What are barbiturates? A podcast for therapists

Episode 53

What are barbiturates?

How were barbiturates used historically?

How are barbiturates used in recent years?

Barbiturates are an older class of drugs that had tons of uses and were the go-to for many years. Newer medications with less risks superseded these drugs and so we don’t think of them as often anymore. However there was a time when they were everywhere. There are still some surprising ways these drugs are being used today.

Transcript

You’re listening to the All Things Substance podcast, the place for therapists to hear about substance abuse from a mental health perspective. I’m your host, Betsy Byler and I’m a licensed therapist, clinical supervisor, and a substance abuse counselor. It is my mission to help my fellow therapists gain the skills and competence needed to add substance use to their scope of practice. So join me each week as we talk about All Things Substance.

Welcome back to the All Things Substance podcast. This is episode 53. Fall is here in the Northwest part of Wisconsin and you can see the colors starting to turn on the leaves. Where we live we’re surrounded by woods, small lakes, and then the much larger lake of Lake Superior. Fall is my favorite season of the year because I love the weather. I love the smells and I just love not having to wear a coat and boots, but not being hot once I step outside.

This September has been busy and just like every other. I’m sure those of you with kids are sending them back to school and even though my kids are grown, I still see a lot of teenagers and college students and so my schedule tends to revolve around when school is back in session. Most schools around here are fully in-person. Masks are required in some places and optional in others. It just sort of depends on the community and what they decided.

There are new things coming up this fall for the podcast. The first one you may have seen if you follow me on social media. If you don’t follow me on social media, head over to Facebook, LinkedIn, Twitter, Pinterest, and look for Betsy Byler and you’ll be able to find me. Having followers and likes is actually helpful. I wish it wasn’t because it feels like the algorithm is in charge. It is the way social media functions.

You may have seen that I’m hosting a workshop. It’s an online workshop and it’ll be three hours on a Saturday, October 16th. If you aren’t able to make it, there will be a recording that you’d be able to watch. The cost is a hundred dollars.

The workshop is about how to talk to clients about substance use and addiction in a way that feels good to them and to you. It can be really hard to start a conversation about addiction and substance use. It seems good in theory, but sitting down across from someone and saying,” Tell me about your use of alcohol” or “do you ever drink?” And we tend to get defensive.

In the workshop I’m going to talk with participants about how to start that conversation, what questions to ask, how to interpret the answers that your client gives and what that means for future intervention. You’ll walk away with tangible assets that you can use in your practice. There are no CEUs for this. That’ll be something that I’ll be able to do in the future when I’m doing more courses. But this workshop is just the first part.

I get asked often how to start a conversation and what questions to ask and what they’re looking for. I really hope that some of you are able to join us. If you feel like you already know how to do these things, I’d appreciate it if you could share the information with colleagues that you think might be interested and may need the information.

In the future there will be other workshops. Currently I’m planning one on how to use the treatment planning tool. I’m happy to talk about anything that people want to hear about as I truly want to be able to share good information. Again, the workshop is on October 16th. You’re going to hear me talk about the workshop in pretty much every episode between now and then and so I ask you to bear with me if you’ve already heard about it, because there may be someone listening who hasn’t heard about it just yet.

We’re onto the third episode of the month which hardly seems possible. Our first episode was an interview I did with a physician from the Chicago land area. She has an inspiring story of recovery. If you haven’t had a chance to listen, I encourage you to head over to the website, betsybyler.com and check it out. Last week’s episode with our student edition, where I talked about licensing and spent time teaching on how to read statute. It really is important and I’ve gotten good feedback on the episode so far.

Today, we’re covering a class of drugs that’s kind of obscure in 2021. It’s not something that was obscure as it was one of the most popular things around in the fifties, sixties and seventies. The class of drugs, barbiturates.

What are barbiturates-History

Barbituric acid itself was first synthesized in 1864 by a German chemist. The legend has it that the day that it was created, which was a holiday, is how it got its name. The story is that the German chemist Baeyer and his colleagues had gone to a local tavern where they were celebrating the feast of St. Barbara, the patron Saint of artillerymen.

