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Barbiturates Overdose and Withdrawal

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Edited & medically reviewed by THE BALANCE Team

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CONTENTS

Barbiturates are central nervous system depressants that were used in the 1960s and 70s for the treatment of sleep disorders, seizures, and anxiety. Barbiturates are not widely used today due to the advent of new and safer drugs such as benzodiazepine that have largely replaced barbiturates. Apart from the medicinal use, barbiturates are often used as recreational drugs to achieve euphoria or as ‘downers’ to counter the effect of stimulant street drugs such as cocaine, it also might cause overdose and withdrawal symptoms.

Barbiturates are dangerous not just because of their potential for addiction and abuse but also due to their narrow therapeutic window. There is very little margin between the dose of barbiturate that is therapeutic to the dose that causes an overdose which may result in coma and death.

Barbiturate intoxication is the state when the mental and physical control of the individual is diminished under the effect of a drug, barbiturate in this case. It is the state of being inebriated after excessively consuming barbiturates. Barbiturate intoxication results when barbiturate depresses the central nervous system and alters the individual’s perception, mood, thought process, and motor skills. Barbiturate intoxication is similar to alcohol intoxication since alcohol is also a central nervous system depressant.

Following are the signs and symptoms of barbiturate intoxication:

Clouding of the brain
Loss of balance
Slurring of speech
Nausea
Decreased heart rate
Impaired coordination
Muscle weakness
Reduced consciousness
Decrease in urine output

No, you cannot mix barbiturates and alcohol since the two of them have a similar effect on the brain. Both barbiturates and alcohol are central nervous system relaxants or depressants. They both act through the GABA receptors on the brain. GABA is the principal inhibitory neurotransmitter and it is responsible to slow down nerve impulses thereby decreasing the activity of the brain.

When alcohol and barbiturates are used simultaneously the dose required to cause an overdose decreases significantly thereby increasing the chances of fatal events taking place. Barbiturates and alcohol can never be mixed since they both synergize the adverse effects of each other leading to deteriorating physical and mental health.

Using alcohol and barbiturate together increases the chances of developing an addiction since both are powerful addictive substances when misused. Abuse of either of the two can rapidly lead to dependence and addiction and when used concomitantly they can lead to painful withdrawal symptoms and the detox and recovery from barbiturates abuse becomes quite complex in such a setting.

Risks of Mixing Alcohol and Barbiturates

Mixing Alcohol and barbiturate results in dangerous consequences. Some of the main depressive effects of barbiturates and alcohol include reduced heart rate, low blood pressure, and depressed and shallow breathing. It further results in hypothermia, lethargy, and loss of consciousness.

Due to the depressive effect of both alcohol and barbiturates, the brain finds it very difficult to cope with the stress exerted by these two substances, and consequently, the functioning of the brain is impaired. It results in life-threatening consequences such as the development of hypovolemic shock, respiratory depression, and coma.

Hypovolemic shock is the state of decreased perfusion of the body because the heart is unable to pump adequate blood for the survival of the body organs due to the depressive effect of barbiturates and alcohol. Hypovolemic shock is a medical emergency and treatment involves intravenous fluids and vasopressors to increase the functioning of the heart.

The respiratory center in the brain is depressed under the action of barbiturates and alcohol which results in labored and shallow breathing, depriving the body of sufficient oxygen required by vital organs such as the brain and heart. Consequently, it impairs the brain’s ability to function normally and the individual loses consciousness and enters in a state of coma.

Long-term concomitant use of barbiturates and alcohol puts a significant toll on the health of an individual. The liver is adversely affected and chronic hepatitis or liver failure ensues. In addition, motor reflexes are impaired and memory issues arise and these changes are irreversible.

Barbiturate overdose is also referred to as barbiturate toxicity and it is the state of excessive consumption of barbiturate such that it results in unconsciousness, coma, or death. Non-medical use of barbiturates is prevalent as 1% of Americans in 2014 have reported using barbiturates for reasons other than a legitimate medical one and without being under the supervision of a medical professional.

Barbiturates are habit-forming drugs and tolerance develops quite rapidly after which individuals require increased doses of the drug to achieve the original effect of barbiturates. Eventually, dependence on barbiturates develops which results in consumption of doses greater than the safe dose and it increases the risk of developing an overdose.

Moreover, individuals involved in poly-substance abuse often use barbiturates as they mix barbiturates with other substances to enhance the euphoric effect such as alcohol, opioids, and benzodiazepines.

Barbiturate overdose can be life-threatening and 10% of cases of barbiturate overdose result in death. Certain risk factors increase the chances of developing a barbiturate overdose such as taking barbiturates for non-medical purposes, taking barbiturates in doses greater than prescribed, taking the drugs for a longer period, and mixing barbiturates with alcohol, opioid, or other psychoactive drugs.

One should be aware of the signs and symptoms of barbiturate overdose so that they can easily spot this situation and provide prompt medical emergency treatment to their loved ones when need be.

Following are the signs and symptoms associated with barbiturate overdose:

Loss of coordination
Staggering gait
Speech disturbances
Difficulty concentrating
Sluggishness
Thirst
Dilated or constricted pupil
Rapid or weak pulse
Decreased heart rate
Slow and shallow breathing
Coma
Death

Individuals who survive Barbiturates overdose have to live with permanent kidney damage. In addition, barbiturate overdose increases the risk of injuries and concussions due to falls and accidents. It also results in paralysis. In addition, pneumonia can also result as a complication of barbiturate overdose due to aspiration of fluid into the lungs.

