Amobarbital(brand names: Amytal Sodium or Tuinal) is a barbiturate drug. Barbiturates are central nervous system depressants that are primarily used as sedatives. They are often referred to as sedative-hypnotics; at lower doses, they produce sedation that can control anxiety, and at higher doses, they can help individuals with insomnia (hypnotic effects).
Uses for Amobarbital
All of the barbiturates are subject to strict control under the Federal Controlled Substances Act, and the United States Drug Enforcement Administration (DEA) classifies amobarbital as a Schedule II controlled substance. The barbiturates were originally developed as treatments for anxiety and as medications to help control seizures. Amobarbital’s approved uses include:
- The treatment of anxiety, anxiety disorders, and other mood disorders
- Treatment for seizures or status epilepticus (seizures lasting more than five minutes)
- Treatment for insomnia
- Use for the Wada test
Amobarbital is best used for initiating sleep and as a very short-term solution for insomnia. After two weeks of use, the drug becomes less effective in treating insomnia unless the dosage is increased substantially and at regular intervals. This can result in the development of a potentially dangerous situation; therefore, it is suggested that the drug only be used on a short-term basis for sleep problems and that individuals develop other strategies to help them sleep.
The Wada test, or the intracarotid sodium amobarbital procedure, is used for people who are candidates for brain surgery, particularly for the treatment of epilepsy. The use of Sodium Amytal (amobarbital) helps the surgeon determine which areas of the brain support memory and language functions, so the surgeon does not remove functional areas of the brain during surgery. The goal of the surgery is to remove areas of the brain that contribute to seizures, but leave the person’s cognitive abilities intact. Because people with epilepsy often have uncharacteristic brain development, where certain areas of the brain that normally are not involved in the production of language or memory actually perform these functions, the Wada test is performed before brain surgery to determine which parts of the brain to spare and to identify which parts of the brain can be removed successfully without a significant loss of important cognitive functions.
There are various off-label uses for amobarbital. For example, it is one of many drugs that has been labeled as a truth serum; it has also been used to get people with mental health disorders who are mute to speak. Drugs used as truth serums are not used for legal purposes. The confessions or testimonies of people under the effects of these drugs are not considered to be legally admissible evidence in court under most circumstances because their self-reports may be unreliable.
No Longer Readily Prescribed
Barbiturate drugs like amobarbital have been largely replaced by benzodiazepines, other sedative drugs, and even antidepressant drugs, in some cases. Barbiturates were highly abused drugs when they were more commonly prescribed, and they are capable of producing very severe physical dependence. The withdrawal symptoms from barbiturates are similar to the withdrawal symptoms from alcohol; they include possible delirium tremens (psychosis, seizures, and severe confusion). The seizures that can occur from withdrawal from barbiturates can be potentially fatal.
The majority of the amobarbital used today is most likely given clinically in hospitals and medical clinics, and the drug is not widely prescribed for personal use. The Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that approximately 452,000 individuals in the United States used some form of barbiturate in 2015. Based on estimates, the number of individuals who misused a barbiturate medication at least once was estimated at around 46,000 individuals. Amobarbital abuse is most likely extremely rare, given the rarity of barbiturate abuse that occurs in the United States.
The limited number of prescriptions and availability of many barbiturates have significantly reduced their abuse; however, some individuals with prescriptions may abuse these drugs. Younger individuals, particularly teenagers and adolescents, may obtain barbiturate drugs from a friend or relative who has a prescription.
Barbiturates are not major drugs of abuse, and they are most commonly abused in conjunction with other drugs. This can present a serious issue.
Some of the street names for amobarbital include downers, blue devils, blue heavens, and blue velvet.
Amobarbital is a barbiturate classified as having an intermediate duration of action, meaning that the effects of the drug can last from 4-6 hours. Sources like SAMHSA suggest that even though barbiturates are rarely prescribed today, they may be prescribed more often to women and elderly individuals than to other individuals. Individuals with prescriptions for these drugs are less likely to abuse them; instead, most abusers get the drug illegally (without a prescription).
