Barbiturates, commonly known as “downers,” were used for many years as a treatment for insomnia and headaches. Prescriptions for these sedatives were commonly obtained with the purpose to sell on the street, leading to abuse, overdose, and death. Barbiturates have now become rare as a drug of choice, but they are still used and abused.
Barbiturates are strong sedatives that are used to depress the central nervous system. They work by slowing down the central nervous system, which includes the brain and spinal cord, like alcohol. Barbiturates are synthetic medications that are made from barbituric acid. Discovered in the 1800s and first called barbital, barbiturates used to be prescribed regularly as a sedative for insomnia and anxiety.
Barbiturates as medication are very strong, and the risk of overdoses was so high that these medications were replaced by safer benzodiazepine medications as soon as they were available.1 Today, barbiturates have a couple of specialized uses:
Barbiturates that take effect quickly and last for less than 6 hours are used as sedatives before administering anesthesia during surgery. The two forms that are most commonly used for surgical procedures are:
Barbiturate medications that have an intermediate effect, lasting for 6 to 12 hours, are used for severe insomnia or headaches. These include:
Barbiturates for insomnia are only used after other pain-relieving medications have proven ineffective.
Long-lasting barbiturates are used to control seizures in people who have seizure disorders, such as epilepsy. The most common of these are:
Before the 1960s, barbiturates were the primary medication prescribed by physicians for insomnia, anxiety, and other conditions requiring sedatives. Abuse of barbiturates was much more common in the 1960s and 1970s than it is today, as the drugs were fairly easy to obtain.
People who use barbiturates as recreational drugs seek effects that are similar to alcohol use, including relaxation, euphoria, and reduced inhibition. Street names for barbiturates include barbs, downers, goofballs, and sleepers among others.
However, barbiturates are strong medications, and the difference between a safe medical dose and a dangerous dose is very small, so abuse of barbiturates puts the user at a high risk of overdose and death. During the 1960s, benzodiazepines became available and physicians began prescribing these safer medications rather than the more dangerous barbiturates. As prescription rates went down, so did overall use of barbiturates.
The federal government eventually classified barbiturates as Schedule II, III and IV controlled substances, depending on their form and how they are used.3 This classification led to a further decrease in the use and abuse of barbiturates due to their limited availability.
The strength of barbiturates has led them to be used for purposefully lethal reasons. The barbiturate sodium pentathol, commonly known as “truth serum,” has been used in large doses as a part of execution by lethal injection.3 Barbiturates have also been used for assisted suicide in some states, and by veterinarians for euthanasia of animals.
Because of the risk of death by overdose and the bad reputation some barbiturates have received due to their use in lethal injection executions or assisted suicide, prescriptions for barbiturates have decreased significantly, to the point that obtaining barbiturates for non-prescription use is now difficult.
According to the National Survey on Drug Use and Health, in 2017, 16,741,000 people ages 12 and over used sedatives for both prescription and nonprescription reasons. Out of this number, only 393,000 used barbiturates.5
People who take an overdose of barbiturates may do so by accident, such as taking one pill too many or taking barbiturates with alcohol; or on purpose, using large doses of barbiturates to attempt suicide. Large doses of barbiturates can lead to low blood pressure, difficulty breathing, pulmonary edema, and coma. About 10 percent of barbiturate overdoses are fatal.5
If an overdose of barbiturates is suspected, the person must receive medical attention in a hospital as soon as possible. The following information is helpful to medical personnel when a person receives treatment for barbiturate overdose:
The amount of barbiturate medication taken. If the exact amount is not known, even having the bottle with the medication dosage can be helpful
Other prescription medications the person currently takes
Other substances the person may have ingested (such as alcohol)
Any health conditions the person has (such as epilepsy)
There is no antidote for barbiturate overdose, so treatment focuses on managing symptoms. If the person is conscious, medical professionals may provide direction on how to force vomiting of any ingested substances while waiting for paramedics to arrive. If the person is unconscious or having difficulty breathing, intubation, and use of a mechanical ventilator may be necessary.6
The common side effects of barbiturates used at prescribed doses are as follows:
Mood altering effects such as loss of inhibition or euphoria
More severe side effects may occur, including the following:
Shallow or slowed breating
Lack of coordination
Difficulty thinking and poor judgment
Altered levels of consciousness
Side effects of long-term use of barbiturates may include:
Difficulty functioning independently
Decreased levels of alertness
The most severe side effect of barbiturate use is respiratory arrest, which can happen when breathing slows to the point that it stops. This is the primary cause of death by barbiturate overdose. Coma is another severe side effect, where consciousness is completely lost long-term.
