Barbiturates

MAIN TYPE

Barbiturates belong to a class of drugs called depressants. There are different varieties of barbiturates, but they all have a sedative effect and are clinically prescribed for people who have trouble sleeping or suffer from anxiety. Barbiturates come in tablet or capsule form and are taken orally, but people who use them illegally break the drugs down into a powder and add it to a liquid for intravenous injection.

The classification of different barbiturates depends mainly on the duration of their effects, the drug being divided into three main types: ultra short, medium and long, with the effects of some barbiturates lasting up to two days.

If taken regularly, barbiturates can cause physical dependence. People who are physically dependent may also develop a strong psychological dependence. Once physical dependence has set in, abruptly stopping the drug can result in death.

Barbiturates are derived from a chemical called barbituric acid, first synthesized by Adolf von Baever in 1864 by condensing animal urine with diethyl malonate (a substance found in apple juice). In 1903, Emil Fischer, a chemist, and Joseph von Mering, a physician, discovered that “barbital,” as it was then called, could be used to euthanize dogs, and the drug was marketed under the name “Veronal.”

Barbiturates were increasingly used as sedatives in humans during the 20th century. During World War II, barbiturates were prescribed to American soldiers to help them tolerate the oppressive heat and humidity of the South Pacific. In the 1950s and 1960s, it became increasingly apparent that this drug was causing behavioral problems and addiction. Deaths from barbiturate overdoses became more common, with famous victims such as Marilyn Monroe and Judy Garland.

In the United States, barbiturates have been regulated by the 1965 Drug Abuse and Control Act, which means that their manufacture and distribution have become strictly controlled and that they can only be legally obtained with a prescription.

Barbiturates, once commonly prescribed to treat insomnia and anxiety, have become much less widely used in this medical setting since the 1970s. They have been replaced by benzodiazepines or diazepam (Valium).

OTHER TYPES

There are many different types of barbiturates, the main difference being the duration of the effects. Drugs classified as barbiturates include amobarbital, pentobarbital, phenobarbital, secobarbital and tuinal.

These barbiturates are referred to by different names by those who take them illicitly, outside of any clinical context.

Amobarbital tablets may be called “blues”, “blue heavens”, “bluebirds”, “blue devils” or “blue velvets”.

Pentobarbital may be called “nembies,” “yellows,” “yellow jackets,” “abbots” or “Mexican yellows.”

Street names for phenobarbital include “purple hearts” and “goofballs”.

Secobarbital is called “reds,” “red devils,” “red birds,” “sekkies,” “lilly,” “pinks,” “pink ladies” and “F-40s.”

Tuinal is called “tooies”, “F-66s”, “double trouble”, “rainbows”, “gorilla pills” and “reds and blues”.

All barbiturates can be grouped together under the term “calming” because they are often used to counter the effects of so-called “stimulants” (such as amphetamines or cocaine). They are also called “barbs”, “dolls” and “sleepers”.

MAIN EFFECTS

Barbiturates enhance and increase the activity of one of the major neurotransmitters in the brain called gamma-aminobutyric acid (GABA). The increase in this chemical has a sedative effect, ranging from moderate relaxation to a state of unconsciousness, depending on the dose administered.

A person taking barbiturates may feel relaxed and euphoric. When used recreationally, barbiturates have an effect similar to drunkenness, causing slurring, affecting coordination and judgment, disinhibiting and causing confusion. At high doses, barbiturates can cause respiratory arrest and death.

The effects of barbiturates last between 4 and 16 hours, depending on the type of barbiturate. Barbiturates become even more dangerous when combined with other depressants such as alcohol and the risk of death is higher.

The risk of addiction is higher with regular use. This may be psychological dependence, physical need or both. Regular users may develop a tolerance to the drug, causing them to take more and more of it to produce the same effect. As the duration of use increases, the margin between the dose that produces the desired effect and the dose that can lead to a fatal overdose decreases, which explains the frequency of overdoses in long-term users.

The amount of barbiturates that can cause an overdose varies from person to person, but over one gram can be fatal. Some barbiturates have a long half-life, which means that an overdose can occur even if small amounts are taken over a long period of time.

