Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Abstract. Oxford Academic. Google Scholar. Cite Cite A. Once improvement is noted withdrawal is accomplished by gradual reduction of barbiturates. It should be remembered that acute barbiturate intoxication may be superimposed on chronic barbiturate intoxication.
Patients who are chronically intoxicated with barbiturates may become confused and ingest such large amounts of barbiturates that serious acute poisoning develops. Whenever a patient who has been acutely poisoned with barbiturates recovers from coma, every effort should be made to ascertain if he has been taking large doses of barbiturates daily and, if so, he should be mildly reintoxicated with barbiturates and then gradual reduction begun.
Combined barbiturate and opiate addiction has become quite common. Withdrawal of both drugs can proceed concurrently with more time usually being required to withdraw barbiturates than opiates.
Such rehabilitative measures are mentioned as dietary, vocational, recreational and social procedures. The suggested legislation is preceded by an explanatory statement.
This was part of its report, Suggested State Legislation programme for At its meeting in September the Drafting Committee reviewed certain provisions of the Act having to do with the regulation of retail and wholesale practices in handling drugs of this category and developed the text of two amendments which have been incorporated in the suggested legislation which follows. These amendments are printed in italics. The safeguarding, dispensing, and use of sleep-producing drugs-notably the barbiturates--present a special problem for state legislation and enforcement, since they do not fall within the legal classification of narcotic drugs, nor are they regulated under the provisions of federal and state narcotic drug Acts.
The sleep-producing drugs include 1 the barbiturates, which are herein defined as" the salts and derivatives of barbituric acid or compounds, preparations or mixtures thereof"; and 2 other drugs of hypnotic or somnifacient sleep-producing effect on humans and animals-such drugs as paraldehyde, chlorahydrate, and compounds under various trade names. Federal and state authorities, as well as representatives of pharmaceutical groups, appear agreed that the properties and characteristics of these sleep-producing drugs, as well as the results of their abusive use, are sufficiently different from narcotic drugs such as morphine and cocaine to make it necessary that their control and regulation should reflect these differences.
There is considerable evidence, however, that the barbiturates and other like drugs are potentially harmful, that their misuse in the form of "sleeping-pill" addiction has become a serious problem, and that there is need for action to bring this area of drugs under effective regulation as a measure essential to the public health and for the protection of individuals.
The following proposal is based partly on a model state barbiturate Act developed by various pharmaceutical organizations, and partly on an Ohio enactment of ; it reflects various features of federal legislation in this field; and it has been reviewed carefully over a two-year period by federal officials concerned with regulation of drugs, as well as by the Drafting Committee.
The proposal is recommended for consideration of states which may require new legislation in this field, or which may wish to broaden or strengthen the coverage of existing legislation. The attention of states which have comparable laws confined to control of barbiturates is specifically called to the wider coverage of this proposal. States which have administrative procedures acts may wish to expand section 6 of this act to provide that regulations issued pursuant hereto shall be in conformity with the provisions of such administrative procedures legislation.
The following is a suggestion: "An Act to regulate the handling, sale and distribution of hypnotic or somnifacient drugs ". The term "drug" means A the salts and derivatives of barbituric acid or compounds, preparations or mixtures thereof, and B other drugs or compounds, preparations or mixtures thereof which the [State Commissioner of Health or other competent state officer or agency] shall find and declare by rule or regulation duly promulgated [ after reasonable public notice and opportunity for hearing ] [ 20 ] to have a hypnotic or somnifacient effect on the body of a human or animal; except that the term" drug" shall not include any drug the manufacture or delivery of which is regulated by the narcotic drug laws of this state.
The term "delivery" means sale, dispensing, giving away, or supplying in any other manner. The term "patient" means, as the case may be, A the individual for whom a drug is prescribed or to whom a drug is administered, or B the owner or the agent of the owner of the animal for which a drug is prescribed or to which a drug is administered, provided that the prescribing or administering referred to in A and B hereof is in good faith and in the course of professional practice only.
The term "person" includes individual, corporation, partnership, and association. The term "pharmacist "means a person duly registered with the [state board of pharmacy] pursuant to [insert proper statutory reference]. The term "prescription" means a written order, and in cases Of emergency, a telephonic order, [ 21 ] issued by a practitioner in good faith in the course of his professional practice to a pharmacist for a drug for a particular patient, which specifies the date of its issue, the name and address of such practitioner, the name and address of the patient and, if such drug is prescribed for an animal, the species of such animal , the name and quantity of the drug prescribed, the directions for use of such drug, and the signature of such practitioner.
The term "wholesaler" means a person engaged in the business of distributing drugs to persons included in any of the classes named in clauses a to e , inclusive, of section 3 1 B of this Act. The term "manufacturer" means a person who manufactures drugs, and includes persons who prepare such in dosage forms by mixing, compounding, encapsulating, entableting, or other process, but does not include pharmacists so preparing such drugs solely for dispensing on prescriptions received or to be received by them.
The term "warehouseman" means a person who, in the usual course of business, stores drugs for others lawfully entitled to possess them and who has no control over the disposition of such drugs except for the purpose of such storage. In the event that such delivery is pursuant to telephonic order, such prescription shall be promptly reduced to writing and filed by the pharmacist; or. Such drug is delivered by a practitioner in good faith and in the course of his professional practice only.
To refill any prescription for a drug unless such refilling is specifically authorized on the prescription. For a practitioner to fail to confirm within 72 hours a telephonic order for a drug by giving to the pharmacist a written prescription therefor. For any person to possess a drug unless such person obtained suck drug on the prescription of a practitioner or in accordance with section 2 1 C of this act or from a person licensed by the laws of any other state or the District of Columbia to prescribe or dispense drugs.
