Because they are legitimately manufactured in large quantities and are readily available in numerous forms, barbiturates are the target of illicit activity. The black market meets its needs by diverting shipments from manufacturers and by robbing drug warehouses; the drugs are then often cut with sugar and other substances. The three major barbiturates common on the black market are secobarbital (reds, red devils, seggys, downers) pentobarbital ( yellow jackets, yellows, nembies), and a combination of secobarbital and amobarbital (reds and blues, rainbows, double-trouble, tooies). Both legal and illegal use of barbiturates seems to be declining.

Binding of the barbiturates to (GABA) receptor complex results in making the neuron more negatively charged and less likely to be stimulated.

Oral use: Barbiturates can be taken orally either occasionally for a high or chronically for a constant calmness. These two patterns of abuse generally involve two different groups of persons. Generally, teenagers and young adults are most likely to take an occasional barbiturate to produce a transient sense of euphoria or well-being. The user�s personality, the expectations of the drug�s effects, and the setting in which the drug is taken also affect the drug experience.

Chronic intoxication occurs mainly in middle-aged, middle-class people who obtain the drug from the family physician as a prescription for sleeplessness or anxiety. Now that the number of refills is limited by law, these abusers may visit many physicians, obtaining a prescription from each. Their drug dependence may go unnoticed for months or even years or until their work begins to suffer or they show physical signs, such as slurred speech.

Intravenous Use: The most dangerous pattern is intravenous barbiturate use. Users are mainly young adults intimately involved in illegal drugs. Typically, their drug experience has been extensive. They often use barbiturates because the habit is less expensive to maintain than a heroin habit.

The rush is described as a pleasant, warm, drowsy feeling. The abusers tend to be irresponsible, violent, and disruptive. The physical dangers of injection include Acquired Immune Deficiency Syndrome (AIDS) through the sharing of needles, skin infection, and vascular complications from accidental injection into an artery, infection into an artery, systemic infections, and allergic reactions to contaminants. Barbiturates are also used by heroin addicts to boost the effects of weak heroin, by alcoholics to enhance the intoxication or relieve the symptoms of alcohol withdrawal, and by speed freaks as a sedative to help avoid paranoia and agitation.

Mild barbiturate intoxication, acute or chronic, resembles alcohol intoxication. Symptoms include sluggishness, incoordination, and difficulty in thinking, poor memory, slowness of speech and comprehension, faulty judgment, disinhibition of sexual or aggressive impulses, narrowed range of attention, emotional lability, and exaggeration of basic personality traits. The sluggishness usually wears off after a few hours, but impaired judgment, distorted mood, and impaired motor skills may remain for as long as 10 to 22 hours. Other symptoms are hostility, quarrelsomeness, moroseness, and occasionally, paranoid ideation and suicidal tendencies. Neurological effects include inability to fix gaze, double vision, imbalance, loss of tone, and decreased superficial reflexes. The diagnosis of barbiturate intoxication, based on these signs and symptoms, may be confirmed by blood tests for barbiturates.

All patterns of use present dangers to health. Acute intoxication can produce death from suicide, accident, or unintentional overdose. Barbiturates in home medicine cabinet are second only to aspirin as a cause of fatal drug overdose in children. Barbiturates are a common cause of lethal accidents and are commonly taken with suicidal intent. The effects of alcohol and barbiturates are additive, and the combination is especially dangerous. Barbiturate induced death follows a sequence of deep coma, respiratory arrest, and heart failure. The lethal dose varies with the route of administration, excitability of the central nervous system (CNS), and acquired tolerance.

An amnstic syndrome may occur as the result of sedative, hypnotic, or anxiolytic abuse. Onset appears to be in the 20s, and the course is variable, having the potential for full recovery

Barbiturate overdose patients who are awake are kept from slipping into unconsciousness. Vomiting is induced and activated charcoal administered to delay gastric absorption. The airway is kept clear and vital signs monitored until there is no danger of coma. If the patient is comatose, a life-threatening emergency exists. It is then necessary to establish an intravenous fluid system, monitor vital signs, insert an endotracheal tube to maintain an airway, and perform gastric lavage (washing of stomach) with fluid containing activated charcoal. Nursing care in an intensive care unit is followed.

Like many other drugs, barbiturates produce CNS tolerance. They also produce metabolic tolerance and reduce the effectiveness of number of other drugs especially anticoagulants (drugs which cause clotting of blood to stop bleeding) and antidepressants. There is cross-tolerance with alcohol.

WITHDRAWAL:

A withdrawal reaction occurs when barbiturates are discontinued. This usually requires at least several weeks or more at doses well above the recommended therapeutic level. The barbiturate withdrawal reaction ranges from mild symptoms, such as anxiety, weakness, sweating, and sleeplessness to fits, disturbed consciousness, and heart failure leading to death.

.Its main features are agitation, false beliefs, and false sensations that are usually visual but sometime tactile (of touch) or auditory. Fever may be present .Most of the symptoms appear in first three days of abstinence, and fits generally occur on the second or third day .This leads to development of delirium. The syndrome rarely occurs more than a week after stopping the drug. Psychosis, starts on the third to eighth day. The various symptoms generally run their course within two to three days but may last as long as two weeks.

To avoid sudden death during the withdrawal process, the clinician uses conservative treatment. First barbiturates are withheld from a comatose or grossly intoxicated patient until these symptoms clear. Meanwhile, the size of habitual dose must be determined. Because the patient is not reliable source for this information, often underestimating the dosage, Family & pharmacists should consult for confirmation. the patient the daily decrement should be halved.

Phenobarbital is substituted in the withdrawal procedure for the more commonly abused short-acting barbiturates. The user is maintained for at least two days at this level before the dosage is reduced further. The regimen is some what analogous to the substitution of the methadone for heroin.

After withdrawal is complete, the patient must overcome the desire to start taking the drug again. Although it has been suggested that nonbarbiturate sedative hypnotics be substituted for barbiturates as a preventive therapeutic measure, this too often results in replacing one drug dependence with another .If user is to remain drug free, follow-up treatment, usually with psychiatric help and community support, is vital. Otherwise, the patient will almost certainly return to barbiturates or to a drug with similar hazards.