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Phenobarbital Technique for Treatment of Barbiturate Dependence

Phenobarbital Technique for Treatment of Barbiturate Dependence Abstract A technique for withdrawal of patients physically dependent upon barbiturates and other sedativehypnotics is described. The technique involves substituting phenobarbital, a long-acting barbiturate, for the addicting agent and subsequent withdrawal of the phenobarbital. The longer action of phenobarbital provides a more constant barbiturate blood level than the shorter-acting barbiturates which are the classical withdrawal agents. The more constant blood level allows the safe utilization of smaller daily doses of barbiturates during withdrawal. WHEN barbiturates were first introduced into medical practice, their ability to produce physical dependence was not immediately recognized. Later, a definite withdrawal syndrome was described. It usually included a progression of symptoms such as muscular weakness, systolic postural hypotension, nausea, insomnia, major motor seizures, hyperpyrexia, and, in some cases, death. Also occurring in some cases —usually on the third to seventh day of withdrawal—was a psychotic reaction which could mimic either delirium tremors or a schizophrenic reaction. A similar abstinence syndrome has been described for many of the newer sedative-hypnotics such as meprobamate and glutethimide (Doriden). In the San Francisco area we are seeing an increasing number of individuals who are physically dependent upon the short-acting and intermediate-acting barbiturates, such as secobarbital (Seconal), pentobarbital (Nembutal), and a mixture References 1. Smith DE, Wesson DR, Lannon R: New developments in barbiturate abuse , in Drug Abuse Papers 1969 . Berkeley, Calif, University of California, 1969. 2. Levy NJ: Use of drugs by teenagers for sanctuary and illusion . Amer J Psychoanal 28:48-55, 1968.Crossref 3. Isbell H: Treatment of addiction to narcotic drugs . Med Clin N Amer 34:425-438, 1950. 4. Wikler A: Diagnosis and treatment of drug dependence of the barbiturate type . Amer J Psychiat 125:758-765, 1968. 5. Essig CF, Carter WW: Failure of diphenylhydantoin to prevent barbiturate withdrawal convulsions in dogs . Neurology 12:481-484, 1962.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

Phenobarbital Technique for Treatment of Barbiturate Dependence

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Publisher
American Medical Association
Copyright
Copyright © 1971 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1971.01750070058007
Publisher site
See Article on Publisher Site

Abstract

Abstract A technique for withdrawal of patients physically dependent upon barbiturates and other sedativehypnotics is described. The technique involves substituting phenobarbital, a long-acting barbiturate, for the addicting agent and subsequent withdrawal of the phenobarbital. The longer action of phenobarbital provides a more constant barbiturate blood level than the shorter-acting barbiturates which are the classical withdrawal agents. The more constant blood level allows the safe utilization of smaller daily doses of barbiturates during withdrawal. WHEN barbiturates were first introduced into medical practice, their ability to produce physical dependence was not immediately recognized. Later, a definite withdrawal syndrome was described. It usually included a progression of symptoms such as muscular weakness, systolic postural hypotension, nausea, insomnia, major motor seizures, hyperpyrexia, and, in some cases, death. Also occurring in some cases —usually on the third to seventh day of withdrawal—was a psychotic reaction which could mimic either delirium tremors or a schizophrenic reaction. A similar abstinence syndrome has been described for many of the newer sedative-hypnotics such as meprobamate and glutethimide (Doriden). In the San Francisco area we are seeing an increasing number of individuals who are physically dependent upon the short-acting and intermediate-acting barbiturates, such as secobarbital (Seconal), pentobarbital (Nembutal), and a mixture References 1. Smith DE, Wesson DR, Lannon R: New developments in barbiturate abuse , in Drug Abuse Papers 1969 . Berkeley, Calif, University of California, 1969. 2. Levy NJ: Use of drugs by teenagers for sanctuary and illusion . Amer J Psychoanal 28:48-55, 1968.Crossref 3. Isbell H: Treatment of addiction to narcotic drugs . Med Clin N Amer 34:425-438, 1950. 4. Wikler A: Diagnosis and treatment of drug dependence of the barbiturate type . Amer J Psychiat 125:758-765, 1968. 5. Essig CF, Carter WW: Failure of diphenylhydantoin to prevent barbiturate withdrawal convulsions in dogs . Neurology 12:481-484, 1962.Crossref

Journal

Archives of General PsychiatryAmerican Medical Association

Published: Jan 1, 1971

References