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Phenobarbital Withdrawal

Phenobarbital is a prescription medication commonly sold under the brand name Luminal and is classified as a barbiturate, a nonbenzodiazepine central nervous system depressant. Discovered in 1912, phenobarbital is prescribed to help treat seizures and epilepsy and is the oldest medication still in use for that purpose.

Phenobarbital is also infrequently prescribed in the treatment of insomnia and anxiety, though in recent years, it has been replaced by benzodiazepines for that purpose. This can be attributed  because there is a much higher risk of overdose with barbiturates and barbiturate overdose is actually considered more dangerous than benzodiazepine overdose.

One significant indication of the danger of phenobarbital and overdosing is its other secondary uses, including euthanasia and lethal injections for those who receive the death penalty.

Phenobarbital is classified by the World Health Organization as a first-line medication recommendation for developing countries. However, in nations like the United States, it is mainly an alternative epileptic medication in situations where benzodiazepines, such as Valium or Ativan have proven ineffective.

In the rare cases that benzodiazepines have failed as an effective treatment for an individual’s anxiety or sleep-related disorder, phenobarbital is only prescribed as a short-term solution to ease symptoms until other medical interventions can be put into place, generally for less than two weeks.

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Phenobarbital is classified by the DEA as a Schedule IV substance, which means that it has a moderate potential for abuse. When someone uses it for long periods of time against doctor recommendation, they can develop a physical dependence that can grow into addiction.

Apart from the high risk of lethal overdose, phenobarbital abuse also comes with severe health risks such as major liver damage, skin lesions, memory loss, and decreased motor skills and coordination.

Long-term abuse is also correlated with a significantly increased chance of developing liver and renal cancer, as well as brain tumors in children whose mothers regularly used phenobarbital throughout their pregnancy.

Phenobarbital withdrawal can be a difficult and dangerous process, especially if someone attempts to quit using it all at once. It is always important to detox in the safety of a medical detox facility under the supervision of a trained medical professional.

WHAT ARE THE SYMPTOMS OF PHENOBARBITAL WITHDRAWAL?

Even though phenobarbital is a barbiturate and chemically separate from benzodiazepines, it works in a very similar manner. It increases the levels and strength of a neurotransmitter called gamma-aminobutyric acid, or GABA. GABA’s function is to inhibit the nerve signals that cause stress, fear, or anxiety in order to help keep the body calm.

As a central nervous system depressant, phenobarbital produces more GABA, increasing its anxiety-blocking effects. This makes the user feel relaxed and drowsy, which is what makes it useful as both a sleep-aid and an anti-anxiety medication. Blocking these signals also has the effect of controlling the irregular electrical activity that occurs in the brain during a seizure.

When a person who has been abusing phenobarbital long enough becomes psychologically and physically dependent on it, their brain will have stopped producing GABA on its own, relying on the supply that comes from the drug to function properly.

Then, when they try to quit using phenobarbital and deny the brain the GABA its become used to, it throws their body into shock. This triggers a crash as all the symptoms the GABA was blocking suddenly reappear, bringing a host of new symptoms with them, which is essentially the experience of phenobarbital withdrawal.

Much like how it affects the brain, phenobarbital withdrawal symptoms are similar to those generally associated with benzodiazepines and can be just as dangerous and difficult to manage, including a range of psychological symptoms as well as physical ones. Common phenobarbital symptoms include:

  • Dizziness
  • Fatigue
  • Uncontrollable trembling and bodily tremors
  • Fever
  • General flu-like symptoms
  • Nausea
  • Vomiting
  • Diarrhea
  • Anxiety
  • High blood pressure
  • Insomnia
  • Hallucinations
  • Delusions
  • Muscle twitching
  • Physical weakness
  • Seizures
  • Memory loss
  • Vivid nightmares and disturbed sleeping
  • Dangerously elevated heart rate
  • Delirium

Many people undergoing phenobarbital withdrawal will also experience rebound anxiety or rebound insomnia, depending on what they were originally taking the medication for. Essentially, as previously mentioned, once deprived of GABA, old symptoms that the phenobarbital was keeping at bay return, including anxiety and insomnia.

