Medically-Supervised Barbiturate Detoxification

Barbiturates are depressant drugs which produce sedative effects that can be addictive. A medically-supervised detoxification is a safe way to wean off these drugs.

Barbiturates, also known as “barbs,” are central nervous system (CNS) depressants generally used to relieve anxiety or aid in sleep. These drugs slow down or “depress” the normal processes that occur in the brain and spinal cord. Common street names for barbiturates include: Barbs, Block Busters, Christmas Trees, Goof Balls, Pinks, Red Devils, Reds & Blues, and Yellow Jackets.

Between the 1920s and the mid-1950s, practically the only drugs used as sedatives and hypnotics were barbiturates. These drugs were later largely replaced by benzodiazepines. Barbiturate use declined in the 1960s. Problems of dependency and death by overdose brought an end to most barbiturate use.

Barbiturate sedatives can become addictive, and may require a medically-supervised detoxification to discontinue use safely. Sedative withdrawal syndrome is treated by tapering the sedative and may require hospitalization. Long-term treatment of sedative addiction may require counseling, often with the help of an addiction-treatment professional.

Barbiturates are Schedule II, III, and IV depressants under the Controlled Substances Act. As the rate of barbiturate prescribing decreased dramatically, so did abuse of barbiturates. Some barbiturates are still used today for general anesthesia. Presently, about 12 different barbiturates are in medical use, although there are a few that are more popular than others.

Common examples of barbiturates include:

  • phenobarbital (Luminal Sodium)
  • pentobarbital sodium (Nembutal)
  • amobarbital (Amytal)
  • secobarbital (Seconal)
  • butalbital (Fiorinal, Fioricet)

It is rare for a patient to develop an addiction to barbiturates alone. Generally, abusers will take a variety of available sedatives to treat the unpleasant effects of illicit stimulants, reduce anxiety, or induce euphoric effects.

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How Barbiturates Work In The Brain And Body

Most CNS depressants affect the brain by increasing the activity of gamma-aminobutyric acid (GABA), a neurotransmitter that sends messages between cells, at the GABAA receptor, causing sedative-like effects. Primary therapeutic uses of barbiturates are as anesthetic and anticonvulsant medications.

Tolerance, dependence, and withdrawal are all reported with sedatives and as a result, detoxing off these drugs may be uncomfortable. Therefore, a medically-supervised detox is recommended.

Barbiturates slow certain functions in the brain and body, triggering a range of effects, such as:

  • increased relaxation
  • easing of muscle spasms
  • increased drowsiness
  • reduced onset of seizures
  • slurred speech
  • shallow breathing
  • disorientation
  • lack of coordination

Barbiturates produce changes in the brain that may cause a user to transition from occasional use, to increased tolerance and dependence, and, in extreme cases, to addiction.

The neurological effects of barbiturates include:

  • Tolerance: characterized by the need to take more of the drug to achieve the same sedative effect
  • Drug dependence: characterized by one’s susceptibility to withdrawal after having taken the drug repeatedly
  • Addiction: characterized by prolonged, habitual use of barbiturates leading to changes in the brain and adverse life consequences

At fairly low doses, barbiturates may make the person taking them seem drunk or intoxicated. Regardless, barbiturates are addictive and people who use them long-term may become physically dependent on them. Stopping them abruptly and going into withdrawal can be life-threatening. A medically-supervised detox is the best option for a person experiencing barbiturate withdrawal.

Detoxification From Barbiturates

According to the Substance Abuse and Mental Health Administration Services (SAMHSA), at least 300,000 patients with substance use disorders or acute intoxication end up detoxing in general hospitals annually, while others detox in other settings.

Detox, often the first acute stage of substance abuse treatment, is generally three to seven days, and may be used to stabilize the patient and manage the potentially dangerous effects of stopping barbiturate use. This initial phase may or may not include medication-assisted treatment (MAT). Statistically, individuals who do not receive any treatment beyond detox usually relapse or cannot maintain recovery.

