Barbiturates

Main type

Barbiturates belong to a class of drugs known as depressants. There are a number of different varieties of barbiturates, but all have a sedative effect and are prescribed clinically for people who have difficulty sleeping or suffer from anxiety. Barbiturates come in the form of a pill or pill-like gel, to be taken orally, but illicit users may crush down pills to a powder and add it to a liquid for intravenous injection.

The classification of different barbiturates depends mainly on how long the effect of the particular barbiturate lasts, with the drug being divided into three main kinds; ultra-short, short-intermediate and long-acting, with some barbiturates having an effect on the user for up to two days.

Taken regularly, barbiturates can become physically addictive. Addicts can also develop a strong psychological addition to the drug as well. Once a physical dependence on the drug has been formed, suddenly withdrawing from the drug can cause death.

Barbiturates are derived from a chemical called barbituric acid, which was first synthesised by Adolf von Baever in 1864 by condensing animal urine with a diethyl malonate (a substance found in apple juice). In 1903 Emil Fischer, a chemist, and Joseph von Mering, a doctor, found that ‘barbital’ as it was then known, could be used to euthanise dogs and the drug became marketed under the name ‘Veronal’.

Barbiturates were used on humans with increasing use throughout the 20th Century as a sedative. During the Second World War barbiturates were prescribed to American soldiers to help them tolerate the oppressive heat and humidity of the South Pacific. During the 1950s and 1960s there was growing evidence of behavioural disturbance and dependency problems related to the drug. Instances of death from barbiturate overdose became more frequent during this time, with high-profile victims including Marilyn Monroe and Judy Garland.

In the USA barbiturates were subject to the 1965 Drug Abuse and Control Act, meaning their manufacture and distribution became strictly controlled and only legally available via prescription.

Once routinely prescribed for insomnia and anxiety, use of barbiturates in this medical context has declined greatly since the 1970s. As an aid for sleep or to combat anxiety, their use has been superseded by benzodiazepines or diazepam (Valium).

Barbiturates are still used in anaesthesia, although the drug Propofol is increasingly preferred. Barbiturates are also used in assisted suicide or euthanasia, as a ‘truth drug’ to lower resistance to interrogation and in combination with other drugs in executions from ‘lethal injection’.

Other Types

here are lots of different barbiturates, with the main difference between them being the amount of time their effects last. Drugs classified as barbiturates include amobarbital, pentobarbital, phenobarbital, secobarbital and truinal.

These barbiturates have acquired a number of alternative names by users taking them illicitly outside a clinical context.

Amobarbital pills might be generically referred to as ‘blues’, ‘blue heavens’, ‘bluebirds’, ‘blue devils’ or ‘blue velvets’.

Pentobarbital might be called ‘nembies’, ‘yellows’, ‘yellow jackets’, ‘abbots’ or ‘Mexican yellows’.

Street names for Phenobarbital include ‘purple hearts’ and ‘goofballs’.

Secobarbital goes by such names as ‘reds’, ‘red devils’, ‘red birds’, ‘sekkies’, ‘lilly’, ‘pinks’, ‘pink ladies’, and ‘F-40s’.

Tuinal has been given the names ‘tooies’, ‘F-66s’, ‘double trouble’, rainbows’, ‘gorilla pills’ and ‘reds and blues’.

All barbiturates might be generically referred to as ‘downers’ because they are often used to negate the effects of so-called ‘uppers’ (stimulants like amphetamine or cocaine). Other generic names include ‘barbs’, ‘dolls’ and ‘sleepers’.

Major Effects

The effect of barbiturates is to enhance and increase the activity of one of the main neurotransmitters in the brain known as gamma amino butyric acid (or GABA). An increase in this chemical has a sedative effect on the user that ranges from mild relaxation to unconsciousness, depending on the strength of the dose.

Someone who takes barbiturates may feel relaxed and euphoric. Used recreationally barbiturates have a similar effect to intoxication from alcohol, resulting in slurred speech, lack of co-ordination, reduced inhibition, impaired judgement and confusion. High doses of barbiturates can lead to respiratory arrest and death.

The effects of barbiturates last between 4 and 16 hours, depending on the kind of barbiturate taken. The dangers of barbiturates become even greater when combined with other depressants such as alcohol and the chance of death is higher.

There is a high risk of dependency from the regular use of barbiturates. This can be a psychological dependency, a physical reliance or both. Habitual users can develop tolerance to the drug, leading to them taking more and more in order to create the same effect. As the length of use increases, the margin between a dose that causes the desired effect and that of a fatal overdose becomes narrower, making the latter more common in long-term users.

The amount required for an overdose of barbiturates varies from person to person, but anything over 1gram of the drug can be fatal. The long half-life of some barbiturates means overdose can occur even if small quantities on the drug have been taken over a long period of time.

