05 Aug Pentobarbital (Nembutal) Addiction
Today pentobarbital is considered so dangerous and addictive that it is mostly used under controlled circumstances, such as during surgery or as an injection given in a hospital or doctor’s office. As a Schedule II Controlled Substance, phenobarbital is subject to the strictest rules of government regulators, which means doctors and pharmacists have to track every pill.
Nevertheless, drug addicts highly desire pentobarbital and usually rate the effect of the drug with an A+. As more people experiment with prescription drugs, pentobarbital is being diverted from medical uses, smuggled from other countries, and made available through illegal pharmacies on the Internet. Once people get addicted to pentobarbital, they face a life-threatening withdrawal syndrome that can last for months and include impossibly unmanageable symptoms such as hallucinations and convulsions. It is also extremely easy to achieve a fatal overdose from pentobarbital, because just a little too much can often be enough to cause death. Addicts tend to keep increasing the amounts they use as they build up a tolerance to this barbiturate, and in this way, they increase their risk for a fatal overdose.
Many of the teenagers and young people experimenting with nembies are too young to remember the experience of their grandparents’ generation, when celebrities like Marilyn Monroe and Judy Garland overdosed on pentobarbital. If predictors of drug trends are correct, this new generation will repeat their grandparents’ mistakes.
What is Pentobarbital?
Pentobarbital is a short-acting barbiturate that comes as a white bitter powder soluble in water and alcohol.[i]
The chemical formula for pentobarbital is Na (sodium) + ethyl + methyl + butyl + al. In 1930 Dr. John S. Lundy used the first letters of these words to create the trademarked name “Nembutal” for pentobarbital products.[ii]
Dr. Adolph von Baeyer of Bayer Aspirin fame first discovered barbiturates in Germany in 1864. He combined animal urine with malonic acid from fruit to create this family of extremely strong sedatives. By 1950 there were 2500 kinds of barbiturates, classified as short-acting, intermediate-acting, or long-acting,[iii] and for many subsequent decades, these drugs were the only thing available for sedation, insomnia, and seizure disorders. Newer and safer families of drugs, especially benzodiazepines, are gradually replacing them. Barbiturates are highly addictive, produce a life-threatening withdrawal syndrome, and can easily cause fatal overdoses, which is why they are not used so much today.
Pentobarbital, like all barbiturates, is a “brain relaxer.” It comes as a liquid or as solid yellow capsules, and can be administered intravenously, rectally or orally.[iv]
In legal terms, pentobarbital products are classified as Schedule II Controlled Substances by the United States government and state governments. This classification means pentobarbital is among the most highly addictive drugs on the market today, but doctors can legally prescribe it because it has some proven medical uses. The penalties for possessing or selling pentobarbital illegally are among the most severe in the legal system. For example, a first offense can bring up to 20 years in prison or not less than 20 years to life if death or serious bodily injury occurred. Fines are $1 million for an individual and $5 million for cartels or other groups.[v]
What Are the Medical Uses of Pentobarbital?
Pentobarbital is prescribed as a sedative, sleeping pill, or anticonvulsant drug. It is sometimes used relax people before surgery. As an anti-seizure drug, pentobarbital is typically used for single acute episodes such as status epilepticus, chorea, eclampsia, meningitis, and tetanus.[vi] Because it is so highly addictive, pentobarbital is usually used only in hospitals and nursing homes, and on an as-needed basis.[vii] Patients who take it on a long-term basis usually have to undergo periodic blood tests because pentobarbital can cause damage to their organs.
Pentobarbital stops working as a sleeping pill within about two weeks.[viii]
The dose an individual takes is based on his weight, age and medical condition, and therefore determined by the patient’s doctor. It has different effects on different patients. If injected into large muscles, no more than 150 to 200mg of pentobarbital is used.[ix]
Pentobarbital is rapidly distributed throughout the tissues, and effects begin within 15 to 60 minutes. If taken orally or rectally, nearly all of it is absorbed from the gastrointestinal tract within one to four hours.[x]
Pentobarbital is used “off label” for physician-assisted suicides and criminal executions. Because of various international legal consequences involving its use in executions, Hospira Inc. of Lake Forest, Illinois, announced in 2011 that it would stop making Pentothal, which meant that that pentobarbital is now more frequently used to execute criminals in capital punishment cases.[xi]
Pentobarbital is considered the best and easiest drug to use for suicide.