Barbiturate overdose is a medical emergency and it needs prompt treatment. The doctor needs to know how much of the drug the individual has taken, what drugs he has used along with barbiturates, and history of any pre-existing medical condition.

CPR and intravenous fluids are administered along with activated charcoal. A chest X-ray is done to rule out aspiration pneumonia. Symptomatic treatment is then started to treat barbiturate overdose.

When barbiturates have overdosed with opioids, Naloxone can help in reversing opioid overdose by regaining the consciousness of the individual. However, Naloxone has no role in reversing barbiturate-induced coma.

Barbiturates are sedative-hypnotics that are used to treat anxiety, insomnia, and seizures. Barbiturates are classified as Schedule II, III, and IV controlled substances based on the potential of abuse and addiction of different types of drugs in this class. No matter which category they belong to, all barbiturates are habit-forming and can lead to the development of tolerance. Once tolerance develops individual consumes increased doses of barbiturates which puts him or her at the risk of developing dependence.

Soon physical and psychological dependence develops on barbiturates and the brain finds it very hard to function in the absence of the drug since it becomes dependent on the increased levels of GABA stimulated by the action of barbiturates. Consequently, withdrawal symptoms ensue after the effect of the drug wears off compelling the individual to consume barbiturates and making it difficult for them to quit barbiturate abuse.

Barbiturate withdrawal symptoms manifest within 8 to 15 hours of the last dose and can last for a few days up to two weeks. For individuals in whom withdrawal symptoms persist for a longer duration, this state is referred to as Protracted Withdrawal Symptoms (PAWS).

Barbiturate withdrawal is associated with a plethora of symptoms that are indicative of this condition. They are as follows:

Tremors
Fatigue
Difficulty sleeping
Agitation
Restlessness
Anxiety
Nausea
Vomiting
Stomach cramps
Suicidal thoughts

In severe cases it can result in:

Hallucination
Increased body temperature
Seizures

According to statistics, 75% of individuals who withdraw from barbiturates experience one or more than one seizure which is accompanied by increased body temperature and confusion. In addition, it is reported that 66% of individuals experience delirium for many days following barbiturate withdrawal. Anxiety, visual hallucinations, and disorientation of time and place are commonly encountered in this case similar to what is seen in alcohol withdrawal. If withdrawal symptoms are not treated they can progress to high-grade fever, heart failure, and ultimately death.

Barbiturate Withdrawal Timeline

Barbiturate withdrawal timeline varies greatly from individual to individual. In addition, the type of barbiturate whether short-acting or long-acting also influences the withdrawal timeline. A general barbiturate withdrawal timeline is discussed below.

Day 1 to day 3 after the last dose: The early symptoms of barbiturate withdrawal are mild that is experienced during this stage.
Day 2 to day 3 after the last dose: The peak withdrawal symptoms encountered during this stage. These symptoms include insomnia, nausea, vomiting, anxiety, hallucination, seizures, and increased heart rate.
Day 3 to day 7 after the last dose: Withdrawal symptoms start to fade during this phase.
Day 14 and onwards after the last dose: During this stage, most people will not have any withdrawal symptoms. However, some people might experience mild withdrawal symptoms.

Barbiturate rehabilitation is the cornerstone of recovery from barbiturate addiction. Medically supervised detox is the first step of barbiturate rehab in which all traces of the drug is removed from the body making the individuals free of barbiturate in their system. During the medical detox, the physical and psychological symptoms are treated so that individuals can smoothly move out from the withdrawal phase.

One can choose between an in-patient rehab facility and an out-patient rehab facility. For individuals who struggle at home with giving up to temptations can enroll in the inpatient rehab facility which provides round-the-clock care. Immaculate treatment is offered to deal with the individuals’ withdrawal symptoms.

Moreover, individuals dealing with any mental illness such as anxiety or depression also have the facility for dual diagnosis rehab where an integrated approach is utilized and both conditions are being treated simultaneously. Inpatient rehab facility lasts for 30 to 90 days depending on the program selected by the individual. In-patient programs offer various amenities such as gyms and pools among other facilities.

There are many evidence-based therapies to bring about positive change in the lifestyle of an individual. These therapies include:

Cognitive Behavioral Therapy (CBT)
Individual Counselling
Family Counselling
Group Counselling
12-Step facilitation therapy
Chemical dependency education

Outpatient rehab facility works for individual who want to start recovery in the comfort of their home. The greatest benefit of outpatient treatment is reduced cost. Outpatient rehab facility involves visiting the rehab clinic for set hours of days each week. Chances of relapse are higher with an outpatient rehab facility.

If you or your loved one are dealing with barbiturate addiction you should take the first step to recovery and choose our rehab facility with a tailored plan to optimize your addiction treatment.

FAQs

Is alcohol barbiturate?

No, alcohol is not a barbiturate. Alcohol is a central nervous system depressant and so is a barbiturate. It exerts a similar effect on the brain and thus both produce similar symptoms when intoxicated.

Can barbiturate overdose cause death?

Yes, barbiturate overdose can cause death since this class of drugs significantly depresses the central nervous system. It is estimated that 1 in 10 cases of barbiturate overdose results in death.

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