Butalbital Detox: Withdrawal Treatment for Butalbital Addiction

What is butalbital and why is it risky? How can you recognize dependence and get lasting help? Use this resource to learn what you need to know about butalbital misuse, addiction, detox, and recovery options. 

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What is Butalbital, and Why is it Dangerous?

Butalbital is a barbiturate medication classified as a sedative-hypnotic.

Barbiturates depress the central nervous system (CNS). Butalbital is combined with other non-steroidal anti-inflammatory drugs (NSAIDS) in order to relieve pain. These compound medications effectively inhibit nerves from transmitting pain signals and can create a euphoric sensation. 

NSAIDS include acetaminophen, ibuprofen, or common aspirin. Sometimes, caffeine is also added to increase blood flow and absorption. Certain butalbital medications also add an opioid like codeine to enhance pain relief.

This combination medication has been prescribed by health care providers to address symptoms related to tension and migraine headaches since the 1970s. 

Any barbiturate based medication is highly addictive and can be abused because it can produce a euphoric response similar to alcohol or other sedative drugs.

It requires a medically supervised detoxification process because the withdrawal symptoms can be life threatening. Seizures, cardiac fluctuations, psychosis, nervous system dysfunction and dehydration are all life-threatening symptoms of barbiturate withdrawal. 

Other Names for Butalbital (and What They Mean)

Common brand names of butalbital compounds include Fioricet, Bupap, Butapap, Allzital, Ascomp, Orbivan, Tencon, and Trianal. Some formulations also contain codeine, an opioid closely related to morphine which can increase dependency.

If you are allergic to opioids like morphine and codeine, it is essential that you talk with your health care provider about which medication is safe for you to use. Different medications also have different amounts of each chemical in them.

Some may have more butalbital and less NSAID, or vice versa. 

• Fioricet/Orbivan/Fortabs/Esgic/Fiormor/Fiortal/Laniroif
  • Contains butalbital, acetaminophen, and caffeine
  • Commonly prescribed for tension headaches
• Butalbital/APAP/Caffeine
  • Generic label for Fioricet
• Fiorinal
  • Similar, but includes aspirin instead of acetaminophen
• Butalbital-Acetaminophen-Caff-Codeine
  • Adds an opioid, increasing risk of addiction and overdose
• Esgic, Axocet, Ascomp
  • Other branded or combo medications that include butalbital
• Trianal
  • Butalbital and aspirin

Street names for other types of barbiturates that are sold illicitly are:

• Downers
• Yellow Jackets
• Red birds
• Reds
• Rainbows

How Butalbital Works, and How It’s Abused

While butalbital is generally prescribed for headaches, barbiturates are used by physicians for a variety of conditions. Barbiturates are used to address anxiety, insomnia and seizure disorders. Butalbital was specifically designed for headache pain relief. All barbiturate medications can be addictive if used over an extended period of time. 

Butalbital is sometimes abused by using it more than it is prescribed to increase the euphoric feelings. It is also abused by selling prescription medications to others for the same purpose.

It can be crushed and snorted like other prescription pills. It can be abused like any other powder when pills are crushed, intravenously when mixed with a fluid, or smoked by sprinkling on tobacco or marijuana. These are very dangerous ways to ingest a medication that is intended to dissolve slowly in the gastrointestinal system.

Signs of Butalbital Dependence or Addiction

Signs of barbiturate abuse and dependence are similar to other addictions. Addiction is a chronic disease defined by the continued use of a substance in spite of negative life consequences.

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Dependence refers to a state when the body physically requires use of a substance to avoid going into withdrawal. Tolerance is built up by continued use of a substance and requiring more and more of the substance to experience the same effects. 

Following are common signs that a person has become dependent or addicted to butalbital:

• Appearing drunk without consuming alcohol
• Frequently missing appointments
• Acting secretive about activities
• Medications are missing from family and friends
• Being unable to perform basic life skills involved in self care
• Being out of control and no longer able to sustain oneself financially, physically, mentally or emotionally

Self-assessment: Am I Addicted to Butalbital?

Take the following quick quiz to see if you are experiencing addiction to butalbital:

• Do I need to take more and more of the drug to get the same effect?
• Do I take it outside of prescribed use?
• Do I feel withdrawal between doses?
• Am I using the drug to cope with daily stress or emotions?

If you answered yes to any of these questions, click here find a detox center near you for support to break addiction or dependence on butalbital.

Side Effects and Dangers of Butalbital Use

Butalbital can cause serious side effects depending on the amount taken, the combination of drugs in the medication, and the route of administration.

Side effects of butalbital include:

• Dizzyness and lightheadedness
• Nausea, diarrhea and constipation
• Sedation and drowsiness
• Euphoria and intoxication
• Impairment of judgment and motor skills
• Memory loss and confusion 

Rarely, butalbital can lead to trouble breathing, anaphylaxis, and death from respiratory depression.

When butalbital is used in conjunction with benzodiazepines, alcohol, opioid pain medications and many other types of drugs, it can cause death. Make sure your health care provider knows all the medications you are currently taking before prescribing butalbital pain relievers. 

What is Butalbital Withdrawal Like? 