According to Robert Mero, an activist in the euthanasia movement, “I see deaths where there is choking, struggling and thrashing. (Pentobarbital) is the death of serenity, a death wrapped in sleep, not struggle.”[xii]
People usually ingest 40 or more Nembutal tablets along with ice cream or applesauce to overcome the drug’s side effects of nausea and vomiting. If they take it with an alcoholic drink, death occurs more quickly.
Pentobarbital is used for physician-assisted suicide in countries like Belgium where that is legal, and illegally in other countries for the same purpose. Pro-euthanasia groups such as Final Exit, the Hemlock Society, and Compassion in Dying send members to buy pentobarbital illegally from pet stores and pharmacies in Mexico and other countries, and then smuggle it back into the United States illegally for assisted suicides. Sometimes it can be bought back legally if it is specified as veterinary medicine.[xiii]
What are the Side Effects of Pentobarbital?
Common side effects of pentobarbital are confusion, drowsiness, slowed heartbeat, headache, nausea, vomiting, weak pulse, and a feeling that you might pass out. Serious side effects can be hallucinations, nightmares, fainting, low blood pressure, lack of coordination, and problems with memory and concentration.
Some people have a paradoxical adverse reaction to pentobarbital, and they experience agitation, excitability, abnormal thoughts, and anxiety.[xiv]
Chronic use of pentobarbital can cause liver damage and megaloblastic anemia. Most doctors require blood tests of patients who take this drug for any length of time.[xv]
What Drugs Interact with Pentobarbital?
In general, barbiturates such as pentobarbital should not be used with medications that slow down the central nervous system or “relax” the brain. These might include alcohol, other barbiturates, narcotic painkillers, illegal narcotics, muscle relaxants, barbiturates, tranquilizers, sedatives, sleeping pills, and medications that cause drowsiness, such as antihistamines and cold and flu medications.
Pentobarbital will cause birth control pills to lose their effectiveness.
Do not take pentobarbital with blood thinners (Coumadin), doxycycline (Adoxa, Mondox, Doryx), other anti-seizure medications (valproic acid, Dilantin), griseofulvin, estrogen replacement drugs, and steroids such as prednisone, prednisolone, and methylprednisolone.[xvi]
What are the Dangers of Using Pentobarbital?
The main danger of using Pentobarbital is addiction with its accompanying problems like drug craving, tolerance, withdrawal syndrome, and physical and psychological dependency. Pentobarbital, as a Schedule II Controlled Substance, is one of the most addictive medications on the market. Barbiturate addiction is extremely dangerous because these drugs have a low therapeutic-to-toxic ratio, which means the difference between a therapeutic dose and a lethal one can be just a tiny amount more of the drug. It is therefore extremely easy to overdose and die from pentobarbital addictions, especially if you combine this drug with alcohol, illegal drugs or prescription painkillers. Most pentobarbital addicts use more than one drug.
Even doctors have problems predicting the correct dose of pentobarbital for a patient. Even a slight overdose can produce a coma.[xvii] If a medical professional injects pentobarbital into a patient in such a way that the patient receives the drug too quickly, the patient can die.[xviii]
Elderly, very ill or very weak patients can overreact to pentobarbital.
This drug is found to be carcinogenic in laboratory animals.
On rare occasions, a patient may have an allergenic reaction to pentobarbital and enter a life-threatening syndrome called anaphylaxis. The person may develop hives, rashes, difficulty breathing, and a swelling of the face, lips, throat and tongue. Sometimes these areas become so swollen that the person stops breathing. People in anaphylactic shock need immediate emergency medical treatment.[xix]
What People Should Not Take Pentobarbital?
Pentobarbital is not prescribed to pregnant women because it is a “Category D” drug or one that has been proven harmful to unborn babies. Nursing mothers should not use pentobarbital.
