Sleeping pills are harmless, taken as prescribed. Misused, they lay waste thousands of lives, kill hundreds yearly
Two SUMMERS ago a man staggered down a street in Charlottetown, stumbled and pitched forward on his head, injuring himself severely.
In the crowd that gathered you could hear people saying that the man was drunk or that he’d suffered a fit or a heart attack. But the doctor, kneeling beside the prostrate body, knew the answer: In the man’s coat pocket was a box of little yellow capsules.
Last November in Vancouver, a woman drew another crowd by suddenly turning on two men and screaming at the top of her lungs. In police court, where she was fined $25 for creating a disturbance, she testified that she could remember nothing about the occurrence. But she admitted that she too had been taking some of the little yellow pills.
A neurologist in Toronto was called to the bedside of a young man who was having strange convulsions. The family physician couldn’t diagnose the trouble, but the neurologist found the evidence when he pulled a box of 100 of these little capsules out of the drawer. The young man had been taking them by the handful.
In Calgary, not long ago, a middle-aged woman got off the plane from Lethbridge bereft of her senses, her face vacant, her hands trembling, her eyes pin points. The same little pills had driven her out of her mind.
In the underworld they call them dizzy pills, goof balls, red devils, giggly pills or yellow jackets.
Physicians know them as barbituric-acid derivatives or simply as barbiturates.
Everybody else calls them sleeping pills.
Abuse of a Good Thing
BARBITURATE sleeping pills were first developed by German Nobel prize winner Emil Fischer in 1903. Fischer discovered that a compound of barbituric acid, a white crystal useless by itself, could produce deep sleep. He was in Verona, Italy, when his assistants completed the discovery and he promptly named the new drug Veronal. (In the U. S. it is called barbital and in Britain, barbitone.) Today there are about 1,500 known derivatives of barbituric acid, an estimated 60 of them in popular use under a variety of trade names —Luminal, Nembutal, Seconal, Amytal, Tuinal, etc. They act on the central nervous system, depriving the nerve cells of oxygen and causing a black-out similar to that encountered by test pilots at high altitudes.
Used properly, on prescription from reputable medical men, the barbiturates are an invaluable drug. They are the most widely used sedative in existence today and have long since edged out the bromides. Most doctors and hospitals prescribe them regularly for their sleep-producing effects and so do psychiatrists and dentists. They are used in childbirth, tooth extractions and for nervous conditions. Phénobarbital (Luminal) has become a must in the treatment of epileptics whose convulsions are quietened by it and who often take it in daily doses. It is also the basis of some soothing syrups. Sodium amytal, the so-called truth serum, administered to battle-fatigued soldiers by psychiatrists during the war, allowed them to talk about their
during the war, allowed experiences and thus
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release their emotions while in a half sleep. Barbiturates are also used in the treatment of alcoholics, overcoming their restlessness and allowing them to sleep or warding off delirium tremens. Almost everybody has had some legitimate experience with them or knows someone who has. To the normal person, taking them in occasional doses, they present no problem.
But the barbiturates can be and are continually being tragically abused. Close to seven million sleeping pills are sold every day in the United States (Canadian figures aren’t available). Their use is apparently increasing. In 1945 they killed 795 people in the U. S., just three times the number they killed 10 years before. More than half were suicides. Big cities see more barbiturate deaths than small towns. Deaths in New York City have increased fivefold in eight years. In England, barbiturates are first on the list of accidental poison deaths, second on the list of poison suicides. In Germany, where they were first discovered, they were responsible for more than one third of all poison deaths by gas, solid or liquid, between wars. The latest edition of Cushing’s “Pharmacology,” one of the medical bibles, reports that barbiturates are involved in one tenth of all drug habits.
Beyond the Law
A good portion of the heavy sale of sleeping pills is a result of their misuse, usually by the same type of person who, under other conditions, might have become an alcoholic. Today, according to Dr. W. E. Hambourger, who has investigated the barbiturates and published his findings in the conservative Journal of the American Medical Association, chronic intoxication from barbiturates—or ‘ ‘barbiturism”—plays a more important role in society than addiction to cocaine.
Thousands of unstable people are now taking this store-bought slumber in ever-increasing doses with lamentable results, yet there’s little that lawenforcement officers can do about it. In Canada, Mounties are often called out on cases of “drug addiction” only to find that the drugs are barbiturates. When this happens, all they can do is
throw up their hands and close the case. In the United States the Bureau of Narcotics has to drop 1,000 reported drug cases a year because the drugs in question are barbiturates which don’t come under their narcotic laws. In many states you can buy them over the counter and until 1941 this was true of parts of Canada. Now a Dominion-wide law, the Food and Drug Act, makes it impossible to procure them without prescription. However, authorities have found it almost impossible to obtain proof of illegal sale without prescription, though they know this goes on.
Because there isn’t the tight rein on sleeping pills that there is on the opium derivatives, they are sometimes dispensed in large quantities by a few unscrupulous or unwitting doctors. Not long ago a Toronto doctor was discovered prescribing 16 dozen Nembutal tablets a month to a woman patient. In one day he had given her two prescriptions of 24 pills each. (The normal daily dosage is one pill, containing a quarter to one and a half grains.) What caused suspicion was the fact that the prescriptions were made out for two different drugstores.
On the West Coast, which is said to he a barbiturate hot spot, one doctor made out 1,000 prescriptions for barbiturates over a three-month period, selling each prescription for $2. In four days of this period he made out 101 prescriptions. All of the “patients” were residents of cheap rooming houses along the water-front skid road. This doctor, who garnered $2,000, had made out no other prescriptions during this period.