The main difference between the regular symptoms of insomnia and anxiety and the rebound versions is that rebound insomnia and anxiety are significantly worse and much more intense than the anxiousness of sleeplessness that someone may have been experiencing before taking phenobarbital.

Rebound insomnia isn’t just experiencing difficulty sleeping but total sleeplessness that can last for days at a time, while rebound anxiety can cause crippling panic attacks.

CAN PHENOBARBITAL WITHDRAWAL KILL YOU?

Phenobarbital withdrawal symptoms can be particularly brutal and, depending on the severity of the addiction, sometimes even life-threatening. Attempting to detox from phenobarbital alone without any kind of medical intervention can put in a needlessly dangerous situation with a high risk of not only relapse but possibly even death.

One major hazard is not just the symptoms themselves, like seizures, which are plenty dangerous on their own, but what they can make someone experiencing them do. The combination of hallucinations, delusions, delirium, and a generally unbalanced and agitated mental state could cause someone to accidentally harm themselves or even begin to exhibit suicidal behavior. Without the constant monitoring of expert staff that a professional medical detox center can provide, a phenobarbital detox can quickly become fatal.

This is especially true if someone attempts to quit phenobarbital cold turkey. The shock of the sudden and total lack of phenobarbital and the GABA it creates can trigger Grand mal seizures, especially in people predisposed to epilepsy.

A doctor at a medical detox facility will instead put someone in phenobarbital detox on a tapering schedule to slowly decrease their doses of phenobarbital until it is safe enough for them to stop using completely without the risk of seizures.

The rebound anxiety and rebound insomnia alone would be extremely difficult to try to manage unaided, let alone, along with all the rest of the symptoms of phenobarbital withdrawal. Taking this into account, it’s no surprise that many people going through phenobarbital detox will relapse out of desperation to end the extreme discomfort caused by the withdrawal symptoms.

Those who relapse during detox are at a very high risk of accidentally overdosing, especially considering how all-too-easy it is to do with a barbiturate, increasing the odds of a fatal outcome.

Detoxing under the care of a medical professional helps avoid the risk of relapse and, therefore, an overdose. It also means that an individual undergoing phenobarbital withdrawal can expect around the clock monitoring that includes administering medications to help ease the symptoms of phenobarbital withdrawal.

Trying to get through a phenobarbital detox alone is a recipe for disaster. It creates unnecessary risks. It makes the withdrawal longer and more difficult than it needs to be and puts your life at risk for absolutely no reason. An individual can go to a detox center instead and have the peace of mind knowing that they are in safe and experienced hands.

DANGERS OF COLD TURKEY DETOX

As we’ve described above, getting past addiction to phenobarbital is not easy. The withdrawals can be hideous, but what can make them even worse is not having adequate support to guide you through the process. Despite this, many individuals will still attempt to stop using phenobarbital without help. Not only is this dangerous, but it can be life-threatening depending on the severity of the addiction.

The phrase cold turkey means to stop the consumption of your drug of choice suddenly. In this case, it means abrupt cessation of phenobarbital. The phrase, which initially was meant to speak clearly, was later on intended to mean leaving a bad habit behind without help.

As we’ve described several times in the article, withdrawal symptoms can be extreme. Imagine trying to cope with these symptoms without any help, or with individuals with no formal medical training that cannot prescribe medication to alleviate the symptoms. The symptoms are strong enough to force even the strongest willed person back into their old ways. On top of that, if you have made a conscious choice to stop using drugs, is it worth dying over?

Detox is more than just a place that can offer medication and assistance during a vulnerable period, but it sets the foundation for your recovery. Detox alone is not enough to overcome a severe addiction. It is merely a starting point and a significant piece of a large puzzle.

Following the continuum of care will allow you to understand what pushes you to use drugs and develop the tools to overcome triggers. A cold-turkey detox will not help you develop these tools, and is not enough to stop using drugs long-term.

WHAT ARE THE STAGES OF THE PHENOBARBITAL WITHDRAWAL TIMELINE?

