Barbiturate Overdose: Symptoms, Effects, and Risks

What are barbiturates?

Barbiturates are a group of sedative-hypnotic drugs that can treat seizure disorder, neonatal withdrawal, insomnia, preoperative anxiety, and induction of a coma for increased intracranial pressure (ICP); and can even be used for anesthesia.¹

As is the case with most substances with similar effects, barbiturates see illegal use and abuse throughout the United States. Barbiturates are generally misused in an effort to produce a mild euphoria, induce sleep, reduce anxiety, decrease inhibitions, or treat some of the unwanted effects of illicit drugs.³

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), in 2018, approximately 405,000 Americans aged 12 and higher reported using barbiturates and 32,000 Americans aged 12 and higher reported misusing barbiturates.

Some examples of barbiturates include:^{1, 2}

• Phenobarbital
• Amobarbital (Amytal)
• Secobarbital (Seconal)
• Butalbital

Dangers of Barbiturate Intoxication and Overdose

Barbiturates have a high potential for abuse, and prolonged use can result in tolerance and physical dependence. A person with an increased tolerance will often seek a higher dosage in order to produce the desired effects, and this may result in dependence and addiction. Frequent barbiturate users may experience severe withdrawal symptoms within 8 to 15 hours of stopping the drug.¹

Polydrug use has long been associated with barbiturate abuse⁴, and barbiturates have historically been a secondary drug of abuse for people who misuse alcohol and heroin as their primary drug of choice.^{5, 6}  Co-administering barbiturates with alcohol and opioids like heroin—as well as benzodiazepines—increases the risk for overdose significantly. Barbiturates have an additive effect on these substances, and consume in conjunction with one another makes them especially dangerous.

Barbiturates are particularly dangerous for individuals with severe respiratory or kidney diseases.⁷ These drugs should be avoided by women who are pregnant, as it poses a health risk to the fetus.⁷  Pregnant women who take barbiturates during the third trimester can give birth to addicted infants who undergo an extended withdrawal syndrome.⁸

Signs and symptoms of barbiturate intoxication include:⁹

• Altered or decreased consciousness
• Coordination problems and muscle weakness
• Clouded thinking
• Lack of balance/vertigo
• Nausea
• Slurring of speech
• Slow heart rate
• Decreased urine output

Signs and symptoms of barbiturate overdose include:^{1, 3}

• Shallow breathing
• Clammy skin
• Dilated pupils
• Weak and rapid pulse
• Respiratory failure
• Coma

Many of these symptoms are very noticeable; awareness can be key in alerting someone to the need for medical help.

Responding to a Barbiturate Overdose

In the event of a suspected barbiturate or polydrug overdose, call 911 immediately, especially in the event of any breathing problems. The presence of medical professionals on the scene can improve the chances of surviving the overdose, which can be deadly.

Knowing whether or not an individual mixed a barbiturate with an opioid can be helpful for medical professionals to know when they arrive on the scene, as naloxone may be a viable immediate treatment.¹⁰  Naloxone is a drug that can help the person regain consciousness and reverse the effects of an opioid overdose, although naloxone cannot reverse a barbiturate-induced coma.

Barbiturate Withdrawal, Detox, and Treatment

For someone who is physically dependent on barbiturates or who are using barbiturates in addition to alcohol and/or opioids, withdrawal can be a painful and dangerous process and typically requires medical assistance.

Symptoms of barbiturate withdrawal include:⁹

• Restlessness
• Anxiety
• Tremors
• Low body temperature
• Sweating
• Insomnia
• Anxiety
• Seizures

Detox should be done in a rehabilitation treatment facility that includes 24-hour monitoring by medical professionals. Doctors will start by tapering drug dosages in an effort to fully wean someone off barbiturates.⁷ After tapering off,  patients will then begin cognitive behavioral therapy (CBT).⁷ According to the U.S. National Library of Medicine CBT examines the connection between feelings, thoughts, and behaviors, and how those in recover are influenced by the substance they are addicted to.¹¹

With the help of medical professionals and treat treatment plan, those suffering from addiction can recovery. Long-term sobriety can be achieved with the new learned behaviors form therapy and support⁹ from family, medical professionals, and community support groups.