Home detoxification and withdrawal are not generally advised for someone who has been using butalbital combination medications or any other barbiturate.

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Similar to alcohol, the withdrawal process may cause seizures, hallucinations, psychosis, dehydration and the possibility of aspiration of vomit into the lungs, causing death. Medications may be needed to create a slow taper off the barbiturates. 

The various withdrawal and detoxification symptoms can include mild to severe effects.

Mild to moderate symptoms

• Anxiety
• Headache
• Nausea
• Diarrhea
• Cramping
• Confusion
• Restlessness
• Insomnia

Severe and life-threatening symptoms

• Delirium
• Seizures 
• Psychosis
• Hallucinations 
• Suicidal thoughts
• Hyperthermia 
• Cardiac arrest

Butalbital Withdrawal Timeline

While butalbital withdrawal can vary somewhat from person to person, you can expect the following general timeline.

• Days 1-3: Intense symptoms start (delirium, seizures possible)
• Days 4–7: Continued physical distress; decreasing symptoms
• Weeks 2–4: Mood symptoms dominate (depression, anxiety, insomnia)
• Up to 2 years: PAWS may occur

Within one to three days, the absence of the barbiturate in the system will create withdrawal symptoms. The symptoms will peak at this time. After four days, symptoms begin to decrease. The process can last from seven to fourteen days, depending on how much, how often and what kind of butalbital or barbiturate has been used. 

Post acute withdrawal syndrome (PAWS) can last up to two years. PAWS creates the psychological symptoms of withdrawal without the drug actually being in the system.

It is believed this is a process where the brain is “remembering” having the drug in the system, as the neuro receptors die off from lack of use. PAWS can create mood swings, vivid dreams and intense cravings while the brain adjusts to the lack of barbiturates in the system.

Dangers of Detoxing Without Help

The greatest danger of trying to detox from butalbital or any other barbiturate without medically assisted treatment is death. The central nervous system (CNS) contains the brain and spinal cord system.

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If it has grown accustomed to sedation through the use of butalbital, then taking that chemical away abruptly can cause seizures and malfunctions in the system. Due to these risks, medical attention is recommended for withdrawal from CNS depressants like butalbital.

Beyond the immediate physical risks, detoxing alone also increases the risk of relapse. This risk of relapse leads to an additional risk of overdose. The bottom line: Detox from butalbital should happen under medical supervision for personal safety and better recovery outcomes. 

Butalbital Detox Treatment Options

Individuals seeking butalbital detox have several options to make this a safe and successful process. 

Medical detox (inpatient treatment)

This is the recommended treatment option. A butalbital detox center that offers inpatient care can provide 24/7 monitoring and support as you experience withdrawal. Experts will provide barbiturate withdrawal treatment to minimize risks and increase comfort levels. 

Tapering strategy

Most treatment centers will use a phenobarbital or a benzodiazepine taper to slowly decrease the amount of sedative in the system. This prevents shock to the central nervous system and lessens the withdrawal symptoms. 

Psychiatric support

In addition to physical support, experts in barbiturate withdrawal treatment can monitor patients for trauma, hallucinations, or suicidal ideation. This psychiatric support can be essential as patients experience barbiturate withdrawal. 

Supplemental therapies

Some therapeutic methods that can be effective in treating butalbital withdrawal include cognitive behavioral therapy and medication. Some therapists may also suggest light therapy to support mood and sleep.

Downloadable Bonus: Headache & Mood Tracker

Monitoring the symptoms of headaches and migraines has proven helpful in mitigation of symptoms. However, tracking can be a challenge without the right tools. 

Our printable Headache & Mood Tracker can help you monitor symptoms and triggers and document recovery milestones This is a great tool for identifying patterns and sharing with your care team!

After Detox: Rehab and Long-Term Recovery 

Changing a lifestyle from addiction to recovery is a long process. With a step down plan, the longer a person remains in treatment, the higher the success rate of maintaining recovery. 

After stabilization and withdrawal, an inpatient treatment program provides a safe environment for the body and brain to adjust during the first 25 to 45 days.

The next step is to enter either an extended 90-day inpatient program or an intensive outpatient program (IOP). This provides three to four months of learning new life skills. It also provides the opportunity to build a peer support system. 

Finally, outpatient treatment can continue for as long as necessary to support a new lifestyle. Rehab can consist of family therapy, individual therapy, relationship counseling, groups for psychoeducational topics and peer support, and many other modalities for healing.

This long-term aftercare should also address any co-occurring mental health disorders present, such as depression, trauma, or anxiety.

Safer Alternatives for Headache Management

Because of the high levels of abuse of butalbital medications, other methods of pain management have been developed over time.

Many hospitals and treatment facilities offer programs that focus on behavioral modification, meditation, relaxation, yoga, Tia Chi, acupressure and acupuncture, along with other nonmedical approaches. Herbal remedies are also available through an increased intake of various vitamins and minerals.

Additionally, alternative medications that offer longer term results for pain management instead of short acting analgesics have been developed. These include botox injections and nerve blocks.

Steroidal injections also have been used to reduce inflammation associated with headaches. Light therapy has also been explored as an alternative therapy for chronic headaches. 

Call now to explore safer alternatives for chronic pain.

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