Barbiturate Use Disorder - Know It All

Introduction

Barbiturates come under a class of drugs called sedative-hypnotics, commonly used for sleep-inducing and as an anxiolytic (anxiety-decreasing effects). Barbiturates are considered dangerous drugs because the correct dose is hard to predict, and even a slight overdose can lead to coma or death. Barbiturates are also associated with an addictive nature and life-threatening withdrawal syndrome.

What Is Barbiturate Use Disorder?

Barbiturates have pleasant psychoactive effects, which are comparable to alcohol intoxication. Barbiturates can be consumed in pill form, granulated and groaned, or by parental means, commonly intravenously. Barbiturates abuse is hazardous because even small doses can reach dangerous levels and exert potentially fatal effects, which may lead to intense short-term and long-term physical and psychologically detrimental symptoms, physical dependence, and accidental death.

More common barbiturates include.

• Phenobarbital.

• Methohexital.

• Secobarbital.

• Butabarbital.

• Butalbital.

Barbiturate use and abuse have dropped dramatically since the 1970s because a specific group of sedative-hypnotics known as Benzodiazepines is used. Benzodiazepine use has predominantly substituted barbiturates in the medical specialization, except for a few specific cases. Sedative drugs appeal to more youthful people because these drugs provide a sense of euphoria and psychoactive effects analogous to alcohol without the apparent smell or bad taste. As teenagers are not entirely grown emotionally, the cognitive side effects of barbiturate abuse might readily manifest more ecstasy or pleasure in these individuals. Despite its well-known adverse effects, adolescents immersed in these drugs often display dangerous behaviors and express extreme emotional states.

Several detrimental side effects are associated with barbiturate abuse

• Isolation.

• Depression.

• Suicidal thoughts.

• Aggression and assaults.

• Driving while intoxicated leads to accidental overdose.

• Struggling with emotional or mental health issues.

What Are the Symptoms of Barbiturate Use Disorder?

Symptoms (patient conveyed to doctor) of barbiturate intoxication are as follows

• Hyperactivity or talkative behavior.

• Elation and euphoria (feeling of excessive happiness and excitement).

• Reduced inhibition.

• Need for more determination and clarity.

• Emotional instabilities.

• Sedation (becoming relaxed or exhausted).

• Slurred speech.

• Lack of coordination (unable to walk without falling).

Signs (doctor inspects the patient):

• Related to Physical Health:

  • Increased sensitivity to sound and pain.

  • Changes in blood pressure (decreased blood pressure) and decrease in heart rate.

  • Breathing (or respiration depression) difficulties.

  • Increased chance of bronchitis and pneumonia.

  • Irregular menstruation in women.

  • Sexual dysfunction.

  • Chance of kidney failure as it increases antidiuretic hormone (ADH) release.

  • Associated with thrombocytopenia and pulmonary eosinophilia.

• Related to Neurological Manifestation:

  • Dose-dependent effects are sedation, sleep anesthesia, and coma.

  • Apprehension, restlessness, or terror.

  • Degraded mental functioning.

  • Emotional fluctuation.

  • Loss of short or long-term memory.

  • Hallucinations and depression.

• Impaired Social Functioning:

  • Occupational issues or loss.

  • Loss of interest in hobbies and commitments.

  • Disturbance in relationships.

  • Dilapidation of self-care, like exercise and diet.

Using barbiturates over a long time may cause tolerance development, mainly with Phenobarbitone. Thus, abrupt stoppage of barbiturates may cause withdrawal effects:

• Anxiety.

• Weakness and restlessness.

• Nausea and vomiting.

• Seizure and delirium.

• Cardiac depression.

Therefore, it is recommended to consult a medical professional before withdrawing such drugs. The healthcare professional will analyze the dose and effects and slowly and steadily reduce the dose without any dependence and adverse effects.

How Does Barbiturate Use Cause Such Dependency?

