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Seconal is the brand name for Secobarbital Sodium, the active ingredient. It’s classified as a short-acting barbiturate, and sedative-hypnotic. This medication is prescribed primarily for;
- an anesthetic for individuals going into surgery
- as an anticonvulsant for epileptics
- in some extreme cases, for those suffering from severe insomnia
- secobarbital is not an anti-anxiety agent
It possesses the following properties;
Whether or not physicians should treat insomnia with Secobarbital is a debate within the medical community. However, even more controversial is its use in physician-assisted suicides. It is defined by wikipedia as; “knowingly and intentionally providing a person with the knowledge or means or both required to commit suicide, including counseling about lethal doses of drugs, prescribing such lethal doses or supplying the drugs.”
Physician-assisted suicide, also known as “death with dignity”, is legal in eight states;
- District of Columbia
Some states make public the number of physician-assisted suicides in an annual report, other states do not.
“Secobarbital is currently the most widely used prescription…” for patients requesting a medically assisted suicide, writes Thomas R. McCormick, a Washington based bioethicist and New York Times contributor. “The patient usually loses consciousness within moments of taking the medication, and death follows quickly.”
According to Oregon’s February 2017 official report, deaths occurring during the first 19 years under that state’s “Death with Dignity Act” took place after patients took the following drugs;
- Secobarbital 59.3%
- Pentobarbital 34.3%
- Other 6.5%
According the AMA’s, Code of Medical Ethics Opinion 5.7; “Physician-assisted suicide occurs when a physician facilitates a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act (e.g., the physician provides sleeping pills and information about the lethal dose, while aware that the patient may commit suicide).”
The code goes on to say “Instead of engaging in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life. Physicians:
- Should not abandon a patient once it is determined that cure is impossible.
- Must respect patient autonomy.
- Must provide good communication and emotional support.
- Must provide appropriate comfort care and adequate pain control.”
Huge Price Hike
Per NPR, “In 2009, Grube remembers the price of a lethal dose of Seconal — 100 capsules — was less than $200. Over the next six years, it shot up to $1,500, according to drug price databases Medi-Span and First Databank.
Then Valeant bought Seconal last February and immediately doubled the price to $3,000.”
“Valeant Pharmaceuticals, the company that makes the drug most commonly used in physician-assisted suicide, doubled the drug’s price last year, one month after California lawmakers proposed legalizing the practice.”
Dosage must be individualized with full knowledge of their particular characteristics. Factors include age, weight, and overall condition.
- It comes in 100mg capsules.
Treatment is temporary, no more than two weeks worth of medication should ever be provided.
According to American Society of Health System Pharmacists (ASHP); “When hypnotic doses are administered orally, the onset of action usually occurs within 15 minutes. The duration of the hypnotic effect is 1-4 hours following oral administration.”
Larger doses can;
- distort judgment
- cloud perception
- suppress motor activity
- produce drowsiness
Even larger doses will induce anesthesia. Its onset of action is 10 to 15 minutes. Its duration of action ranges from 3 to 4 hours.
- severe CNS depression
- mental depression
Residual sedation or “hangover” occurs frequently following hypnotic doses, and subtle distortion of mood, impaired judgment, and impaired motor skills may persist for many hours.
- Barbiturates should not be administered in the presence of uncontrolled pain.
According to the NIH, “Complex behaviors such as “sleep-driving” (i.e., driving while not fully awake after ingestion of a sedative-hypnotic, with amnesia for the event) have been reported.
These events can occur in sedative-hypnotic-naïve as well as in sedative-hypnotic-experienced persons. Although behaviors such as sleep-driving may occur with sedative-hypnotics alone at therapeutic doses, the use of alcohol and other CNS depressants with sedative-hypnotics appears to increase the risk of such behaviors, as does the use of sedative-hypnotics at doses exceeding the maximum recommended dose. Due to the risk to the patient and the community, discontinuation of sedative-hypnotics should be strongly considered for patients who report a “sleep-driving” episode.”
Most physicians stopped prescribing this and other barbiturates for anxiety or sleep disorders by the 1980s.
According to a report by the National Institute of Health, long-term prescriptions and widespread barbiturate abuse led to a rash of addiction issues from the mid-1960s into the ’70’s. This is one reason doctors stopped prescribing it.
Another reason is a new class of sedatives – benzodiazepines – were deemed safer.
The Drug Enforcement Administration (DEA) categorizes the medication as a schedule II drug. Which means a substance with a high potential for abuse and the potential to cause severe psychological and physical dependence.
- This drug is a controlled substance.
Anecdotal reports by users suggest that the “high” user feel is like being very drunk on alcohol, though more sedated and serene.
- While that might sound enticing, the medication is extremely potent.
If you take too much sedative-hypnotic and or overdose, call your doctor or poison control center right away. Get emergency treatment. A toxic dose of barbiturates does vary.
- In most adults, an oral dose of 1 g of most barbiturates produces serious poisoning.
Barbiturate overdose may be confused with alcoholism or various neurologic disorders. Symptoms of overdose may occur within 15 minutes and begin with;
- central nervous system depression
- under ventilation
The lethal dose of a barbiturate is far less if alcohol is also ingested. Mixed with other substances it can easily lead to death. Some overdose symptoms may include:
- Difficulty breathing
- Low blood pressure, weak pulse
- Physical weakness
- Loss of coordination and slurred speech
- Sleepiness, exhaustion and coma
This drug is known to have caused several high-profile overdoses, including;
- Jimi Hendrix
- Judy Garland
Surprisingly, the symptoms of barbiturate dependence are similar to chronic alcoholism. If an individual appears to be intoxicated with alcohol to a degree that is radically disproportionate to the amount of alcohol in his or her blood, the use of barbiturates should be suspected.
- This drug is considered habit-forming.
- Tolerance and psychological and physical dependence may occur with continued use.
Patients who develop a dependence on barbiturates may increase the dosage or decrease the interval without consulting a physician. This behavior may develop a physical dependence. Because this medication is addictive, kicking any barbiturate habit can be difficult and painful. Withdrawal symptoms can include some of the following:
- Loss of appetite
- Possible death
According to the manufacturer, you may have withdrawal symptoms for 1 to 2 days when you stop taking the sedative-hypnotic. Withdrawal symptoms include trouble sleeping, unpleasant feelings, stomach and muscle cramps, vomiting, sweating, shakiness, and seizures. Drug dependence arises from repeated administration on a continuous basis.
The characteristics of dependence on barbiturates include:
- strong desire or need to continue taking it
- tendency to increase the dose
- psychic dependence
- physical dependence
As it turns out, it is a difficult drug to come by. One reason is that outside of hospitals, emergency rooms or surgery centers, pharmacies have no need to carry the medication because it’s so rarely prescribed.
- According to reporting by NPR News, a lethal dose retailed for $3,000 in 2016 compared to $200 in 2009.
Given a prescription, patients report having to wait several days for a pharmacy to order the medication or call several pharmacies to see if one has it in stock. For end of life use, Valeant Pharmaceuticals has come under federal scrutiny for price hikes related to the medication.
Its half-life in adults range between 15 to 40 hours. The average is approximately 30 hours. Approximately 90% of an oral dose of secobarbital is absorbed within 2 hours after ingestion. It reaches peak level within 2-4 hours.
Nicknames for this drug include;
- red devils
- red dillies
- ruby slippers
- red hearts