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Fioricet “High”: Intoxication From Butalbital-Containing Agents

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), a pain reliever (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.

  1. Fioricet dosage

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.

  1. Tolerance onset

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.

  1. Specific formulation

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.”

  1. CYP450 isoenzymes

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.

  1. 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.

  1. 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.

  1. Ingestion

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.

  1. 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.

  1. 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.

  1. 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.

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.

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  • Zip Zip January 2, 2017, 6:42 pm

    Interesting page and a conversation that needs a larger platform. I have chronic migraines since 2010 and fioricet is the only thing that reliably works for me. I need to take 2 for it to be effective.

    Otherwise I need to use high dose sumatriptan (100mg oral or 6mg injection) and they may or may not work, and often leave me groggy. Fioricet always works and the caffeine is a boost for me as migraines make me fatigued. For some intense migraines resembling cluster headaches – i.e. pick axe orbital pain – I need to take both 100mg sumatriptan and 2 fioricet.

    I also suffer from peripheral neuropathy due to Sjogren’s Syndrome, and the nerve inflammation causes occipital neuralgia (ON). ON pain often requires steroid-based nerve blocks. Fioricet helps ON pain during acute flare ups concurrent with migraines, or works as a bridge between nerve blocks. I take 300mg daily of Lyrica (aka pregabalin) for the peripheral neuropathy, but it does not help with the ON pain, nor as a migraine preventative.

    I have failed over a dozen migraine preventative medications, including first-line recommended drugs such as TCA’s, beta blockers, anti-convulsants, SNRI’s, and others. These medications either did not reduce my migraine activity, and/or caused side effects, ranging from gastritis to neuropathy. There are no FDA approved drugs designed to prevent or reduce migraines, they are medications that have been re-branded for migraine prevention.

    Of those only topamax, botox (both caused me side effects), beta-blockers and depakote are FDA approved for migraine prevention. So I was prescribed at minimum 5-10 preventative medications off-label by neurologists at reputable headache clinics. Triptans are the only FDA approved drug designed for acute abortion of migraines.

    Meanwhile, fioricet is designed specifically for headaches (tension type not migraine) yet doctors are hesitant prescribe it, despite 30 years of safe use and compiled patient data for migraines. A few reasons I can deduct for this hesitant hive-mind prescribing behavior regarding fioricet is:

    1, it’s old and not “cutting edge”.
    2, it’s generic and there are no salespeople pushing the medication.
    3, it’s become legend that it causes medication overuse headache/rebound headache, and will worsen the patient’s situation.
    4, it’s been lumped in with opiates, like percocet and vicodin, but fioricet is not opiate, and does not bind to opiate receptors; it binds primarily to cannabinoid and GABA-A receptors.
    5, it is a narcotic and can be abused.

    This mentality is a shame because the most frequently used abortive migraine treatments are triptans, OTC caffeine-analgesic combos, or opiates, which are ineffective for many people, and are just as likely to cause potential medication overuse headache (MOH). Fioricet actually works for me. I do not have side effects, though I sometimes get a brief euphoric feeling when the drug starts working.

    I find fioricet also helps with the muscle tension in neck and back which often accompany my migraines. I’ve read, anecdotally, that doctors are prescribing fioricet for fibromyalgia off-label with some success (likely due to its GABA agonist activity which induces smooth muscle relaxation). I am conscientious of my fioricet intake, and have never taken more than 4 fioricet in a day in over 2 years of use.

    I have taken 2 fioricet a day, against my better judgement, on consecutive days for up to 7-14 days. Maybe because I am waiting for a nerve block, or because my migraine trigger is weather – a week of changes in barometric pressure, humidity, temperature, and precipitation, can break my brain. I do take breaks from fioricet and use triptans only for 3-4 weeks every couple of months instead of fioricet so I do not develop a tolerance to the fioricet.

    I have never had withdrawal symptoms. In all, I take fioricet more often than I would like, but I get migraines more often than I would like! The frequency of migraines has not worsened with fioricet usage. Although the medical consensus concludes that medication overuse (MO) leads to medication overuse headache (MOH), aka rebound headache, that is not true for every patient. MO is sufficient but not necessary for MOH.

    In fact Fioricet has an advantage in that butalbital has a 35 hr half life, where as most triptans have a half-life of 2-5 hrs, making them much more likely for a headache to rebound. The short half-life of triptans may not be long enough to cover the time period when the brain is generating migraine activity from the periaqueductal gray matter, which in turn activates CGRP and substance P, the chemical that causes migraine symptoms. CGRP antibodies and CGRP metabolites are the next wave of cutting edge migraine treatments.

