Common Street Barbiturates
Short-acting barbiturates, specifically pentobarbital and secobarbital, are the preferred drugs of abuse on the street, though secobarbital and amobarbital are no longer licensed in the United States and most developed countries. 1, 2
Primary Street Barbiturates
- Pentobarbital (short-acting) is commonly abused, with an elimination half-life of 15-48 hours and duration of action of 3-4 hours 2
- Secobarbital (intermediate-acting) was historically a major drug of abuse but is no longer licensed for use in the United States, United Kingdom, and most developed countries, and can only be prescribed to patients already taking it for intractable insomnia 2, 1
- Amobarbital (intermediate-acting) is similarly no longer licensed as a standalone agent in developed countries 2
- Phenobarbital (long-acting) has high abuse potential and was commonly used in suicide attempts historically, though it is less preferred by recreational users due to its longer half-life of 80-120 hours 3, 2
Why Short-Acting Barbiturates Are Preferred
- Short-acting barbiturates like pentobarbital and secobarbital are more protein-bound and lipid-soluble than long-acting counterparts, resulting in more rapid onset and higher pKa, which produces the desired "flash" effect that abusers seek 2
- Adolescents and drug abusers use these sedatives most often to treat unpleasant effects of illicit stimulants, to reduce anxiety, and to get "high" 1
- The expected result is a state of ecstasy with a feeling of comfort when administered orally or intravenously 4
Critical Dangers of Street Barbiturate Use
- Barbiturates are extremely dangerous drugs with a narrow therapeutic index between the dose required for sedation and the dose that will cause coma and death 1
- They suppress the medullary respiratory center, causing dose-dependent respiratory depression that can progress to apnea 5, 6
- When combined with alcohol or other CNS depressants (opioids, benzodiazepines), additive depressant effects on the CNS and respiratory system occur, dramatically increasing the risk of respiratory failure and death 5, 6
Addiction Potential
- Barbiturates are physiologically addicting if taken in high doses over 1 month or more, and the abstinence syndrome can be life-threatening 1
- They induce both physical and psychic dependence 4
- Tolerance to sedative-hypnotic effects develops with chronic use, but tolerance to lethal serum concentrations causing respiratory failure does not develop proportionally 5, 6
Uncommon Street Barbiturates
- Butalbital (intermediate-acting) is no longer licensed as a standalone agent but remains available in combination products (butalbital-acetaminophen-caffeine), which is classified as a Schedule III controlled substance 2
- Barbital has unusual epidemiology as it is not available as a prescription or over-the-counter drug in the United States, being used primarily in laboratory buffers; cases of abuse typically involve theft from clinical or research laboratories 7