Barbiturates vs Benzos
Both barbiturates and benzodiazepines are central nervous system depressants and are often prescribed to treat symptoms of anxiety and sleep disorders. In 2019, an estimated 2.1 million barbiturates and 52 million benzodiazepines were prescribed in the U.S. They belong to a class of drugs called sedative-hypnotics. Despite being from a pharmacy and the recommendation of a medical physician, these substances have the potential to become intensely habit-forming and can lead to dependence and addiction. Today benzodiazepines have become more commonly prescribed and used. But what are barbiturates and how do they compare with benzodiazepines?
Barbiturates were first developed in the 1900s and were FDA-approved as an anesthetic and anticonvulsant. It was used to treat conditions such as anxiety, migraine headaches, traumatic brain injuries and sleep disorders such as insomnia. Barbiturates are synthetic drugs derived from barbituric acid. They work by binding with the gamma-aminobutyric acid (GABA) receptors in the central nervous system of the brain to reduce the stimulation of nerve impulses. When nerve activity is slowed down, activity in the brain and body is also slowed down. This produces sensations of drowsiness and sedation ranging from mild to coma.
Other common names for barbiturates include barbs, block busters, yellow jackets and red devils. They can be classified into four sub-categories: ultra short-acting, short-acting, intermediate-acting and long-acting substances. Ultra short-acting barbs are often given through an intravenous line and can wear off in 15 minutes or less. Short-acting barbs can last anywhere from 3 to 4 hours. Intermediating-acting barbs can last anywhere from 6-12 hours and are usually used to treat conditions such as insomnia. Long-acting barbs can last longer for up to 24 hours. Barbs can appear in a variety of multi-colored pills and tablets.
Barbiturates are highly potent and have a high risk of becoming habit-forming. They are often used to reduce symptoms of anxiety, can cause mild euphoria, decrease inhibitions and even treat unwanted side effects of other substances. Because of the high risk for tolerance, barbs are often prescribed only for short-term use. Long-term use can cause impairment of memory, coordination and judgment, along with the development of tolerance and overdose.
There are 12 commonly prescribed barbiturates in the U.S. Some of the most popular include phenobarbital, methohexital, butalbital, pentobarbital, primidone and amobarbital.
- Phenobarbital – This drug is most commonly prescribed as an anti-epileptic drug and to help treat those with severe traumatic brain injury. It helps with preventing seizures or treating them when they happen.
- Methohexital – This drug has been used clinically for sedation for short periods of time during pediatric outpatient surgeries.
- Butalbital – This drug is used for the treatment of headache disorders. Butalbital is a combination of aspirin, acetaminophen, caffeine and codeine.
- Pentobarbital – This drug is often used as a pre-anesthetic medication.
- Primidone – This drug is commonly prescribed to treat seizure disorders and essential tremors.
- Amobarbital – This drug is often prescribed for treating sleep disorders such as insomnia.
Today barbiturates have minimal use in the clinical world and only a few still remain in medical use. This is due to newer and more innovative drugs such as benzodiazepines having a better safety track record. Barbs are considered a Schedule II, III and IV depressant under the Controlled Substance Act and unless prescribed by a physician, illegal.
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Barbiturates vs Benzos
Barbs and benzos are often prescribed to treat similar medical conditions because they perform similar functions and are often mistaken for one another. They are both CNS depressants that affect the GABA transmitters, reducing nerve activity and slowing down activity in the brain and body. Conditions such as anxiety and seizures are characterized by increased nerve activity. When these transmitters are slowed down, this also reduces negative symptoms associated with these mental health conditions.
Both drugs produce feelings of drowsiness, lethargy, fatigue and depression. They can especially be harmful when used together. Because both substances are CNS depressant drugs, combining barbs and benzos can result in excessive sedation, altered motor functions, slurred speech, loss of appetite, mood swings and respiratory depression. So what are the differences and similarities between barbiturates and benzodiazepines?