To refuse to make available and to accord full opportunity to check any record, file, stock or inventory as required by section 5 of this Act. For any person to use to his own advantage, or to reveal other than to a public officer or employee charged with the duty of enforcing law relating to the handling, sale and distribution of drugs, or to a court when relevant in a judicial proceeding, any information acquired under the authority of section 5 of this act concerning any method or process which as a trade secret is entitled to protection.
For any person to obtain or attempt to obtain a drug by fraud, deceit, misrepresentation or subterfuge; or by the forgery or alteration of a prescription; or by the use of a false name or the giving of a false address. The provisions of paragraphs 1 and 5 of section 2 of this Act shall not be applicable A to the delivery of drugs for medical or scientific purposes only to persons included in any of the classes hereinafter named, or to the agents or employees of such persons, for use in the usual course of their business or practice or in the performance of their official duties, as the case may be; or B to the possession of drugs by such persons or their agents or employees for such use : a Pharmacists; b practitioners; c persons who procure drugs i for disposition by or under the supervision of pharmacists or practitioners employed by them, or ii for the purpose of lawful research, teaching, or testing and not for resale; d hospitals and other institutions which procure drugs for lawful administration by or under the supervision of practitioners; e manufacturers and wholesalers; f carriers and warehousemen.
Nothing contained in section 2 of this Act shall make it unlawful for a public officer, agent or employee, or person aiding such public officer in performing his official duties, to possess, obtain, or attempt to obtain a drug for the purpose of enforcing the provisions of any law of this state or of the United States relating to the regulation of the handling, sale or distribution of drugs. Persons other than carriers to whom the exemptions of section 3 of this Act are applicable shall A make a complete record of all stocks of drugs on hand on the effective date of this act and B maintain detailed, but not necessarily separate, records and inventories relating to drugs manufactured, purchased, sold, distributed and handled and retain all such records and inventories required by this subsection 1 for not less than two calendar years after the date of the transaction shown by such record and inventory.
Pharmacists shall, in addition to complying with the provisions of subsection 1 of this section, retain each prescription and written record of telephonic order for a drug filled by them, for not less than two calendar years immediately following the date of the filling or the date of the last refilling of such prescription whichever is the later date.
Persons required by section 4 of this act to keep files, inventories or records relating to drugs shall, upon the written request of a public officer or employee charged with the duty of enforcing laws relating to the handling, sale and distribution of drugs, A make such fries, inventories or records available to such officer or employee, at all reasonable hours, for inspection and copying, and B accord to such officer or employee full opportunity to check the correctness of such files, inventories or records, including opportunity to make inventory of all stocks of drugs on hand.
The [insert name of appropriate state agency] may pro-mulgate necessary regulations for the administration and enforcement of this act. Any person violating any provision of this act shall be punished by a fine not exceeding [one thousand dollars], or by imprisonment for not more than [one year], or both; but if the violation is committed after a conviction of such person under this Act has become final, such subsequent conviction shall be punished by a fine not exceeding [ten thousand dollars], or by imprisonment for not more than [three years], or both.
If any provision of this Act is declared unconstitutional or the applicability thereof to any person or circumstances is held invalid, the constitutionality of the remainder of the Act and the applicability thereof to other persons and circumstances shall not be affected thereby.
See, e. Isbell and White cited below, according to which this dosage is "far in excess of those used therapeutically ". States which have basic administrative procedures legislation in effect may wish to insert reference to such legislation at this point in place of the words appearing here in brackets. States which desire to eliminate the use of telephonic orders should omit the words" and in cases of emergency a telephonic order ".
Corresponding changes should be made by deleting sections 2 1 B , section 2 4 , and by altering section 4 2. The parent compound barbituric acid was first synthesised in but the first pharmacologically active agent, barbital, was not produced until and introduced to medicine in The most widely used compound, phenobarbital, was synthesised in and first used clinically the following year.
While some 2 derivatives have been synthesised, only about 50 have ever been used medically. Some barbiturates are now more widely used in the treatment of epilepsy and shorter acting molecules are used in anaesthesia.
Twelve barbiturates are under international control. The different drugs have various substituents on this basic skeleton, usually at the 5 position. Phenobarbital, also known as phenobarbitone CAS , is the most widely used barbiturate. It is also referred to as 5-ethylphenylbarbituric acid. Barbiturates are a group of central nervous system depressants which produce effects ranging from mild sedation to general anaesthesia.
Depending on how quickly they act and how long their effects last, they can be classified as ultra-short-, short-, intermediate-, and long-acting. Compounds with a 5-phenyl substituent, e. Because of this, the therapeutic index is low. Adverse reactions include drowsiness, sedation, incoordination followed by respiratory depression, headache, gastrointestinal disturbances, confusion and memory impairment. Users may appear to be inebriated because they experience paradoxical excitement or euphoriant effects that are comparable to those of morphine.
Some individuals are reported to have consumed between 1. A residual central nervous system depression may occur the day following a hypnotic dose. This may involve impairment of judgement and fine motor skills e. Accidental deaths and suicide attempts involving barbiturate use have been reported. A study of fatal overdoses due to anxiolytics and sedatives in the UK between and reported a figure of The lethal dose varies from 2—3 g for amobarbital and pentobarbital to 6—10 g for phenobarbital.
The concentrations that can cause death are lower if alcohol or other central nervous system depressants such as benzodiazepines are present. Symptoms of an overdose include incoordination, slurred speech, difficulty in thinking, coma, respiratory and cardiovascular depression with hypotension and shock leading to renal failure and death.
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