Barbiturate Use Disorder

Barbiturate use disorder:

The commonly abused barbiturates are secobarbital, pentobarbital and amobarbital. Their use has recently decreased markedly as benzodiazepines have replaced barbiturates in the majority of their clinical uses.
Barbiturates produce mark physical and psychological dependence. Tolerance (both central and metabolic) develops rapidly and is usually mark. There is also a cross tolerance with alcohol.

Indian epidemiology then other

Causes of Barbiturate used disorder:

There are many different reasons why someone might become addicted to barbituric acid. Addiction can be difficult to understand in many cases. While it may seem like there is a clear reason, it is often complicated. Some of those reasons include:

• Genetic predisposition
• Biological causes
• Environmental influences
• Psychological issues
• Substance use disorders

There is no single reason why anyone develops an addiction to barbiturate drugs, just like there is no single reason why some people become alcoholics while others do not. However, there are things we know about how barbiturate drug addiction works that can help us understand what it takes to overcome the problem.

1. Genetics

People who have a family history of substance abuse are at greater risk of developing addictions to substances like cocaine, heroin, or alcohol. This is because their brains are already wired to respond to these substances in a way that makes them feel good. When a person has a genetic predisposition toward substance abuse, he or she will likely develop a stronger response to these chemicals than someone without this predisposition. In other words, if you have a family member who abuses drugs, you are much more likely to abuse them yourself.

2. Biological Causes

When a person uses a barbiturate drug, his or her body produces certain hormones called neurotransmitters. These neurotransmitters play a role in regulating mood, sleep, appetite, and energy levels. By altering the number of neurotransmitters produced in the brain, barbiturates affect how well a person feels. For example, when a person takes a barbiturate drug such as phenobarbital, he or she will produce less serotonin, a neurotransmitter that helps regulate mood. As a result, the person may feel depressed and anxious.

3. Environment

In addition to genetics and biological factors, environmental influences also contribute to the development of barbiturate addiction. If a child lives in an environment where drugs are readily available, he or she is more likely to try them out sooner than later. Likewise, if a parent or caregiver regularly drinks alcohol or uses illegal drugs, children living in that home are more likely to experiment with these substances as well.

4. Psychological Issues

Some people who take barbiturates experience psychological problems before they start abusing the drug. They may be experiencing depression, anxiety, or insomnia. Because of these underlying conditions, they may find it easier to get high from taking barbiturates than they would from drinking alcohol or using other illicit drugs.

5. Substance Use Disorders

Some people who abuse barbiturates begin by abusing another substance first. For example, a person who starts smoking marijuana may eventually move on to abusing prescription painkillers. The same goes for a person who begins drinking alcohol. He or she may progress to using cocaine or heroin. (3)

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Risk factors are things that make you more likely to develop a disease in the first place.

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Sign & Symptoms of Barbiturate used disorder

• Euphoria
• Irritability
• Confusion
• Delirium
• Hallucinations
• Mood Swings
• Dizziness
• Disinhibited behavior
• Memory impairment
• Difficulty in Sleep
• Ataxia
• Lack of coordination
• Physical dependence
• Withdrawal symptoms
• Increased productivity of speech
• Slurring of speech. (2)

In brief, the barbiturate withdrawal syndrome can very severe. It usually occurs in individuals who are taking more than 600-800 mg/day of secobarbital equivalent for more than one month.
Furthermore, It is usually characterised by marked restlessness, tremors, hypertension, seizures, but in severe cases, a psychosis resembling delirium tremens. Most important point is that, the withdrawal syndrome at its worst about 72 hours after the last dose. Occasionally, Coma, followed by death, can occur in some cases.

