When one talks about substance abuse or drug abuse, we immediately assume think of drugs which are illicit and illegal. However, contrary to this perception, most of the drugs which are often abused include prescription drugs, which are easily available over the counter and thus easily accessible to masses. Barbiturates constitute one such class of prescription drugs, which are widely abused.
Barbiturates represent the class of compounds which are derivatives of Barbituric acid. They belong to a group of medications usually known as Sedative-hypnotics. They constitute the drugs that act on the central nervous system. They exert a range of effects on the CNS, acting as sedatives, anaesthetics, anticonvulsants, hypnotics, depressants and anxiolytics. Barbituric acid was first manufactured by Adolf Von Baeyer, a German chemist in 1864. However, its medicinal properties were not known until 1903, when Adolf von Bayer, Joseph Von Mering and Emil Fischer discovered psychotropic property of the drug. On its own, barbituric acid does not exert a direct effect on the CNS, but it is the chemicals derived from it (numbering around 2500), that possess strong psychoactive properties and cause the depression of the central nervous system. Anaesthetic and anxiolytics properties of the drug were recognised first, which led to these drugs being used in surgery and given to severely depressed patients. Various other barbiturates were used to treat seizures, epilepsy, insomnia, and delirium. But, as had happened with other psychedelic drugs, barbiturates began to be abused in 1950s and 1960s and like most other psychedelic drugs, their use reached its peak in the 1970s, which led to barbiturates and its various derivatives being classified as Schedule II and Schedule III drugs, by US government under the Controlled Substance Act.

Consumption of barbiturates brings about a feeling of calm and relief and reduces tension in the mind. High doses of this drug, however, result in drowsiness and loss of consciousness. Chronic intake of the drugs in higher doses builds up a tolerance for the drug in the user. As a result, users need to increase the dose of the drug constantly for achieving the same results after every subsequent use. Even when this drug is prescribed by the doctor, getting addicted physically as well as psychologically to this drug is remains a real possibility. Tolerance to the drug increases the risk of overdose manifold. While being in a state of ‘high’, the users experience a range of symptoms from low blood pressure to respiratory depression, confusion, fatigue, impairment of judgement, fever, etc. This drug, as mentioned earlier, also has a sedating effect on the CNS. However, one of the most harmful effects of use or rather abuse of barbiturates includes susceptibility to respiratory arrest, slipping into coma, partial or complete paralysis and eventually even death.
Barbiturates, being very addictive physically as well as psychologically are very difficult to quit it without experiencing severe withdrawal symptoms, which are quite uncomfortable and very painful. It is therefore recommended to attempt rehabilitation and detoxification procedures under medical supervision or under register and participate in supervised drug treatment programs.

Barbiturates act on the brain by affecting the activity of brain chemicals called neurotransmitters, especially Gammaaminobutyric acid (also known as GABA). Neurotransmitters assist in communication between various neurons (brain cells). GABA decreases the activity of the brain. Barbiturates, being the CNS depressants increase the activity of Gammaaminobutyric acid, thereby prolonging the calming effect of GABA on the Central Nervous System. Thus they have a beneficial effect for those people suffering from sleep disorders, panic attacks and anxiety.
Initial 2-3 days of barbiturate abuse induce a feeling of depression and drowsiness and loss of coordination. However, these feelings disappear as the body becomes accustomed to the drug. As barbiturates depress the activity of the brain, sudden abstinence from the drug usage causes the brain to rebound back with increased activity and getting out of control, which can eventually lead to seizures and concussions. Prolonged and unabated use of barbiturates may lead to life-threatening complications.
Using depressants in combination with other drugs should be avoided or carried out under doctor’s supervision. Barbiturates should not be using alongside other CNS depressant drugs, such as alcohol, flu medications and anti-allergic drugs. These medication combinations may slow down heart rate and respiratory rate significantly and lead to death.
Interestingly, the use of barbiturates has decreased significantly for the last four decades, since a new class of sedative – hypnotic drugs known as ‘Benzodiazepines’ have come to the party. The overall decrease in the production of barbiturates has led to drastic decline in both prescription as well as abuse of the drug, although the abuse of barbiturates among teens has increased substantially since 1990s. One of the reasons for the increased use of barbiturates may be immense popularity of stimulant drugs such as methamphetamines and cocaine. As they counteract the effect of those drugs, these drugs are used to dampen the effects of stimulant drugs. These drugs have since long been used for attempting suicides.