Prolonged use of barbiturates can lead to chronic respiratory problems, bronchitis, pneumonia, impaired sexual function, slowed reflexes, limited attention span, memory loss and permanent drunkenness.

PRODUCING COUNTRIES

Barbiturates are legally produced in the majority of industrialized countries by global pharmaceutical companies, although production declined in the second half of the 20th and early 21st centuries as barbiturates were replaced by other sedatives and anti-anxiety drugs.

Production of barbiturates increased dramatically in the United States during the first half of the 20th century, where the drug was sold without a prescription. In 1938, the Food, Drug and Cosmetic Act began to regulate the sale of barbiturates, providing that companies wishing to produce the drug needed government approval.

In the United States, approximately 300 tons of barbiturates are produced legally each year and it is estimated that about one in three people in the country have barbiturates in their medicine cabinet. Approximately 2,500 different types of barbiturates are produced in the United States, yet only about a dozen are commonly used. The most popular barbiturates are prescribed as sleeping pills, with 19 million prescriptions written each year.

Federal investigations into the illicit supply of barbiturates in the United States have shown that the majority of barbiturates are legitimately produced by pharmaceutical companies, shipped to Mexico, and then smuggled back into the country to be sold on the black market.

It appears that only a small portion of the barbiturates circulating on the street are illegally produced. Most are diverted from legitimate domestic production.

With regard to illicit production, a report by the International Narcotics Control Board found that 543 tons of barbiturates were produced in 2007, of which 447 were phenobarbital. Between 2003 and 2007, just five of the twelve barbiturates regulated by international law accounted for 98.7% of world production. Phenobarbital was produced in the largest quantity, with 78% of the total production. Next came butalbital, with 8.6% of total production, followed by pentobarbital with 6.9%, barbital with 3% and finally amobarbital with 2.6%.

Regarding the countries that manufactured the above mentioned barbiturates, most of them came from China, which is responsible for exactly half of all illicitly produced barbiturates in the world. India was estimated to account for 11% of the world’s illicit production, followed by Russia with 10%, the United States with 8% and Denmark and Hungary, both with 7%.

The 2010 INCB report, based on data collected the previous year, found that Bulgaria, Latvia and Ukraine had the highest per capita consumption of barbiturates. In Bulgaria, between 2007 and 2008, per capita consumption jumped from 1.2% of adults to 2.7%.

FACTS AND STATISTICS

FATS

Barbiturates are legally produced drugs that were once commonly prescribed to treat anxiety, insomnia and depression. They are used recreationally for their euphoric and relaxing effects and to counteract the effects of stimulants. Barbiturates are addictive and very dangerous because of the way they stay in the body, causing an overdose with a fatal outcome, especially in people who take them regularly. Here are some additional facts about barbiturates.

• Barbiturates have been used in human medicine since 1903.
• Barbiturates became popular sleeping pills in the 1950s and 1960s.
• Barbiturates can only be legally obtained by prescription.
• Unauthorized possession of barbiturates is punishable by five years in prison.
• Barbiturates are sedatives that, in small doses, help you relax and be more sociable.
  In large doses, barbiturates cause an effect similar to drunkenness, making you slurred, disinhibited and disrupting coordination.
• It is easy to overdose on barbiturates because the fatal dose is not much higher than a normal dose.
• The effect of some barbiturates on the brain lasts for two days.
• Fatal barbiturate overdoses are more common when barbiturates are combined with other depressants such as alcohol, tranquilizers or heroin.
• Once a person has become addicted to barbiturates through prolonged use, stopping them abruptly can be fatal.
• Pregnant women pass on barbiturates to their babies, who may also experience withdrawal symptoms at birth.
• Withdrawal symptoms in people taking small doses of barbiturates include anxiety, insomnia and nausea.
• With higher doses or prolonged use, withdrawal symptoms include seizures, hallucinations and suicidal thoughts.

Thiopental, a barbiturate marketed as Pentothal, is used in small doses as a “truth serum” during interrogations and, in higher doses, is one of three drugs used in executions by “lethal injection” in the United States.

