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February 23, 2019

Fioricet Detox Guide

Fioricet is a prescription medication commonly used to treat tension headaches. The drug—which is chemically composed of butalbital, acetaminophen, and caffeine—is considered a barbiturate, a sedative, sleep-inducing class of medications. Fioricet’s potent analgesic properties affect the central nervous system (CNS) in a manner similar to opiates and muscle relaxants, blocking pain signals emitted by the brain and increasing relaxation through the mechanism of increased GABA and other neurotransmitters.

Although the Food and Drug Administration (FDA) hasn’t specifically approved Fioricet to treat migraine headaches, physicians routinely prescribe it for that purpose. The drug’s unique combination of ingredients produces effects that have been described as mildly euphoric and highly addictive, and it is widely abused as a result.  According to the US Library of Medicine, approximately 1 in 10 barbiturate overdoses are fatal.       


Fioricet’s effect on the CNS is addictive, especially to those suffering from painful and debilitating headaches. When used inappropriately through diversion or ingesting high doses—and sometimes even when used exactly as prescribed—Fioricet begins to create physical and psychological dependence. Once someone becomes Fioricet-dependent, they inevitably experience withdrawal symptoms whenever it is taken in lower doses, there is a lapse in between uses, or complete cessation. Many headache sufferers find themselves initially doing quite well on the medication only to be increasingly consumed by a desire for higher doses of the medication in shorter intervals of time

Empirical research indicates that healthy, short-term Fioricet users are less likely to experience severe withdrawal symptoms when compared to cases of long-term, immoderate use. For users who have taken the drug for a period of 6 months or longer (4 months by some estimates), withdrawal symptoms will be of higher intensity and more difficult to safely navigate. Due to the inclusion of butalbital as a primary ingredient, Fioricet features a relatively long half-life of 36 hours, although major withdrawal symptoms may occur within 12-16 hours following cessation.  Fioricet dependence produces a broad spectrum of neurological, cardiovascular, gastrointestinal, and psychological withdrawal symptoms including:

  • Paranoia
  • Suicidal ideation (SI)
  • Incoordination
  • Accelerated heart rate
  • Impaired cognition
  • Difficulty concentrating
  • Agitation
  • Panic attacks
  • Slurred speech
  • Nausea
  • Anxiety
  • Mood swings
  • Sluggishness
  • Hallucinations
  • Dizziness
  • Depression
  • Loss of inhibition
  • Shallow breathing
  • Dilated pupil
  • Coma
  • Seizures
  • Death


Fioricet withdrawal is typically broken down into three separate stages—acute withdrawal, protracted withdrawal, and post-acute withdrawal syndrome (PAWS). The following provides an overview of the process, although exact timelines are difficult to establish due to individual variables:

  • Protracted withdrawal—the protracted withdrawal phase typically lasts between 10 and 14 days, although it can extend for much longer depending upon the intensity and duration of use. During this phase, users may experience milder anxiety and depression-related symptoms in addition to increased cravings as their body acclimates to the absence of the drug.
  • Post-acute withdrawal syndrome (PAWS)—PAWS describes the primarily psychological, mood-based symptoms that may linger for months, or even years, beyond the acute and protracted withdrawal phases. In many users, PAWS may produce decreased motivation, apathy, erratic mood swings, or other forms of psychological instability. These symptoms may be difficult to detect, although they are still clinically relevant.


Although numerous treatment options for Fioricet detox exist, inpatient treatment in a residential facility is considered optimal. Frequently referred to as the industry “gold standard,” medically managed inpatient treatment offers a comprehensive range of services and benefits. In addition to regular evaluation and assessment by a team of licensed medical professionals and clinicians, clients enjoy the added advantage of a safe, supportive environment where sobriety remains the highest priority throughout their stay. In addition to cutting-edge treatment, many reputable facilities also offer life and jobs skills coaching, alternative healing modalities, alumni networking, community volunteer opportunities, on-site recreational amenities, and aftercare services.  More importantly, the 24/7 staff monitoring provides an additional blanket of security which proves invaluable to clients navigating the various stages of withdrawal.     


Medication-assisted treatment (MAT) describes a popular Fioricet detox protocol that combines behavioral and psychotherapy with Food and Drug Administration (FDA) approved pharmacological interventions for maximum benefit. The following evidence-based modalities are frequently included in the scope of treatment:

  • Cognitive behavioral therapy (CBT)
  • Dialectical behavior therapy (DBT)
  • Motivational interviewing (MI)
  • Trauma-informed therapy
  • Family therapy
  • Creative and expressive arts

Fioricet addiction, and barbiturate addiction in general, does not conform to a one-size-fits-all treatment protocol. Depending upon client needs, various prescription medications ranging from antidepressants (SSRIs) to benzodiazepines (benzos) may be administered during detox and subsequent treatment. Ultimately, a licensed physician and supporting clinicians collaborate to decide what is best for each client on a case-by-case basis following careful evaluation and assessment. Regardless of what medication—or medications—are selected as part of the primary treatment regimen, it is important to remember that medication alone is not enough to treat the precipitating factors involved in Fioricet addiction.  Clients must make a concentrated effort to self-improve while strictly adhering to treatment guidelines.