There weren’t really any medical uses until around 1903 when two German scientists discovered that Barbital was found to induce sleep in dogs. After that Barbital was marketed by Bayer, as in Bayer aspirin, under the trade name, Veronal. Barbiturates were used medically and by prescription. It wasn’t until the 1950s that the problems with barbiturates began to appear.

One of the most famous accounts of someone using barbiturates was with the death of Marilyn Monroe. It’s well-known that Marilyn Monroe died from a drug overdose. Her death was ruled as an acute barbiturate poisoning. The amount in her blood was said to have been as much anesthesia needed to kill 10 men.

Barbiturates were also found in relation to Margeaux Hemingway. A model and the granddaughter of Ernest Hemingway. She was 41 when she overdosed on phenobarbital in Santa Monica, California. Another actress. Judy Garland was said to have died from a self overdose of barbiturates.

The introduction of barbiturates being used as sedatives was actually kind of a big deal. So much so that between the 1920s and the 1950s, practically the only drugs used as sedatives and hypnotics were barbiturates. The hypnotic properties of some barbiturates were being applied to the treatment of psychotic patients. They were being used to put psychotic patients into a medically induced deep sleep.

In March of 1913, an Italian psychiatrist administered the first dose of luminol to a girl who was 19, affected by psychosis associated with bipolar disorder. They used the treatment of the barbiturate over a period of four days, and she fell into a deep sleep, which lasted from March 25th to April 9th of that year. She was later discharged in the month of June in the same year and it was stated that she was in remission from manic episodes and psychosis for two years following. They called this prolonged sleep therapy.

Generally, it was suggested for patients with schizophrenia who were agitated, people with delirium tremens (which we talked about in the alcohol episode). It was also used for treating autism and withdrawal for morphine.

The idea of the sleep cure as it was called had some really significant issues as we can imagine. One of them was safety. They put the fatality rate of this treatment at 5%. The risk was actually pretty substantial. Concurrently, phenobarbital was being used extensively to treat epilepsy and seems to be one of the first, truly effective drugs in treating epilepsy.

What are barbiturates-Definition

Because of the immediate acting nature of some of the barbiturates and the long duration. It seemed that these medications were sort of the drug of choice for trying to commit suicide. The three stars that I mentioned earlier were all said to have died from suicide, using a mixture of barbiturates.

There are a number of different types of barbiturates all based on how fast they act and their half-life. We’ll talk about a few of these, a little more in depth, but the names of the most common ones are secobarbital, mephobarbital, butabarbital, pentobarbital and amobarbital.

While the United States doesn’t really use barbiturates much anymore, phenobarbital has an extensive use as an antiepileptic drug in the neonatal and pediatric population. It is the most cost-effective drug treatment for epilepsy in low resource countries. Barbiturates have been used for neurosurgery due to the way it interacts in the brain and it’s reduction in the metabolism of oxygen consumption.

Barbiturates are downers. In and of themselves they don’t act directly on the central nervous system, but it does slow the body down hence their use as an anesthesia. In addition to anesthesia, barbiturates are often used to treat anxiety, insomnia and seizure disorders. Part of the reason they’re not as widely prescribed today is that benzodiazepines have superseded them and are seen as more effective treatment than barbiturates

So the main difference between the different barbiturates is how long they act for. Long acting barbiturates, such as phenobarbital can last for well over 24 hours. Which makes them useful in combination with other agents to prevent seizures and epilepsy. Some of the half lives are pretty short, three hours, five hours, but there are a few that could last up to a hundred hours. A drug called butisol has a hundred hour half-life.

I found out something really interesting in my research for this episode, I ran across the name of a drug that was familiar to me. And it was familiar to me because it was prescribed to me in 2000. I was at Michigan State University and went to the health center there at the school. Now university health centers are notoriously not great. However, Michigan State has a pretty prominent medical school and so our health center was pretty well-staffed.