STATISTICS

• In 1955, more than 70% of admissions to a substance abuse center in Copenhagen, Denmark, involved barbiturates.
• Statistically, barbiturates were mainly consumed by the middle and upper classes in the 1950s. In the 1960s, barbiturate use spread to the lower social classes.
• In 1975, concerns about the high number of deaths caused by barbiturate overdose prompted doctors to lead a campaign to warn people about the dangers of these drugs.
• They estimated that about 27,000 people had died from barbiturate overdoses between 1969 and 1974.
• In 1977, U.S. doctors wrote about 7.9 million prescriptions for the barbiturate Phenobarbital.
• Between 1983 and 1999, there were approximately 146 fatal overdoses per million barbiturate prescriptions.
• In 2001, 2.8% of U.S. high school seniors reported taking barbiturates.
• In the United States in 2010, phenobarbital overdoses resulted in 1493 emergency room admissions. In the same year, barbiturates were responsible for 396 deaths.
• Today, barbiturate overdoses are involved in about one-third of all drug-related deaths.
• A lethal dose of barbiturates ranges from 2-3 mg with amobarbital and pentobarbital to between 6 and 10 g for phenobarbital.
• It is estimated that there are more than 3,000 barbiturate overdose deaths each year in the United States, with 42% of these deaths classified as suicides and the remainder as accidental, with the victim unintentionally exceeding the prescribed dose or mixing it with other depressants such as alcohol.
• Barbiturates are prescribed more to women than to men because they are statistically more likely to seek help for insomnia, anxiety and depression.
• Barbiturates are also prescribed more often to older people than to younger adults

SIGNS OF ADDICTION

A person who has taken a dose of barbiturates for pleasure may appear euphoric, cheerful, talkative and uninhibited. He or she may also babble, appear uncoordinated, and may appear almost drunk.

A person addicted to barbiturates may appear to be permanently half-asleep and lethargic, uncoordinated and may often fall. He or she may show signs of nervousness, sensitivity to noise and restlessness, exhibit the physical symptoms of insomnia, such as a sallow complexion and red eyes, and sweat profusely.

A person who regularly takes barbiturates may appear extremely relaxed at all times and show no apparent anxiety. They may also be prone to short-term memory loss. A person on barbiturates can be recognized by shallow breathing and a lack of facial expressions.

Women who habitually use barbiturates often have irregular menstrual cycles. In men, habitual use of barbiturates can cause impotence.

A person who is dependent on barbiturates may also experience withdrawal symptoms between doses, or when the drug is no longer available. These symptoms may include weakness, anxiety, tremors, tics, abdominal pain, sensitivity to light, fever and profuse sweating. These effects are actually very similar to those caused by taking large doses of barbiturates

A person addicted to barbiturates who suddenly stops taking them may have a seizure, lose consciousness and die.

People who are used to injecting barbiturates in solution may get needle-stick marks on parts of the body such as the arms, ankles and back of the knees. Abscesses may also occur in people who inject the drug with dirty needles.

TREATMENTS

A person who has taken a large dose of barbiturates should be hospitalized because although he or she may appear to be merely drunk or half asleep, he or she may quickly develop more serious symptoms.

She may be given liquid charcoal, which binds the drugs together in the stomach to prevent them from being absorbed into the bloodstream. A hospital may also choose to pump the stomach of the barbiturate user. Both of these techniques are only partially effective, however, because they only remove the amount of drug that has not yet been absorbed by the body.

A person who overdoses on barbiturates may have shallow breathing or even stop breathing, in which case a respirator will be used to breathe for him or her while the effect continues.

Kidney dialysis may also be performed in an attempt to “wash” the drug out of the user’s blood.

It is extremely dangerous for a person who has been taking barbiturates for a long time to stop suddenly, which can result in death. A doctor should be consulted immediately to help the user detoxify and wean him or herself off the drug safely.

The symptoms of barbiturate withdrawal are more severe and painful than those associated with heroin and if left untreated will involve at least two weeks of painful symptoms including nausea, vomiting, cramps, palpitations, hallucinations, seizures and convulsions. The stress caused to the body by untreated withdrawal can lead to kidney failure, heart failure and death.

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