Fioricet is a medication approved by the FDA for the treatment of three specific types of headaches including: tension, muscle contraction, and post-dural puncture. It contains a unique blend of a barbiturate (butalbital 50 mg), an NSAID (acetaminophen 300 mg), and a stimulant (caffeine 40 mg); hence the reason it is sometimes abbreviated as Butal-Acet-Caff. For those that have been properly evaluated and accurately diagnosed with tension, muscle contraction, and post-dural puncture headaches – Fioricet is a highly effective intervention and can be a lifesaver.
Although the usage of Fioricet for migraines is not supported by the FDA nor scientific literature, medical professionals may, nonetheless, prescribe it for this condition. A subset of those who take it may experience a mild analgesia, psychomotor slowing, and a sense of physiological tranquility. This sensory experience is facilitated principally by action of butalbital, the barbiturate component of Fioricet, on GABAergic systems to suppress CNS activity.
While the caffeine (40 mg) component of Fioricet attenuates some of the CNS depression induced by butalbital (50 mg), it doesn’t fully override it. For this reason, individuals who abuse, misuse, and/or overuse Fioricet may experience a neurophysiological “high.” Upon experiencing this mildly pleasurable intoxication [characterized by pain relief and relaxation], users may be more likely to abuse Fioricet in the future.
Fioricet “High”: Intoxication from Butalbital-Containing Agents
The FDA initially approved Fioricet in 1984, which at the time, was manufactured by Novartis Pharmaceuticals. In 2003, manufacturing rights were purchased by Watson Pharmaceuticals and by 2012, Watson acquired the pharmaceutical company Actavis and opted to switch their company name to Actavis Inc. When Fioricet initially hit the market in the 1980s, the original formulation included 50 mg butalbital, 325 mg acetaminophen, and 40 mg caffeine.
In 2011, the FDA issued a mandate that all combination pharmaceutical products limit acetaminophen constituents to a dosage threshold of 325 mg or below by 2014; this was primarily to reduce likelihood of acetaminophen-induced hepatotoxicity. To be on the safe side, Fioricet manufacturers reduced acetaminophen contents to 300 mg per dose. Hence, the new formulation consists of the same 50 mg butalbital and 40 mg caffeine, but slightly less acetaminophen (300 mg) compared to the old formulation (325 mg).
That said, of the constituents within Fioricet, the “high” that some users experience isn’t associated with acetaminophen or caffeine. The intoxication is derived principally from the 50 mg butalbital, a short-to-intermediate acting barbiturate. Butalbital is understood to alleviate anxiety, relax muscles, reduce pain, and induce sedation.
The array of neurophysiological effects associated with butalbital remain somewhat unclear due to the fact that it is only manufactured as a component within combination products. Researchers believe butalbital upregulates the inhibitory neurotransmission of GABA (gamma-aminobutyric acid) by binding to receptor sites within an area known as the chloride receptor ionopore complex. The chloride receptor ionopore complex is a distinct area from that implicated in the binding of benzodiazepine agents.
Upon binding of butalbital to receptor sites within chloride ionopore complex, chloride channels remain open for a longer duration, allowing for a heightened influx of chloride ions. The chloride influx causes neurons to become hyperpolarized, which dampens receptivity to excitatory postsynaptic stimulation. This, in turn, depresses activity within the CNS – likely in a dose dependent manner and leads to a recreational buzz and/or high.
Fioricet High: Characteristics of Intoxication
The characteristics of Fioricet intoxication are similar to those associated with other CNS depressants. Scientific publications indicate that, upon comparison, features of intoxication from butalbital are nearly identical to those of alcohol. Those who abuse Fioricet and/or ingest abnormally high doses to experience a “high” will likely report a mix of the characteristics below.
