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Nembutal as a Drug Option
Nembutal's role in Voluntary Euthanasia and Assisted Suicide.
I am hoping to get access to your ‘peaceful pill’ — not for immediate use, but to have on hand should my health deteriorate too much in the future. Arthur, 77 years
The barbiturate Sodium Pentobarbital is the drug that comes closest to the concept of the Peaceful Pill. Exit defines the ‘Peaceful Pill’ as a pill, tablet or mixture that can be taken orally and that is guaranteed to provide a peaceful, dignified death at a time of one’s choosing.
A Short History of Barbiturates
Sodium Pentobarbital or Nembutal as it is commonly called is an important and historically significant drug. Although Nembutal is one of over 50 barbiturate derivatives to have been used medically, it is the drug of choice when it comes to dignified, peaceful dying.
All Barbiturates are derivatives of barbituric acid which was first synthesized by Adolph von Bayer in 1864. A ‘condensation’ of malonic acid and urea, barbituric acid is said to have acquired its name after St Barbara’s Day (4 December) - the day on which it is believed to have been discovered.
Other historians have speculated that the discovery may have been named after the chemist’s favourite barmaid, Barbara. Either way, the name stuck and barbituric acid has enjoyed an infamous history ever since (Mendelson, 1980). Barbituric acid was found to have no physiological effect and it took another 40 years before chemists, Emil Fischer and Joseph von Mering, discovered that the introduction of two additional side-arms onto the molecule produced a range of compounds with marked physiological activity. It was only then that it became known that the nature of the sedative, hypnotic, or anaesthetic properties of the substance were determined by the characteristics of the side-arms attached.
The first of these di-substituted barbiturates was Veronal. Here two ethyl side-arms were added to produce diethyl-barbituric acid a weak hypnotic/ depressant which was marketed by the Bayer company as ‘Veronal’ in 1904. This was followed by phenobarbital (Luminal) in 1913. While barbituric acid is a German discovery, during the First World War when German shipping was blockaded, American chemists made use of the ‘Trading with the Enemy Act,’ to copy the work of the Germans and manufacture their own modifications of barbituric acid.
Barbiturate Sleeping Pills
In the half of the 20th Century, barbiturates were manufactured around the world, with production peaking in the 1950s. By then there were more than 20 marketed forms of barbiturates, with most sold as sleeping tablets.
Along with the original Veronal, there was Barbital, Amytal, Seconal, Soneryl, Nem butal and several others.
While these barbiturates were highly effective sleeping tablets, a significant problem was the very serious side-effect associated with their overdose - death. This was found to be especially true if the pills were taken with alcohol. Many famous people have died - some deliberately, some inadvertently - from an overdose of barbiturates. Marilyn Monroe, Judy Garland and Jimmy Hendrix are a few.
Barbiturates as Drugs of Abuse
In the 1960s, the image of barbiturates suffered further when they were found to be useful mood-altering drugs. At this time, the depressant effect of the drugs was exploited. By carefully adjusting the dose, a desirable soporific and tranquil state could be achieved and they became known as ‘downers.’ As downers, barbiturates would often be intermixed with ‘uppers’ - drugs like amphetamines. This type of usage led to a set of slang street terms for these drugs such as ‘Pink Ladies’, ‘Yellow Bullets’, ‘Peanuts’ and ‘Dolls’ (from Barbie dolls) (Mendelson, 1980).
With only a small margin of safety in dose between the desired sleep, euphoria and death, there was considerable danger associated with the prescription of these drugs. History shows they fell out of favour with the medical profession once newer, safer sleeping tablets became available.
The Advent of Non-barbiturate Sleeping Pills
The first of the new class of sleeping drugs (the benzodiazepines) was diazepam (Valium), which became available in the early 1960s. These drugs were welcomed by the medical profession as a safe alternative to the barbiturate sleeping tablets. At this time there were many prescribed forms of barbiturates on the market but with the introduction of these new benzodiazepines, the use of the barbiturates steadily declined.
By the mid 1990s in countries like Australia, there were just two barbiturate sleeping tablets left, amylobarbital (Amytal) and pentobarbital (Nembutal). Nembutal was withdrawn with little notice in 1998 with Amytal following suit in 2003. Today, the only barbiturate commonly prescribed by doctors is the slow-acting Phenobarbital. This drug still finds a niche in medicine as an anti-convulsant, but is a poor substitute to the specific barbiturate sleeping tablets in providing a reliable, peaceful death.
Barbiturate Use in Veterinary Practice
The veterinary use of the barbiturates has persisted. Nembutal, in particular, is used as an agent for euthanasia. A large dose delivered intravenously, quickly and peacefully ends an animal’s life. This green-dyed form of the drug, known as Lethabarb or Valabarb, is also known as ‘the green dream.’
A sterile form of Nembutal has also persisted as a useful complete anaesthetic agent that can quickly render an animal unconscious for surgery. Pentobarbital continues to play a role in veterinary practice to this day even though its use by the medical profession has all but disappeared. A development that has led to a resurrection of these outdated drugs is their increasing use as the drugs of choice for voluntary euthanasia.