    Phase III trials are underway and it’s hoped they are FDA approved and on the market by 2020. So what are non-responder migraineurs to do until then? I have read doctors argue in published articles that fioricet should not be used for headaches at all, and should have its exemption from being a scheduled drug revoked.

    In counterargument, Dr Lawrence Robbins (not my doctor), neurologist and American Headache Foundation member, wrote a short article in 2012 called “In Defense of Butalbital”.* Dr Robbins concludes his defense by stating:

    “If we eliminate BCM (butalbital-containing medicines), many patients are left without effective options. We would not have BCM-mediated MOH, but many of these patients would subsequently overuse opioids, along with other analgesics. BCM have well-known downsides, but they also provide significant benefits.”

    Migraines manifest differently in different patients, and their response to medications are the farthest thing from one size fits all. In a published study** testing sumatriptan with naproxen (trade name treximet) vs fioricet, author A.W. Fox stated “Migraine is intrinsically pleiomorphic: diverse treatment options help match patient with therapy.” Fioricet is a fine option for those with no other working options.

    So why is fioricet so demonized? The addiction component is a real concern, and this can be controlled by not writing prescriptions with refills. Having a history of friends and family with substance abuse history, I can see how people with addiction behavior could abuse this drug and take large doses.

    The opioid epidemic is very real, but statistics have shown that opioid induced deaths are primarily from heroin and fentanyl patches (many of which are black market and mixed with other drugs). While I do sometimes get mild euphoric feelings when they drug kicks in, it’s short lived, and much less than potent than opioids (or benzodiazepines). I prefer marijuana to the high of opioids (make me irritable) or benzodiazepines (make me sedate), but unfortunately smoking or eating marijuana does not help my migraines.

    I am approved for medical marijuana in NY State, but I still have to fight to get my doctors to write me prescriptions of Fioricet. It’s time time to reevaluate the role of fioricet in migraines and non-migraine headache use. It’s important to educate doctors that fioricet is not an opioid, and is a better option than the opioids they may be prescribing their patients.

    The science of migraines and pain has advanced greatly in the 21st century. It is now understood that GABA is implicated in the nociceptive (pain) process. Fioricet’s GABA agonist properties should be emphasized to doctors for its ability in helping to relieve painful symptoms in patients with nociceptive pain syndromes, including migraine, fibromyalgia, and myofascial pain syndrome. These patients have a paucity of medications available to them to begin with, and fioricet can improve their quality of life without great expense to their pocket, and with a positive risk/benefit ratio.

    * “In Defense of Butalbital, Headache. 2012;52(8):1323-1324.” http://www.medscape.com/viewarticle/770550

    **”Efficacy, end points and eventualities: sumatriptan/naproxen versus butalbital/paracetamol/caffeine in the treatment of migraine.”


  • Elle December 20, 2016, 1:54 am

    I started taking Fioricet for migraines/headaches induced by a trauma I was going through. Eventually, I became dependent upon it because the euphoria from it took me out of the unpleasant reality of dealing with facing the issues that I needed to. In time, I began taking up to 16 a day. 6 at a time was what it took to get me high.

    I would honestly not wish this crap upon my worst enemy. It’s worse than alcoholism in many ways. I’m now an addict. It makes me sick but I keep taking it for the high. I don’t understand why anyone would recommend this.

    It doesn’t help you in the long run. It ruined so many parts of my life and made me crazy. You’d probably be better off doing heroin. Don’t take this! It will ruin your life! It doesn’t help after you take it long enough!

  • Kathleen October 10, 2016, 4:09 am

    I was prescribed Fioricet for tension headaches a few months ago. Which honestly I had no idea that’s what they were until I was prescribed the medication and experienced how effective it was. I have had a problem with physical addiction to pain pills in the past, which was not intentional, until after I had my son and subsequently an emergency cesarean section.

    This was over two years ago and was not a problem once I weaned my self off the medication (btw I was not told this is what was going on when I started experiencing physical withdrawal symptoms, and had to figure it out on my own). Anyways, I have gotten to the point with Fioricet where I need to take 3 in the early afternoon when I feel a headache coming, which is the only way for it to be effective since my body builds tolerance to pain medications quickly. Then I may take 2 about 4 -5 hours later.

    I know this is pushing the limit on acetaminophen daily dosages, and I never used to take acetaminophen regularly before now. This concerns me in terms of taking to much since I am a petite person. I am also concerned with building a tolerance to this med as I have in the past. So my main point being here, is that the article does not offer any other alternatives to the medication for those who are using it in the treatment of tension headaches or anything that is it is generally prescribed for.