- Anxiety reduction: Many people with anxiety disorders have discovered that Fioricet can significantly decrease anxious feelings even when ingested at a normative dose. When taken irresponsibly at supratherapeutic concentrations, anxiety may completely vanish. This anxiolytic effect occurs as a result of butalbital’s ability to modulate GABA. In fact, one reason some individuals may abuse Fioricet is specifically for anxiety reduction. Users have compared the anxiety reduction during a “high” to that attained from benzodiazepines and/or alcohol.
- Depersonalization: Not all users find the “high” associated with Fioricet to be pleasant. In fact, a majority of individuals who’ve experimented with large doses drug report the opposite – they feel uncomfortable and worse than prior to its ingestion. This unpleasant intoxication is characterized by confusion, depersonalization, and sluggishness. As a result of the unpleasant effects experienced by many, there are often debates as to whether it holds any recreational value.
- Drowsiness: It is common for those who ingest large doses of Fioricet to experience drowsiness. Feeling drowsier than usual can occur with even standard doses of the drug, but when the intake is increased to an abnormally high level, users often report lethargy, fatigue, and a sense of drowsiness. This drowsiness results from excessive CNS depression induced by the higher-than-recommended dosage.
- Euphoria: Those who take Fioricet with the intent of attaining a “high” often experience a mild-to-moderate sense of pleasure and/or euphoria. This effect occurs as a result of GABA modulation and corresponding CNS downregulation induced by butalbital. However, with frequent recreational use and/or abuse of Fioricet, its euphoriant effect will dwindle and/or subside. Newer users are more likely to experience the euphoria compared to long-term ones.
- Jitteriness: Certain individuals may ingest large doses of butalbital and report feeling jittery. This jitteriness is a result of caffeine reaching a certain concentration within the body. Although most of the stimulatory effects of caffeine are significantly offset by butalbital, the caffeine is still capable of provoking jitters when metabolized at a certain rate and/or when reaching a specific concentration in the body. As a result, recreational users of Fioricet could feel relaxed, yet simultaneously jittery.
- Lightheadedness: High-doses of Fioricet could lead to sensations of lightheadedness plus dizziness. In extreme cases, a person may end up fainting as a result of their abnormally high Fioricet dosing. That said, this lightheadedness may not be perceived as problematic to the accompanying neurophysiological relaxation.
- Mood enhancement: Not everyone taking Fioricet for intoxication will necessarily report significant (or even mild) euphoria. However, a non-euphoric mood enhancement may still occur. Mood enhancement may be induced via the GABAergic effect of butalbital, but could be facilitated by the other components – acetaminophen and caffeine. Caffeine can sometimes perk up one’s mood and acetaminophen can reduce inflammation (which also can improve mood). Perhaps the combined adenosine, GABA, and inflammatory modulation contributes to Fioricet’s mood enhancing properties when ingested in large doses.
- Numbness: An aspect of Fioricet intoxication that many claim to enjoy is the sensation of numbness. This numbness may be physical numbness, as if all sensations of pain have been eliminated, but could also be emotional numbness. Some users may experience a hybrid of physical and emotional numbness simultaneously after ingesting Fioricet. It is understood that GABA is implicated in nociception processes, possibly a means by which numbness is induced.
- Relaxation: Perhaps the top reason individuals ingest large amounts of Fioricet is to induce physical and/or psychological relaxation. The butalbital is more than capable of dampening activity within the CNS, especially in large quantities, which facilitates feelings of internal calmness, peace, and tranquility. Anecdotal accounts have described the relaxation associated with Fioricet as feeling “loosened up” (e.g. no tight muscles) and extremely comfortable. Some accounts have gone as far as to compare the relaxing “high” from Fioricet to benzodiazepines and opioids.
- Recklessness: Those that take high doses in attempt to experience a “high” may feel fearless and engage in reckless or careless behaviors. Large dose users may appear uninhibited similar to they would if they had ingested copious amounts of alcohol and/or other CNS depressants. While everyone is ultimately responsible for their behavior, conscious oversight is cast by the wayside as a result of excessive GABA activity.
