Can you overdose on Barbiturates

Marilyn Monroe died of a barbiturate overdose in 1962, as did famous Indian Mathematician C P Ramanujam in 1974. 

Barbiturates are a type of sedative-hypnotic drug that slow down the brain and body. They are often used in antiepileptics. Sleeping pills, and for inducing anaesthesia. In some states, barbiturates are also used for physician-assisted suicide and capital punishment by lethal injection. Barbiturate overdose, also known as barbiturate poisoning, can be highly lethal. 

This article discusses barbiturate overdose in detail about its causes, signs, long-term consequences, immediate action and prevention.  

Understanding Barbiturates

Barbiturates are a class of depressant drugs. These drugs are chemically derived from barbituric acid. Barbiturates are used in clinical settings for anxiety, insomnia, and epilepsy. These drugs can be addictive, and overdosing on barbiturates can potentially be fatal. This drug is also used recreationally and has various street names like barbs, blues, rainbows, sleepers, etc. Barbiturates are not illegal but are a strictly controlled drug in India. 

People often confuse barbiturates and benzodiazepines, which are prescription tranquilisers, and not sedatives. Barbiturates work by interacting with certain parts of our brain cells called receptors. They mainly interact with two of them:

• GABA: Our brain uses a GABA chemical to slow down brain activity. Barbiturates help GABA work better. Imagine GABA as a brake for your brain, and barbiturates make that brake work even harder. 
• AMPA and Kainate Receptors: These receptors speed things up in our brain. These parts are like the gas pedal in a car. Barbiturates step on the brake pedal (GABA) and also stomp on the gas pedal (AMPA and Kainate receptors). 

This dual action is why barbiturates have such strong effects on the brain. This is why taking too much of this drug can lead to overdose.  It’s like pushing down on both the brake and the gas pedal in a car at the same time – it can cause the brain to slow down too much, leading to severe problems or even death.

Barbiturate Overdose: Causes and Risk Factors

Barbiturate overdose is a severe medical emergency that can have life-threatening consequences. It can occur for several reasons, often related to the misuse or abuse of these drugs. Here are some key factors that can lead to a barbiturate overdose:

1. Misuse or Abuse: People may take more barbiturates than prescribed or use them recreationally to experience their sedative effects.
2. Tolerance: Over time, individuals who use barbiturates regularly may develop tolerance. In an attempt to achieve the desired results, some individuals may take dangerously large amounts of barbiturates, increasing the risk of overdose.
3. Mixing with Other Substances: Combining barbiturates with other substances, such as alcohol or opioids, can significantly increase the risk of overdose. 
4. Accidental Overdose: Accidental overdose can occur when individuals forget that they have already taken a dose of barbiturates and accidentally take another one.
5. Seeking a High: Some individuals may misuse barbiturates in an attempt to achieve a euphoric high. 

There are two significant factors, common to all addictions, that often cause Barbiturate overdose: tolerance and dependency. Tolerance occurs when the body becomes less responsive to the effects of a drug over time. This means that individuals who have developed tolerance to barbiturates need larger and more frequent doses to achieve the same desired effects. As they increase their dosage, the risk of overdose proportionally increases.

Dependency is a psychological and physical reliance on a substance. With barbiturates, dependency is not uncommon among individuals who use them regularly. They may experience withdrawal symptoms when attempting to reduce or stop their use. To avoid these withdrawal symptoms, individuals may continue using barbiturates, even when unsafe.

The cycle of dependency can lead to a dangerous pattern. Individuals may become trapped in a cycle where they need higher doses to satisfy their dependency, increasing their risk of overdose. Breaking free from this cycle often requires professional help and support.

Signs and Symptoms of Barbiturate Overdose

Barbiturate overdose is a critical medical emergency that requires immediate attention. Recognising the signs and symptoms of barbiturate overdose is crucial for early intervention and potentially saving a life.

1. Slowed Breathing (Respiratory Depression): This is one of the most concerning symptoms of barbiturate overdose. Breathing becomes slow, shallow, and irregular. In severe cases, it can lead to respiratory arrest, where the person stops breathing altogether.
2. Confusion and Agitation: Initially, there may be confusion, disorientation, and agitation. The person may be restless or agitated, but they often become less responsive as the overdose progresses.
3. Loss of Consciousness: As the overdose worsens, the individual may lose consciousness and be completely unresponsive to stimuli. They may not wake up when called or stimulated.
4. Seizures: In some cases, barbiturate overdose can trigger seizures, which are sudden, uncontrolled movements of the body. Seizures are a medical emergency and require immediate attention.
5. Extreme Drowsiness: One of the earliest signs of a barbiturate overdose is excessive drowsiness or sedation. The person may become increasingly lethargic and have difficulty staying awake.
6. Slurred Speech: Barbiturates can affect a person’s speech, leading to slurred or incoherent language.
7. Impaired Coordination: Individuals who have overdosed on barbiturates may exhibit poor coordination and unsteady movements, resembling the effects of alcohol intoxication.
8. Confusion: Confusion and disorientation are common cognitive symptoms of overdose. The person may struggle to respond to questions or maintain a coherent conversation.
9. Muscle Weakness: Overdose can lead to muscle weakness, making it difficult for the person to move or even sit upright.
10. Nausea and Vomiting: Some individuals may experience nausea and vomiting as the body reacts to the toxic levels of barbiturates.
11. Respiratory Depression: Barbiturate overdose can lead to dangerously slow and shallow breathing. This is a critical symptom that requires immediate medical attention.
12. Low Blood Pressure: Overdose may result in a drop in blood pressure, leading to dizziness, fainting, or even shock.
13. Hypothermia: Body temperature may drop significantly in overdose cases, causing the person to feel extremely cold and shiver.

