Sedative

A sedative is a drug that depresses the central nervous system (CNS), which causes calmness, relaxation, reduction of anxiety, sleepiness, slowed breathing, slurred speech, staggering gait, poor judgment, and slow, uncertain reflexes. Sedatives may be referred to as tranquilizers, anxiolytics, soporifics, sleeping pills, downers, or sedative-hypnotics. At high doses or when they are abused, many of these drugs can cause unconsciousness and death.

Types of Sedative

Barbiturates and benzodiazepines are the two major categories of oral sedative. Some well-known barbiturates are secobarbital (Seconal), pentobarbital (Nembutal), and amobarbital (Amytal). Benzodiazepines include diazepam (Valium), chlordiazepoxide (Librium), lorazepam (Ativan) and chlorazepate (Tranxene). Many sedatives do not fit in either category. They include methaqualone (Sopor, Quaalude), ethchlorvynol (Placidyl), chloral hydrate (Noctec), meprobamate (Miltown), glutethimide (Doriden), methyprylon (Noludar), zolpidem (Ambien), alpidem, gamma-hydroxybutyrate (GHB) and gamma-butyrolactone (GBL). Antihistamines such as diphenhydramine (Benadryl) also have sedative effects, though not generally referred to as sedatives, and are sold as over-the-counter sleep aids. Herbs and plant-based drugs with sedative properties, such as valerian and mandrake, have been known since ancient times.

Sedative Dependence

All sedatives can cause physical and psychological dependence when taken regularly over a period of time, even at therapeutic doses. When dependent users decrease or end use suddenly, they will exhibit withdrawal symptoms ranging from restlessness, insomnia and anxiety to convulsions and death. When users become psychologically dependent, they feel as if they need the drug to function although there is no biological dependence. In both types of dependence, finding and using the drug becomes the focus in life. Both physical and psychological dependence can be treated (see Sedative Dependence).

Abuse and Overdoses

All sedatives can be abused, but barbiturates are responsible for most of the problems with sedative abuse due to their widespread "recreational" or non-medical use, as well as over-prescribing by medical doctors. People who have difficulty dealing with stress, anxiety or sleeplessness may overuse or become dependent on sedatives. Heroin users take them either to supplement their drug or to substitute for it. Stimulant users frequently take sedatives to calm excessive jitteriness. Others take sedatives recreationally to relax and forget their worries. Barbiturate overdose is a factor in nearly one-third of all reported drug-related deaths. These include suicides and accidental drug poisonings. Accidental deaths sometimes occur when a drowsy, confused user repeats doses. In the US, in 1998, a total of 70,982 sedative exposures were reported to US poison control centers, of which 2310 (3.2%) resulted in major toxicity and 89 (0.1%) resulted in death. About half of all the people admitted to emergency rooms in the US as a result of nonmedical use of sedatives have a legitimate prescription for the drug, but have taken an excessive dose or combined it with alcohol or other drugs. Others get sedatives from friends who have bona fide prescriptions or by using faked prescriptions.

Sedatives and Alcohol

Sedatives and alcohol are sometimes combined recreationally or carelessly. Since alcohol also is a strong CNS depressant that slows brain function and depresses respiration, the two substances reinforce each other and this combination can prove fatal. Karen Anne Quinlan collapsed into a coma after swallowing alcohol and tranquilizers at a party in 1975. Her case spurred worldwide discussion of the ethics surrounding termination of life-sustaining treatment.

Therapeutic Use

Sedation is widely used by doctors and nurses to dull the anxiety related to painful or anxiety-provoking procedures. Athough sedatives do not relieve pain in themselves, they can be a useful adjunct to analgesics in preparing patients for surgery or invasive procedures like catheterization or MRI. They increase tractability and compliance of children or troublesome or demanding patients. In California, 5 preschool children died from oversedation in dental offices between 1991 and 2002; four were given the oral sedative chloral hydrate to keep them still.

Lookalikes

Lookalikes, or pills made to mimic the appearance and the effects of authentic sedatives, are sold on the street. Lookalikes may contain over-the-counter drugs, such as antihistamines, that cause drowsiness. Like any other drug that is illicitly manufactured and sold, their composition and effects cannot be predicted.

Sedative Drugs and Crime

Some rapists administer sedative drugs, particularly GHB or GBL, to unsuspecting women in bars or at parties to reduce the intended victim's defenses. To protect yourself against being sedated against your will, see Sedative Drugs and Violence