- Sleepiness: A subset of individuals may become sleepy while taking Fioricet. While Fioricet contains caffeine in attempt to balance out the depressant effects of butalbital, this caffeine may not be enough for some individuals. Someone who is a rapid metabolizer of caffeine may experience more jitteriness and stimulation quickly after taking Fioricet, whereas another individual may notice no significant effects from the caffeine and end up feeling drowsy and/or sleepy.
- Slurred speech: Similar to those who abuse alcohol, individuals experiencing Fioricet intoxication may communicate with slurred speech. While slurring of speech does not occur among all intoxicated users, speech slurring is a sign that the recommended dosage guidelines have been exceeded. Slurred speech may be a sign that the intoxication attained from butalbital within Fioricet is severe and potentially life-threatening.
- Stumbling: Those that take high doses of Fioricet for the purposes of intoxication may find it difficult to maintain balance and fine motor skills. The person may stumble when he/she walks and will certainly not be equipped to engage in any sort of strenuous physical activity. The combination of stumbling plus slurred speech is easily mistaken as alcohol intoxication.
Factors influencing the Fioricet “high” (intoxication)
The extent to which a person feels “high” following the usage of Fioricet is contingent upon numerous factors including: the dosage ingested, specific formulation, CYP450 isoenzymes, and ingestion of other substances. Additionally, whether a user have developed tolerance to butalbital can also predict whether a “high” is likely to be attained. The synergism of these factors will determine the extent to which someone is intoxicated while using Fioricet, particularly the butalbital within it.
The standard dosage of Fioricet for the treatment of headaches is 1 to 2 tablets every 4 hours. Instructions indicate that patients should not exceed more than 6 tablets per day. Those who take Fioricet recreationally with the intent of attaining some sort of “high” tend to exceed the recommended dosage guidelines, sometimes by a longshot.
The extent to which these dosage guidelines are exceeded will dictate the degree of the psychological and/or physical high attained by the user. A slight increase in dosing from the medically recommended amount may lead to a mild or moderate high. On the other hand, those that ingest a substantially greater amount than recommended by professionals may experience a very potent intoxication.
Tolerance is an important factor to consider whenever contemplating how high someone is likely to get from Fioricet. An individual that’s been using Fioricet frequently over a long-term may take a seemingly large dose, yet as a result of their chronic usage, no “high” is experienced. Conversely, a person who’s never ingested Fioricet, and starts with a large dose, is surely to experience some sort of intoxication that may be classified as a “high.”
Individuals that have accrued a high tolerance to Fioricet will necessitate a dangerously large dose to attain any sort of pleasurable intoxication. Those without a tolerance who take slightly more than the normally prescribed dose (e.g. 4 pills instead of 2) are likely to experience some sort of high.
Though most people are prescribed the standardized Fioricet (50 mg butalbital, 300 mg acetaminophen, 40 mg caffeine), there is another less common format that adds 30 mg codeine to the mix. Those that are using the opioidergic version of Fioricet with codeine are surely more likely to attain a “high” than those ingesting the standardized version. The GABAergic effects of butalbital are likely to act synergistically with the opioidergic effects of codeine for a more potent intoxication.
Barbiturates (e.g. butalbital) and opioids (e.g. codeine) are seldom recommended to be ingested together. Taking slightly too much of each could lead to respiratory depression, hepatotoxicity, and/or death. Those taking Fioricet with codeine will require a much lower dose than the formulation devoid of opioids to experience a “high.”
Assuming individuals administer Fioricet orally, the 50 mg butalbital within each tablet is metabolized by CYP450 (cytochrome P450) isoenzymes in the liver. The metabolism of butalbital is mediated principally by the CYP3A4 isoenzyme, as well as CYP2D6 and CYP2C9. Since a subset of Fioricet users may have genetic polymorphisms affecting expression of these enzymes, some may experience a more significant “high” compared to others.