    This I think would be very useful or those who do not want to gain a physical dependence on the substance.

    • Crystal Callaway December 1, 2016, 2:38 pm

      Kathleen, if you are taking 5 Fioricet a day that is not too much acetaminophen yet. The max per day is 2000 mg or 2 g. Fioricet contains 325 mg per tab so that is 1625 mg is you take 5. You would not want to exceed 6 in a day because acetaminophen can kill you if you take too much. Thanks.

      • Sarah Armentrout March 7, 2017, 11:01 pm

        Actually the max of Tylenol (acetaminophen) is 4000 mg/24°. So you’re fine. Sarah RN

  • Ashley Fieramosca July 27, 2016, 6:01 am

    I take fioricet with codeine as a last resort for migraines. I have tried everything (medication and counseling) out there and this is the only effective treatment to actually eliminate the headache. BUT… I hate the ‘high’ and side effects. In fact… I only take the version with codeine because the codeine helps me go to sleep while the butalbital is what actually will get rid of the headache.

    Without the codeine though… the intoxication I get from the butalbital is so bothersome I cannot sleep and my headache will not subside for days. Butalbital makes me feel numb and seasick. I HATE the effects of alcohol and people compare it to that. I don’t think it’s exactly the same but I dislike the feeling of both alcohol and butalbital. I also notice that it builds up in my system and if I take too much and I can’t sleep.

    If I were to take 1 every 4 hours (6 pills a day!) like prescribed, I would feel so sick and be too dizzy to function. Generally on my headache days I will wait until the end of the day to medicate at home… no driving or being in the heat while I’m on this stuff. I will take 2 pills and go to bed like normal. If I don’t medicate at all… the headache will linger for days.

    If I gut through the pain and medicate in the evening and sleep… usually it will go away for at least 24-48 hours. I do get frequent (3-4 per week) migraines… but if I only medicate the really bad ones. If I use too much Fioricet then it takes 3 pills instead of two for pain relief….but that puts too much butalbital in my system and I hate that feeling more than a migraine.

    I should note that I take a high dose of ativan (18 years of tolerance) and a medium dose of adderall for anxiety and other psychiatric problems. Neither of those drugs gives me any noticeable psychotropic ‘high’ and I will purposely skip doses of I can to keep my tolerance down. Everybody’s body must be different though. I can take 6mg (3mg×2) ativan and 40mg adderall (20mg×2) without any side effects or ‘high’ to note (except to ease the symptoms I am prescribed them for), but more than 2 pills of fioricet in a day makes me feel seasick and can’t sleep.

    I have never been able to get past the ‘buzzed’ state from alcohol without dizziness and vomiting… I hate drinking and fioricet is just the same. Also, I cannot tolerate caffeine anymore. I used to be a coffee junkie…but after dropping from 10 psych meds a day to 3… I cannot drink anything but decaf coffee (maybe a small half-decaf if I eat and want to treat my migraine without medication).

    So my opinion of fioricet is that it is a life-saver and ONLY medication that will actually get rid of my migraine, but the side-effects of the butalbital keep me from wanting to use it except sparingly. I use the codeine version just to help distract me from the horrible feeling of butalbital. Mostly, I just live with chronic treatment-resistant headaches.

    I’m tired of eating and sleeping NSAIDS which don’t help anyway… I’m too sensitive to caffeine all of a sudden… and the only med that works gives me a sickening feeling (which only builds up the more often you take it). Fioricet is actually a good drug for me… it really works for my pain and headaches, but it has such unpleasant side effects I really don’t worry about over-using it and having withdrawals.

    I know there are people who struggle with addiction to this drug. I can’t understand actually wanting to take it for the ‘high’, but I am sorry they have to go through the detox process. From what I have read barbiturate w/d is terrible and dangerous and to couple that with caffeine w/d and codeine w/d is frightening. I have a dependence (not addiction) to ativan already and that is enough to worry about.

    Stay away from fioricet if you can…but if you need it as a last resort…it is highly-effective.

    • juju March 8, 2017, 3:54 am

      I have been on Esgic+ for years – over 20. I am not a regular user thank goodness. I however cannot take anything else for my migraines. Nothing else has ever worked. As I have gotten older, gone through menopause, I don’t have to take 2 tabs – one usually is enough to stop the aura, the light sensitivity, the terrible one sided brain crushing pain.

      I can’t imagine how this drug can make you high. It pretty much helps me feel like I won’t die because the pain subsides. I am very thankful to have it. I am very sorry to hear that others find this combo a recreation and get addicted or others who have legit used it and became addicted. God help you all.

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