Pentobarbital (N) is NOT as good as it seems. Not even close.

[Gone.]

Hi, I wanted to address all those who still believe that pentobarbital (N) is the gold standard.

Intramuscular, subcutaneous or any injection route other than IV, IC, or IP is NOT acceptable, even in veterinary practise. Oral pentobarbital is not recommended, and is even illegal in many jurisdictions for veterinary euthanasia.

The Humane Society of the United States' publication. The Society recommends the use of pentobarbital for the purpose of veterinary euthanasia, administered via intravenous (39 mg/lb), intraperitoneal (117 mg/lb), or intracardiac (39mg/lb) route. The Society explicitly states that no other injection routes are permissible.

Intracardiac injection is extremely painful. The Society only recommends the use of intracardiac injection when the patient is fully unconcious, and in humans, the use of this route is extremely rare outside of emergencies (if a patient is actively coding) and is guided to avoid injecting into the lung accidentally.

The oral route of pentobarbital is generally not advisable in veterinary practise as pentobarbital is extremely bitter and requires 3x the IV dose. In humans, a minimum of nine grams is required to achieve death. However, new evidence indicates that 15 grams is required to achieve death consistently in humans. Human administration is always preceeded by an administration of antienemics. Euthasol, the formulation commonly found in American veterinary practise, contains 390mg/ml. Using the latest guidance, this means the patient will be required to orally consume 38.46ml of Euthasol in order to die. And recall that that pentobarbital is extremely bitter and unpleasant to consume, and results in nausea hence the administration of antienemics. Oral pentobarbital also takes quite a while to kill, with the average length in bearded dragons to be 300 minutes.

Existing research indicates an average of five minutes between consumption and LOC, so during that five minutes, you'll be there feeling the full force of the bitterness before you finally pass out. 10% of patients vomit after consuming pentobarbital, antienemic notwithstanding. 9% have difficulty swallowing the dose, and emerging out of coma in 2 percent of cases.

Therefore, it is of my opinion that pentobarbital is not optimal for the use in human euthanasia, and that other avenues must be explored.

References

EUTHASOL®(pentobarbital sodium and phenytoin sodium)Euthanasia Solution

Assistierter Suizid in der Schweiz - Sterben auf Wunsch

In der Schweiz nehmen sich mehr Menschen mit Begleitung von Suizidhelfern das Leben als ohne Begleitung. Manche Experten sagen: So könnte es auch bei uns in zehn Jahren aussehen. Ist unser Nachbarland ein Vorbild für Deutschland oder muss uns die Entwicklung zu denken geben?

www.deutschlandfunk.de

https://doi.org/10.2146/ajhp100333

https://humanepro.org/sites/default...g/view/journals/ajvr/85/6/ajvr.24.02.0026.xml

Transmucosal administration of pentobarbital and phenytoin solution induces euthanasia in bearded dragons (Pogona vitticeps)

Abstract OBJECTIVE To assess the efficacy of transmucosal euthanasia solution to induce euthanasia. ANIMALS 6 bearded dragons (Pogona vitticeps). METHODS An initial dose of euthanasia solution containing pentobarbital and phenytoin sodium was administered transmucosally in conscious lizards (100...

doi.org

https://doi.org/10.1111/anae.14532

 

[TragedyBornCrimson]

I could never inject myself, I am glad I found a way to get SN. The payment process however is just as hard as finding the source to begin with.

 

[Seele]

N is extremely bitter and leaves a bad feeling in the throat, but the person doesn't feel anything and passes out. I chose N, not just because it's quicker, but because it's a more peaceful death.
I followed the CTB of a person from my country with SN and it took a long time and she turned purple, the other person used N and she simply passed out and gradually stopped breathing.

 

[Gone.]

N is extremely bitter and leaves a bad feeling in the throat, but the person doesn't feel anything and passes out. I chose N, not just because it's quicker, but because it's a more peaceful death.
I followed the CTB of a person from my country with SN and it took a long time and she turned purple, the other person used N and she simply passed out and gradually stopped breathing.

