This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (33)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

David E. Smith, MD; Donald R. Wesson, MD

Arch Gen Psychiatry. 1971;24(1):56-60.

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

Author Affiliations
San Francisco

From the Department of Pharmacology, San Francisco Medical Center, and the Haight-Ashbury Free Clinic (Dr. Smith), and the Department of Psychiatry, San Francisco General Hospital (Dr. Wesson), San Francisco.

Footnotes
Accepted for publication March 16, 1970.

Reprint requests to Department of Pharmacology, San Francisco Medical Center, University of California, San Francisco 94122 (Dr. Smith).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Role of the Primary Care Physician in Problems of Substance Abuse
Weaver et al.
Arch Intern Med 1999;159:913-924.
ABSTRACT | FULL TEXT  

Evaluation and Treatment of Agitation in the Intensive Care Unit
Tesar and Stern
J Intensive Care Med 1986;1:137-148.
ABSTRACT  

Acute Toxic and Withdrawal Reactions Associated with Drug Use and Abuse
KHANTZIAN and McKENNA
ANN INTERN MED 1979;90:361-372.
ABSTRACT  

Outpatient Treatment and Outcome of Prescription Drug Abuse
Tennant
Arch Intern Med 1979;139:154-156.
ABSTRACT  

Guidelines for the Management of Hospitalized Narcotic Addicts
FULTZ and SENAY
ANN INTERN MED 1975;82:815-818.
ABSTRACT