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Differential diagnosis of Barbiturate used disorder

• Acute Hypoglycemia

• Benzodiazepine Toxicity

• Carbamazepine Toxicity

• Carbon Monoxide Toxicity

• Clonidine Toxicity

• Depression and Suicide

• Encephalitis

• Gamma-Hydroxybutyrate Toxicity

• Hypothermia

• Hypothyroidism and Myxedema Coma

• Neuroleptic Agent Toxicity

• Pediatric Urinary Tract Infection

• Sedative-Hypnotic Toxicity

• Shock, Cardiogenic

• Stroke, Hemorrhagic

• Tricyclic Antidepressant Toxicity (4)

Intoxication and Complications

Generally, Acute intoxication, typically occurring as an episodic phenomenon, is characterize by irritability, increased productivity of speech, lability of mood, disinhibited behavior, slurring of speech, incoordination, attentional and memory impairment, also ataxia.
Mild barbiturate intoxication resembles alcohol intoxication; Additionally, severe forms may present with diplopia, nystagmus, hypotonia, positive Romberg’s sign also suicidal ideation. Lastly, Drug automatism may sometimes lead to lethal accidents.
In short, Intravenous use can lead to skin abscesses, cellulitis, infections, embolism and hypersensitivity reactions.

Investigation

• Blood or urine tests may be used to check the level of barbiturates in your system. (4)

Treatment of Barbiturate Use Disorder

• The barbiturate intoxication should treat symptomatically. If patient is conscious induction of vomiting and use of activated charcoal can reduce drug absorption. If coma ensues, intensive care measures should be employed on an emergency basis.
• The treatment of withdrawal syndrome is usually conservative. However, pentobarbital substitution therapy has suggested for treatment of withdrawal from short-acting barbiturates.
• After detoxification phase is over, follow-up supportive treatment and treatment of associated psychiatric disorder, usually depression, are important steps to prevent relapses.

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Homeopathic treatment

Homeopathic Treatment of Barbiturate Use Disorder

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

Which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines.

Homeopathic Medicines for Barbiturate Use Disorder:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Medicines:

Nux vomica:

• Useful for drug addiction with sour taste and nausea in the morning, accompanied by retching .
• Useful when patient feels Intoxicated, Useful when the feeling is worse in the morning.
• There may feeling of vertigo with momentary loss of consciousness.
• There is indigestion caused by alcohol, coffee, and other drugs. 

Hyoscyamus : 

• Useful for drug addiction when patient experiences a confused mind and seems intoxicated, laughs, sings, recites poetry, and babbles deliriously.
• Recommended when patient does foolish things and does not behave normal.
• Also useful for patients with an addiction to alcohol and those who experience intoxicated rages.
• There is involuntary urination along with hallucinations.

Opium : 

• Useful for drug addiction when patient falls into  heavy and deep sleep, he wants nothing, and says that nothing ails him.
• The patient is hot, sweaty, drowsy and has cold limbs accompanied by a heavy, deep sleep, and noisy laboured breathing.
• Also useful for loss of consciousness and a coma from overdose of drug. (5)

Diet & Regimen of Barbiturate used disorder

• Eat nutritious diet.
• Take enough sleep.
• Do regular physical exercise.
• Avoid addictive drugs.

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Reference

1. A Short Textbook of Psychiatry by Niraj Ahuja / Ch 4.
2. https://drugabuse.com/drugs/barbiturates/
3. https://zinniahealth.com/substance-use/barbiturate
4. https://emedicine.medscape.com/article/813155-differential
5. https://www.rajeevclinic.com/disease/other-disease-110/drug-addiction-632.html

What is Barbiturate Use Disorder ?

Barbiturate use disorder is now subsumed under sedative, hypnotic and anxiolytic use disorders.

What are the symptoms of acute intoxication of Barbiturate?

• Irritability
• Increased productivity of speech
• Lability of mood
• Disinhibited behaviour
• Slurring of speech
• Incoordination
• Attentional and memory impairment
• Ataxia

Name of the withdrawal symptoms of Barbiturate Use Disorder ?

• Restlessness
• Tremors
• Hypertension
• Seizures
• Psychosis

What is the treatment of Barbiturate Use Disorder.

• Induction of vomiting
• Activated charcoal can reduce drug absorption
• Pentobarbital
• Supportive treatment
• Treatment of associated psychiatric disorder