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OTC & Prescription Drugs

Barbiturates: Amytal ®, Nembutal ®, Seconal ®, Phenobarbital

Barbiturates are drugs that slow down the central nervous system. Like alcohol, painkillers, sleeping pills and antihistamines, barbiturates "relax the brain."1 Doctors prescribe them as sedatives, hypnotics, anesthetics, and anticonvulsants.2

German scientist Adolph von Baeyer, of Bayer Aspirin fame, synthesized the first barbiturates in 1864 by combining urea from animal urine and malonic acid from fruit.3 By 1912, drug companies were selling phenobarbital to treat epilepsy and other barbiturates for insomnia. By 1950, there were more than 2500 kinds of barbiturates on the market.4

Though they were becoming extremely popular, barbiturates posed a huge threat to users. The difference between a therapeutic dose and a lethal one is tiny - and many people died of overdoses. A typical scenario involved a person who took a barbiturate to relax and then, perhaps forgetting that he had taken the pill earlier, took an alcoholic drink. The combination was deadly.5

By the 1970s, benzodiazepines such as Valium replaced barbiturates, except for in the treatment of epilepsy and for those who did not respond to the safer new drugs.6

Today the illegal use of barbiturates is on the upswing, perhaps because teens are too young to remember all people who died of overdoses between 1950 and 1970.7 One recent government survey found that about 8 percent of teenagers had tried barbiturates.8

Forms and Brands9
There are three basic kinds of barbiturates: short acting, intermediate and long acting. The most frequently abused are intermediate ones whose effect last three to six hours. They usually come as pills or tablets. Non-specific street names for barbiturates are barbs, barbies, dolls, goof balls and downers.

Amytal ® is a trademarked form of Amobarbital. These come as light blue capsules with "Lilly 33" on them. Street names are blue heavens, blue velvets, blue devils, blue angels, blue bullets, and blue dolls.

Tuinal ® contains both Amobarbital Sodium and Secobarbital Sodium. It is a dark red and blue capsule marked twice with "Lilly 66." Street names are blues and reds, rainbows, tooies, double trouble, gorilla pills, F 66s, and gangster pills.

Nembutal ® contains pentobarbital and comes as a bright yellow capsule with a stylized A on it and the capital letters "CH." Street names are Nembies, yellow jackets, abbots, and Mexican Yellows.

Seconal ® contains secobarbital and comes as a bright red capsule marked twice with Lilly F 40. Street names are reds, red lillies, red hearts, seccies, red devils, lilies, F 40s, pinks, pink ladies, seggies, and red birds.

Phenobarbital is less commonly used because it lasts twelve hours. It comes as an injection (Luminal ® ) or more commonly as small white pills, bisected on one side and marked RX 744 on the other. Street names are feenies, phenos, and phennies.

Fioricet ®, which is prescribed for headaches, contains caffeine, Butalbital and acetaminophen. It is a small round blue pill marked Fioricet. Fiorinal ®, composed of butalbital, aspirin and caffeine, is a yellow green and dark green capsule marked "Fiorinal" and 78-103. Fiorinal with codeine is a blue and yellow capsule with an S in a triangle, and the notation "Sandoz 78 107."

Less commonly used barbiturates are butabarbital (Butisol ® ), talbutal (Lotusate ® ), aprobarbital (Alurate ® ) and mephobarbital (Mebaral ® ).

Effects and Use
If taken at medically recommended levels, barbiturates relieve anxiety and sedate people. Common side effects are drowsiness, headache, dizziness, depression, constipation, and upset stomach. Less common are nightmares and joint and muscle pain.10 However, some people have paradoxical reactions to barbiturates and become overly excited and agitated. For example, if Secondal ® is passed around at a party, a few people may become less inhibited and excitable, while the majority will become withdrawn and sedated.11

The effect of barbiturates is almost identical to alcohol. Many teens prefer these pills because they do not leave a telltale smell on their breath.

As with drinking, when you take a barbiturate, you may at first feel a sense of relaxation and even happiness, followed by sedation and sleepiness. At higher doses, you will experience impaired judgment, poor coordination, slurred speech, lowered inhibitions, slowed pulse and breathing, lowered blood pressure, poor concentration/fatigue, confusion, and impaired memory and judgment. At still higher levels, you will pass out and may die.12

Some teens under the influence of barbiturates will lie in the same position for as long as ten hours. This causes black and blue spots that look like bruises on their backs, legs, and arms as their blood pools from lack of movement.13 The next day, they may experience hangovers similar to alcoholic ones, characterized by depression, irritability, headache, and anger.14

Dangers and Risks
The greatest risk of using barbiturates is that it is very easy to overdose. Barbiturates have a low "therapeutic to toxic" ratio, which means taking only a tiny amount more than medically recommended can kill you. Also, barbituates can interact with substances such as alcohol and antihistamines to become lethal.

Another huge problem is that it only takes a week or two to become psychologically dependent on barbiturates and about a month to become physically dependent15. Once a person builds up tolerance, she has to take more of the drug to get the same effect. Again, this phenomenon is extremely dangerous because taking slightly too much of the drug can be fatal.16

It is easy for teens to buy barbiturates from phony Internet pharmacies. Others obtain them by providing false symptoms to doctors.17 The penalties for illegal possession of barbiturates are harsh: five years in prison and a $250,000 fine. This punishment doubles with the second offense.18

Another danger to teens is the risk of driving under the influence of barbiturates, which, like alcohol, impairs coordination and judgment.

