Abstract
Barbiturates are depressants that produce a wide spectrum of central nervous system depression from mild sedation to coma. Barbiturates are depressants that produce a wide spectrum of central nervous system depression from mild sedation to coma. They have also been used as sedatives, hypnotics, anesthetics, and anticonvulsants. Barbiturates are classified as Ultrashort, Short, Intermediate, Long-acting.
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Street Names
Barbs
Block Busters
Goof Balls
Red Devils
Reds & Blues
Yellow Jackets
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Brand Names
Amytal and Amytal Sodium
Soneryl
Prominal
Nembutal
Luminal
Seconal Sodium
Tuinal
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History
Barbiturates were first used in medicine in the early 1900s and became popular in the 1960s and 1970s as treatment for anxiety, insomnia, or seizure disorders. With the popularity of barbiturates in the medical population, barbiturates as drugs of abuse evolved as well. Barbiturates were abused to reduce anxiety, decrease inhibitions, and treat unwanted effects of illicit drugs. Barbiturates can be extremely dangerous because the correct dose is difficult to predict. Even a slight overdose can cause coma or death. Barbiturates are also addictive and can cause a life-threatening withdrawal syndrome.
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Pharmacology
The original use of barbiturates as sedative/hypnotics is no longer recommended because of their adverse reactions and risk of dependence. Ultra-short-acting compounds such as thiopental, which is an analogue of pentobarbital where the oxygen at position 2 is replaced by sulphur (CAS 76-75-5), and methohexital (CAS 151-83-7) are used for anaesthesia, while long-acting derivatives such as phenobarbital are used in the treatment of epilepsy and other types of convulsions. Phenobarbital may be used in the treatment of withdrawal symptoms in neonates of mothers suffering from multiple substance dependence during pregnancy. It is the substance of choice for the treatment of neonatal abstinence syndrome in cases of combined dependence or benzodiazepine dependence.
Besides medical use, as barbiturates produce effects similar to ethanol during intoxication, it can be often used for recreational use.
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Uses
The barbiturates were the most widely used sedative/hypnotics from the early part of this century until the early 1970s, when flurazepam entered the US market. The agents most commonly used as hypnotics are the short- to intermediate-acting compounds such as amobarbital, pentobarbital and secobarbital, which have half-lives of 10-15 hours to 40-50 hours.
During sleep, barbiturates reduce neurogenic respiratory drive; doses approximately three times those used therapeutically virtually eliminate neurogenic drive and greatly reduce hypoxic drive. Protective respiratory reflexes such as coughing are only mildly affected until very high doses are administered. For these reasons, patients with pre-existing respiratory compromise may be at increased risk when given hypnotic barbiturates.
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Scheduling
Scheduling of barbiturates depends on what is the specific drug that is being prescribed.
Those in current medical use are the Schedule IV drug methohexital (Brevital®), and the Schedule III drugs thiamyl (Surital®) and thiopental (Pentothal®). Barbiturate abusers prefer the Schedule II short-acting and intermediate-acting barbiturates that include amobarbital (Amyta®), pentobarbital (Nembutal®), secobarbital (Seconal®), and Tuinal (an amobarbital/secobarbital combination product). Other short and intermediate-acting barbiturates are in Schedule III and include butalbital (Fiorina®), butabarbital (Butisol®), talbutal (Lotusate®), and aprobarbital (Alurate®).
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Psychological and physical addiction liability
In small doses, the person who abuses barbiturates feels drowsy, disinhibited, and intoxicated.
In higher doses, the user staggers as if drunk, develops slurred speech, and is confused.
At even higher doses, the person is unable to be aroused (coma) and may stop breathing. Death is possible.
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Withdrawal Effects
Symptoms of withdrawal or abstinence include tremors, difficulty sleeping, and agitation. These symptoms can become worse, resulting in life-threatening symptoms, including hallucinations, high temperature, and seizures.
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Long term effects
The worst effect in long term use of barbiturates is that a user may develop tolarance to it. Tolerance to the drug occurs quickly, and people will take higher and higher doses to get the same effect. Physical and psychological dependency may also develop with repeated use. Barbiturate abusers are prone to fatal overdose because the difference between an effective dose and a lethal dose narrows as the length of use increases.
Physical effects
Physical effects of barbiturate intoxication include: drowsiness, lateral and vertical nystagmus, slurred speech and ataxia, decreased anxiety, a loss of inhibitions.
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Psychological treatment options
Thiopental As withdrawal symptoms can be severe, there are some psychological treatment options available for addicted patients. It starts with detox and then followed by counselling. Further individual and group therapy session help in overcoming the addiction smoothly.
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Medical Treatment
An opiate-blocking drug called naloxone (Narcan) is often used to treat overdose when an opiate was part of the mix. If opiates are involved, naloxone will often rapidly restore consciousness and breathing.
There is no direct antidote to barbiturates or alcohol overdose. In such overdoses, respiration must be maintained by artificial means until the drugs are removed from the body. Some drugs may help speed the removal of barbiturates.
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Pychological Treament
Although rare, anyone who is addicted to barbiturates requires prolonged therapy to avoid the dangerous symptoms of withdrawal. Addicted individuals are treated with decreasing doses of barbiturates ( detox) until they are drug free.
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Related drugs
Barbiturates are themselves synthetic drugs. Hence the related synthetics are other kinds of barbotirates such as:
Allobarbital
Alphenal
Amobarbital
Butalbital
Cyclobarbital
Methohexital
Related Synthetics
