What are Barbiturates?
- Depressant drugs that decrease the activity of the central nervous system (Santrock, 2003)
- Synthetic drugs that act as depressants to calm the individual and induce sleep (Butcher, Mineka & Hooley, 2004)
Introduction to Barbiturates
Barbiturates are synthetic drugs that reduce tension and anxiety by slowing down respiration and heart rate, and by calming the central nervous system. These drugs stimulate the CYP450 enzymes in the liver, and act upon the GABA (gamma aminobutyric acid) receptors in the brain to produce these sedating effects. As with other drugs, the specific effects of barbiturates depend upon many interacting factors, including characteristics inherent within the person using the drug, such as past experiences, attitudes, and personalities; the context in which the drug is taken; and the type, form of administration (intravenous/injected or oral/swallowed), and dosage of the drug. Generally, however, the short-term effects of barbiturates in low doses are relaxation and calmness in the skeletal muscles and sometimes accompanied with drowsiness, dizziness, and fever; reduced performance in cognitive tasks, such as impaired decision making and problem solving, mental confusion, poor judgment, sluggishness, slow and blurred speech; and, lowered inhibitions, manifested in muscular incoordination, increased outgoingness and talkativeness, irritability and shifting moods, and feelings of euphoria. In higher doses, barbiturates almost immediately induce sleep. In the 1920s, for example, barbiturates were used in a form of treatment called “narcosis therapy,” in which those who can afford it, particularly affluent clients, are put to sleep in one week or more. Today, barbiturates function medically as anesthetics (especially during electroconvulsive therapy), as anticonvulsants (in controlling epileptic seizures), and as sleeping aides in the form of pills. In psychotherapy, barbiturates and other antianxiety drugs, like the benzodiazepines, are often used in hypnosis to help clients recover repressed memories, and in psychoanalysis to boost client’s talkativeness. Because of its use in psychotherapy, barbiturates, specifically thiopental sodium, and other drugs used similarly (like the anticholinergic scopolamine), came to be known as “truth serums,” although the increased talking produced doesn’t always guarantee truthfulness.
Barbiturates are classified as sedatives, along with alcohol and the benzodiazepines; and sedatives, along with tranquilizers and narcotics, form a large class of drugs known as depressants. (An important note to the reader, however, is that this classification scheme is quite inconsistent in different sources. For instance, some sources say that narcotics are sedatives, or that barbiturates belong to a more specific subgroup called the sedative-hypnotics. Even the drugs belonging to which particular group are classified differently. But for the purpose of this text, that is, to provide a comprehensive overview of barbiturates, the author decided to separate narcotics from sedatives due to its distinct effects, and to include, as much as possible, all the drugs mentioned to this particular group.) Among the 2,500-plus barbiturates that have already been synthesized, the most common examples, with their generic, commercial/trade, and street names, are: barbital (Veronal), the first barbiturate to be clinically used in 1903, and which started the practice of ending the names of subsequent barbiturates with “-al”; phenobarbital (Luminal), which was introduced in 1912, and was the second barbiturate synthesized for clinical use; pentobarbital (Nembutal), which is observed to be more sedating than alcohol, and is known in the streets as “blue devils”; secobarbital (Seconal), also known as “blue heavens”; amobarbital (Amytal), also known as “blue angels”; a variant of secobarbital-amobarbital drug (Tuinal), also known as “rainbows”; butabarbitol (Butisol), also known as “goofballs”; methaqualone (Quaalude), popularly called “lude”; thiopental sodium, which is used as a “truth serum” during psychotherapy; diazepam (Valium); and, chlordiazepoxide (Librium). According to some sources, the last four barbiturates mentioned - methaqualone, thiopental sodium, diazepam, and chlordiazepoxide - belong to a group of barbiturate-like substances called the benzodiazepines. Other known street names for barbiturates are “downers”, “barbs”, “reds”, “red birds”, “phennies”, “tooies”, “yellows”, and “yellow jackets.”