Existing research indicates an average of five minutes between consumption and LOC, so during that five minutes, you'll be there feeling the full force of the bitterness. (Sinmyee, S., Pandit, V. J., Pascual, J. M., Dahan, A., Heidegger, T., Kreienbühl, G., Lubarsky, D. A., & Pandit, J. J. (2019). Legal and ethical implications of defining an optimum means of achieving unconsciousness in assisted dying. Anaesthesia, 74(5), 630–637. https://doi.org/10.1111/anae.14532)

It takes time, a long time, for your GI tract to absorb the medication, which is why other routes of administration exists. If the GI tract can absorb drugs instantly, other routes of administration would never have to be invented.

 

[Seele]

Existing research indicates an average of five minutes between consumption and LOC, so during that five minutes, you'll be there feeling the full force of the bitterness. (Sinmyee, S., Pandit, V. J., Pascual, J. M., Dahan, A., Heidegger, T., Kreienbühl, G., Lubarsky, D. A., & Pandit, J. J. (2019). Legal and ethical implications of defining an optimum means of achieving unconsciousness in assisted dying. Anaesthesia, 74(5), 630–637. https://doi.org/10.1111/anae.14532)

It takes time, a long time, for your GI tract to absorb the medication, which is why other routes of administration exists. If the GI tract can absorb drugs instantly, other routes of administration would never have to be invented.

I understand what you mean, but the reality is that they won't sell us N syringes. In that case, even animals die better than us. I'm thinking about what's possible for me, and unfortunately, even though I don't want to, and it's still difficult to get N, I'll still have to ingest it. I'm also looking for ways to have a peaceful death...

 

[lnlybnny]

So, do you think SN is a better option?

 

[rozeske]

End of life assistance videos of people drinking N says otherwise, although it seems to be the powder form? They just take a piece chocolate for the aftertaste. It looks fast and peaceful and just a perfect exit. Too bad it isn't easily accessible.

 

[Wendigo]

Hi, I wanted to address all those who still believe that pentobarbital (N) is the gold standard.

Intramuscular, subcutaneous or any injection route other than IV, IC, or IP is NOT acceptable, even in veterinary practise. Oral pentobarbital is not recommended, and is even illegal in many jurisdictions for veterinary euthanasia.

The Humane Society of the United States' publication. The Society recommends the use of pentobarbital for the purpose of veterinary euthanasia, administered via intravenous (39 mg/lb), intraperitoneal (117 mg/lb), or intracardiac (39mg/lb) route. The Society explicitly states that no other injection routes are permissible.

Intracardiac injection is extremely painful. The Society only recommends the use of intracardiac injection when the patient is fully unconcious, and in humans, the use of this route is extremely rare outside of emergencies (if a patient is actively coding) and is guided to avoid injecting into the lung accidentally.

The oral route of pentobarbital is generally not advisable in veterinary practise as pentobarbital is extremely bitter and requires 3x the IV dose. In humans, a minimum of nine grams is required to achieve death. However, new evidence indicates that 15 grams is required to achieve death consistently in humans. Human administration is always preceeded by an administration of antienemics. Euthasol, the formulation commonly found in American veterinary practise, contains 390mg/ml. Using the latest guidance, this means the patient will be required to orally consume 38.46ml of Euthasol in order to die. And recall that that pentobarbital is extremely bitter and unpleasant to consume, and results in nausea hence the administration of antienemics. Oral pentobarbital also takes quite a while to kill, with the average length in bearded dragons to be 300 minutes.

Existing research indicates an average of five minutes between consumption and LOC, so during that five minutes, you'll be there feeling the full force of the bitterness before you finally pass out. 10% of patients vomit after consuming pentobarbital, antienemic notwithstanding. 9% have difficulty swallowing the dose, and emerging out of coma in 2 percent of cases.

Therefore, it is of my opinion that pentobarbital is not optimal for the use in human euthanasia, and that other avenues must be explored.

References

EUTHASOL®(pentobarbital sodium and phenytoin sodium)Euthanasia Solution

Assistierter Suizid in der Schweiz - Sterben auf Wunsch

In der Schweiz nehmen sich mehr Menschen mit Begleitung von Suizidhelfern das Leben als ohne Begleitung. Manche Experten sagen: So könnte es auch bei uns in zehn Jahren aussehen. Ist unser Nachbarland ein Vorbild für Deutschland oder muss uns die Entwicklung zu denken geben?

www.deutschlandfunk.de

https://doi.org/10.2146/ajhp100333

https://humanepro.org/sites/default...g/view/journals/ajvr/85/6/ajvr.24.02.0026.xml