Particularly, an ultrarapid metabolizer of CYP2D6 may increase likelihood of a high from a lower dose of Fioricet due to the fact that some of the butalbital is metabolized at a faster rate. Quicker metabolism leads to a sudden delivery of some butalbital (or metabolites) to the CNS, thereby enhancing its effect. Since most polymorphisms of CYP3A4 slow the metabolism of butalbital, those with CYP3A4 polymorphisms may experience no significant high from an increased dose.
Contrarily, a person with normal CYP3A4 function and simultaneous rapid CYP2D6 and/or CYP2C9 metabolism may report a high from a lower dose due to the quicker sudden circulation of the butalbital. Someone taking the Fioricet version with codeine (30 mg) will need to be especially cognizant of their CYP450 isoenzyme statuses. A rapid CYP2D6 metabolizer who takes even slightly more Fioricet (with codeine) than medically intended may experience a high and possibly serious consequences.
Co-administration of substances
In attempt to enhance the high associated with Fioricet, some individuals administer additional drugs and/or supplements. Perhaps inadvertently or unknowingly, a small percentage of those taking Fioricet may engage in the occasional drinking of alcohol during treatment. Alcohol alters the neurotransmission of GABA similarly to butalbital, in fact, some studies suggest that butalbital intoxication is nearly indistinguishable from alcohol intoxication.
When Fioricet is combined with alcohol, the synergistic CNS depressant effect from butalbital plus alcohol will be significant. This will leave an individual feeling intoxicated even if a normal dose of Fioricet is ingested. Keep in mind that alcohol is just one substance that potentiates the “high” associated with Fioricet, arguably to a dangerous extent.
Nearly any CNS depressant administered along with Fioricet (regardless of its potency) should be regarded as a potentiator of the “high” to be attained. Oppositely, those who ingest any sort of stimulatory agent would be less likely to experience a high from Fioricet. Stimulatory agents will cancel out the GABAergic intoxication induced by butalbital.
In addition to pharmacodynamic interactions, users should consider that pharmacokinetic interactions may alter the intoxication associated with butalbital. A seemingly benign agent like capsaicin acts as a CYP3A4 inducer, meaning it enhances CYP3A4-mediated metabolism, possibly enough to promote faster breakdown of butalbital. This faster breakdown could (theoretically) facilitate a more potent high from a lower dose.
Note: The aforestated factors that influence a user’s degree of intoxication while taking Fioricet will be contingent upon modality of administration. This article was written under the assumption that most abuse occurs via oral ingestion. A subset of abusers may administer Fioricet intranasally (such as by snorting) which may affect their high.
Potentiating the Intoxication: Extraction of Butalbital from Fioricet…
It is necessary to highlight that some individuals have gone as far as to extract butalbital contents from Fioricet in attempt to eliminate caffeine and acetaminophen. Their impetus for caffeine and acetaminophen elimination is two-fold: caffeine offsets CNS depressant effects of butalbital and acetaminophen is capable of damaging the liver. Isolation of butalbital delivers a more potent sense of intoxication and reduces risk of hepatotoxicity.
Anecdotal accounts discuss extraction techniques online in various forums throughout the internet. Whether these extraction techniques are effective is debatable and is likely contingent upon the competency of the person performing the extraction. All extraction methods involve tampering with the Fioricet tablets and are regarded as illegal.
Those using Fioricet to attain their high are usually not concerned with legality. They report crushing tablets to form a fine powder, dissolving the powder in water, shaking it, filtering out the APAP and caffeine, and adding to hydrochloric acid. Many claim that their techniques yield 100% pure butalbital, which if the case, would facilitate a potent neurophysiological high.
Why Fioricet is Abused or Used Recreationally for a “High”
Fioricet is utilized recreationally for a number of obvious reasons including: its easiness to obtain, its lack of legal restriction, and relatively low cost (as a generic). All that’s required is the diagnosis of a tension headache and you may end up with a Fioricet prescription. Among drug addicts and/or thrill seekers, there’s likely significant temptation to misuse and/or abuse Fioricet on a recreational basis.