If you find barbiturates in your teen's room or car, you now know that your teen is in a very dangerous situation that requires your help. You need to take immediate action by talking to your teen and seeking professional advice from your doctor. You should not encourage your teen to quit "cold turkey," because this type of withdrawal can be dangerous, and even deadly.

Signs of Use
Teens on barbiturates often exhibit mood swings. Because their drug sedates them, when the effect wears off, they feel anxious, agitated and nervous. They may be hostile, irritable and angry, picking fights with family members. The angry mood alternates with the sedated one. Some become paranoid and suicidal.

Teens who become physically dependent on barbiturates may spend hours alone. They will sleep so hard it will look like they "passed out." Teens who are injecting the drug may have sores and infections on their arms and legs.

Habitual barbiturate users often drop old friends who do not approve of their new habit and form new friendships with drug abusers. As their drug becomes priority, they will skip school and their grades will drop. They will lose interest in sports and other activities and drop out of them.

Many parents find out their teens are using barbiturates after car accidents or after a teacher phones to report that they came to school "high." Another mode of discovery is learning that their child is stealing money, running up credit cards and selling household items to get money for their drugs.

Overdose
A teen who is overdosing on barbiturates will usually be found unconscious. If his respiration, heartbeat and other bodily functions slow down too much, he will die.19 Take him to an emergency room where doctors will use IVs or even a breathing machine to help him stay alive.

The ER personnel will perform various blood and urine tests to determine the level of drugs in his body. If he has built up a tolerance to barbiturates, he will be harder to treat.

Once the person regains consciousness, nurses and doctors may have to monitor him for several hours.20

Withdrawal and Treatment
Physical and psychological withdrawal from barbiturates is extremely unpleasant and can be life-threatening. If a teen tries to stop using barbiturates on her own, she can go into convulsions and die. The reason for this is that these drugs interfere with the brain's neurotransmitters. If the drug suddenly stops, the brain becomes overwhelmed and the person suffers life-threatening seizures.21

The teen needs professional help during withdrawal. Usually, she will have to enter a residential treatment center. Clinicians will monitor her closely and reduce her amounts of barbiturates in tiny increments (less than 5 mg a day) .22

During the first 24 hours of withdrawal, she may have violent cramps, tremors, sweats, headaches, dizziness, light-headedness, vomiting, anxiety, and paranoia. Between 24 and 72 hours later, she may have seizures. On day three and four, she may have delirium, confusion, and fever. Between day three and eight, she may have auditory hallucinations, nightmares, insomnia, rapid heartbeat and shortness of breath.23 She needs professional monitoring and supervision during this period.

After becoming physically clear of barbiturates, a teen needs long-term help in order to preclude a return to use. Psychological withdrawal averages between six months and a year, depending upon which barbiturate was abused, how much and how often it was taken.24

Often residential treatment at a therapeutic boarding school is beneficial, because this removes the teen from his old drug environment and provides him with regular access to intense counseling. The focus is on setting long-term goals, stimulus control, parental involvement, and better communication skills.

Because many teens use barbiturates to mask depression and anxiety, a stoppage in use may cause the emotions that the barbiturates suppressed to surface and rebound with a vengeance. Thus, recovering barbiturate addicts need professional help to address any underlying mental problems.

The prognoses of barbiturate rehabilitation can be positive with good long-term, follow-up care.

Footnotes
1"Barbiturate Abuse," eMedicine Health, WebMD, Inc., posted at http://www.emedicinehealth.com/script/main/art.asp?articlekey=58912&pf=3&page=13
2Bellenir, Karen. Drug Abuse Sourcebook (Detroit: Omnigraphics, 2000), pg. 134.
3Henn, Debra and D. DeEugenio. Barbiturates (New York: Chelsea House, 2007), pg. 30.
4"Barbiturates," United States Drug Enforcement Agency Briefs and Background, posted at http://www.usdoj.gov/dea/concern/barbiturates.html
5Klosterman, Lorrie. Facts About Depressants (New York: Cavendish, 2005) pg. 47.
6Bellenir, op cit., pg. 134.
7"Barbiturate Abuse," WebMD, op cit.
8Henn, op cit, pg. 26.
9See specific barbiturates by name on WebMD, in Griffith, H. Winter (Editor). The Complete Guide to Prescription and Nonprescription Drugs. (New York: Penguin Group, 2007), and in Physicians Desk Reference, 61st Edition 2007.
10Butabarbital, Phenobarbital and Seconal at Medline Plus, The National Institute of Health website, posted at http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682417.html
11Weil, Dr. Andrew. From Chocolate to Morphine. (New York: Howard Mifflin), 1998, pg. 70.
12Henn, op cit, pg. 21.
13Ibid, pg. 47-48.
14Ibid, pg. 22.
15"Barbiturate Abuse," WebMD, op cit.
16Ibid.
17Henn, op cit, pg. 45.
18Bellenir, op cit, pg 49.
19Ibid, pg. 22.
20Bellenir, op cit, pg.16.
21Klosterman, op cit, pg. 66.
22Bellenir, op cit, pg. 288.
23Henn, op cit, pg. 49-54.
24Ibid, pg. 68-70.