Transmucosal administration of pentobarbital and phenytoin solution induces euthanasia in bearded dragons (Pogona vitticeps)

Abstract OBJECTIVE To assess the efficacy of transmucosal euthanasia solution to induce euthanasia. ANIMALS 6 bearded dragons (Pogona vitticeps). METHODS An initial dose of euthanasia solution containing pentobarbital and phenytoin sodium was administered transmucosally in conscious lizards (100...

doi.org

https://doi.org/10.1111/anae.14532

Existing research indicates an average of five minutes between consumption and LOC, so during that five minutes, you'll be there feeling the full force of the bitterness. (Sinmyee, S., Pandit, V. J., Pascual, J. M., Dahan, A., Heidegger, T., Kreienbühl, G., Lubarsky, D. A., & Pandit, J. J. (2019). Legal and ethical implications of defining an optimum means of achieving unconsciousness in assisted dying. Anaesthesia, 74(5), 630–637. https://doi.org/10.1111/anae.14532)

It takes time, a long time, for your GI tract to absorb the medication, which is why other routes of administration exists. If the GI tract can absorb drugs instantly, other routes of administration would never have to be invented.

I understand what you mean, but it is still the most reliable and peaceful method out there.
In terms of bitterness, Euthasol is less bitter than SN, and bitterness isn't really much of a concern.
In the article you shared about reptiles, they use Euthasol, which contains phenytoin sodium. Dechra, the version of Euthasol manufactured and found in Europe, does not contain phenytoin, phenytoin causes gastrointestinal irritation.
N is the gold standard for its reliability and peacefulness. It has been used for assisted euthanasia for many years, including in drinkable form.


Many other methods are way less reliable and could cause severe consequences after a failed attempt.
SN, Inert gas, OD, Hanging, Gun, Jumping, Train, Carbon monoxide are better methods?.

 

[Unleashtherain]

I would definitely take my chances if it were available to me.

 

[ijustwishtodie]

I would easily take nembutal if I had access to it. The bitter taste is nothing and I repeat... nothing compared to the shit that I have to go through in existence. Even vomiting is fucking nothing compared to the pain that I go through of simply living though of course I wouldn't want to vomit all of it out as then I wouldn't be dead

 

[ThisIsMe1357]

I do not understand which parts of the post or the articles make pentobarbital be "not as good as it seems"?

Yes, people need roughly 15 grams to succeed, and that means they require a few bottles of the veterinary version, but that means the only part of the article which possibly raises any kind of an issue is the bitter aftertaste. There is literally nothing else about pentobarbital that matters in any way. And I would say some bitterness is not really that relevant.

Besides, experience tells us something else, otherwise they would not be using the substance in Switzerland.

 

[Tesha]

As someone who has tasted N, I didn't find it unbearable. Unpleasant, but perfectly manageable. It also knocked me out in a few minutes for a lengthy sleep..

Just as well we're all entitled to our own opinions on our methods. N is by far the gold standard for a number of reasons IMO.

 

[Wendigo]

As someone who has tasted N, I didn't find it unbearable. Unpleasant, but perfectly manageable. It also knocked me out in a few minutes for a lengthy sleep..

Just as well we're all entitled to our own opinions on our methods. N is by far the gold standard for a number of reasons IMO.

May I ask you what brand was it? Concentration and how many ml did you take?

 

[Bleh61]

I have a seizure disorder, so I take Phenobarbital and Lamictal.

Right now, I have 3000mg of Phenobarbital at home. When I kill myself, that will be my method.

 

[Tesha]

May I ask you what brand was it? Concentration and how many ml did you take?

N from D (years ago). Sold as 6.5G, but tested at 6.7G. I've orally tried up to 5ml in one go, but I had a benzo tolerance at that time.

 

[maniac116]

I disagree!
I've used N in capsule form many times in the past & it was very easy to see that it could be very deadly. I'm no pharmacist but think it could easily work. Just my 2 cents worth...

 

[Talvikki]

Oh dear, I flushed my N down the toilet right away! Thanks for the warning!

 

[nihilistic_dragon]

LOL

 

[lnlybnny]

As someone who has tasted N, I didn't find it unbearable. Unpleasant, but perfectly manageable. It also knocked me out in a few minutes for a lengthy sleep..