Barbiturate pharmacokinetics (how the body reacts to the drug) depends on the distribution and duration of the drug's action, which is determined by the lipid solubility and rate of metabolic inactivation of that particular drug. Well-absorbed and distributed after oral administration, its onset of action ranges from 20 to 60 minutes, while in intravenous administration, the start is immediate to five minutes.

The highest lipid-solubility drugs are

1. Amobarbital.

2. Pentobarbital.

3. Thiopental.

This allows them to be well metabolized, rapidly redistributed, and form inactive compounds before excreting in the urine. Phenobarbital is a long-acting, polar drug that is slowly absorbed and redistributed and contributes to a longer duration of action. Barbiturates easily cross the blood-brain barrier (BBB) and placenta, which depress the fetus and are excreted into breast milk. All barbiturates redistribute from the brain to the splanchnic (related to internal organs, especially the abdomen) areas, the skeleton, and finally to adipose tissue.

What Is A Detox From Barbiturates?

The first step in getting rid of a barbiturate addiction is to undergo a barbiturate detox. Detoxification is used to properly clean the body of the drug and any dangerous substances and return it to how it was before substance misuse. Medical detox programs can assist controlling the incapacitating withdrawal symptoms; therefore, detox is most effective when carried out under the guidance of medical professionals. Medical detox considers the kind of barbiturate a person is dependent on, how long they have abused the substance, and how much of a drug dependency they are showing.

Barbiturates, also known as "downers," are substances that depress the central nervous system and were historically commonly used to treat problems like insomnia and anxiety. They are not used very frequently now because safer drugs like Benzodiazepines have mostly taken their place. Since barbiturates work well as sedatives, hypnotics, anesthetics, and anticonvulsants, they are occasionally recommended. Barbiturates slow down the activity of the central nervous system by interfering with GABA receptors and neurotransmitters in the brain. They can result in a wide range of health issues when used carelessly for recreational purposes, including blood-related disorders, liver illness, and seizures. Barbiturates are highly addictive and can quickly cause physical dependence, despite the fact that this particular drug class does offer some medical advantages.

What Are the Conditions That Require Barbiturates Drug as a Treatment?

The most common uses are:

• Treating seizures.

• For insomnia (hard to fall asleep or lack of sleep).

• Pre-anesthesia sedation was used earlier but not now because many newer drugs (like Benzodiazepines) are more effective and have fewer side effects.

• Anxiety reduction.

• Intracranial hypertension (high cerebrospinal fluid pressure inside the skull).

Can One drink alcohol if Taking barbiturates?

No, one should never drink alcohol if taking barbiturates. Alcohol and barbiturates interaction can cause many detrimental effects like severe tiredness and trouble breathing. In extreme cases, the drug can cause severe organ damage or death.

When Should One Consult Medical Healthcare Provider?

It is crucial to consult the doctor who prescribes individual barbiturates for a specific condition for follow-up. Sudden stoppage of barbiturates can lead to adverse withdrawal effects; thus, it is better to consult a physician. One should also consult a medical healthcare provider if one notices that barbiturate medications are not working or have extreme side effects disrupting the usual routine and activities.

One should be aware of requiring emergency care in case of a barbiturate overdose, which can glance identical to alcohol intoxication:

• Dyspnea (breathing difficulties).

• Confusion or unstable state of mind.

• Fainting.

• Bradycardia (slow pulse); and barbiturate overdose can also cause a fast, weak pulse.

• Dizziness and vertigo.

• Nausea and vomiting.

• Hypothermia (low body temperature).

• Muscle weakness.

• Feeling very thirsty.

• Cyanosis (blue discoloration to lips or fingernails).

• Eyes become unfocused or rapidly shifting, with unusually small or large pupils.

Conclusion

Barbiturates are neurological-related medications used to relax anxious individuals and as anti-convulsion, hypnotic, or sedative. Barbiturates have been around since the 1860s and are still in use for many conditions today. But not as common anymore, these medications still help people with various medical conditions. To get the benefits of barbiturates, use the medication cautiously, based on the prescribed dose and formulation.