Barbiturates typically differ from each other in terms of how fast the drug takes effect (onset), and how long the effects last (metabolic rate). Generally, rapid-acting barbiturates are the most lipid-soluble; they enter and leave the brain quickly. Physicians play upon this important characteristic when prescribing medications for different purposes. For example, barbiturate sleeping pills are often short-acting and in a higher dose, about 100 to 200 mg of Tuinal; and calming barbiturates are usually long-acting and in a lower dose, about 30 to 50 mg Luminal. This is also the reason why rapid-acting thiopental sodium is used in psychotherapy in lower doses than with sleeping pills. As anticonvulsants, barbiturates are prescribed in low doses, and are often more effective when combined with other anticonvulsant drugs.
Barbiturates are now largely replaced by benzodiazepines in reducing tension and relieving anxiety. Legal use of barbiturates today is severely restricted and requires strict medical supervision. This is because it was later found out that overdose of barbiturates produce unwelcoming physical effects - difficulty breathing, brain damage, personality deterioration, and death due to respiratory failure. In fact, it is even more lethal than heroin. Besides the dangerousness of overdose, users are typically guilty of combining it with other stimulants (like amphetamine), or using it in conjunction with alcohol, which multiplies the effect of each other. Unlike other drugs, the lethal dosage for barbiturates does not increase with time; and because tolerance (or the need to take increasing amounts of the drug to obtain the same effects) tends to develop with these drugs, as when barbiturates are chronically used to manage epilepsy, the risk for overdose, whether intentional or not, is quite high. To make matters worse, it is estimated that psychological and physical dependence for barbiturates is from moderate to high. Statistics show that more than a million of barbiturate users are addicts (mostly middle-aged and older people); and that next to narcotics, they are the second most abused group of drugs. Barbiturate addicts are typically undetectable. They are often called “silent abusers” because they take the drug usually at home and do not engage in any public scandals. Research points to the short-acting, but longer-lasting barbiturates as the culprit behind dependence. Rats were shown to be more willing to press a level for short-acting barbiturates than with longer-acting ones; and that they are more willing to self-inject barbiturates (which are shorter-acting) than benzodiazepines. In one research study, humans generally chose pentobarbital (which is shorter-acting) over diazepam, that they were willing to work in a hospital ward just for the drugs, and that they have developed regular working patterns for those drugs. The most frequently abused barbiturates are Seconal, Nembutal, Amytal, Butisol, and Tuinal.
As with overdose, the effects of barbiturate withdrawal is also dangerous, especially if complicated by alcoholism or dependence on other drugs. Barbiturate withdrawal is characteristically longer-lasting and more unpleasant than both narcotic- and benzodiazepine-withdrawal syndromes. Onset of withdrawal symptoms varies with the half-life of the drug, and the symptoms typically (and surprisingly) resemble the effects of stimulants - trembling hands and face, insomnia, nausea, abdominal cramps, elevated heart rate and blood pressure, and weight loss. For barbiturate users who ingest large dosages (800 mg or more) daily, withdrawal symptoms decline after the first week of abstinence and halt by the end of the first month. If the withdrawal is abrupt, however, the person’s condition immediately seems to improve because no signs of barbiturate intoxication are observed, until after 8 to 12 hours when symptoms start to show (including inability to stand up). After two or three days, severe (“grand mal”) convulsions appear, and the person experiences disorientation and becomes psychotically delirious (similar to alcohol delirium tremens) that begins at night and abruptly ends with a critical sleep. Around 5 percent of those people who experienced this kind of psychosis never wake up. Fortunately, withdrawal symptoms may diminish upon administration of small doses of the barbiturate itself or other similar sedatives. When seeking the help of a physician, it is imperative that patients indicate the problem as a withdrawal syndrome and not barbiturate intoxication because different treatments are required for them.
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Frequently Asked Questions
- How are these drugs abused? In what ways do abusers use these?
- What other substances act like barbiturates? What are the reasons for their similarities? Do they have the same chemical structures? Do they produce almost the same effects?
- Are they classified as depressants or stimulants?
- If these drugs can induce sleep, are they also prescribed laxed in people who have difficulty sleeping, like the elderly?
- Are they helpful in reducing symptoms of people with dissociative disorders?
- What are the physical and psychological effects of using these drugs?
- What are the available treatments and corresponding outcomes of such treatments in people who abuse them?
- What are the different withdrawal symptoms of using barbiturates?