There are numerous types of barbiturates, depending upon the duration till their effects last. Effects of the drugs which are long-lasting subside after up to 2 days, while effects of short-acting drugs may last only a few minutes.
Barbiturates can be administered by intramuscular or intravenous injections, but they are mostly consumed in the form of tablets. They are commonly known by the colour of the pills, markings on the tablets or by the effects they exert on the body. Amobarbital, a barbiturate is known as blue devil, downer, blue velvet or blue heaven, owing to the colour of the tablet. Another barbiturate Secobarbital, being reddish to pinkish in colour is popularly called Red devil, pink ladies, F-40s or red birds. Tunial is another medicine which is stronger than secobarbital, hence named F-66, gorilla pills or rainbows.
Withdrawal symptoms of barbiturates include sleeping difficulties, tremors, agitation. On further deterioration, these symptoms can lead to constantly higher body temperature, seizures and hallucinations. If a pregnant woman abuses barbiturates, the drug is passed on to the foetus through the bloodstream and it may cause withdrawal symptoms to the baby after being born, as the level of the drugs in the bloodstream decreases. This drug can also be transmitted via breast milk by nursing mothers to the babies.
The use of barbiturates can be diagnosed by a simple urine examination. But the most common test of diagnosing abuse of barbiturates includes observation of symptoms commonly experienced by drug abusers such as drowsiness, lethargy, hallucinations, etc. Some other diagnostic methods include monitoring the suspected person for the vital signs such as heart rate, blood pressure, temperature, respiratory rate among others.
There is no specific treatment for abuse of barbiturates per se. However, if somebody has inappropriately attempted to consume or consumed barbiturates, it is better to take him/her to the hospital for a timely medical evaluation by a physician. There is a minor difference between the dose of the drug causing drowsiness and the one causing death, which in medical terms is known as the Therapeutic toxic index or therapeutic toxic range. The therapeutic index of barbiturates is quite low, and if taken in an inappropriate way, especially by elderly and children, it can be quite harmful to the body. As minors weigh less and are smaller as compared to adults, it becomes especially life-threatening for them, while elderly people being more sensitive to CNS depression risk slipping into coma on consumption of even smaller doses of such drugs.

Generally, the treatment of overdose and abuse of barbiturates is supportive and the quantity of support required is dependent upon the symptoms of the person using the drug. If drowsiness and lethargy are the only symptoms of the drug abuser and if he is largely able to swallow and breathe without any apparent difficulty, the treatment includes just close monitoring of the person in the hospital or a drug rehabilitation centre. In case the person has difficulty in breathing, he/she can be put on a breathing machine until the effect of the drugs subsides.
In case, a person has overdosed on the drug, emergency should be called without delay and if possible, the leftovers of the drug tablets, capsules or bottles should be taken alongside to the hospital so that appropriate treatment can be initiated immediately.
In case of overdose of barbiturates, activated charcoal in liquid form is administered into the stomach of drug abusers with the help of a tube inserted (via mouth or nose) into the stomach or simply given to them as a drink. It binds to the drugs in the stomach, effectively neutralising their effects.
Generally, prolonged treatment is required by the persons having severe withdrawal symptoms. They are admitted into hospital and the dose of barbiturates is continuously reduced until the detoxification process is complete. The outcome of barbiturate abuse is determined by a number of factors, which include among others the type of drugs ingested (whether long acting or short duration drugs) and on the potency of drugs; the health related complications the person has had or is currently suffering from and the time lapse since the consumption of the drug till the receiving of medical attention.
In nutshell, these drugs are quite harmful to the body. The long term effects as well as withdrawal symptoms are quite painful. If you’re smart enough, you would rather avoid a momentary pleasure than risk a long term pain. So think about it before you decide to pop a brain depressor pill into your mouth.