Possession of barbiturates without a valid prescription is considered a criminal offense, with charges ranging from misdemeanors to felonies based on the quantity and intent, such as personal use versus Barbiturate Withdrawal Case distribution. Barbiturates are classified as Schedule II, III, or IV controlled substances under federal law, depending on their medical use and potential for abuse, and North Carolina enforces these classifications with stringent monitoring and penalties. The legal complications of barbiturate use in North Carolina are strict prescription regulations, severe penalties for unauthorized possession, and criminal charges for misuse or distribution. According to the National Institute on Drug Abuse (NIDA), the transition to these alternatives has greatly decreased the prevalence of barbiturate-related dependency and overdoses in the United States. Implementing prescription monitoring programs and raising public awareness about the dangers of barbiturate dependency are also effective strategies for reducing misuse. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), individuals who seek professional care for barbiturate addiction are significantly more likely to achieve sustained recovery compared to those attempting detox without supervision.

• Barbiturate abuse is using the drug when it’s not prescribed for you.
• According to the National Institute on Drug Abuse (2023), approximately 15% of overdose deaths involving sedatives in the U.S. are linked to barbiturates, primarily due to their recreational abuse and combination with other depressants.
• According to the National Institute on Drug Abuse (2023), the risk of overdose with barbiturates is much higher, even with slight deviations from the prescribed dose, due to their profound suppression of the central nervous system.
• The combination medication Fioricet, consisting of butalbital, caffeine, and paracetamol (acetaminophen), however, is specifically exempted from controlled substance status, while its sibling Fiorinal, which contains aspirin instead of paracetamol and may contain codeine phosphate, remains a schedule III drug.

Substance use disorders, particularly polysubstance abuse, are extremely common, with barbiturates frequently being combined with alcohol, opioids, or benzodiazepines to enhance sedative effects. The signs of barbiturate misuse and abuse include drowsiness, slurred speech, impaired coordination, mood swings, and frequent cravings for the drug. Compared to other substances, barbiturates induce psychological dependence similar to alcohol, as both suppress the central nervous system and create a reinforcing cycle of substance abuse to avoid withdrawal. The National Institute on Drug Abuse (NIDA) reports that barbiturates carry a high risk of dependence, overdose, and respiratory depression, which led to the development and adoption of safer alternatives like benzodiazepines.

How commonly prescribed are barbiturates?

This is why barbiturates are so dangerous and why they’re not often prescribed today. In general, barbiturates are relaxants, much like alcohol. Since it’s a combination of these two drugs, it can start taking effect after only 15 minutes or so, but it can last as long as 8 hours. It’s a short-acting drug, starting to have an effect in 10 to 15 minutes, but only lasting three to four hours.

A rare adverse reaction to barbiturates is Stevens–Johnson syndrome, which primarily affects the mucous membranes. After the baby is born, it may experience withdrawal symptoms and have trouble breathing. When a person ages, the body becomes less able to rid itself of barbiturates. Different barbiturates have different substituents in the basic structure, mainly in position 5 on the ring. In 1988, the synthesis and binding studies of an artificial receptor binding barbiturates by six complementary hydrogen bonds was published. Sodium thiopental is an ultra-short-acting barbiturate that is marketed under the name Sodium Pentothal.

Related Disease Conditions

One study found that 11% of males and 23% of females with a sedative-hypnotic misuse die by suicide. Recreational users report that a barbiturate high gives them feelings of relaxed contentment and euphoria. The combination medication Fioricet, consisting of butalbital, caffeine, and paracetamol (acetaminophen), however, is specifically exempted from controlled substance status, while its sibling Fiorinal, which contains aspirin instead of paracetamol and may contain codeine phosphate, remains a schedule III drug. Many soldiers returned with addictions that required several months of rehabilitation before discharge. No substance of medical value was discovered, however, until 1902 when two German scientists working at Bayer, Emil Fischer and Joseph von Mering, discovered that barbital was very effective in putting dogs to sleep.

Amobarbital is an intermediate-acting drug, starting to work in 45 to 60 minutes and lasting up to eight hours. The greatest danger to misusing barbiturates is that you can become dependent on them. The drugs can be injected into the veins or muscles, but they are usually taken in pill form. Unfortunately, barbiturate misuse among teenagers may be on the rise again, particularly phenobarbital, compared with the early 1990s. Since doctors prescribed fewer barbiturates, they became harder to get illegally. First, the U.S. government developed stricter guidelines for when and how barbiturates were used.

Long-Acting Barbiturates

According to the National Institute of Abuse (2023), unmanaged withdrawal carries a mortality rate of up to 10%, necessitating medically supervised detoxification to ensure patient safety. Barbiturate withdrawal is considered one of the most severe among all substances, often causing symptoms like seizures, delirium, and respiratory distress. The NIDA estimates that about 10% of barbiturate-related emergencies involve recreational use combined with alcohol or other sedatives, which amplifies the risk of fatal overdose. By the mid-20th century, their widespread medical use declined due to the development of safer alternatives like benzodiazepines, as reported by the Substance Abuse and Mental Health Services Administration (SAMHSA). WebMD does not provide medical advice, diagnosis or treatment. Barbiturate abuse is using the drug when it’s not prescribed for you.

When should I see my healthcare provider?

• Our treatment services are catered toward discovering and implementing solutions for sustained, long-term recovery.
• Barbiturates have some risks, but these risks should be minimal if you take your medication exactly as prescribed.
• Common side effects of barbiturates include drowsiness, dizziness, and confusion, while severe effects like respiratory depression, coma, and death occur at higher doses.
• In comparison, alcohol withdrawal is dangerous and causes delirium tremens (DTs) and seizures, but the slower onset and broader range of treatment options make it somewhat more manageable.
• The biggest difference between the barbiturates is how long their effects last.