Anxiety and depression-related disorders are known precursors to Fiorcet addiction and polysubstance abuse. Untreated post-traumatic stress disorder (PTSD) is also a major precipitating factor that leads many users to self-medicate. These co-existing, or “co-occurring” disorders as they are often called, require professional medical management and psychotherapy in order to effectively address. Depending upon a client’s individual medical and psychological diagnoses, supplementary medications including pregabalin, buspirone, gabapentin, and SSRIs may be incorporated into the primary treatment regimen—a process known as dual diagnosis treatment.


Outpatient treatment is another popular treatment method for clients requiring greater flexibility. Since clients are not required to live at a designated residential facility for the duration of treatment, outpatient treatment provides a cheaper, but generally less effective alternative, ideally suited for clients whose personal or professional schedules demand it. Outpatient treatment is also excellent as a transitional level of care for those recently completing inpatient detox, or for clients seeking longer-term maintenance therapy.


Fioricet is a potent, mind-altering drug that requires the intervention of trained physicians and therapists specializing in professional addiction treatment. At-home, self-guided Fioricet detox is never recommended under any circumstances and is considered extremely dangerous. Each year, thousands of people are admitted to hospital emergency rooms (ER) after ignoring medical advice against attempting self-treatment—all in an effort to save money. In the end, the complications and unnecessary risks incurred in the process end up costing more, up to and including death.


Tapering is a controversial yet effective practice that involves a physician administering carefully controlled doses of Fioricet while the client weans off the medication. Tapering injects the body with the very same substance (or of the same substances) that created the addiction in the first place and, in the opinion of many experts, entails certain complications and risks. By the same token, quitting Fioricet—or any medication—cold turkey is never recommended. In extreme cases it may even prove fatal as a result of precipitated withdrawal.  Following a conservative, customized tapering schedule is the industry preferred detox method that is considered relatively safe while minimizing the chance of future relapse.  


The decision to seek treatment for Fioricet addiction involves careful consideration, proper motivation, and self-education. There are literally thousands of private treatment centers to choose from nationally and a wide range of government-funded options. Reputable facilities can help alleviate the stress associated with seeking treatment by verifying insurance coverage and benefits prior to enrollment and addressing any treatment-related questions or concerns. In the majority of cases full, if not partial, coverage is granted. In the unusual event that coverage is denied, additional financial options will be discussed. These include federal grants, private scholarships, and other forms of need-based aid.

Aside from affordability and location—two of the most important factors—choosing an appropriate treatment center may depend upon additional factors that add value to a client’s experience. Certain facilities are locally or nationally renowned based upon the quality of clinical care they provide in addition to an attractive package of ancillary benefits and services. Exploring the following factors will help when making an informed decision: 

  • Program reputation—locally and nationally
  • Addition of amenities, aftercare services, and on-site benefits
  • Use of state-of-the-art technology and evidence-based treatment options
  • Availability of alternative or holistic healing modalities
  • Proximity to major recreational attractions (ocean, mountains, etc.)
  • Accessibility from major airports and other convenient means of transportation


For many clients, recovery is a long and perilous journey and successful completion of inpatient detox is only the beginning of the road. A comprehensive relapse prevention plan should include the following aftercare support services—all of which are empirically proven to increase favorable treatment outcomes, reduce the risk of relapse, and improve causative factors frequently associated with addiction:

  • 12-Step involvement (NA and AA)
  • Sponsorship—actively working the program
  • Random drug testing
  • Life and job skills coaching (as needed)
  • One-on-one and/ or group therapy
  • Sober peer support and community involvement
  • Avoidance of social and environmental triggers
  • Ongoing medication management


Like other psychotropic drugs, Fioricet is an overly-prescribed, overly, abused medication that can easily lead to addiction. Its addictive potential does not depend upon a family history of substance abuse, genetic proclivity, or abuse outside the scope of legitimate medical practices. Anyone, at any time, can find themselves addicted to Fioricet and in need of professional help.  

If you or someone you love are addicted to Fioricet (or other barbiturates) and in need of professional help, call a substance abuse professional today. In case of an overdose, seek immediate medical attention by dialing 911 or visiting your nearest hospital emergency room (ER).

For more about Fioricet addiction and recovery, check out these related articles:


  • Journal of the American Medical Association. Barbiturate Withdrawal Following Internet Purchase of Fioricet.  Nov, 2018.
  • Journal of Medical Toxicology. Combined Butalbital/Acetominophen/Caffeine Overdose: Case Files of the Robert Wood Johnson Medical School Toxicology Service. Dec, 2012.
  • Neuropsychiatric Disease and Treatment. The history of barbiturates a century after their clinical introduction.  Dec, 2005.
  • The Journal of Neuroscience. Barbiturates Induce Mitochondrial Depolarization and Potentiate Excitotoxic Neuronal Death. Nov, 2002.