Barbiturate Overdose – Symptoms, Treatments, and Prevention

Last Updated: June 24, 2020

Authored by Sharon Levy, MD, MPH

Reviewed by Michael Espelin APRN

What Barbiturates Are

Barbiturates are highly addictive medicines that cause sleepiness and relaxation. They act as central nervous system (CNS) depressants. They bind to the GABA receptors causing mild to severe sedation. However, because of their narrow therapeutic and toxic window, they are not used as much as they once were. Most importantly, there is a very small difference between a dose that causes sedation and a fatal dose. However, despite the many dangerous effects which come with barbiturates, people still abuse them. This is especially true in teenage circles. The reason for this mainly lies in the similarity between the effect of alcohol and barbiturates.

Non-Medical Barbiturate Use

Non-medical use of barbiturates includes a couple of areas; buying barbiturates on the streets without a prescription, having a prescription but using more than a doctor ordered or using medication prescribed to someone else.

A 2014 study showed that 1% of the American population admitted to using barbiturates for nonmedical purposes. One percent may not seem like a lot but it’s actually 2,700,000 people. What is more concerning is the fact that those using barbiturates for nonmedical purposes are at a much higher risk of overdose. If the drug was not prescribed to them then they are not using it under medical supervision and may be less conscious of the risks. They also are more likely to mix barbiturates with other depressant drugs like heroin or alcohol. This creates a toxic mix, which may cost someone their life.
Barbiturate abuse over an extended length of time can cause additional symptoms, including chronic:

  • Changes in alertness
  • Decreased functioning
  • Irritability
  • Memory loss

Barbiturate Intoxication

Barbiturates are a group of drugs which doctors prescribe for anxiety and insomnia relief. At first, they saw a tremendous increase in medical use in the 1960s. However, due to their habit-forming properties barbiturates are no longer doctors’ first choice.

This is a critical point in Barbiturate use. It is because tolerance means the need for larger doses of the drug. As a result, this can be fatal.
Some of the effects this substance has on one’s body are:

  • Speech problems
  • Euphoria
  • Hostile behavior
  • Aggression
  • Delirium
  • Sleepiness
  • Inability to complete tasks
  • Memory issues
  • Slow heart rate
  • Low blood pressure

Barbiturate Overdose Definition

Barbiturate Overdose
Barbiturate overdose happens when one takes more of the drug than instructed by their doctor. This can also happen when one self-medicates. Unfortunately, the line between the therapeutic and toxic effects is very thin. As a result, an increase in dosage, especially during self-medication is not a good idea. As with many drugs, overdose can happen accidentally. It is intentional only when one is trying to take their own life by ingesting a lethal dose of the medication.
Using the drug longer than the proper period can also cause an overdose. This usually happens when a person has become addicted. Mixing it with other drugs and alcohol is extremely dangerous, as the drug reactions can be fatal. Unfortunately, in certain situations, users might not realize they are doing it. There are a number of other factors that can increase the possibility of an overdose. These include a person’s age, mental health issues, chronic illness, and physique.

Barbiturate Overdose Statistics

Barbiturates have become somewhat obsolete in medical circles. However, their dangerous and often fatal side effects do not deter some users from taking this CNS depressant. According to statistics, barbiturates caused about 396 deaths in the last year alone. Some of these are due to the drug alone whereas, other cases are from bad reactions with other drugs, accidents, or mental illness. Furthermore, barbiturate phenobarbital resulted in 1,493 visits to the E.R. that same year despite the low prescription numbers.

Causes of Barbiturate Abuse and Overdose

Barbiturates, as we’ve mentioned before, can be medically prescribed for legitimate reasons for anything from seizure disorders to headaches. Their use has significantly declined since the 1970’s and the discovery of a newer, safer form of hypnotic (sleep-inducing) and sedating anesthetic drugs, benzodiazepines. Though less common, barbiturates are still being used today.

The Challenge of Obtaining Barbiturates

Addiction to Barbiturates often starts in people legally prescribed the drug. They grow dependent, continuing its use for longer than medically advised, or at a greater quantity. This presents a problem besides the obvious danger of addiction, seeing as this is a prescription drug and it cannot simply be bought at will. This leads to illegal purchasing of barbiturates on the streets, which presents a danger in itself because there is no way to regulate what users are purchasing. Another way people may become addicted is by borrowing medication from someone who has a legal prescription, which leads to a dependency. This again presents a problem as someone with no medical claim to the medication has become addicted, and must find other ways of obtaining it. In some situations, this may include stealing the medication from people who have a legal prescription. This is why it is very important to keep any prescription medication in a safe place.