Users who consume alcohol or other sedatives after the drug’s effects have worn off, but before it has cleared the system, may experience a greatly exaggerated effect from the other sedatives which can be incapacitating or even fatal. Tolerance to the anticonvulsant effects tends to correlate more with tolerance to physiological effects, however, meaning that they are still a viable option for long-term epilepsy treatment. The lethal dose is highly variable among different members of the class, with superpotent barbiturates such as pentobarbital being potentially fatal in considerably lower doses than the low-potency barbiturates such as butalbital. The lethal dosage of barbiturates varies greatly with tolerance and from one individual to another.

These occur because barbiturates excessively suppress the central nervous system, leading to a critical loss of brain function that results in coma or death without immediate medical intervention. The symptoms of barbiturate overdose are severe respiratory depression, unconsciousness, pinpoint pupils, and slowed heart rate. Behavioral signs such as secretive actions, neglecting responsibilities, and using barbiturates without a prescription are also common indicators of substance abuse. Recreational users frequently mix barbiturates with alcohol or opioids, amplifying their effects, which lead to life-threatening respiratory depression. Intravenous use, though less common, involves injecting liquid barbiturates directly into the bloodstream, resulting in a rapid and intense sedative effect but significantly increasing the risk of overdose and infection.

Are barbiturates the same as benzodiazepines?

Someone who is addicted to barbiturates needs prolonged therapy to prevent dangerous withdrawal symptoms. The treatment of barbiturate abuse or overdose is generally supportive, meaning that the staff works to make sure the person doesn’t get worse. Someone who has taken a barbiturate and has symptoms of side effects or an overdose must be cared for in an emergency room. Symptoms of withdrawal after you stop taking barbiturates include tremors, difficulty sleeping, agitation, and hallucinations. The barbiturates counteract the excitement and alertness obtained from stimulant drugs like cocaine and methamphetamines. The street names of commonly misused barbiturates describe the desired effect of the drug or the color and markings on the actual pill.

Barbiturate Misuse Symptoms

This class of drugs was commonly used by American doctors to treat conditions like anxiety, insomnia, and seizures in the 1960s and 1970s. Substance abuse treatment centers are equipped to help individuals struggling with barbiturate abuse. Time is crucial in barbiturate overdose situations because there is no specific antidote available to reverse the effects.

Overdose

Taken together, the findings that barbiturates potentiate inhibitory GABAA receptors and inhibit excitatory AMPA receptors can explain the superior CNS-depressant effects of these agents to alternative GABA potentiating agents such as benzodiazepines and quinazolinones. The longest-acting barbiturates have half-lives of a day or more, and subsequently result in bioaccumulation of the drug in the system. (ex. If a benzodiazepine increases the frequency of channel opening by 300%, and a barbiturate increases the duration of their opening by 300%, then the combined effects of the drugs increases the channels’ overall function by 900%, not 600%). In the case of benzodiazepines, not only do they have additive effects, barbiturates also increase the binding affinity of the benzodiazepine binding site, leading to exaggerated benzodiazepine effects.

Therapy, including cognitive-behavioral therapy (CBT), is essential for addressing the underlying psychological dependence and helping individuals develop healthier coping mechanisms. Barbiturate addiction is addressed using detoxification, therapy, and specialized rehab programs designed to manage both the physical and psychological aspects of dependence. In comparison, alcohol withdrawal is dangerous and causes delirium tremens (DTs) and seizures, but the slower onset and broader range of treatment options make it somewhat more manageable.

Tolerance to the anxiolytic and sedative effects of barbiturates tends to develop faster than tolerance to their effects on smooth muscle, respiration, and heart rate, making them generally unsuitable for a long time psychiatric use. Some symptoms of an overdose typically include sluggishness, incoordination, difficulty in thinking, slowness of speech, faulty judgement, drowsiness, shallow breathing, staggering, and, in severe cases, coma or death. Patients should never try to tackle the task of discontinuing barbiturates without consulting a doctor, owing to the high lethality and relatively sudden onset of the withdrawal. Mental cravings for barbiturates can last for months or years in some cases and counselling/support groups are highly encouraged by addiction specialists. In addition, nursing mothers who take barbiturates may transmit the drug to their babies through breast milk.

Other effects of barbiturate intoxication include drowsiness, lateral and vertical nystagmus, slurred speech and ataxia, decreased anxiety, and loss of inhibitions. Barbital, methylphenobarbital (also known as mephobarbital), and phenobarbital are designated schedule IV drugs, and “Any substance which contains any quantity of a derivative of barbituric acid, or any salt of a derivative of barbituric acid” (all other barbiturates) were designated as being schedule III. Among that group of drugs are the barbiturates amobarbital, butalbital, cyclobarbital, and pentobarbital. In the Netherlands, the Opium Law classifies all barbiturates as List II drugs, with the exception of secobarbital, which is on List I.

This Cys-loop receptor superfamily of ion channels includes the neuronal nACh receptor channel, the 5-HT3 receptor channel, and the glycine receptor channel. Withdrawal symptoms are dose-dependent with heavier users being more affected than lower-dose addicts. It is considered one of the most dangerous withdrawals of any known addictive substance. Research shows tolerance can develop with even one administration of a barbiturate. There are special risks to consider for older adults, and women who are pregnant. The memory-impairing effects and cognitive impairments induced by sodium thiopental are thought to reduce a subject’s ability to invent and remember lies.