Immediate Actions for Suspected Overdose

Medical professionals have the knowledge and resources to appropriately treat overdose cases. They can administer antidotes, provide supportive care, and monitor the person’s vital signs. Early medical intervention can help prevent complications such as severe respiratory depression, seizures, or coma. 

Delaying medical help can lead to more severe consequences and reduce the likelihood of a full recovery. Medical facilities are equipped to manage emergencies, including administering life-saving measures. Attempting to manage an overdose situation without professional help can be risky and ineffective. Keep the following steps in mind:

• Call 108 or Your Local Emergency Number: The first and most crucial step is to call for professional medical assistance immediately. Time is of the essence in overdose situations, and paramedics or emergency medical personnel can provide the necessary treatment on the way to the hospital.
• Stay Calm and Assess the Situation: While waiting for help to arrive, try to stay as calm as possible. Assess the person’s condition and check for signs of life, such as breathing and responsiveness. If the person is not breathing or unresponsive, you may need to perform CPR if you are trained.
• Do Not Leave the Person Alone: Stay with the person at all times to monitor their condition. If they become unconscious or their breathing stops, you will be there to provide immediate assistance.
• Provide Information: When calling 108, be prepared to provide important information, including the person’s age, weight, the suspected substance ingested (barbiturates in this case), and any symptoms or changes in their condition.
• Do Not Try to “Wait It Out”: It is crucial to understand that barbiturate overdose can be life-threatening, and hoping the person will recover independently is not safe. Timely medical intervention is essential.

Long-Term Health Consequences

Organ Damage: One of the most significant long-term health consequences of a barbiturate overdose is the risk of severe organ damage. Overdosing on these drugs can burden the liver and kidneys tremendously as they work to metabolise and eliminate the toxic substances from the body. These organs play critical roles in filtering and processing toxins, and an overdose greatly strains their functions.  

Neurological Effects: Barbiturate overdoses can result in lasting neurological effects, including cognitive impairment, memory problems, and difficulties with concentration and attention. Some individuals may experience long-term mood disorders, such as depression or anxiety.

Respiratory Complications: Overdosing to barbiturates can cause significant damage to the respiratory system. In severe cases, it may lead to chronic respiratory problems, making it difficult for the person to breathe properly.

Cardiovascular Issues: The cardiovascular system may also be impacted, with potential long-term consequences such as high blood pressure, heart rhythm disturbances, and an increased risk of heart disease.

Psychological Effects: Individuals who survive a barbiturate overdose may face psychological challenges in the form of post-traumatic stress disorder (PTSD) or ongoing anxiety related to the overdose experience.

It is essential to acknowledge that barbiturate overdoses can be fatal. The acute consequences, such as respiratory depression leading to respiratory arrest, coma, and death, are immediate threats. However, even if a person survives the overdose, the long-term consequences and risks to their health can be severe and life-altering.

Preventing Barbiturate Overdose

If you have been prescribed barbiturates, following your healthcare provider’s instructions is essential. Take only the prescribed dose; do not adjust it without consulting your doctor. Keep your medications secure out of reach of children and pets. Ensure that others in your household cannot access your prescription drugs.

Schedule periodic medication reviews with your healthcare provider. Discuss whether the medication is still necessary and if alternative treatments are available with a lower risk of dependence or overdose.  Be aware of potential drug interactions. Inform your healthcare provider about all the medications and supplements you are taking to avoid combinations that can increase the risk of overdose.

Treatment and Recovery

Hospitalisation is extremely essential in case of an overdose. his provides a controlled environment where medical professionals can closely monitor the individual’s condition, administer life-saving treatments, and address any complications that may arise. Individuals who experience respiratory depression or failure may need assistance with breathing, which may involve mechanical ventilation.

After emergency medical care, the person can consider taking residential treatment which can address their addiction, psychological as well as physical condition. In a rehab, a person who has experienced a barbiturate overdose can benefit from the following:

• Detoxification: For individuals who have developed a dependence on barbiturates, a medically supervised detoxification process may be necessary to safely manage withdrawal symptoms. 
• Behavioral Therapy: Behavioral therapy, such as cognitive-behavioral therapy (CBT) and contingency management, is effective in helping individuals address the underlying causes of addiction, develop coping skills, and maintain abstinence.
• Support Groups: Support groups, such as Narcotics Anonymous (NA) or SMART Recovery, provide a sense of community and ongoing support for individuals in recovery.
• Lifestyle Changes: Adopting a healthy lifestyle, including regular exercise, a balanced diet, and stress management, can play a crucial role in long-term recovery.
• Ongoing Care: Recovery from barbiturate addiction is often a lifelong journey. Ongoing care and support, including regular check-ins with healthcare providers and participation in support groups, can help individuals maintain their sobriety.

Barbiturate addiction treatment in India is provided by several premium rehabs across the country. One of the centers that uses a 360-degree approach, using a range of therapeutic techniques is Sukoon Recovery Centre, Delhi. Another such rehab in Jagruti Rehabilitation Centre. This centre is located in four cities in India, including Chennai, Gurgaon, Ahmedabad and Mumbai. 

If you or someone you know is looking for treatment for barbiturate abuse in India, you can browse our list of treatment centres here.