Barbiturates: Composition, Therapeutic use, Treatment. Barbiturates Effects. Reactions with other drugs.

Last modified: Thursday, 25. December 2008 - 6:01 am

 

Official names: Methohexital (Brevital), thiamylal (Suri-tal), thiopental (Pentothal), pentobarbital (Nembutal), secobarbital (Seconal), amobarbital (Amytal), bubalbital (Florinal, Fioricet), butabarbital (Butisol), talbutal (Lotusate), aprobarbi-tal (Alurate), amobarbital and secobarbital (Tuinal), phenobarbital (Luminal), mephobarbital (Mebaral)

Street names: Barbs, downers, red devils, Mexican reds, red birds, blue devils, blue heavens, goof balls, yellow jackets, block busters, reds, blues, pinks, Christmas trees, Amys, rainbows, purple hearts

Drug classifications: Schedule II, III, IV; depressant

 

Key terms

BROMIDE: A sedative compound made from the chemical element bromine.

CHLORAL HYDRATE: A colorless compound used as a sedative.

OPIATE: Drug derived directly from opium and used in its natural state, without chemical modification. Opiates include morphine, codeine, thebaine, noscapine, and papaverine.

POLYDRUG USE: Use of more than one drug.

 

Overview

Barbiturates are among the drugs classified as central nervous system (CNS) depressants. These drugs depress or slow down the activity of nerves that control emotions and bodily functions such as breathing. Barbiturates are prescribed as a sedative that calms the patient or as a hypnotic that helps a person sleep. Other uses include epilepsy treatment and anesthesia before surgery.

Barbiturates are compounds derived from barbituric acid, a substance discovered in 1863 by German chemist Adolf von Baeyer. The year after von Baeyer’s discovery, German scientists von Mering and Fischer synthesized the first barbiturate. Production began on the drug called barbital, and medical practices began using it in treatment in 1882.

In 1903, barbital with the brand name of Veronal was marketed as a sleeping pill. Before that time, remedies for insomnia included drinking alcohol or taking bromides, chloral hydrate, or opiates.

In 1912, phenobarbital was introduced under the trade name Luminal. Since 1912, several thousand barbituric acid derivatives have been synthesized. At the beginning of the twenty-first century, only about 12 were on the market.

During the 1930s, many Americans received barbiturate prescriptions to help them sleep or relax. However, people discovered that barbiturates produced an intoxicating effect similar to that produced by drinking alcohol. People took barbiturates to get drunk. They combined the pills with alcohol to become more intoxicated.

The sedative becomes a “thrill pill”

German chemists knew in the 1900s that barbiturates could be addictive. However, people who took barbiturates did not always exhibit symptoms of drug dependence or withdrawal. By the 1940s, the addictive nature of barbiturates alarmed groups ranging from the American Medical Association (AMA) to the United States Food and Drug Administration (FDA).

The 1938 Food, Drug, and Cosmetic Act gave regulatory powers to the FDA. The federal agency used those powers to restrict access to drugs that had a potential for abuse or misuse. The FDA placed barbiturates and amphetamines in that category of drugs that could only be obtained with a prescription from a doctor or dentist. In several decades, the federal government would classify barbiturates and amphetamines as the most abused prescription drugs in the country.

During the 1940s, research indicated that barbiturates produced intoxication and were addictive. People showed signs of withdrawal when they stopped taking barbiturates.

The AMA began warning people about barbiturate abuse in articles with titles like “1,250,000 Doses A Year.” That article appeared in a 1942 issue of Hygeia, an AMA magazine published for a general audience.

Warnings about the dangers of nonprescription use of barbiturates did not have the intended effect. Instead of taking precautions about barbiturates, people wanted to try the drug that some called a “thrill pill.”

A popular drug combination

The barbiturate became one half of a polydrug habit that became acceptable throughout America. People took barbiturates to sleep at night. In the morning, the barbiturate might make them feel sleepy, so they took an amphetamine.

Amphetamines are central nervous system stimulants. People called them “uppers” because amphetamines gave them energy. Amphetamines cut a person’s appetite, so people also used them as diet pills. In the evening a person still “up” from an amphetamine took a “downer” (barbiturate) to sleep at night. In the morning, the drug-taking cycle would start again.

Polydrug use was so widespread by the 1950s that the federal government classified barbiturates and amphetamines as the most abused drugs in the country. The abuse problem grew even though barbiturates were prescription drugs.

Prescription abuse

The FDA discovered the scope of the abuse problem after a 1948 Supreme Court ruling gave the agency the authority to investigate drug sales at the pharmacy level. According to an FDA report, barbiturate transactions included:

• A prescription refilled 61 times, with three refills after the patient died from barbiturate intoxication.

• A Kansas City woman obtained 40 refills for a prescription. Her doctor prescribed refills. Other refills came by mail order. The woman died from barbiturate intoxication.

• The staff at a Tennessee drug store could not explain what happened to more than 180,000 barbiturates sent to the store by manufacturers and wholesalers.

According to the FDA report, enforcement action during the 1940s and 1950s centered primarily on pharmacies. Those involved in the illegal sales of barbiturates included pharmacists as well as drug store owners and employees.

As pharmacies complied with the law, the FDA targeted black market sales of barbiturates from 1960 through 1965. Meanwhile, a new generation discovered barbiturates.

Drug use during the 1960s

During the 1960s, youths began to experiment with drugs on a wider scope. Middle-class and upper-class youths discovered that it was easy to obtain barbiturates; they often found them in their parents’ medicine chests.

A United States Senate Subcommittee heard about the severity of the problem from a Dr. Sidney Cohen. He said that 10 billion barbiturate doses would be produced in 1969. That figure represented an 800% increase in the amount produced in 1942, according to the 1972 Consumers Union Report on Licit and Illicit Drugs.

The 1970s bring restricted access to barbiturates

According to the FDA, barbiturate abuse continued during the 1970s and 1980s. However, the adoption of the federal Comprehensive Drug Abuse Prevention and Control Act in 1970 would limit access to highly addictive drugs like barbiturates. The act placed barbiturates on a list of controlled substances that were subject to abuse. The act limited the number of prescriptions a person could receive. It also set annual quotas for the amount of drugs that pharmaceutical companies could manufacture.

As access to barbiturates was limited, benzodiazepines were promoted as a safer alternative. Benzodiazepines went on the market during the 1960s and were thought to be less addictive than barbiturates.

With barbiturates less available, drug abusers turned to other illegal substances during the 1970s and 1980s. One indication of drug demand was the record of drugs seized by the United States Customs Service. Customs confiscated greater quantities of marijuana, heroin, and cocaine. As a result, Customs recorded seizures of each drug separately.

Barbiturates in the late twentieth century

At the close of the twentieth century, the DEA reported that barbiturates represented about 20% of all depressant prescriptions in the United States. Uses ranged from epilepsy treatment to assisted suicide in Oregon. In 1997, Oregon voters approved the Death with Dignity Act, which allows doctors to prescribe lethal dosages of barbiturates to terminally ill people.

Furthermore, the late 1990s brought concerns about benzodiazepines, the drugs thought to be a safe alternative to barbiturates. Benzodiazepines produced side effects similar to those produced by barbiturates. These included the risk of addiction when high doses were taken. Benzodiazepines accounted for 30% of all prescriptions for controlled substance, according to the DEA.

 

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