Doctors do not prescribed pentobarbital to people with histories of substance abuse or alcoholism because it is so highly addictive. It is also not prescribed to people with a genetic enzyme disorder called porphyria or to those with liver or kidney diseases, mental illnesses, chronic obstructive pulmonary disorders (COPD), or breathing disorders such as asthma and bronchitis.[xx]
Does Pentobarbital Show Up in Urine Tests?
Barbiturates are controlled substances regulated under the Comprehensive Drug Abuse Prevention Control Act passed by the United States Congress in 1970, and the majority of urine tests at school and work will detect them. Pentobarbital has a half-life of between 38 to 88 hours and can be detected within two to ten days of taking it.
What is a Pentobarbital Overdose?
Pentobarbital overdoses occur when a person ingests too much of the drug. This is relatively easy to do. One gram of pentobarbital can cause a serious poisoning, and two to ten grams can cause death.
Symptoms of a pentobarbital overdose are severe slowing of the central nervous system that includes slow breathing and heartbeat, weakness, limpness, lack of urination, pinpoint or dilated pupils, and weak pulse.[xxi] Other symptoms can be absence of reflexes and coma.[xxii] As their breathing and heart rates slow down, some people in pentobarbital overdoses develop Cheynes-Stokes breathing or “death rattles.” Most people are found unconscious.[xxiii]
Treatment for pentobarbital overdose is to maintain the patient’s airway, monitor vital signs, administer fluids intravenously, force diuresis, and to perform hemodialysis. Those who develop pneumonia may need antibiotics.[xxiv] Emergency medical personnel usually perform blood and urine tests to determine the level of pentobarbital and other drugs that may have been involved.[xxv]
Some people overdosing on pentobarbital can have “flat” electrocardiograms, but these can sometimes be reversed. Complications of a pentobarbital overdose can be pneumonia, edema, congestive heart failure, and kidney failure.[xxvi]
What is Pentobarbital Withdrawal?
Withdrawal from barbiturates such as pentobarbital can be life-threatening, and should never be attempted without professional medical supervision. Barbiturates interfere with the way neurotransmitters work in the brain. If you stop using them suddenly, your brain can become overwhelmed with nerve impulses and you will develop frightening hallucinations and life-threatening seizures.[xxvii] Withdrawing from barbiturates is among the most difficult of all syndromes to endure.
Withdrawal usually begins within eight to 12 hours of the last dose. The first symptoms may be anxiety, sweating, fever, shortness of breath, rapid heartbeat, paranoia, muscle twitching, tremors, weakness, dizziness, distorted visual perception, nausea, vomiting, low blood pressure, and insomnia. After 16 hours, some people have convulsions and delirium. The seizures might continue for the next three days. These troubling symptoms can last up to five days, and then gradually reduce in intensity after about 15 days, but it can take six months to a year to feel completely free of pentobarbital.[xxviii]
Sometimes the doctor will substitute 30mg of pentobarbital for every 100mg to 200mg a person has been taking. This amount can be given three to four times a day for up to 600mg a day. Sometimes a physician will do a “loading dose” of 200mg the first day. Using this method, the amount of pentobarbital is gradually decreased by 30mg a day.[xxix]
What is Pentobarbital Addiction?
It is possible to become physically dependent on pentobarbital if you take 400mg or more for 90 days,[xxx] but some people have become physically and psychologically dependent on barbiturates within one or two weeks.[xxxi] If you take 600 to 800mg of pentobarbital per day, you will experience a withdrawal syndrome after just 35 days. The typical pentobarbital addict takes 1.5 grams.[xxxii]
Addiction to pentobarbital will include symptoms such as a compulsion to take the drug, a need to increase the levels as tolerance to its effects develops, a need to keep taking the drug in order to maintain a “normal” state, an appreciation of how good the drug feels to you, and experiencing severe withdrawal symptoms when you stop taking it.[xxxiii]
According to government data from the TEDS study of admissions to drug rehabilitation centers, admissions for sedative addictions such as pentobarbital account for less than one percent. People addicted to sedatives are 84% white non-Hispanic, 34% college graduates, 3% over 65 years old, and 60% alcohol abusers.[xxxiv] As more high school students experiment with prescription drugs that they perceive to be safer than street drugs, sedative abuse may increase in the future.[xxxv] People also typically abuse pentobarbital to modulate the effects of cocaine and methamphetamine and to commits suicide. Risk factors for a pentobarbital addiction are addictions to alcohol and other drugs.[xxxvi]
Slang names for pentobarbital are yellow jackets, abbots, Mexican yellow, and nembies. Addicts can buy these tablets from street dealers, who often obtain them from Mexico, or through illegal Internet pharmacies.
