I had a tolerance of 2000mg of butalbital a day.. and to sleep at night? I was basically putting myself in a barbitic coma (you couldn't wake me up--phenibut does the same thing oddly enough?)--anyway, long story short since i've told it several times here on this board: I took my night dose 500mg; accidentally took another dose, it was at least 700mg b/c i had forgotten I took my night dose already. I ended up in the ICU for 12 days, on a ventilator for 2-3 days (i don't remember, i was still out of it). The first day, my family freaked b/c my pupils weren't reacting to any light stimuli early on in the ER.
I was on IV lorazepam/ativan 2mg every 2 hours, but i still went through severe delirium tremens- i ripped the IV out of my neck & it took 5 people to restrain me b/c i thought I was in prison and was trying to escape (ripping a neck IV out is VERY dangerous.. if any bacteria gets into a pulled out IV register-spot in your neck? Fucking any type of germ, bacteria, or virus that are typically harmless can pass straight through your blood brain barrier & fuck up your brain big time--if not kill you). I still had a seizure 1 definite seizure, but possibly two. Anyway, was sent off to a psychiatric hospital for 32-35 days (the days run together in places like that; in some ways its worse than county)..
But first: my first stint at this hospital was about a month & a half prior & it was a SELF admission (which dumbfounded the admission doctor, the admission nurse, & the TPWs). Was about a 12-13 day stay, they had me on phenobarbital, 4 99.2mg pills, 4x a day; w/ 30mg temazepam night & IM or subcutaneous (couldn't tell difference) of diazepam, 100mg to control panic attacks when my BPM were over 130 (mine's usually 60-90.. were about 90-110 w/ the pheno & nightly temazepam). I was absolutely fine, a bit edgy during the--in my opinion--WAY too quick wean. Was sent home w/ 2400mg gabapentin & 30 day supply 30mg temazepam.
But, i flipped the first day & relapsed.. I was weaned ENTIRELY too fast; this requires at least 1 month, if not longer of weaning in my opinion. But I had it rough. ended up in the ICU situation & was back in the same hospital for those 30-some days the 2nd time; and after the ICU? They didn't get me shit but gabapentin 900-fucking-milligrams, despite having two seizure "events" (call them "events" b/c they refused to bring me to a hospital nor treat me w/ benzodiazepines or pentobarbital.. or thiopental to stop the event; no they just let the brain damage keep occurring w/ THAT & the delirium tremens). Utter hell. full 3 weeks I was out of it (at least ativan hit the worst of it i suppose; but the mental shit REALLY starts around day 6-12; physical symptoms are the first 1-6 days or so for short-intermediate barbiturates); I was smoking imaginary cigarettes; thinking i was at work & having full-blown conversations; thinking I was at my mother's, thinking the shit going on in Crimea at the time (i'm into geopolitics) on was happening BECAUSE of me, AND that Russia was talking to me through the TV & was taking over my body--i kept asking the doctor & nurse, "where's Matt? WHERE'S MATT?"--they kept saying, "MATT, i can't answer.
The reason barbiturates are stronger, more euphoric, more effective antiepileptics is b/c for one they're positive allosteric modulator at the barbiturate/picrotoxin receptor on GABA-A (instead of the benzodiazepine GABA-a receptor-binding site)--BUT more importantly, they also act as AMPA antagonists--which block glutamate; this causes anesthesia w/ fast acting barbiturates, analgesia, euphoria, etc. BUT- since it completely blocks glutamate? It completely shuts down your built-in central nervous system "back up system" to keep it functional. It makes barbiturates very dual effective, especially for analgesia+anxiety situations (aka, tension migraines).. however, they have such a short margin of error between medicinal & lethal effects.
SO: this is why barbiturates are so dangerous compared to benzodiazepines. Benzodiazepines just act on GABA-a BZP binding sites; while certain GABA-a BZP subunits act just efficiently as anticonvulsants/antiepileptics as AMPA antagonists--which is where barbiturates get their antiepileptic, anticonvulsant effects--but they fully block glutamate, remember, the CNS's "back up" system to keep you ALIVE & breathing. While benzodiazepines exert the same action but by not fully blocking glutamate (& thus not risking death so easily w/ benzodiazepine overdose compared to AMPAr antagonists/barbiturate overdoses)