Prolonged barbiturate use can result in chronic breathing problems, bronchitis, pneumonia, sexual dysfunction, delayed reflexes, short attention span, memory loss and continual inebriation.

Production countries

Barbiturates are produced legally in the majority of industrialised nations by global pharmaceutical companies, although production has declined throughout the second half of the 20th and early 21st Centuries, thanks to barbiturates being replaced by alternative sedative and anti-anxiety drugs.

Barbiturate production in the USA increased greatly throughout the first half of the 20th Century, when the drug could be bought without prescription. In 1938 the Food, Drug and Cosmetic Act started to regulate the sale of barbiturates, meaning that companies who wished to produce the drug needed governmental approval.

In the USA around 300 tons of barbiturates are legally produced every year and it is estimated that the drug can be found in around 1 in 3 medicine cabinets across the country. There are around 2,500 different types of barbiturates produced in the USA, yet only about a dozen of these are in common usage. The most popular barbiturates are prescribed as sleeping pills, and 19 million prescriptions are written out for them every year.

Federal investigations into the illicit supply of barbiturates in the USA have found that the majority are produced legitimately by pharmaceutical companies, shipped to Mexico and then smuggled back into the country for sale on the black market.

It would appear that only a small fraction of street barbiturates are illegally produced. Most are diverted from legitimate domestic production.

Regarding illicit production, a report from the International Narcotics Control Board found that 543 metric tons of barbiturates were produced in 2007, of which 447 of those were specifically phenobarbital. Between 2003 and 2007 a mere five out of the twelve barbiturates under international regulation accounted for 98.7% of global production. Phenobarbital was produced in the largest quantity, responsible for 78% of total production, next largest was butalbital with 8.6% of total production, then pentobarbital with 6.9%, barbital with 3% and lastly amobarbital with 2.6%.

In terms of the countries where the above barbiturates were manufactured, most came out of China, with the country responsible for exactly half of all illicitly produced barbiturates in the world. India was found to account for 11% of illicit global production, followed by Russia with 10%, the USA with 8%, and Denmark and Hungary both responsible for 7%.

The INCB report of 2010, based on data gathered the previous year, found that consumption of barbiturates was highest per capita in the countries of Bulgaria, Latvia and Ukraine. In Bulgaria between 2007 and 2008, consumption per capita leapt from 1.2% of adults to 2.7%.

Facts and stats

Facts

Barbiturates are legally produced drugs that used to be commonly prescribed to treat anxiety, insomnia and depression. They are used recreationally for their euphoric, relaxant effects and to come down from the effects of stimulant drugs. Barbiturates are addictive and highly dangerous because of the way they remain in the body, making overdose, with fatal results, more likely if habitually taken. Here are some more facts about barbiturates.

  • Barbiturates were used in human medicine from 1903.
  • Barbiturates became popular as sleeping pills in the 1950s and 1960s.
  • Barbiturates can only be legally obtained via a doctor’s prescription.
  • Unauthorised possession of barbiturates can result in five years in prison.
  • Barbiturates are sedatives that in small doses make people feel relaxed and sociable.
  • Larger doses of barbiturates create an effect similar to intoxication from alcohol including slurred speech, lack of inhibition and loss of co-ordination.
  • It is easy to overdose on barbiturates because a normal dose is not much smaller than a fatal dose.
  • Some barbiturates continue to have an effect on the brain for two days.
  • Fatal overdose from barbiturates is more common when combined with other depressants like alcohol, tranquillisers or heroin.
  • Once someone has become dependent on barbiturates through long-term use, sudden and abrupt cessation has the potential to kill.
  • Pregnant mothers transfer barbiturates to their unborn babies who may also suffer withdrawal symptoms once born.
  • Small dose barbiturate withdrawal symptoms include anxiety, insomnia and nausea.
  • With larger doses or long-term barbiturate use withdrawal symptoms include seizures, hallucinations and suicidal feelings.
  • The barbiturate thiopental is commercially known as Sodium Pentothal and has been used in small doses as a ‘truth serum’ during interrogation, and in larger doses is one of three drugs used in ‘lethal injection’ executions in the USA.