Someone abusing amobarbital would most likely present with:
- Significantly slowed and slurred speech
- Very slowed thinking and reasoning processes
- Problems with walking that resemble being intoxicated
- Extremely slow reflexes
- Lethargy, confusion, or extreme sedation
A person diagnosed with a substance use disorder as result of amobarbital abuse (a sedative, hypnotic, or anxiolytic use disorder) would display:
- Significant problems in everyday functioning as a result of amobarbital use (problems at work, at school, or in other important areas)
- Problems in relationships as a result of amobarbital use
- Problems with physical and/or emotional health as a result of amobarbital use
- Problems with their ability to control their use of amobarbital
- Potential tolerance (needing more of the drug to get the desired effects) and withdrawal symptoms associated with discontinuing amobarbital
Any prolonged use of amobarbital would result in the development of physical dependence, which would exacerbate the individual’s abuse of amobarbital because they would be driven to avoid withdrawal symptoms.
Barbiturates are commonly taken in conjunction with other drugs, including alcohol, other barbiturates, benzodiazepines, sedatives, and other central nervous system depressants, such as narcotic pain medications. Combining these drugs results in enhancement of the central nervous system depressant effects of the drugs and can lead to serious issues in both the short- and long-term.
The most serious short-term issue would be an overdose associated with amobarbital use. The symptoms of overdose can include:
- Severe confusion
- Extremely decreased or even lost reflexes
- Poor judgment, irritability, and even aggression
- Extremely slowed breathing, shortness of breath, and/or decreased heart rate
- Lethargy, sedation, unconsciousness, or a comatose state
An overdose on amobarbital can be fatal due to the drug shutting down areas of the brain that control breathing and heart rate. Combining amobarbital with other central nervous system depressants enhances these potential effects.
Other Health Issues Associated with Abuse
Other short-term effects of abuse of amobarbital and other barbiturates can occur. Some of these include:
- Problems with forming new memories
- Irregular menstrual cycles in females and impotence in males
- Increased sensitivity to noise
- Increased sensitivity to pain
- Problems sleeping
- Respiratory issues that result from chronic use of the drug and are due to the effects of respiratory suppression caused by the drug
- Psychotic behaviors, including hallucinations and/or delusions
Short-term issues can evolve into chronic issues that can include:
- The development of a sedative, hypnotic, or anxiolytic use disorder (a substance use disorder as a result of abusing amobarbital)
- The development of physical dependence on amobarbital
- Damage to the liver as a result of taking high doses of the drug
- Long-term cardiac problems
- Long-term cognitive issues that stem from brain damage associated with respiratory suppression (a lack of oxygen to the brain) and the direct effects of the drugs
- Movement disorders as a result of long-term brain damage
- Sexual disorders
- The diagnosis of other psychological/psychiatric disorders in addition to a substance use disorder
- Potential overdose
Whenever there is concern that a person may have a formal substance use disorder, the person should be evaluated by a licensed mental health professional. Only trained clinicians can formally diagnose substance use disorders. A person with a sedative, hypnotic, or anxiolytic use disorder as a result of amobarbital abuse has developed a severe form of mental illness that can be fatal (withdrawal from barbiturate drugs can be fatal). These individuals require long-term treatment in order to help them control their behavior.
The initial step is to convince the person to enter treatment and then get the person into a physician-assisted withdrawal management program (a medical detox program) to help them safely get through the withdrawal process. Other interventions could be initiated during this phase of the treatment. After the withdrawal management program has been completed, the person should enroll in a long-term treatment program that includes:
- Continued medical management and medically assisted treatments as needed
- Formal substance use disorder therapy in either individual sessions, group sessions, or in both individual and group sessions
- Strong family and peer support
- Continued abstinence from amobarbital and any other drugs, including alcohol
- Long-term participation in treatment
Success is strongly related to the amount of time an individual stays in treatment. Individuals who remain in treatment for years have the best overall outcomes. For many people, recovery is a lifetime process and an overall way of life instead of a short-term solution to a very serious problem.