Just as well we're all entitled to our own opinions on our methods. N is by far the gold standard for a number of reasons IMO.

Is there anything, any food or drink, that resembles it in your opinion?

 

[Forever Sleep]

Why would they use it in the clinics if an alternative is better? I'm guessing they prefer not to do the IV route in the clinics because they still want the person to make that final choice on whether to drink it. Sadly, I doubt anything is 100% pleasant.

Do you think the Sarco pod would be more peaceful? Perhaps they will start using them predominantly in assisted suicide.

 

[Wendigo]

Why would they use it in the clinics if an alternative is better? I'm guessing they prefer not to do the IV route in the clinics because they still want the person to make that final choice on whether to drink it. Sadly, I doubt anything is 100% pleasant.

Do you think the Sarco pod would be more peaceful? Perhaps they will start using them predominantly in assisted suicide.

Inert gases like helium or nitrogen are definitely as peaceful as it can get, I had tachycardia when I attemped tho, but it was definitely painless and very quick.
A room full or nitrogen would kill many people at the same time without them even noticing! It's probably the best way to go.
An exit bag is different, it requires a lot of research, technique and many things can go wrong ( leak, running out of gas, not enough gas flow, too much pressure, holes, etc) and you need to put a plastic bag over your head.

 

[Sunset Limited]

 

[Gone.]

Note to all: Current protocols does NOT use pentobarbital as a monotherapy! Pentobarbital is always preceeded by Metoclopramide 20mg PO and Ondansetron 8mg PO, with oral lidocaine spray (optional) (CAN). The dutch protocol is even more careful. The current protocol is a mix of barbituates, chloral hydrate, and morphine. Also, patients are to keep NPO for 4-5hr pre-administration.

For those saying it isn't as bitter as I pose it to be, guidelines state:
"Oral protocol is bitter tasting and can burn. Consider offering the patient Lidocaine spray before administration of the oral protocol"

For those saying it is still the first-line, and that if it is used in healthcare, it must be the best:

An overwhelming majority of Dutch and Canadian patients opt for the IV
protocol as there is a 3-10% failure rate with the oral route (though "failure" in some
studies means death not occurring within 2 hours). It is a requirement of the CPSBC
that a back-up IV protocol is available if the oral route has been selected by the patient
as their initial choice. We strongly advise that two IV cannulae are placed in all cases
regardless of protocol choice.

I understand what you mean, but it is still the most reliable and peaceful method out there.
In terms of bitterness, Euthasol is less bitter than SN, and bitterness isn't really much of a concern.
In the article you shared about reptiles, they use Euthasol, which contains phenytoin sodium. Dechra, the version of Euthasol manufactured and found in Europe, does not contain phenytoin, phenytoin causes gastrointestinal irritation.
N is the gold standard for its reliability and peacefulness. It has been used for assisted euthanasia for many years, including in drinkable form.


Many other methods are way less reliable and could cause severe consequences after a failed attempt.
SN, Inert gas, OD, Hanging, Gun, Jumping, Train, Carbon monoxide are better methods?.

I personally would either go for propofol, long drop, or inert gas. Can you provide evidence on the phenytoin being the sole source of GI irritation?

The oral form is being deprecated, at least in British Columbia, as it's risk of failure is rather high. Pentobarbital monotherapy is NOT the gold standard for sure.

I disagree!
I've used N in capsule form many times in the past & it was very easy to see that it could be very deadly. I'm no pharmacist but think it could easily work. Just my 2 cents worth...

Pentobarbital capsules is likely better in my non-evidence-based opinion as it removes the bitterness. However, it's also very easy to see based on experience post-administration as a patient how something like midazolam can be lethal as well, despite it not being so. It is critical that we evaluate drugs based on evidence over experience.

Why would they use it in the clinics if an alternative is better? I'm guessing they prefer not to do the IV route in the clinics because they still want the person to make that final choice on whether to drink it. Sadly, I doubt anything is 100% pleasant.

Do you think the Sarco pod would be more peaceful? Perhaps they will start using them predominantly in assisted suicide.

Why would they use it in the clinics? Well, the current protocol being used in BC is midazolam+lido+prop+rocu+potassium, with barbituates as an oral option, that physicians are to offer but to advise against as it's rate of failure is rather high.