Stats

  • In 1955 over 70% of admissions to a centre for substance abuse in Copenhagen, Denmark, were connected with barbiturates.
  • Statistically, barbiturates were most commonly taken by the middle and upper classes in the 1950s. In the 1960s barbiturate use had expanded into lower social classes.
  • In 1975 concern over the high number of deaths from barbiturate overdose resulted in a campaign by doctors to warn people of the dangers of the drug. They estimated that approximately 27,000 people had been killed as a result of barbiturate overdose between the years 1969 and 1974.
  • In 1977 doctors in the USA wrote around 7.9 million prescriptions for the barbiturate Phenobarbital.
  • From 1983 to 1999 it was found that there were around 146 fatal overdoses per million prescriptions of barbiturates.
  • In 2001, 2.8% of American high school seniors said they had used barbiturates.
  • In the USA in 2010, overdose of the barbiturate phenobarbital resulted in 1,493 emergency room admissions. In the same year barbiturates were responsible for 396 deaths.
  • Today, overdose from barbiturates is a contributing factor in approximately a third of all drug-related deaths.
  • A lethal dose of barbiturates ranges from 2-3mg with amobarbital and pentobarbital and between 6g and 10g for Phenobarbital.
  • It is estimated that there are over 3000 deaths every year from barbiturate overdose in the USA, with 42% of those deaths classed as suicides, and the rest as accidental due to unwittingly exceeding the prescribed dose or through mixing with other depressant drugs like alcohol.
  • More women than men receive prescriptions for barbiturates as they are statistically more likely to seek help for insomnia, anxiety and depression.
  • Barbiturates are also more commonly prescribed to older rather than younger adults.

Addiction Signs

Someone who has taken a dose of barbiturates for recreation may appear euphoric, high-spirited, talkative and uninhibited. They may also slur their speech, appear uncoordinated and to all intents and purposes may appear drunk.

If someone is addicted to barbiturates they might constantly appear drowsy and lethargic, may display a lack of co-ordination and fall over a lot. They might display signs of nervousness, sensitivity to noise and restlessness, show the physical symptoms of insomnia like pallid skin and red eyes and perspire profusely.

Someone regularly taking barbiturates might appear extremely relaxed at all times, with seemingly no anxiety. They also might be prone to lapses in short-term memory. Barbiturate use may be detected by very shallow breathing from the user and a lack of animation facially.

For women, irregularities in menstrual cycle are common in those habitually taking barbiturates. In men regular users of barbiturates are prone to impotence.

Someone who is addicted to barbiturates may also display withdrawal symptoms between doses, or when their supply has been cut off. These symptoms may include weakness, anxiety, shaking, twitching, abdominal pains, sensitivity to light, high temperature and profuse sweating. These effects are actually very similar to those caused by taking large doses of barbiturates.

A barbiturate addict who suddenly stops taking the drug may be subject to convulsion, loss of consciousness and death.

Those who habitually inject barbiturates in a solution may show needle puncture marks in areas like the arms, ankles and backs of the knee. Injecting the drug with dirty needles may also cause skin abscesses to be observed.

Treatments

Someone who has taken a large dose of barbiturates should be treated in hospital because although they may simply seem intoxicated or drowsy, they are liable to rapidly develop more serious symptoms.

The barbiturate abuser may be given a drink of liquid charcoal, which has the effect of binding the drugs together in their stomach to stop them being absorbed into the bloodstream. A hospital might also elect to pump the stomach of the barbiturate abuser. Both these techniques are only partially effective, however, because they only remove the amount of the drug not yet absorbed into the body.

An overdose of barbiturates will cause someone’s breathing to become shallow and may make them stop breathing altogether, in which case a respirator will be used to breathe for them until the effect subsides.

Kidney dialysis might also occur in an attempt to ‘wash’ the drug from the blood of the barbiturate abuser.

It is extremely dangerous for someone who has been taking barbiturates long-term to stop taking them suddenly, and can result in death. So a doctor should be consulted immediately in order to aid the user in detoxifying and ridding themselves of their dependency safely.

The symptoms of withdrawal from barbiturates are more severe and painful than those associated with heroin and untreated will involve at least two weeks of painful symptoms including nausea, vomiting, cramps, palpitations, hallucinations, convulsions and seizures. The stress upon the body caused by untreated barbiturate withdrawal can result in kidney failure, heart failure and death.

Barbiturate withdrawal symptoms tend to appear between eight and sixteen hours after the last dose of barbiturates. A doctor will put in place an initial programme of gradual withdrawal for a barbiturate addict often lasting between ten days to two weeks, although the duration depends on the severity of the addiction. Some withdrawal programmes can last months. Treatment may occur in a clinical setting; in a hospital or rehabilitation centre, or may be given to the addict as an out-patient, although chances of rehabilitation are greater when the addict agrees to a live-in programme.

In medically supervised withdrawal the addict’s usual barbiturate dose is administered on the first day of the programme, followed by a 10% reduction in this dose every day. A closely monitored nutritious diet, plenty of fluids and additional drugs are usually a part of the programme as well. Barbiturates might be replaced with other sedatives like benzodiazepines, and medications to treat the withdrawal symptoms including high heart rate and blood pressure may also be prescribed. Alcohol might also be administered to relieve some of the first symptoms of barbiturate withdrawal.

In conjunction with medically managed detoxification, counselling is also given. This is because treating the physical dependency is only one part of the equation of addiction and rehabilitation must also address the psychological dependence.

Behavioural therapy is designed to help former addicts avoid using barbiturates in the future and may be long term, lasting many months. Long-term support might also include regular group therapy sessions, including those that take place as part of 12 step programmes.