Detoxification consists of three essential components:

  • Evaluation: assessing the patient and possibly administering diagnostic tests
  • Stabilization: bringing the patient back to a state of balance
  • Fostering patient readiness and entry into a treatment program: preparing the patient for rehabilitation

Barbiturate detox can be medical (medically-supervised) or non-medical (without the use of medication). The health care professional will determine a patient’s needs. In most cases, young, healthy individuals with no previous adverse withdrawal history may fare well with non-medical detox. But the course of drug withdrawal detox can be unpredictable, and supervising medical staff should be prepared for serious situations.

In some instances, individuals may end up in emergency care for withdrawal or other substance use-related issues and are then admitted to a medical detox unit. But only 15 percent of those individuals continue on to long-term treatment.

One indication of a successful detox is evaluated in part by whether the person who was substance-dependent enters and remains in a longer-term rehabilitation program. Individuals seeking medically-supervised detoxification each have different needs, and proper treatment should be tailored to the specific person.

When searching for a medically-supervised detoxification program, whether a short-term detox program or a longer form of care, there are certain things to look out for. Most detox programs provide standard services, but it is important to choose a reputable program with all the essential components.

Here are a few factors to consider when choosing a detox program:

  • the screening and assessment process is thorough and conducted by a trained clinician or physician
  • the detox facility employs certified, licensed, trained, and experienced staff
  • the treatment methods are tailored to individual need: CBT, medically-assisted, non-medically-assisted, etc.
  • the amount of assistance provided to help individuals transition to the next level of care (inpatient, outpatient)

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Barbiturate Detoxification Programs

For people struggling with barbiturate addiction who want to quit, a range of detoxification options are available to safely and comfortably deal with the withdrawal process. Detoxification can occur in different settings and vary in length and intensity.

The type of program required will depend largely on individual needs and can be determined by a clinical assessment through a medical professional familiar with addiction. Various types of detoxification settings include:

  • Hospital: Individuals with a history of severe withdrawal symptoms, such as seizures and delirium tremens, are safer detoxing in a hospital. Additionally, people with health problems such as cardiac issues, depression, or those who are suicidal may be best monitored in the ICU or ER.
  • Inpatient detox program: Inpatient programs are often useful because patients live at the facility 24/7 and are constantly monitored. They may receive medically-assisted detox support along with behavioral therapy, such as individual and group counseling.
  • Outpatient detox program: Short-term detox and recovery programs are also available on an outpatient basis. Outpatient detox works well for those with: no comorbidity, disorders that could interfere with withdrawal, and/or a strong support system and full assessment that rules out any potential complications during withdrawal.
  • Doctor’s office: Individuals may benefit from outpatient detox assistance from their primary care physician (PHP) with structured office visits.

No matter what type of barbiturate detox program a person chooses, it’s important to know that detoxification alone does not account for complete barbiturate addiction treatment. Once a person is stabilized and completes a medically-supervised detox program, entering a substance abuse treatment program can help them build a foundation to maintain sobriety by providing healthy coping skills.

Inpatient treatment ranges from 30 to 90 days, or longer, depending on the individual. Outpatient treatment meets less often and for fewer hours per week. Some inpatient and outpatient facilities offer detox programs as well as a formal treatment program. These programs are effective for individuals with co-occurring mental health disorders or for those with more severe psychological issues.

Addiction treatment is sometimes overwhelming at first, when patients complete detox and are weaning off barbiturates. Intense physical and emotional changes may occur during this time. It’s best to secure the right type of support that will address all of an individual’s unique needs in treatment.

To learn more about medically-supervised barbiturate detoxification, contact us today.

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Sources

Drug Enforcement Administration — Drugs of Abuse (2017)
National Institute on Drug Abuse for Teens — Prescription Depressant Medications
National Institute on Drug Abuse—Treatment Approaches for Drug Addiction
U.S. National Library of Medicine — Barbiturate Intoxication And Overdose

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