An overwhelming majority of Dutch and Canadian patients opt for the IV
protocol as there is a 3-10% failure rate with the oral route (though "failure" in some
studies means death not occurring within 2 hours). It is a requirement of the CPSBC
that a back-up IV protocol is available if the oral route has been selected by the patient
as their initial choice. We strongly advise that two IV cannulae are placed in all cases
regardless of protocol choice.

(https://divisionsbc.ca/sites/default/files/51936/Medical Assistance in Dying (MAID) Protocols and Procedures Handbook Comox Valley 2017 - 2nd edition_0.pdf)

I understand what you mean, but the reality is that they won't sell us N syringes. In that case, even animals die better than us. I'm thinking about what's possible for me, and unfortunately, even though I don't want to, and it's still difficult to get N, I'll still have to ingest it. I'm also looking for ways to have a peaceful death...

Uhm, pentobarbital syringes? Just go get an IV catheter, 18g syringe, and a large barrel from the pharmacy... Place the IV, draw pentobarbital into the barrel using the 18g syringe, and push it...

End of life assistance videos of people drinking N says otherwise, although it seems to be the powder form? They just take a piece chocolate for the aftertaste. It looks fast and peaceful and just a perfect exit. Too bad it isn't easily accessible.

This may be the case for certain patients. However, videos of a procedure is not a replacement for patient interviews. For example, if I was to get a lumbar puncture w/o anesthetics, I would look okay on video, but if you were to ask me if it hurts, I would say "It hurts a fuck ton".

The powder form is available as a compounded preparation.

 

[Tesha]

For those saying it isn't as bitter as I pose it to be

So, you've not tasted it yourself then? Ok.

Place the IV, draw pentobarbital into the barrel using the 18g syringe, and push it...

You'll most likely be asleep (anaesthetised) before being able to self administer the full dose.

it's rate of failure is rather high

No, what it says in that document is 3-10% may not die within 2 hours, indicating the studies differ - there is no defined failure rate. It does not state anywhere that the failure rate is rather high. You would also be unconscious, and will die within 24 hours; but the clinics use an IV option to reduce that time.

I appreciate you've got your own views on the peacefulness or reliability of oral N, but that doesn't make your views the correct one. By all means share your research for others to read and feed into their own decisions, but to just state it's not a good method is incorrect, imo.

 

[yellowjester]

 

[davidtorez]

Well this thread has me all worried. My method of ctb is N from AV and it is expired N at that. Being a 90kg male I'm wondering if the 2 bottles will fo the trick now.....oh the stress

 

[FadingDawn]

Bitterness in the mouth is hardly that bad. N was used in medical euthansia by several doctors in switzerland already. Please be more conscientious with your sources and things you say. Fairly low quality post, and pretty useless.

 

[rozeske]

This may be the case for certain patients. However, videos of a procedure is not a replacement for patient interviews. For example, if I was to get a lumbar puncture w/o anesthetics, I would look okay on video, but if you were to ask me if it hurts, I would say "It hurts a fuck ton".

We can't really get any where if we are basing our argument off of "it looks peaceful but what if it's not". I mean one could argue "they look dead, but what if they are not?". If it looks peaceful and fast it's because it is. You would definitely know if it wasn't peaceful. One would definitely know how you are feeling while getting lumbar puncture w/o an anesthetic. Although it isn't an intolerable pain, patients usually can't sit still both from the anticipation of what's coming plus whatever pain they feel. Which is when physicians avoid doing it w/o an anesthetic. No one would wanna be near your spine with that giant needle while you are writhing. There is no such a thing as "it's so much more painful than it looks". One could maybe say "it's not as bad/painful as it looks".

 

[justwannadip]

Inert gases like helium or nitrogen are definitely as peaceful as it can get, I had tachycardia when I attemped tho, but it was definitely painless and very quick.
A room full or nitrogen would kill many people at the same time without them even noticing! It's probably the best way to go.
An exit bag is different, it requires a lot of research, technique and many things can go wrong ( leak, running out of gas, not enough gas flow, too much pressure, holes, etc) and you need to put a plastic bag over your head.

What went wrong if I may ask? How did you keep the gas in a controlled space without the bag? Did you use a tube and mask attached to a tank or did you just release the tank in a room?

 

[cryptoinvestor]

i've ingested pure aloe vera gel, san pedro cactus, N will be a walk in the park