Pentobarbital addicts tend to use this drug in the same way others might use alcohol. At low levels, pentobarbital will cause sleepiness, relaxation, mild euphoria, and sedation. At higher levels, pentobarbital can cause impaired judgment, poor coordination, slurred speech, lowered inhibitions, slowed pulse and breathing, lowered blood pressure, poor concentration/fatigue, confusion, and impaired memory and judgment. The next day, people often get “hangovers” that might include headaches, depression, irritability, and problems with anger management.[xxxvii] If you keep increasing your dose of pentobarbital, you run the risk of passing out, entering a coma, and dying.[xxxviii]
Pentobarbital addicts will sometimes lay in stupors that last for so many hours that they develop bruises on their arms, legs and backs from lack of movement.[xxxix]
What Treatments Are Available for Pentobarbital Addiction?
Residential treatment centers offer comprehensive and intense programs for pentobarbital addiction. The usual steps to recovery are physical and psychological examination, detoxification, intense psychotherapy, physical recovery, acquiring tools to deal with drug cravings, career counseling, support meetings, and treatment for any comorbidities. Comorbidities are psychiatric conditions that travel with but do not necessarily cause drug addiction. People who are addicted to heavy sedatives like pentobarbital are often self-medicating themselves because they have psychiatric conditions such as depression, eating disorders, childhood trauma, personality disorders, and so forth. Doctors need to treat comorbidities in separate protocols with an appropriate set of medications and therapies for the particular condition along with your treatment for pentobarbital addiction.
When you enter a drug rehabilitation center, a medical doctor will evaluate you physically and psychologically to determine the level of your addiction and if you have any undiagnosed psychiatric comorbidities. You and your doctor, along with your personal psychotherapist, will create your individualized program of recovery. Then you will enter a detoxification unit, where you can safely withdraw from pentobarbital under the supervision of medical professionals.
Once your detoxification process is complete, you move into the residential center to complete an individualized program of psychotherapy, group therapy, physical fitness, social activities, and classes. You will learn why you became addicted to pentobarbital and how to handle environmental triggers that will cause you to relapse into drug abuse. You will learn how to relax without drugs by using healthy techniques such as sports, yoga, and meditation. Rehab can be life-changing in that you may consider a new career, replacing unhealthy relationships, and going back to school. You cannot just give up drugs – you have to find something to replace the void in your life that drugs have filled in the past.
Once you return home, you usually continue in individual and family therapy, and attend support meetings near your home.
How Can I Tell if I am Addicted to Pentobarbital?
If you can answer yes to any of the following questions, it is time to talk about your problem with pentobarbital with your family physician or an addiction specialist in residential treatment center for drug and alcohol abuse.
- Are you taking pentobarbital without a doctor’s prescription?
- Are you taking pentobarbital at amounts not medically recommended?
- Do you have to keep increasing the dose of pentobarbital that you take to achieve the effect you want?
- Do you develop withdrawal symptoms when you stop taking pentobarbital?
- If you take pentobarbital during the day, do you find it difficult to sleep at night?
- Have you tried unsuccessfully to stop taking pentobarbital on your own?
- Do your family members or friends criticize you for your drug abuse?
- Have you ever driven an automobile under the influence of pentobarbital or otherwise endangered your life physically because of drugs?
- Are you having financial and legal problems because of your drug use?
- Do you feel ashamed, guilty or worried about your drug abuse?
- Are you experiencing physical symptoms from pentobarbital that interfere with your life?
- Do you worry that you will damage your liver or accidentally died from overdose because of your use of pentobarbital?
- Are you unable to go more than a day or two without taking drugs or alcohol?
- Do you need pentobarbital just to feel normal?
Lacey, Marc. “In Tijuana, a Market for Death in a Bottle,” The New York Times, July 21, 2008.
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