Pentobarbital and Compounding Pharmacies

[usedtobe]

So Pentobarbital is really good at killing things.

There seems to be only one legit supplier, and it doesn’t like capital punishment, so it won’t ship it to states who have capital punishment on their books.

(yes, that IS a big issue, but please take it elsewhere)

CA just implemented Physician-assisted suicide. (again. please take it elsewhere for the 7,562nd go-round on THAT debate)
Since we can’t get pentobarbital, the specified dose is another barbie in massive dosage.
The upshot is: $2500 - $3000 for the prescription. Have heard of the stuff being dissolved in apple juice - I hope that it can at least be soluble in vodka

So, can a compounding pharmacy whip up a batch of Pento? Can it do so legally, or would this be a patent infringement?

One possible side issue: Chloral Hydrate - still around? Usable for lethal oral dosage?

It was hard enough to get the State to allow the prescription, to now have to fight a drug company or be forced to get into the business of manufacturing drugs is obscene.

So

[Left_Hand_of_Dorkness]

@usedtobe

So Pentobarbital is really good at killing things.

There seems to be only one legit supplier, and it doesn’t like capital punishment, so it won’t ship it to states who have capital punishment on their books.

I’m not sure if this is a nitpick or an important point, but Fatal Plus is a sodium pentobarbital compound used for animal euthanasia, and I’m unaware of any limitations on states it can be shipped to.

However, it’s clearly indicated only for animal use, and it can only be shipped to a licensed veterinarian, and I’m guessing there would be plenty of problems with a veterinarian who signed for it then turned it over to a Department of Corrections.

Is there a different supplier of pentobarbital who supplies for human use?

[usedtobe]

My Q was triggered by the repeated reference to “can’t get it because capital punishment”

From Sacramento Bee
http://www.sacbee.com/news/local/health-and-medicine/article95676342.html#storylink=hpdigest :

Perhaps the biggest hurdle for California physicians and pharmacists has been figuring out the right combination of medications to prescribe. California’s law does not specify which drugs should be used. For years, pentobarbital was the preferred drug for assisted dying. But in 2011, the drug’s Danish manufacturer halted bulk sales of pentobarbital to U.S. states that practice capital punishment.

The alternative, Seconal, is often expensive, costing as much as $3,000 for the required dose. In Tom House’s case, the prescribed 90 tablets, which were individually crushed and mixed with juice, cost about $2,200, according to his son.

So, aside from diverting vet medicines (which have not been approved for human use, and thus cannot be prescribed for human use.
And note: I am not concerned with the Dept of Correction or its problems with Lethal Injection.
I am curious if it would be

1. Possible for a Compounding Pharmacy to create Pento (maybe using a Vet med as feeder stock, wink, wink)
2. Legal for them to both created the drug AND provide it for human consumption. I’m guessing that any drug compounded, if it is a lawful drug, would be legal for human use.

[Left_Hand_of_Dorkness]

@usedtobe

I am curious if it would be

1. Possible for a Compounding Pharmacy to create Pento (maybe using a Vet med as feeder stock, wink, wink)
2. Legal for them to both created the drug AND provide it for human consumption. I’m guessing that any drug compounded, if it is a lawful drug, would be legal for human use.

Gotcha–and this is an issue I’ve heard about before. This article may answer your questions. It looks like it’s generally legal, and done, and the legal difficulties it may run into don’t involve patent infringement.

[PastTense]

From Wikipedia

One brand name for this drug is Nembutal, coined by John S. Lundy, who started using it in 1930, from the structural formula of the sodium salt—Na (sodium) + ethyl + methyl + butyl + al (common suffix for barbiturates).[3] Nembutal is trademarked and manufactured by the Danish pharmaceutical company Lundbeck, and is the only injectable form of pentobarbital approved for sale in the United States.[4]

https://en.wikipedia.org/wiki/Pentobarbital

1930? Patent rights should have long since expired, so it should be available as a generic. Why isn’t it?

[lazybratsche]

Getting approval for a generic drug takes years and millions of dollars, and that’s if you already have a production facility that meets FDA standards. That might be a good investment if you’re already making a drug with a lot of potential demand. But it’s probably a bad idea when you’re talking about a highly controlled, uncommonly prescribed, and possibly controversial drug like pentobarbital.

[snowthx]

I know the OP is about phenobarbitol, but if the intended use is to off one’s self legally, the drug, Seconol, mentioned above, is usually prescribed in much lower doses as a sleep aid. Once a Dr. agrees with the patient, s/he could just prescribe the usual dose of that, and the patient can just save up the required number of pills and then do what they want. IANAP.

[Martin_Hyde]

So is the question, “can a compounding pharmacy compound pentobarbital?” The answer would be yes, they have done so for the purposes of supplying execution drugs in the past. I believe sodium thiopental has also been compounded for the same purpose.

But I am not sure if getting a drug from a compounding pharmacy would be any cheaper than the dollar amount you’ve said here, I have legitimately no idea. These are very old compounds (80+ years now), and probably easily in the capabilities of a modern compounding pharmacy, but anything done in small batch to order is going to be expensive I suspect.

I believe that most insurers do not pay the cost of compound drugs, because compounding pharmacies aren’t regulated by the FDA and they don’t produce a standard prescription medication, although I believe some recent legal changes have allowed larger compounders to get FDA regulation if they seek it.

[usedtobe]

Found this: (the Seconal is the expensive drug)

The phenobarbital/chloral hydrate/morphine sulfate mix produces a lethal dose that is similar in effect to Seconal. The cost of this alternate mix is approximately $450 to $500. A compounding pharmacy will need to prepare the mixture.

One Q: WHY would a pharmacist need to “prepare” this (assuming oral administration) “compound”?
There are 3 stacks of pills. I can figure out how to get them all into my stomach at the same time

My guess was right -chloral hydrate is handy for this purpose.

As for Medicare - given that it covered exactly ZERO
Barbiturates
Benzo-diazepines

until friggin’ 2013 - long after they were used as anti-anxiety and hypnotic purposes, I’m not holding out a lot of hope.

[Bill_Door]

You’ll note that the compounding pharmacy does just that, makes a compound. I doubt that they’re doing any real synthesis from benzene/ toluene and alcohols of four carbons or fewer, plus any inorganic reagents. They mix pills and a solvent to produce a mixture. They’re not making a chemical reaction here.

[usedtobe]

This is what I suspected - a “Compounding Pharmacy” may have the ability to mix and measure, I couldn’t imagine an actual chem lab in back.

I do note that there is a powdered version of sodium pentobarbitol made for vet use.
Could a pharmacy simply buy the vet version and whip up some pills?
Or does the human/vet border make that legally impossible?

[Wesley_Clark]

@snowthx

I know the OP is about phenobarbitol, but if the intended use is to off one’s self legally, the drug, Seconol, mentioned above, is usually prescribed in much lower doses as a sleep aid. Once a Dr. agrees with the patient, s/he could just prescribe the usual dose of that, and the patient can just save up the required number of pills and then do what they want. IANAP.

I thought physicians didn’t really prescribe barbiturates and preferred benzos because benzos are harder to OD on.