Nembutal (pentobarbital) belongs to the class of drugs known as the barbiturates.
Barbiturates are central nervous system depressant drugs that are often referred to as sedative-hypnotic drugs because, at low doses, they help to initiate sleep (sedative effects), and at higher doses, they can treat issues with anxiety (hypnotic effects).
The major uses of Nembutal are as a short-term treatment for insomnia (most often used to help people fall asleep but not as useful in helping people stay asleep), in the treatment of anxiety, as an anticonvulsant in emergency situations, and as a preanesthetic prior to surgery. The drug has also been used to reduce pressure within the skull in cases of traumatic brain injury and as a euthanasia drug for both animals and humans, including use in state executions of criminals. Any drug that can be used to euthanize animals or people is obviously potentially dangerous in high doses.
The United States Drug Enforcement Administration classifies Nembutal as a Schedule II controlled substance, recognizing that the drug has some important medical uses but is also a major candidate for the development of abuse and physical dependence.
The federal government put restrictions on the use of barbiturates in 1970 due to their extreme potential for abuse and physical dependence. Benzodiazepines, which at that time were a newer class of drugs that were believed to be less prone to abuse, have assumed most of the uses that were assigned to barbiturates prior to 1970.
According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) estimates for 2015, only about 452,000 individuals over the age of 12 in the United States used barbiturate drugs, and an estimated 46,000 of these individuals may have misused a barbiturate at least once. Misuse of a drug is not the same thing as abuse. The type of drug abuse that occurs in individuals with substance use disorders represents a chronic and longstanding misuse of a drug that leads to significant distress and/or impairment in the person’s ability to function normally. Simple misuse often only occurs a few times or on an occasional basis when an individual uses a drug in a manner that is inconsistent with its intended purposes.
SAMHSA also reports that barbiturates are most commonly used in hospital settings or clinics. When they are prescribed, barbiturates are more commonly prescribed to elderly people or women.
Abuse of barbiturates most often occurs in individuals who do not have a prescription for the drug, but get it illegally. Younger people, such as adolescents, demonstrated a minor trend of increasing barbiturate abuse previously, but this trend has leveled off. Adolescents most likely get barbiturate drugs like Nembutal from their parents, a friend with a prescription, or an elderly relative with a prescription (most often by stealing it).
Barbiturates are not normally the primary drug of abuse for individuals who abuse these substances. Instead, barbiturates and even benzodiazepines are more commonly abused in conjunction with other drugs. The most common drug that is abused with barbiturates is alcohol, although it is not uncommon for abusers to mix barbiturates with other barbiturates, benzodiazepines, narcotic pain medications, or nonprescription drugs including cannabis products. Because these drugs are often abused in conjunction with other drugs, the potential to develop very complicated issues with substance use disorders is increased.
Effects of Nembutal Abuse
Abuse of Nembutal can result in:
Similar effects that occur with intoxication to alcohol, such as slow and slurred speech; problems with motor coordination; a shuffling or staggering gate; problems with balance; decreases in breathing rate, heart rate, blood pressure, and body temperature; slowed rate of thought; problems with reasoning and logic; aggression; sedation and lethargy; and unconsciousness and/or coma
The development of physical dependence (having both tolerance and withdrawal)
The development of a sedative, hypnotic, or anxiolytic use disorder, a specific substance use disorder identified in the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition
Long-term effects that can include significant issues with one’s respiratory system (as a result of chronic respiratory suppression), cardiovascular system, and liver as well as and potential damage to the central nervous system (the brain and spinal cord)
Damage to the brain that can result in cognitive problems, such as issues with attention, memory, and reasoning, or the development of long-term emotional issues, including depression, anxiety, and even psychosis
Significant problems in one’s personal life, including issues at work, in school, with relationships, etc.
Potential overdose, which can be fatal
Individuals under the influence of barbiturates often have the same issues with reasoning and functioning as individuals who are highly intoxicated from alcohol. This increases the risk for the person to become involved in accidents, to make poor decisions that can be potentially dangerous, and to engage in behaviors that are risky, such as having unprotected sex. Chronic abuse of Nembutal can lead to various dangerous events that can affect both physical and mental health in the long run.
Overdose and Withdrawal
An overdose of Nembutal can be fatal due to the drug’s ability to shut down areas of the brain that control breathing and heart rate. Individuals can fall into a coma and die, or they may survive but develop severe brain damage as a result of decreased oxygen to important areas of the brain. Pentobarbital was widely abused and known on the streets as “yellow jackets” due to the yellow capsule of the Nembutal brand. Pentobarbital in pill form is no longer available. The death of Marilyn Monroe1962 was ruled as probable suicide due to an overdose of pentobarbital. The Kenneth Halliwell’s death is also attributed to an overdose of pentobarbital. .
Those who overdose on Nembutal often become very lethargic and confused, display significantly decreased breathing, and may become unconscious or comatose. Remember that Nembutal has been used to euthanize animals and even people. An overdose of Nembutal would have the same effects as the dose used for euthanasia.
When individuals mix central nervous system depressant drugs like barbiturates and benzodiazepines or barbiturates like Nembutal with alcohol, they are enhancing the suppressing effects of these drugs on the central nervous system. This makes overdose far more likely; hence, combining central nervous system depressant drugs is extremely dangerous.
Likewise, the withdrawal syndrome from drugs like Nembutal can be very dangerous due to the potential development of delirium tremens (DTs), similar to the DTs that can occur from alcohol withdrawal. It consists of severe confusion, hallucinations (most often, visual), tremors, and the potential for seizures. The seizures that can occur as a result of barbiturate withdrawal can be fatal.
Individuals who have chronically abused Nembutal will need to be monitored by a physician and placed on a physician-assisted withdrawal management protocol. This typically involves the administration of a longer-acting barbiturate or benzodiazepine in a dose sufficient enough to control any withdrawal symptoms, and then slowly tapering down the dose periodically to allow the person to slowly become accustomed to functioning on lower doses of the drug without experiencing significant withdrawal symptoms. Eventually, once the dose is small enough, the drug can be totally discontinued.
Recovery after Withdrawal
Simply getting through the withdrawal period from Nembutal is not sufficient for recovery. Individuals who do not get involved in an aftercare program, which is a professional organized substance use disorder recovery program following withdrawal management, will inevitably relapse. Even individuals who get involved in a recovery program relapse at relatively high rates, but these individuals will be prepared to deal with relapse, make corrections to their plans of recovery, and move forward.
According to the National Institute on Drug Abuse, there are some major treatment components that have been shown to be important in recovery from any type of substance use disorder. These include:
A thorough physical, psychological, and social evaluation to determine all areas of need that should be addressed during treatment
Withdrawal management when indicated
A treatment program that should include:
Continued medical management, including treatment for any co-occurring disorders as identified in the assessment
Substance use disorder therapy and other psychotherapy as indicated in the assessment
Integration of family and social support, including participation in peer support groups such as 12-Step groups
Support for other important areas of life, such as skills training, employment and housing assistance, etc.
Treatment that lasts a sufficient length of time
A key point in successful recovery from Nembutal is to get support from others. This may come from family, therapists, or peers in support groups. Often, individuals who are in recovery from a substance use disorder as a result of abusing Nembutal find that they must make significant changes in their circle of friends in order to avoid triggers and temptations to use the drug again. Many times, these people develop new friendships through therapy and social support groups that last a lifetime.