I remember the doctor and he was probably, I don’t know, mid thirties, maybe 40 at the time. So he’d been a doctor for a while. I went in and told him that I was having migraines. I didn’t have them often, but they were difficult for me. He prescribed me a medication called butalbital. Trade name, Fioricet. Fioricet is a barbiturate. As I sat back and thought about that I remember getting those drugs and I remember feeling that I didn’t like how it made me feel.

I was sober at the time. When I was using, I didn’t get as far into pills as getting to barbiturates. And so I wasn’t aware of what I was taking. I just knew I didn’t like how it made me feel and that when I had a migraine and I took it, I’d have to lay down and basically sleep for the rest of the day and night. Now I understand why.

In the year 2000 I went in for the very first time telling a doctor I’m having migraines. Nowhere in my history. Have I ever said that? And here I get a barbiturate to treat a migraine; and a barbiturate that has a 35 hour half life.

Some common side effects of barbiturates are confusion, dizziness, drowsiness, a headache, (ironically so) irritability, low blood pressure, nausea and vomiting and vertigo. As you can guess there are some very dangerous potential side effects and overdose is absolutely possible and fairly easy to induce.

Some of the symptoms of overdose are impaired judgment in coordination, sluggishness, speech disturbances, staggering, slow and shallow breathing, and finally coma and death. People who survive an overdose on a barbiturate may be left with permanent kidney damage because of how it’s processed in the body.

Barbiturates are also highly addictive and there’s a high chance of becoming physically dependent on them. If you take them for more than a couple of weeks. Tolerance develops quickly within two weeks. Stopping barbiturates abruptly in people who have been taking them longer than a couple of weeks can cause a pretty severe withdrawal syndrome, including hallucinations, high fever and seizures.

There are a number of drug interactions listed for barbiturates as well. Phenobarbital itself is known to reduce the efficacy of warfarin, which is a blood thinner, steroids, oral contraceptives, and immunosuppressants.

What are barbiturates-Use in lethal injection

In 1934, a drug called thiopental was introduced for the induction of anesthesia. Thiopental was the predominant anesthetic induction agent until its replacement by another drug. Because of its use in lethal injection protocols, the major supplier of Thiopental in the U S decided to discontinue production in 2011

In the United States, barbiturates being used in lethal injections in the United States, were part of a three drug cocktail. The thiopental was used to cause sedation. But it’s so short acting that the criticism of it is that it could wear off. The other two parts of the drug are one to lock down the muscle reaction and the second to stop the heart. The problem with thiopental is that it could wear off. And because the person has no ability to move muscles you couldn’t tell if they were feeling any pain or not. This has been the large criticism for the lethal injection in the United States.

The latest method that the justice department decided to use is pentobarbital. Basically, they’re trying to create a barbiturate overdose by injecting pentobarbital directly into the inmate’s system. They state that this would eliminate the potential for silent agony caused by the first method. Part of the issue with this, besides death penalty issues in general, is that the supply is really small in the United States. There are no current manufacturers that will manufacture this drug and so it comes from Europe.

It’s not a very popular drug. Getting supplies of it can sometimes be difficult, leading some places to use compounding pharmacies to sort of make it up. There are reports coming out of Texas, that inmates who were given this lethal injection from a compounding pharmacy were not sedated and in fact could feel what was happening.

What are barbiturates-Narcoanalysis

During the course of the 20th century 2,500 barbiturates were synthesized with only 50 actually being used in a clinical manner. We’ve talked about phenobarbital. We’ve talked about thiopental , which is the one used in lethal injections. And now we need to talk about sodium Amytal and Sodium Pentothal. Sodium Amytal is also known as amobarbital. For some of you, especially those of you watching a lot of Law and Order or true crime type things would recognize these names because they’re both used, sometimes interchangeably, as people refer to as a truth serum. Another phrase for truth serum is narcoanalysis.