- Addiction: Many individuals struggling with drug addiction are very knowledgeable about the constituents of pharmacological agents such as Fioricet, understanding that butalbital can facilitate a potent high. While addicts may dislike the acetaminophen and caffeine components, they may not mind as long as the Fioricet alters perception and/or yields some sensory pleasure.
- Frequently prescribed: To receive a prescription for Fioricet, all it takes is a diagnosis of certain headaches including: muscle contraction, post-dural puncture, and/or tension subtypes. While many doctors issue interventions besides Fioricet, some may use Fioricet as a first-line anti-headache agent. Additionally, Fioricet is commonly prescribed off-label as an anti-migraine agent, thereby reaching more customers (and potential abusers).
- Price: For those with good health insurance, the cost of Fioricet may be extremely cheap. For others who are able to purchase it with a coupon and/or from specific pharmacies, 30 pills can be attained for under $30. While the average cost ranges from $40 to $80 from other pharmacies without a discount, most would still consider this price to be reasonable. As a result of its reasonable generic price, some may perceive Fioricet as a low-cost means of intoxication.
- Legal classification: Due to its barbiturate component, Fioricet is classified as a Schedule III controlled-substance in 4 states within the U.S., namely: Georgia, Maryland, New Mexico, and Utah. Throughout the rest of the country, the drug is available with a standard prescription and refills can be issued without a follow-up visit. The lack of restriction in most states results in a greater number of individuals attaining Fioricet and abusing it without suspicion of medical professionals.
- Thrill seekers: A small number of those who’ve managed to attain Fioricet prescriptions may be thrill seekers (rather than drug addicts). Upon realizing that Fioricet contains butalbital, these thrill-seekers may ingest a high dose simply to experience an intoxication and/or buzz. They may also dispense some of their prescription to close friends and/or a significant other for a shared intoxication experience.
Consequences & Dangers of Fioricet Intoxication
There are numerous dangers associated with using Fioricet to experience a neurophysiological “high.” When used recreationally for intoxication, users are often unaware of a threshold dosing limit for safety. This upper threshold of dosing is individualized based on other medications a person is taking, his/her isoenzyme function, and body size.
Without knowledge of this upper dosing limit, it is possible that an array of deleterious effects may occur such as: hepatotoxicity, fainting, and possibly death (via respiratory arrest). For this reason, utilizing Fioricet to get “high” should be considered unsafe and a recipe for potential long-term damages. Though not everyone abusing Fioricet ends up in the hospital with liver damage and/or respiratory depression – these are possible consequences.
- Addiction: Barbiturates are known to be among the most addictive drugs on the market, and as a result, they are seldom used. Since butalbital is not manufactured as a standalone agent, its usage is less restricted such as within Fioricet. Many individuals have struggled with Fioricet addiction, yet only a small percentage of these cases is reported to professionals. Misusing Fioricet to get high, especially if done regularly, increases risk of developing an addiction.
- Adverse reactions: The possibility of experiencing an adverse reaction is amplified when ingesting dosages of Fioricet exceeding clinical guidelines. Not only will users be likely to encounter the usual side effects of dizziness, drowsiness, lightheadedness, sedation, etc. – they may experience Stevens-Johnson syndrome or anaphylaxis. Both Stevens-Johnson syndrome and anaphylaxis are considered to be potentially life-threatening if untreated.
- Brain damage: While the caffeine content alone could theoretically cause neurotoxicity if Fioricet is ingested in an extremely large dose, usually the caffeine is counterbalanced by the butalbital. Therefore, neurotoxicity resulting from any particular component of Fioricet is unlikely. However, at extremely large doses, individuals may experience brain damage through hypoxia. Assuming you experience respiratory depression from the butalbital and feel “high,” your lung function may be impaired to such an extent that brain oxygenation is reduced, leading to hypoxia-induced damage. Certainly not all users will experience hypoxic damage when misusing Fioricet, but the possibility shouldn’t be dismissed.