Barbiturates
- CNS depressants that cause drowsiness and used to treat insomnia, seizures, anxiety, panic disorders, muscle spasms and alcohol withdrawal.
- Side effects include reduced heart rate, reduced blood pressure, reduced breathing, dizziness, nausea, vomiting headache and abdominal pain.
- Withdrawal from barbs includes agitation, anxiety, nausea, vomiting, weakness, fast heart rate and hallucinations.
- Common brand-name barbiturate medications include Amytal, Seconal, Butisol and Nembutal.
- According to data from 2019, the most common barb in the US is Butalbital – a drug made up of a mix of butalbital, acetaminophen and caffeine.
- Barbs are available as injections, tablets, capsules and liquids.
- Barbs are fast-acting medications that can take effect quicker than benzos. However, they also have a shorter half-life, which means they must be taken more frequently in order for the effects to be felt.
- Barbs are very unstable, especially when mixed with other drugs and could even produce violent reactions in addition to the added level of toxicity.
- When used in combination with other substances, barbs can accelerate the breakdown leading to a decrease in effectiveness. It can also cause added sedative effects with other medications such as allergy medicines, pain medicines and other types of benzos.
Benzodiazepines
- CNS depressant that slows down brain activity causing sedation and is used to treat symptoms of anxiety, panic disorders, muscle spasms and seizures.
- Side effects of benzos include confusion, memory impairment, balance, changes in appetite, fatigue, drowsiness, sedation, respiratory depression, withdrawal symptoms, seizures, slowed heart rate and severely low blood pressure.
- Benzo withdrawal symptoms include difficulty concentrating, sleep problems, irritability, anxiety, panic attacks, headaches, vomiting, stiffness and perceptual changes.
- Commonly used benzos include Valium, Xanax, Ativan and Klonopin.
- Benzos fall into short-acting, intermediate-acting acting and long-acting categories of medications. According to the American Academy of Pediatrics, short-acting benzos have a half-life of between 1-12 hours. Intermediate-acting benzos have a half-life between 12-40 hours. Long-acting benzos have a half-life between 40 and 250 hours.
- Benzos can last much longer in the body to help reduce anxiety and produce feelings of calm and sedation over a longer period of time. However, they are less potent than barbiturates and have fewer negative side effects. They are considered to be a safer alternative to barbs.
- Adverse side effects of benzo addiction include disturbing or vivid dreams, irritability, hostility and amnesia.
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We specialize in treating addiction and other co-occurring disorders, such as PTSD. Our Admissions specialists are available to walk you through the best options for treating your addiction.
Long-term use of barbiturates can lead to tolerance and dependence and are highly prone to misuse. One sign of dependence and addiction includes experiencing withdrawal symptoms when drug use has stopped. Hotel California by the Sea provides evidence-based treatment and care for people struggling with prescription drug use disorders such as addiction to barbiturates.
The substance use disorder treatment program offers varying levels of care including detox, residential treatment, PHP and IOP programs. Through each level of care, clients will receive full medical assessments, medication treatments as necessary and access to intensive therapy treatments.
Unique therapies such as CBT, DBT and family therapy help clients uncover the root causes of their addiction. Clients will learn coping techniques to help them manage addiction-related stressors. Hotel California by the Sea understands the importance of having an individualized care plan. Clients have unique circumstances and backgrounds they must overcome in order to heal from their addiction. The prescription drug treatment program offers clients the tools and resources to recover from their addiction and mental health conditions.
References:
https://addictionresource.com/drugs/barbiturates/vs-benzodiazepines/
https://www.dea.gov/sites/default/files/2023-02/Barbiturates%202022%20Drug%20Fact%20Sheet.pdf
https://www.news-medical.net/health/What-are-Barbiturates.aspx
https://www.healthline.com/health/barbiturates
https://www.unodc.org/documents/scientific/barbiturates_and_benzodiazepines.pdf
https://my.clevelandclinic.org/health/treatments/23271-barbiturates