The idea of narco analysis or the truth serum is that when these drugs are administered and not to the full sedation level, that subjects are supposed to be more suggestible and supposedly more likely to tell the truth. There are a lot of issues with using these drugs and calling it a truth serum. One of the main issues, besides human rights violations and abuse of power, the reliability of the reports given by people under these conditions are really sketchy.

People are really open to suggestion, really open to memories being shifted or things being hazy. For those of us who’ve had surgery, or even those of you have been drunk or high. The way we view space and time is really different. We can’t really rely on what’s happening during these kinds of investigations or interrogations.

Over the years in different countries, there have been the uses of these drugs in order to induce truth and also research done on them. In the United States, there was some research done on a specific drug called scopolamine used on women in childbirth. Scopolamine comes from the seeds of a tree, which locals call the, get you drunk tree. They found that the women were able to give accurate answers even while in what they called “twilight sleep”. It was noted that the women were often “exceedingly candid” in their responses.

So the way this works is that barbiturates in general slow down brain activity. When your brain activity is slowed it’s more difficult to perform high functioning tasks, such as concentrating on a single activity, walking a straight line, or even lying. The idea that it takes away your ability to lie is based on the premise that you need concentration in order to do that and that concentration is a higher functioning behavior that supposedly would be limited if you were on one of these drugs.

The most recent and well publicized use of these drugs for this purpose was in India. In 2007, police in New Delhi administered sodium pentothal to a wealthy businessman and his servant who were suspects in the infamous Noida serial murders. While under the influence of this drug, they confessed to luring children to their home raping and then killing them. The servant was given the death sentence. His boss was later acquitted.

The use of this drug as a truth serum was being hotly debated in India around that time. The Bombay High Court ruled that subjecting a person to physical tests involving minimal bodily harm, which in their estimation included narco analysis, lie detector tests, and brain mapping, did not violate their constitutional rights.

The history of these barbiturates is dark and winding. There were some ways in which barbiturates were used that were a revelation. It’s use in anesthesia and in helping the brain activity slow down while also reducing the brain’s consumption of oxygen during that time was a huge medical breakthrough. Additionally, the medication being used to treat epilepsy effectively was also a really big deal.

The darker sides of the barbiturate class being the use in people’s suicides or lethal injections, or as a “truth serum”. This class of drugs has a murky past. For the most part, barbiturates are not used very often. It has to be really, really rare. A number of companies stopped producing them and they’re harder to get in the United States since about 2011. These drugs are dangerous. They cause overdose. There’s tolerance. There’s withdrawal. And when they’re used recreationally today, oftentimes they’re being used to help someone come down from a different drug or deal with withdrawal.

There’ve been some reports that use of barbiturates is on the rise. I’m kind of wondering where they’re getting them. I suppose someone could be compounding them, but that seems like a lot of trouble to go to for something like that. But I suppose it’s possible.

I wanted to cover the class of barbiturates because a word that gets used when we’re talking about drug use in the fifties, sixties and seventies. Certainly there is barbiturate use and recreational use continuing to evolve. But its heyday was during that time period. There are going to be people who have used these drugs and so I feel like it’s important for us to know that. Certainly these people are going to be older as they stopped being manufactured in the United States around 2011 but I do think that we should know what barbiturates are.

I hope that this information was interesting and informative. Don’t forget about the workshop coming up in October. For more information, go to betsybyler.com/workshop. Next week, we’re going to be covering a different kind of drug, one that people use for its benefits, but not necessarily to get high. We’re going to be covering steroids. I hope you’ll join me for that podcast. And until then have a great week.

Thank you for listening to the All Things Substance podcast. For show notes, links and downloads, please visit betsybyler.com/podcast. If you loved what you heard today, it’d be great if you would share those with your therapist friends and colleagues. If there are topics that you think would be useful and you’d like to hear me cover them, please let me know. Just send a message to podcast@betsybyler.com. I’ll see you on next week’s podcast. And until then have a great week.

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