- Crash: Many users have noted that once their pleasurable “high” from Fioricet wears off, they experience a significant crash. While the severity of the crash is subject to individual variation, characteristics of this crash include: brain fog, cognitive deficits, fatigue, and extended bouts of sleep. You may find it difficult to get out of bed, stay productive and/or motivated, and feel like a slug for a day or two after the Fioricet misuse.
- Dependence: Those who regularly ingest Fioricet to experience a “high” may become dependent on its pharmacological effect. Dependence isn’t likely to occur among every Fioricet user, but the likelihood increases among those who misuse it by taking larger quantities than were instructed by a doctor. Unfortunately, after someone has become dependent on Fioricet, discontinuation effects may be extreme and/or impair overall functionality for an extended period.
- Fatality: Assuming someone ingests a supratherapeutic dose of Fioricet without any tolerance, he/she may experience respiratory depression, followed by respiratory arrest. It is understood that the butalbital content within Fioricet facilitates CNS depression, and when taken to an extreme, the lungs may fail to function properly. As a result, carbon dioxide levels increase, respiratory acidosis may ensue, and/or breathing may cease altogether – leading to brain damage and possibly premature death.
- Interactions: Fioricet is understood to interact with a host of other substances, particularly CNS depressants. Therefore, it is contraindicated among those who drink alcohol or regularly ingest benzodiazepines, opioids, barbiturates, etc. Some Fioricet users may take it along with another agent in attempt to potentiate the intoxication of butalbital. However, co-administration of an agent such as alcohol increases risk of hepatotoxicity (liver damage) as well as risk of respiratory depression (leading to death of brain cells via hypoxia), and death by respiratory arrest.
- Overdose potential: Many individuals using Fioricet to get “high” are ignorant to the fact that they may overdose. While some would argue that the presence of caffeine minimizes likelihood of an overdose, it is important to realize that the butalbital-induced CNS depression outweighs the stimulatory mechanisms of caffeine. Those who’ve never used Fioricet and decide to take a mega-dose for intoxication could overdose. If the Fioricet is combined with a benzodiazepine, the GABAergic potency may be amplified by over 9-fold, substantially increasing likelihood of an overdose.
- Rebound effects: Those using most drugs to get “high” are not generally great at considering the long-term consequences. They seek instant pleasure and/or gratification, but this instant pleasure comes at a significant cost. Not only will individuals experience a “crash” following usage, but rebound effects will ensue. These rebound effects may include: severe headaches, anxiety, depression, irritability, and mood swings. It is unclear how long these rebound effects will persist following cessation of Fioricet, but they’ll likely linger for a much longer duration than the “high” itself.
- Tolerance: Those who misuse Fioricet will eventually become tolerant to its effects. The intoxication from an initial “large” dose may no longer be experienced with continued administration of the same dose. Once tolerance is established, an addict may attempt to further increase his/her dose to experience the butalbital high. The problem is that dosages may reach such an extreme amount, that the individual may inadvertently overdose as a result of CNS depression. Additionally, those with a high tolerance will experience a tougher and prolonged discontinuation period compared to those with lower tolerance.
- Withdrawal: Fioricet withdrawal is often debilitating and long-lasting – especially among individuals that abused it. During withdrawal, users tend to experience numerous unwanted effects including: anxiety, confusion, depression, headaches, muscle aches, etc. Withdrawal is essentially a double whammy in that users are discontinuing multiple agents simultaneously – caffeine and butalbital. Abrupt discontinuation of Fioricet may result in seizures, drug-induced psychosis, and/or other disastrous effects (as a result of changes in GABA activity), hence the reason it should always be tapered. Coupling these GABAergic consequences with caffeine withdrawal symptoms may cause a subset of users to experience post acute withdrawal syndrome (PAWS).