Building Up A Tolerance

Barbiturates are addictive and with prolonged use, people can become dependant on the drug. Simply stopping taking barbiturates without medical supervision (withdrawal from barbiturates) can be life-threatening.
As with any addiction and prolonged use, tolerance builds. This requires the user to consume larger amounts of the drug to achieve the same desired effect as before. Though tolerance to the mood-altering effects of the drug may happen quickly, tolerance to the lethal effects takes more time. This is where we find the danger of an unintentional barbiturate overdose.

The Dangers of Relapse

An addict may be at greater risk of a barbiturate overdose if he relapses after a period of abstinence. With prolonged use of the drug, our bodies build up a tolerance, requiring more and more of the substance to reach the desired effect. When someone who has built up a tolerance stops taking the drug and has a period of abstinence, that tolerance diminishes. If the addict then decides to return to using, the body will not be able to handle the same amount of the drug as it did at the peak of usage. This causes shock to the body and can lead to a barbiturate overdose.

What To Do Being A Witness Of Barbiturate Overdose

If a person suspects that someone has overdosed on barbiturates, one must call 911. Make sure to inform a medical professional about any other drugs the person might have ingested along with barbiturates. Usually, knowing the drugs the victim took can help doctors plan a proper treatment.
Stay with the person until medical help arrives. Answering the following questions can help the medical workers to manage overdose more accurately:

  • What drugs were used?
  • How much was used?
  • Are there any pre-existing health conditions?

Symptoms of Barbiturate Overdose

Some of the signs of barbiturates overdose are:

  • Thinking problems
  • Altered awareness
  • Drowsiness
  • Coma
  • Speech problems
  • Shallow breathing
  • Low heart rate
  • Coordination issues
  • Fatigue
  • Impaired judgment

What are the Complications of Barbiturate Overdose?

Some of the most serious problems from barbiturate overdose are:

  • Coma
  • Death

Head injuries are very common in people who overdose on barbiturates. Due to lack of coordination, they often fall and hurt themselves. Head injuries can vary between mild and severe. Furthermore, they can even result in coma or death.

Prognosis

When it comes to a prognosis of barbiturates overdose, it is far from bright. Presently, one in ten users dies from barbiturates overdose. In most cases, the cause of death is lung or heart failure. This is the reason why it is so important to act fast. Take the person who has overdosed to the emergency room so that they receive the proper medical attention immediately.

Barbiturates Overdose Treatment

The treatment of barbiturate overdose is highly supervised. All vital signs are carefully observed and the patient is monitored 24/7 due to various possible health problems.

A priority for treatment of a barbiturate overdose is an accurate drug test, so that medical professionals know how to best handle the individual’s situation. This is especially vital because a majority of barbiturate overdoses are a result of a combination of drugs (often barbiturates and alcohol or barbiturates and opioids). These combinations are often a result of one of two groups of people. These are either novel drug users who do not know the effect this mix may have or, what is often more difficult to treat, experienced users who know exactly what they are trying to achieve. If the barbiturate overdose involved opioids, the patient may receive a drug called naloxone (Narcan) which acts as an antidote to opioid overdoses, quickly restoring breathing functions and consciousness. This often is life-saving.
Furthermore, activated charcoal is inserted through the nasogastric tube to neutralize the toxin in the victim’s stomach. Because breathing is harder in this time, most cases require intubation.
Unfortunately, there is no drug such as Narcan which would reverse the effects of a barbiturate overdose.

Prevention

It is imperative to follow these guidelines to avoid potential overdose:

  • Do not self-medicate
  • Take the proper amount of the drug
  • Don’t mix barbiturates with alcohol or any other drugs
  • Do not take other people’s medicine because the dosage might not be right
  • If one is taking other medication, inform a doctor

If one, on the other hand, is using barbiturates non-medically the most reliable way to prevent a barbiturate overdose is to stop using immediately. However, quitting barbiturates without medical supervision can be incredibly dangerous because of some of the possible withdrawal symptoms, including dangerous mental states such as delirium and physical symptoms such as convulsions. Therefore, the best solution for those seeking to quit their barbiturate use is detox centers where one can safely come off the drug under medical supervision. This is the safest way to get the drug out of the system. After the initial detox, drug addiction treatment is a good next step. There, patients learn coping mechanisms and ways not to return to drugs in the future.


Page Sources

  1. https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs2014/NSDUH-DetTabs2014.pdf

Published on: March 15th, 2017

Updated on: June 24th, 2020

About Author

Sharon Levy, MD, MPH

After successful graduation from Boston University, MA, Sharon gained a Master’s degree in Public Health. Since then, Sharon devoted herself entirely to the medical niche. Sharon Levy is also a certified addiction recovery coach.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.

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