronchitis or pneumonia
• Issues with control over body movements
• Cardiac issues
• Liver and/or kidney damage
• Sexual disorders
• Cognitive issues that are related to potential damage to the brain (e.g., issues with attention, learning and memory, and problem-solving abilities)
• Emotional issues that can include long-term problems with anxiety and/or depression
• The development of physical dependence
• The development of a substance use disorder

Addressing the Issue

Confronting an individual with a suspected substance use disorder and accusing them, labeling them, or arguing with them does not often result in positive effects. Sometimes, these individuals become very defensive, reactive, angry, etc., when someone attempts to discuss their use of drugs with them. They often strongly deny they have a problem, even when it is clear that they do have a significant problem with substance abuse. In fact, this scenario is so common that many individuals consider denial a sign that the person has a substance use disorder, although this is not a diagnostic sign of a disorder, nor is it a valid sign that the individual is abusing any substance.

Anyone who suspects that a loved one is abusing barbiturates should discuss the situation with an individual who has been in recovery for substance use disorder for a significant period of time, a licensed mental health professional who treats individuals with substance use disorders, or with a social support group for relatives of individuals with these disorders, such as Al-Anon, before attempting to take action. If there is a potential crisis situation, one may not have time to discuss a strategy with someone else and instead may have to intervene directly; however, in most cases, it is wise to get assistance and advice from others who have experience with the situation.

Finding individuals who are in recovery for substance use disorders or who treat these disorders is not a difficult task. One can simply check with their local mental health community center for times and places of recovery group meetings, find meeting times and places online, find local therapists who treat substance use disorders online or through community mental health centers, or discuss the situation with nurses or psychiatrists who treat these disorders. In addition, many comprehensive addiction treatment programs exist that can guide families toward appropriate resources.

The goal should be to help the individual realize that they have a problem and get them to consider a medical detox program in orange county as opposed to venting any anger or frustration upon the person.

Individuals with substance use disorders typically respond more positively to concern, warmth, and an open attitude and approach as opposed to coercion.