Sunday, June 12, 2016

Sleeping Pills: A Hypnotics History From 1960-1990

Sleeping pills always reminded me of the organized crime situation in Chicago; widespread, old players withdrawn (or jailed), new players or pills on the scene every decade, claims to be safe and acceptable, but very dangerous, and often fatal with long term use.

In the 1960's the big time hypnotic players were barbiturates such as the alluring red/pink Seconal. These little capsules were like a knock out punch in a medicine cup. After witnessing their power, I used to get sleepy just looking at the potent pill. Give one of these little 100mg capsules to a patient and it was guaranteed that in 30 minutes they would be sawing logs. I used to speculate that in a pinch these gems could be used for light anesthesia in minor cases.  I discovered that notion was not far from the truth. Dr. Bustoff, our plastic surgeon, used to order Seconal prior to performing local cases with Lidocaine. I vividly recall one case involving the excision of multiple sebaceous cysts where Dr. Bustoff  underestimated the length of the procedure and the patient began to arouse. "Tell him to stop screaming and give him 100mg of seconal STAT," was the order from the good doctor. Sure enough, 5 minutes later the patient was sound asleep and business went on as usual in the OR. Maybe open heart surgery could be done with a double dose!

Seconal was a drug that was carefully accounted for even before the Controlled Substances Act of 1970. The drug was sold by Eli Lilly and was packaged in small numbered cellophane ( a plastics precursor) packets that were reverse  numbered and rolled into strips and packaged 25 in a memorable green box with the Lilly logo plastered all over it. The company must have really been proud of this product. Nurses had a tremendous amount of respect for this powerful drug and I was never aware of diversion or abuse issues with nurses, although I have heard stories about health care workers becoming addicted. This drug was like penicillin in that fancy marketing campaigns and drug salesmen were unnecessary. The end results speak for themselves and did not really require promotions.

Occasionally, I research google something before I write (if you could call it that) about it. It was shocking to me that a pharmaceutical company recently acquired the right to market Seconal and was currently selling it for $3,000 per 100 capsules because the drug had been found useful in physician assisted suicides. Kind of sad, but then I realized that I must have handled over a million dollars worth of this drug.  It seemed like almost every hospital patient was on Seconal. As a nurse it always seemed like big money was flowing right through me or around me, but I can't complain, I've always had everything I could want with the wealth accumulated from being a scrub nurse. Life is good and most mornings I couldn't wait to get going in the OR which was probably a lot more important than the money. All of my old colleagues who have gone onto their great reward ran out of health long before they ran out of money.

Around 1970 or so, Seconal began to fall out of favor as it's addictive potential was recognized. A patient experiencing symptoms of barbiturate withdraw was not pleasant and the only way to combat the problem was with reintroducing the drug and tapering off it. Sometimes old school detox treatments were probably not too smart. Abbott labs actually made a D5W solution containing ethyl alcohol to prevent DTs while alcoholics underwent medical treatment. As a young nurse, I noticed a disproportionate number of alcoholics coming from suburbs around Ohare airport. I figured the jet noise must have driven them to the bottle.

In 1970 the shift to "safe" alternatives to Seconal was in full swing. The two I remember best were Doriden and Pacidyl. The most popular of these at our hospital was by far Placidyl. It came in 3 memorable doses; big, green jelly bean 750 mg cartoonish looking gelatin capsules, red gelatin jelly bean capsules which were 500mg and round gelatin 200mg capsules. The 200mg strength was intended to induce sleep if a patient aroused (not likely) from the heavy duty jelly bean capsules. Placidyl was not counted and there were huge stock bottles of it in every med room. Some nurses claimed the 500mg capsules were an effective way to deal with working an occasional night as a daytime sleep aid, but I never really wanted to try it after seeing what it did to patients.

One of the perks of being a senior student nurse was a class bus trip to Abbott Labs in North Chicago, Illinois. This drug company treated us like royalty (so different from our instructors.) We were treated to a really good lunch and a tour of the facility. The Placidyl production line was very memorable with 1000's of those red  Placidyl capsules and gelatin waste everywhere from molding the capsules. The excess gelatin was not really wasted, the drug company reused it as backing for the little paper memo tablets they gave away to medical personnel to promote their products. One of the tag lines printed on the Placidyl gelatin bound notepads was; "PLACIDYL...and softly,gentle slumber comes. Rest assured." When I saw this clever slogan the first thing that came to mind was "take one Placidyl too many and rest in peace." How different from the pharmaceutical industry of today that just raises prices to whatever level they please. I don't think that any drug company of today would worry about wasting gelatin or taking the trouble to use it as paper tablet binding material. It was very clever to convert a waste product (gelatin) into a marketing promotion for the product that created the waste. A profit circle of sorts.

Despite an alluring, peaceful sounding name there were big time problems with Placidyl. There was a very narrow margin between therapeutic and toxic levels of the drug which resulted in overdose. I did not have much experience with Doriden, but I think it was so addictive that the FDA banned the manufacture of it. Both Placidyl and Doriden were on the way out in the late 1970's and the new decade ushered in the benzodiazepine era.

Dalmane was a biggie and widely used sleeping pill in the 1980's. Patients used to complain of a funny taste in their mouth in the morning after awakening from a Dalmane induced sleep. To me, it did not seem to have the potent knockout ability of Seconal or Placidyl. In the mid 1980's there was some discussion that perhaps Dalmane had too long of a half life and a short acting benzodiazepine, Halcion was used. From my observation, this did not seem to be effective and there was much patient dissatisfaction. Lots of patients complained from feeling hung over the day after taking Dalmane.

I don't really know what came next in the hypnotic arena, but judging from the direct to consumer advertising, this must be a fertile market. Direct consumer advertising of toxic prescription drugs is one of the dumbest things that I have ever witnessed, but that's a contemporary issue and beyond the scope of my old time foolishness.

Foolishness and science are about as dangerous of a combination as guns and alcohol so don't take anything here as being factually accurate. There is probably enough misinformation in some of my posts to launch a Donald Trump speech. Oopsie, I should not have said that, but at least I have a good excuse. These are old memories sifted through an ancient nervous system.

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