How Fioricet is Obtained for Abuse or Recreational Use
It’s relatively common sense to determine how Fioricet is obtained and used recreationally. Those that are able to attain a prescription for Fioricet as a treatment for headaches may decide to administer a dosage exceeding the amount recommended by a professional. Following administration of a large dose, the person will notice a significant change in various aspects of consciousness including cognition, emotion, and perception.
Medical prescription or unauthorized purchase
There are two primary ways by which Fioricet is attained for recreational use and/or intoxication. The first involves consulting a doctor and reporting a tension, post-dural puncture, and/or muscle contraction headache. Though some doctors will hesitate to prescribe Fioricet, some will dole it out as a first-line intervention.
While most who attain a prescription for Fioricet have legitimate headaches, it could be speculated that a subset of individuals may report headaches simply to obtain the prescription for abuse. Another subset of individuals may purchase Fioricet illicitly on the internet (e.g. dark net), from a street dealer, friends, and/or family. In 46 out of 50 states within the U.S., Fioricet is considered a general prescription, whereas in 4 states, it is tightly restricted as a Schedule III substance.
While certainly against medical guidelines, many users report taking 5-6 Fioricet tablets at once to experience the intoxication. Hypothetically, if a person were to take 6 Fioricet tablets, this would deliver a total of 300 mg butalbital, 1800 mg acetaminophen, and 240 mg caffeine. This places a serious burden on the liver, especially among those with various forms of hepatic impairment (e.g. cirrhosis).
Compared to a normative dose of 1 to 2 tablets per hour, this triples the amount circulating throughout a person’s system. These tablets are most commonly ingested orally, but some accounts have documented intranasal insufflation (snorting). The modality by which Fioricet is ingested can have an impact on degree of intoxication experienced, as well as its duration.
Intoxication or “High”
The onset of the Fioricet’s intoxicating effect is considered rapid and is thought to last approximately 4 hours. The duration of effect may be subject to slight variation depending on specific CYP450 polymorphisms of the particular user. Some individuals may report a slightly faster peak effect with a shorter total duration of intoxication, while others may report a slightly slower peak effect with a longer-lasting duration.
While intoxicated, individuals will experience psychomotor slowing, physical relaxation, and CNS depression. The high may be subject to slight variation based on the specific amount of Fioricet ingested. Some have compared the intoxicating effect of Fioricet to that of alcohol, other benzodiazepines, and select opioids. Others claim that the intoxication derived from Fioricet is unpleasant and markedly distinct from other CNS depressants.
Maintenance of the intoxication
Those addicted to the intoxication provided by Fioricet may readminister the drug in moderate doses every 4 hours for a maintenance effect. The purpose of this readministration is to delay the comedown or “crash” experienced after the neurophysiological intoxication subsides. The timing at which a second dose is administered, as well as the dosage of Fioricet readministered will determine whether the “high” is maintained.
Since most individuals have a limited supply of Fioricet, not all abusers engage in readministration. However, those looking to remain intoxicated for an entire day may continuously readminister the drug. The “high” cannot be maintained forever, but some individuals may stay intoxicated until their normal sleep time, allowing them to sleep through part of the inevitable crash.
Crash + Withdrawal
Unmistakably, Fioricet abusers will experience some sort of “crash” starting immediately after the drug’s effect wears off. This crash is considered acute, unwanted effects characterized by cognitive deficits, fatigue, and somnolence. The crash may last several hours or continue for days after a large Fioricet dose.
If someone had been using Fioricet for a long duration, this “crash” may be among the earliest stages of Fioricet withdrawal. Most individuals will experience unpleasant symptoms that are the exact opposite of the intoxication provided by the drug including: anxiety, depression, mood swings, muscle tension, etc. Should an individual continue taking Fioricet to avoid discontinuation symptoms, an individual may be considered dependent on the drug for functioning.
