Monday, April 22, 2019

Complications with Lethal Drugs Used for Assisted Suicide

The Patients Rights Action Fund published the following information.

Warning: If you are experiencing suicidal thoughts, do not read this article but call: 1-800-273 (talk) 8255
Seconal
· The lethal dose prescribed to cause the death of the patient is 9 grams of seconal (secobarbital) capsules. To reach this dosage, the patient takes 100 capsules which are opened and mixed with a sweet substance to mask the bitter taste.

· The price of seconal in 2009 was estimated at around $200. The price increased over the next few years to $1,500. When Valeant bought seconal in early 2016, the price increased to $3,000 -- $7,000. [1]
Phenobarbitol
· To counter the cost increase of seconal, proponents of assisted suicide began experimenting with combinations of drugs to induce death. One of the drug combinations being used is a mixture consisting of phenobarbital, chloral hydrate and morphine sulfate. The patient mixes the powder with water, alcohol, applesauce or juice. This drug combination lowered the cost to $400-$500.

· In Oregon, the phenobarbital combination has been used to cause the death of 65 patients. For known durations, 59.1% of patients experienced deaths from one to six hours in length and 22.7 % experienced deaths over 6 hours in length. [2]
DDMP 1; DDMP2
· Increasingly, a four drug-cocktail consisting of diazepam, digoxin, morphine sulfate and propranolol (DDMP) is being used to reduce costs. DDMP 1 contains 10 grams of morphine sulfate and DDMP 2 contains 15 grams.[3]

· When a patient took 18 hours to die using DDP (diazepam, morphine sulfate and propranolol), digoxin was added to the mix and the dosage was subsequently increased to form DDMP2. Researchers have described DDMP2 as “blue-whale-sized doses…..And the mixture tastes extremely bitter. ‘Imagine taking two bottles of aspirin , crushing it up, and mixing it in less than half a cup of water or juice.’”[4]

· In Oregon, DDMP 1 and DDMP 2 accounted for 145 deaths through 2018. For known durations, 40% of patients experienced deaths from one to six hours in length and 24% experienced deaths over six hours in length. Two patients regained consciousness after ingesting the drugs.[5] “The median time until death was longer for the DDMP2 compound (120 min) than for secobarbital (25 min)…”[6]

· In Oregon in 2018, DDMP was prescribed for 38.1% of patients compared to 13.2% in previous years.[7]
Morphine Sulphate
· In Washington State in 2017, 130 out of 196 deaths (63%) were attributed to use of morphine sulfate in isolation.[8] Deaths from secobarbital and morphine sulfate lasted from 5 minutes to 35 hours in range.[9]
General Complications From Lethal Drugs Used In Assisted Suicide Deaths
· Experimenting with combinations of drugs is “research” which has not been approved by any ethics review committee like an "Institutional Review Board" (IRB), which appears to violate research ethics standards.

· According to The Atlantic: “No medical association oversees aid in dying, and no government committee helps fund the research……... The doctors’ work {to experiment with drugs which kill patients} has taken place on the margins of traditional science. Despite their principled intentions, it’s a part of medicine that’s still practiced in the shadows.”[10]

· According to Kaiser Health News, “The first Seconal alternative turned out to be too harsh, burning patients’ mouths and throats, causing some to scream in pain.”[11] “The second drug mix, used 67 times, has led to deaths that stretched out hours in some patients – and up to 31 hours in one case……the next longest 29 hours, the third longest 16 hours and some 8 hours in length.”[12]

· According to the New England Journal of Medicine: One in five Dutch patients using standard barbiturates to kill themselves experienced complications including vomiting, inability to finish the medication, longer than expected time to die, failure to induce coma, and awakening from coma.[13]
 
· According to Anaesthesia: “However, for all these forms of assisted dying, there appears to be a relatively high incidence of vomiting (up to 10%), prolongation of death (up to 7 days), and re-awakening from coma (up to 4%), constituting failure of unconsciousness. This raises a concern that some deaths may be inhumane……”[14]

1. http://www.medscape.com/viewarticle/869023?src=emailthis#vp_2

2. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf, page 15

3. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf, page 15

4. https://www.theatlantic.com/health/archive/2019/01/medical-aid-in-dying-medications/580591/

5. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf, page 15

6. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf, page 7

7. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf, page 7

8. https://www.doh.wa.gov/Portals/1/Documents/Pubs/422-109-DeathWithDignityAct2017.pdf, page 9

9. https://www.doh.wa.gov/Portals/1/Documents/Pubs/422-109-DeathWithDignityAct2017.pdf, page 10

10. https://www.theatlantic.com/health/archive/2019/01/medical-aid-in-dying-medications/580591/

11. Kaiser Health News, “Docs in Northwest Tweak Aid-In-Dying Drugs to Prevent Prolonged Deaths”, February 21, 2017

12. Kaiser Health News, “Docs in Northwest Tweak Aid-In-Dying Drugs to Prevent Prolonged Deaths”, February 21, 2017

13. Groenewoud, J.H., van der Heide, A., Onwuteaka-Philipsen, B.D., Willems, D.L., et al. (2000). Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands. The New England Journal of Medicine, 342, 551-556.
 

14. Sinmyee, S., Pandit, V.J., Pascual, J.M., Dahan, A., Heidegger, T., Kreienbuhl, G.,…Pandit, J.J. (2019). Legal and ethical implications of defining an optimum means of achieving unconsciousness in assisted dying. Anaesthesia, 74,557-559.

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