People who use barbiturates long-term build up tolerance to the drugs, requiring higher and higher doses to achieve the desired effects. This can lead to addiction. If a person using barbiturates increases the dose themselves, rather than consulting with their physician, then tolerance can also lead to overdose and death.
The withdrawal symptoms for barbiturates are similar to those for alcohol. They include:
Nausea and stomach cramps
Worldwide, about 66 percent of people in withdrawal from barbiturate use experience delirium for several days, and 75 percent suffer seizures.7
The risk of death from barbiturate withdrawal is increased due to the risk of seizures. Because of this, people who are treated for barbiturate addiction are usually admitted to an inpatient facility for medically supervised detoxification, where withdrawal symptoms can be monitored and medical intervention can be provided in the event of life-threatening symptoms such as seizures or high fever. Detox from barbiturate addiction must be medically managed and should not be attempted at home.
Since barbiturate use has declined in recent years, the number of people receiving treatment for barbiturate addiction has also declined significantly, to the point that treatment statistics no longer separate barbiturates from other sedatives. In 2017, 164,000 people over age 12 received treatment for sedative addiction¹¹. Detox is the first step in treatment for barbiturate addiction.
Once the drug is removed from a person’s system, treatment can address the physical and psychological issues that led to addiction in the first place. Unlike some rehabilitation programs for drug addiction, medications cannot be used to help curb cravings for barbiturates. Instead, treatment focuses on counseling and education to help people change their patterns of thinking and lifestyle choices to help avoid relapse. Treatment for barbiturate addiction may include the following:
One of the key factors in ending addiction to barbiturates is addressing the behaviors and emotions that surround the addiction. Behavioral treatment focuses on identifying and changing the patterns of thinking and behaviors associated with barbiturate addiction. Behavioral treatments include:
One-on-one counseling with a psychologist that helps a person identify the thought patterns associated with barbiturate use and gives the person strategies to change those thought patterns.
One-on-one counseling helps a person identify the personal and family issues that underly the addiction and helps to resolve those issues.
Programs that provide rewards for abstaining from barbiturate use. Voucher exchange programs and prizes are used in this type of program.
Counseling that is led by a professional counselor and occurs in a group setting. The members of the group help to support each other through the rehabilitation process and challenge those who are having difficulty gaining awareness of the problems surrounding their addictions.
Counseling with family members that helps to repair the relationships damaged before or during addiction.
Individuals who have lived with an addiction to barbiturates for a long time may have lost the ability to manage their health, and programs that support people in relearning these skills may be a part of treatment for barbiturate addiction. People recovering from addiction to barbiturates may receive education in:
Healthy levels of exercise
Healthy eating and food preparation
People who have had high levels of barbiturate intake for long periods may require re-education in more basic daily living skills, such as hygiene, grooming, cooking, and household management.
Since many people who become addicted to barbiturates began taking the medication as a treatment for another health condition, recovering from addiction must include exploring and selecting different treatment methods for the health conditions that led to barbiturate use. People who became addicted to barbiturates due to insomnia, migraine headaches, or other health problems need to work with medical professionals to find alternative treatments for these conditions. It is important that these health conditions are addressed and managed while the person is in the medical setting or the risk of relapse increases.
Barbiturate addiction has become a rarity in our modern society, but it does still happen. Treatment for addiction to these dangerous medications is necessary and available. Anyone who struggles with a barbiturate addiction should get the help they need as soon as possible.