Strategies to minimize Fioricet misuse and abuse
In effort to minimize the likelihood that Fioricet is abused and/or misused, I’ve listed some strategies to be employed. To reduce Fioricet abuse, the most logical intervention is to decrease its total number of prescriptions by considering alternative, less risky first-line options for headaches. Other treatment strategies include: minimizing off-label prescriptions, determining high risk patients (addiction history or thrill seekers), limiting pill numbers, and/or changing its status to a Schedule III controlled-substance.
- Avoid as a first-line intervention: The easiest way to reduce the likelihood of Fioricet abuse is for medical professionals to avoid it as a first-line intervention. Though it has proven effective for the treatment of tension, post-dural puncture, and muscle contraction headaches – it has potential for abuse and dependence. There are numerous other headache treatments and interventions that do not carry the same set of risks.
- Reduce off-label prescriptions: Despite a paucity of evidence to support the usage of Fioricet for migraines, it is commonly prescribed to migraine sufferers. There are a multitude of other treatments that have no abuse potential and aren’t associated with dependence that should be tested prior to Fioricet. To decrease likelihood of abuse, professionals may want to reserve it as a last-resort treatment for migraines.
- No prescriptions to high-risk patients: Patients should be evaluated to determine whether they have a history of drug abuse and/or addiction, an addictive personality, and/or a thrill-seeking personality – prior to getting a Fioricet prescription. While it’s difficult to ask patients about their personality in a direct 1-on-1 consultation, a questionnaire should be administered. Furthermore, medical professionals should use their best judgment to determine if a person is likely to misuse Fioricet. If a patient is considered “high-risk,” he/she should receive an alternative, safer treatment.
- Restrictions: It may be helpful for medical professionals to place restrictions on the dosage and total number of Fioricet tablets received per prescription. Additionally, it may be beneficial to limit the number of refills available. If a patient quickly “runs out” of his/her pills and/or refills, misuse and/or abuse should be suspected. Evidence indicates that with Fioricet, larger doses and frequent usage does not produce greater therapeutic efficacy than lower doses, in fact, most research suggests the opposite (better outcomes occur on the minimal effective dose). By restricting Fioricet and carefully monitoring patients, usage for intoxication is less likely to occur.
- Schedule III status: In the opinion of some, Fioricet should be classified as a Schedule III controlled substance throughout the entire United States. This would make it more difficult for patients to attain. Doctors would be more conservative about issuing it to patients, especially in large doses and/or quantities. It is currently a Schedule III controlled substance in 4 states, but since it contains butalbital, most would agree that it should be a Schedule III in all states.
Have you experienced a “high” from Fioricet or Butalbital?
If you’ve managed to obtain Fioricet and have ingested a large dose with the intention of experiencing a high and/or buzz, share your experience in the comments section below. To help others get a better understanding of your experience, mention some specifics including: the dosage you took at once (e.g. 6 Fioricet), whether you were taking any other substances along with it (e.g. drugs, supplements, etc.), and how long the effect lasted. Would you classify your subjective experience as: pleasurable, neutral, unwanted, or negative?
Document whether you attained your Fioricet from a medical doctor, online purchase, a friend/family, and/or street purchase. For those that have experience using CNS depressants for a “high,” which agents remind you most of Fioricet (e.g. alcohol, benzodiazepines, opioids, etc.)? Literature suggests that the intoxicating effects of butalbital, the barbiturate component of Fioricet, are most similar to those of alcohol.
Clearly there are many other substances with greater abuse potential and/or recreational value when compared to Fioricet. However, Fioricet remains relatively easy to attain as a prescription, and for this reason, abuse with the intent of “getting high” will continue among a small percentage of patients. Medical professionals should beware of Fioricet misuse among patients, while patients should be informed of the the deleterious and potentially life-threatening consequences associated with Fioricet abuse.