The biggest question on most people’s minds when beginning a phenobarbital detox is how long the process will last. And while there is a typical timeline for the stages of phenobarbital withdrawal, there still isn’t an exact answer, as each person’s experience will vary based on different factors unique to them, including:

Not only does detoxing under the care of a medical professional help to avoid the risk of a relapse and therefore an overdose, it also means that an individual undergoing phenobarbital withdrawal can expect around the clock monitoring that includes administering medications to help ease the symptoms of phenobarbital withdrawal.

Some of the different factors that may play a part in the severity and length of your phenobarbital withdrawal are as follows:

  • How much phenobarbital someone has been abusing
  • How long they have been abusing phenobarbital
  • How they were taking phenobarbital
  • Polydrug use
  • If they have a history of prior addictions
  • If they have a co-occurring disorder or other mental health issues
  • The current state of their general overall health
  • Whether or not they stop using through a tapering schedule
  • Age of the individual

Keeping these factors in mind, the stages of the phenobarbital withdrawal is usually as follows:

8-12 Hours: Phenobarbital is a long-lasting barbiturate, so it takes longer to leave the body. It can take as long as 12 hours after the last dose is taken for it to leave the body and the early withdrawal symptoms to begin.

One Week: Over roughly the next seven days, the symptoms will all be present and eventually reach their peak strength, including the rebound insomnia and anxiety. This is the period when people are generally most vulnerable to relapse.

Two Weeks: After the one-week mark, the majority of the symptoms should have either dissipated or otherwise become significantly weaker and easier to manage. By the end of about two weeks, the withdrawal process should have run its course, although certain symptoms such as insomnia and anxiety will most likely persist for several weeks longer, though in a much milder form.

WHAT IS THE NEXT TREATMENT STEP?

Once someone has successfully made it through the withdrawal period, the next step should always be engaging in some form of aftercare, ideally a recovery treatment program. Detox is not a solution to addiction, but only the first step toward being able to maintain sobriety.

In order to avoid the relapse that is all but inevitable without a rehabilitation treatment program, you need to get the tools and skills necessary to understand the root of your addiction and how to curb addictive behaviors. Otherwise, all a detox does is put a bandage on the problem.

At most treatment facilities, a client will typically work with their counselors and doctors to create a collaborative, customized treatment program that will be the most effective method for a successful recovery, choosing from a range of treatment programs and therapies.

AFTER-CARE PROGRAMS

An effective treatment program will leave you feeling as though you’ve been transformed on all levels. Your mind, body, and soul will feel revitalized, and you will be ready to take on the rigors of life. Unfortunately, this will not be enough to get through life.

You are still fragile once you leave the comfort of treatment, and the stress and triggers in life can wear you down if you do not tread lightly. To ensure you remain tuned at your best level, you must consider joining and aftercare program. These are helpful for individuals to get the bump in confidence they may need as they acclimate to societal standards.

The purpose of after-care programs are not to abstain from using the drug, but to keep you engaged in your recovery as you transition into society. It can mean avoiding addictive behavior as a whole.

Some of these programs include:

  • 12-step programs
  • Counseling and therapy
  • Family education and counseling
  • Case management
  • Relapse prevention therapy
  • Outpatient recovery services
  • Sober living homes

Sources

Phenobarbital: MedlinePlus Drug Information. (n.d.). from https://medlineplus.gov/druginfo/meds/a682007.html

Ilangaratne, N. B., Mannakkara, N. N., Bell, G. S., & Sander, J. W. (2012, December 01). Phenobarbital: Missing in action. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3524964/

Alcohol, Benzos, and Opiates-Withdrawal That Might Kill You. (n.d.). from https://www.psychologytoday.com/us/blog/all-about-addiction/201001/alcohol-benzos-and-opiates-withdrawal-might-kill-you

Treatment, C. F. (1970, January 01). Chapter 3. Intensive Outpatient Treatment and the Continuum of Care. from https://www.ncbi.nlm.nih.gov/books/NBK64088/

T, B. (2019, July 02). 12 Step Recovery Programs Are a Guide for New Addiction-Free Lives. from https://www.verywellmind.com/the-twelve-steps-63284

Polcin, D. L., & Henderson, D. M. (2008, June). A clean and sober place to live: Philosophy, structure, and purported therapeutic factors in sober living houses. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2556949/

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