Butalbital is clinically referred to as 5-allyl-5-isobutylbarbituric acid. It is an organic barbituric acid, which in essence is a central nervous system depressant. This is usually prescribed in combination with an acetaminophen substances like aspirin, caffeine, and codeine that work synergistically to alleviate the pain and suffering of severe tension, migraine, muscle contraction, and post-dural headaches. However, misuse of this drug can segue into butalbital addiction and abuse.
Common Street Usage and Names for Butalbital
A common street name for butalbital is Butisol. However, people with butalbital addiction often take this drug in combination with other drugs such as Fioricet, which is the brand for combination medication containing butalbital, acetaminophen, caffeine, and codeine. The street name used for this Butalbital combination drug includes feenies, phenos, and phennies (among others.)
Butalbital Drug Classification
The complexities of classification for butalbital as a controlled substance is impacted by the propensity of manufacturers to utilize this substance in combination with other non-controlled substances. In its original formulation, Fioricet is a brand name product with DEA exemption that contains 50 mg of Butalbital, plus acetaminophen and caffeine.
However, Fiorinal, which is the sister formulation to Fioricet, contains the same amount of butalbital per dose in combination with caffeine and aspirin instead of acetaminophen. It is listed as a Schedule III substance in five states including Maryland, Georgia, Utah, Florida, and New Mexico.
History of Abuse and Butalbital Addiction and Abuse
The potential for butalbital addiction and abuse means that products containing this substance are not always recommended as a first-line treatment option for headaches. In addition to butalbital addiction, one of the primary concerns with misuse of butalbital is that episodic headaches in some people can become chronic.
However, in cases where patients being treated with this medication or combination medications containing butalbital received appropriate medical oversight, the development of chronic headaches was prevented.
Historically, people who engage in butalbital drug abuse are usually also poly drug users. It is not uncommon for opioid addicts to preface their drug use with Butalbital to heighten the effects of their primary drug. Using barbiturate medications with other depressants such as alcohol or heroin, however, can exacerbate the risk of respiratory depression, liver toxicity, and death.
Side Effects of Butalbital Addiction and Abuse
Although butalbital is mostly well-tolerated, in rare cases adverse reactions to the barbiturates contained in butalbital have occurred in some people that cause serious side effects that usually require immediate medical attention and treatment for butalbital abuse. These side effects usually include severe respiratory depression, anaphylaxis (or an aggravated skin condition known as Steven-Johnson Syndrome), coma, seizures, and extreme shock.
Other common butalbital related side effects include:
- Irregular heartbeat
- Shortness of breath
- Feeling of Intoxication
- Impaired Judgement
- Memory Loss
Of course, the potential for and severity of side effects increases if butalbital based medications are consumed with other sedatives such as alcohol, opioids, benzodiazepines, and antihistamines. Consumers should also be aware that between each dose of butalbital, there is a narrow window of therapeutic effect and toxicity that leads to drowsiness and euphoria and coma or death.
Signs of Butalbital Addiction and Abuse
Signs of butalbital abuse are typically congruent with a growing need to consume more of the drug to achieve the same results. This behavior is indicative of an increase in tolerance levels and a developing dependency. Once physical and psychological dependence occurs, some or all of the following signs of butalbital drug abuse or butalbital addiction begins to manifest:
- Noticeable increase in the amount of drugs consumed on a daily basis.
- Changes in appearance which can manifest as weight loss or gain.
- Discomfort of withdrawal symptoms if Butalbital is temporarily halted that are relieved when drug use resumes.
- Neglect of routine responsibilities at school or work.
- Changes in social activities and normal patterns of behavior.
- An unnatural urgency or obsession with getting butalbital that leads to risk taking behavior.
- Lack of interest or participation in maintaining relationships.
- Efforts to hide butalbital use through lies, denial and manipulation.
- An inability to stop or control drug use.
Withdrawal Symptoms of Butalbital
Dependency or butalbital addiction usually becomes evident when a missed dose triggers withdrawal symptoms. The severity of butalbital withdrawal symptoms is often determined by the duration of abuse and levels of dependency. Studies show that withdrawal symptoms are usually mild to moderate for short term periods of butalbital drug abuse.
However, after long term use result in both physical and psychological dependence, withdrawal symptoms can range from severe to life-threatening and last for more than two weeks in some individuals. These symptoms may include:
- Agitation to severe anxiety
- Muscle aches and pains
- Nausea and vomiting.
- Rebound headaches.
Treatment for Butalbital Addiction and Abuse
Once the signs of dependence or butalbital addiction begins to manifest, treatment becomes necessary. Like all addictions, continued use incrementally exacerbate the harmful effects of the drug. Effective treatment for butalbital addiction therefore, must first address the obsessive consumption process that drives butalbital addiction.
This initial treatment is detoxification that, for the patient’s safety and well-being, should always occur with medical oversight. Whether a rapid or gradual detoxification process is selected based on a number of variables such as the current patient’s physical and mental stability (among others.)
After the withdrawal process is completed, the treatment for butalbital addiction must also address the psychological symptoms of dependency through various forms of behavioral therapy. The rehabilitation phase of recovering from butalbital addiction may occur through an inpatient or outpatient intervention arrangement which is usually determined by the unique circumstances and needs of the patient. The rehabilitation treatment is essential because it provides the education and prevention skills that support long term sobriety.