80. Phenobarbital for Alcohol Withdrawal80. Phenobarbital for Alcohol Withdrawal
Addiction Medicine Journal Club
Dr. Sonya Del Tredici and Dr. John Keenan review a community hospital study on phenobarbital for alcohol withdrawal, alongside policy updates on kratom and alcohol. They also consider dual medication approaches for alcohol use disorder and how new evidence might reshape everyday practice.
37:33•27 Jul 2026
Phenobarbital, Kratom, and Rethinking Alcohol Withdrawal Care
Episode Overview
- Phenobarbital loading protocols can reduce benzodiazepine exposure, alcohol withdrawal severity, and hospital length of stay without increasing safety risks.
- A simple, hospital-wide electronic order set and brief provider education can support adoption of phenobarbital for alcohol withdrawal across care settings.
- The DEA’s temporary scheduling of concentrated synthetic 7‑OH kratom products targets high‑risk formulations marketed like sweets and energy shots.
- Public health movements that minimise alcohol harms, even while focusing on other risk factors, may ignore evidence that alcohol is a major cause of death.
- Starting two complementary medications for alcohol use disorder, rather than relying on monotherapy, may offer better outcomes in some patients and merits further study.
“I think that going forward for me, unless there's a medical contraindication, I'm probably going to be starting with a phenobarb load as kind of my alcohol withdrawal treatment of choice.”
How do different strategies aid in addiction recovery and treatment? This journal club episode digs into how hospital teams are rethinking alcohol withdrawal care, with Dr. Sonya Del Tredici and Dr. John Keenan unpacking fresh research on phenobarbital. The heart of the discussion is a community hospital study on a phenobarbital order set for alcohol withdrawal.
John walks through how the team moved from benzodiazepine-heavy protocols to a single phenobarbital loading approach, pointing out that it works on both GABA and glutamate and has a very predictable serum level. As he puts it, phenobarbital “really kind of has a dual mechanism of action,” which may explain shorter withdrawal and hospital stays without extra safety problems.
You’ll hear practical details clinicians care about: how the electronic order set was designed, the role of the emergency department in starting treatment, and what happened to CIWA scores, restraint use, intubations and in‑hospital mortality. Sonia raises the key question many doctors have—does this actually change practice?—and John admits this paper is “probably the tipping point” for him towards phenobarbital first‑line. The episode also touches on policy and public health.
John reacts to the DEA’s move to temporarily schedule 7‑hydroxymitragynine (7‑OH) from kratom, especially the concentrated synthetic products sold as sweets and shots. Sonia brings in a Stat News series on alcohol as “the deadliest drug” and critiques the MAHA movement and RFK Jr. for downplaying alcohol harms with lines like “use common sense when you’re drinking” and “don’t have it for breakfast.” To round things off, they share feedback from Dr.
Casey Grover on using two medications at once for alcohol use disorder, sparking a conversation about whether monotherapy is enough for many patients. If you’re treating alcohol withdrawal or alcohol use disorder, what changes—big or small—might this evidence prompt in your own practice?
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