Barbiturates act as central nervous system depressants, which essentially means they slow down the functions of the central nervous system.
Barbiturates were designed to treat issues with anxiety, assist in withdrawal from alcohol, assist in the control of seizure disorders, control muscle spasms, and initiate sleep. Nembutal (phenobarbital) is a short-acting barbiturate drug.
What Is Nembutal?
Nembutal is a barbiturate that has several medicinal uses. Its most common uses include:
- As a sedative for the treatment of anxiety
- As a hypnotic for short-term treatment of insomnia: Nembutal is a short-acting benzodiazepine and is useful in helping to initiate sleep in individuals who have difficulty getting to sleep; however, it appears to lose its effectiveness after an individual uses it for a period of about two weeks. This is probably due to the development of tolerance.
- As a preanesthetic agent to help relax individuals who are about to undergo surgery, generally before a more powerful anesthetic is administered
- As an anticonvulsant to control seizures associated with a number of different disorders, including epilepsy, brain injury, and brain infections
- To treat withdrawal from benzodiazepines or alcohol
Nembutal has been used in state executions by lethal injection. It is also used in some countries where assisted suicide is legal.
The United States Drug Enforcement Administration classifies Nembutal as a Schedule II controlled substance, indicating that it does have medicinal uses but is also a high candidate for the development of abuse and physical dependence. Barbiturates like Nembutal were commonly used in the treatment of anxiety disorders and anxiety-related issues, such as depression with anxiety, prior to 1970. However, the entire class of drugs was deemed a potential health hazard due to their potential for the development of serious abuse and physical dependence. In addition, these drugs can be fatal when they are used in large quantities, and they are often used in potentially dangerous situations, such as with alcohol. In 1970, the federal government put restrictions on their use, and barbiturates like Nembutal were replaced with a newer class of drugs: benzodiazepines.
Since the restrictions on barbiturates, there has been a drastic drop in abuse of drugs like Nembutal; however, the drugs are still used, especially for the control of seizures and as preanesthetics. The Substance Abuse and Mental Health Services Administration (SAMHSA) keeps tabs on drug use and abuse in the United States and indicates that Nembutal and other barbiturates are:
- No longer abused as commonly as they were prior to 1970
- Often used in clinic and hospital settings as compared to being prescribed for private use
- More likely to be prescribed to elderly individuals or women when they are prescribed for private use
- Still useful in the control of seizures
Abuse of barbiturates most likely occurs when individuals obtain them illegally or get them from someone else who has a prescription to them. According to sources like SAMHSA, barbiturate abuse often occurs in the context of abuse of multiple drugs, such as with concurrent abuse of alcohol, other prescription medications, and stimulant medications. Essentially, barbiturate abuse typically does not occur in isolation, but most often occurs as a result of polydrug abuse. This suggests that individuals who are abusing barbiturates are most likely abusing some other drug, with the most common drug being alcohol.
Abusing multiple central nervous system depressants, such as Nembutal and alcohol, is extremely dangerous and can be potentially fatal.
According to the book Concepts of Chemical Dependency, abuse of barbiturates like Nembutal result in several different categories of symptoms.
Physical effects: The physical effects of abusing Nembutal include very marked sedation, slurred speech, issues with coordination, a staggering gate, issues with balance, decreased respiration, decreased heartbeat, changes in blood pressure, decreased body temperature, sweating, fever and chills, and at high doses, the potential for unconsciousness and/or coma.
Mental effects: Individuals abusing Nembutal often present as being confused, disoriented, and illogical. They may have issues with problem-solving, have trouble with attention, display memory loss, become very depressed or have mood swings, become very suicidal, and present with hallucinations and/or delusional behavior.
- Other effects: Other effects from using Nembutal typically affect the individual’s relationships and ability to work, such as a decreased interest in socializing or performing activities at work, isolating oneself from others, decreased social interactions, the presentation of extreme behaviors that alternate from one spectrum of the behavior to another (such as being very sociable and pleasant to being very aggressive and disruptive), and apathy regarding the feelings of others.
The major risks of abusing Nembutal are the development of a barbiturate use disorder (barbiturate abuse or addiction to barbiturates) with the co-occurring development of physical dependence on the drugs. Physical dependence consists of the symptoms of tolerance and withdrawal.
Tolerance to Nembutal occurs when the individual finds that they no longer get the same effects from the dose of Nembutal they have been taking over time, and they need to take more Nembutal to get the same effects that were once achieved at lower doses. Tolerance to Nembutal develops very quickly, and individuals may soon be taking extremely high doses.
As tolerance develops, the individual system begins to adjust to having Nembutal in its tissues, and this can result in the development of withdrawal symptoms when the individual stops using the drug or cuts down the dosage. This syndrome occurs when the levels of Nembutal in the person’s system drop, and the system is thrown out of balance. The individual will experience a number of negative physical and psychological symptoms, which can potentially be fatal.
The development of physical dependence on Nembutal is itself a dangerous condition. Individuals who abuse Nembutal with other drugs that can also result in the development of physical dependence, such as alcohol or prescription pain medications, will have serious complications as a result of these co-occurring disorders. Medical supervision is required for the detox process.
According to the American Psychiatric Association, the signs of the development of a barbiturate use disorder as a result of Nembutal abuse include the following:
- Recurrently using more Nembutal than originally planned or using it for longer periods than originally planned
- Spending significant amounts of time trying to obtain Nembutal, using it, and/or recovering from using it
- Having recurrent cravings to use Nembutal
- Continuing to use Nembutal in spite of negative ramifications as a direct result of using the drug, such as issues at work, in personal relationships, at school, etc.
- Repeatedly failing to fulfill major obligations in life as a result of Nembutal use
- Recurrent use of Nembutal when it is dangerous, such as while driving, operating machinery, or watching children
- Continuing to use Nembutal even though one is aware that it is directly responsible for issues with health, emotional functioning, or mental status
- The development of significant tolerance to Nembutal
- The development of withdrawal symptoms related to Nembutal
Individuals who have developed a substance use disorder as a result of abusing Nembutal will require initial enrollment in a withdrawal management program where they are closely supervised by a psychiatrist or addiction medicine physician while they undergo the withdrawal process (most often in an inpatient setting) and long-term therapy to deal with the underlying issues of the substance use disorder.