A druggist in Vancouver was called upon to fill 12 prescriptions daily for one doctor. Still another doctor was found who had sold 50 prescriptions, undated, all in different names. In Edmonton, two known drug addicts, living together as man and wife, were able to obtain 1,677 grains of barbiturates over a six-month period without trouble. In Calgary a woman was found using an apartment suite as a base from which she distributed sleeping pills to canned-heat artists for injection. (The pills were dissolved in water and injected into the veins or muscles by needle or eye dropper.) She got the drugs in a normal way—
from a physician by prescription. In Winnipeg a doctor was found stilling them freely at $2 a dozen without prescription.
The Food and Drug Act is powerless to deal with any doctors who prostitute their profession by prescribing barbiturates for nonmedical reasons. The only disciplinary action that can he taken is by the professional association itself. (The most flagrant medical offender in Vancouver has skipped town.) Pharmacists called upon to fill repeat prescriptions for barbiturates for inhabitants of skid roads have become uneasy. A member of the Hoard of the B. C. Pharmaceutical Association was among those who questioned abnormal demands upon his own pharmacy. But the druggists point out that it is hardly, ethical for them not to honor a doctor’s prescription if it’s made out by a medical man in good standing.
There are other ways for the underworld to get goof balls, which sell for as much as a dollar apiece on the black market. (They cost four or five cents in a drugstore.) Some are stolen. In Windsor a thief made away with a doctor’s black hag containing phénobarbital. He didn’t get far. He swallowed the drug and was unconscious for 72 hours.
Police nabbed one man in the fall of 1946 in Vancouver who had forged a prescription for 100 Nembutal tablets. He got five years. In Montreal, not long ago, authorities raided the home of a suspect and found $10,000 worth of drugs, including quantities of barbiturates, cached on his premises. He collected them from doctors without prescription because they were free samples which the commercial drug houses send around to medical men and drugstores to promote the sale of their particular brands. The doctors either gave him or sold him the sample pills without question, though they weren’t in the racket with him.
Taking Out the Kinks
'The rise of the barbiturates as an underworld substitute for narcotics or alcohol is reflected in the social standing of the bits of human flotsam who use them. Ten years ago u man who used barbiturates was an outcast in underworld society. Now he’s accepted as normal.
There are several hundred members of the Vancouver underworld now using sleeping pills more or less habitually. They fall into two groups: The larger group is composed of dope addicts who use barbiturates to “take out the kinks,” to lengthen the effect of morphine, or to spread out a small dose of the more expensive drug.
“A goof ball in a glass of beer’s got a kick like a mule,” one man told a Mountie. The addicts have found that one or two “nembies,” taken just before or after an injection of morphine, will lengthen the effect of the latter drug. Others have taken them to sleep during the painful withdrawal cramps which occur when morphine is unavailable. The heaviest users of barbiturates among this group are all over 35. Some drug addicts consider these pills more harmful, both physically and mentally, than narcotics. The drugs don’t give them the feeling of mental alertness or well-being that narcotics do.
The second group are older—most of them over 55—and several rungs further down the moral and social ladder. These are the wine birds, the goof hounds, the rubbies—dregs of humanity who, unable to afford the more expensive alcohol, have taken to sleeping pills. There are an estimated 150 of them in Vancouver and
almost all take the drug by injection (which gives them a bigger kick) in the sordid little rooms along the water front which they call “bomb shelters.”
But these are the freaks. Among the men and women whose lives are dominated by the sleeping pill, they form a minority. Most people who form a dependence on barbiturates are quite ordinary people who are to outward appearances normal human beings.
They don’t find too much difficulty in getting the pills they think they need. A few are dentists, doctors and druggists who have easy access to them. One doctor in Edmonton cashed a prescription for 36 grains of Seconal every day for three months at various drugstores. Another in Northern Ontario made the rounds of six drugstores to get pills. Laymen have used similar methods.
Not long ago a Toronto doctor \yacalled in to prescribe for a woraai. whose family thought she was an alcoholic. The doctor thought different. He shoved his hand under the pillow and brought out a box of sleeping pills. There were more under the bed. He searched the house and found the capsules hidden in nooks and crannies all around the house. This woman had simply been going to several doctors complaining of insomnia. Each gave her a small prescription for the pills — not knowing she was getting the same thing from others.
Sometimes doctors themselves are fooled by the symptoms. One doctor in Toronto prescribed sleeping pills for a patient he thought was an alcoholic. Actually her “drunk” condition had been brought about by earlier doses of sleeping pills. He was simply aggravating her condition. [i
Sobbers and Wall Climbers
Different varieties of sleeping pillé will produce different effects on different patients. One dentist found that a single sleeping pill, given as a sedative, caused some women to sob bitterly in the chair. Many people have fqund themselves subject to a depressing hang-over—similar to an alcoholic hang-over—after the effects of the* pill have worn off. Sometimes women have found that instead of sleep a dose of a barbiturate will produce enhanced excitement. “It doesn’t quiet me—it makes me want to climb a wall like a cat,” a woman patient told a doctor at the Mayo clinic. The reason for this, physicians think, is that the highly keyed brain, anticipating sleep from the pill, looks forward to it with siicli excitement that exactly the opposite effect is produced.
Who takes sleeping pills? Farmers, laborers, workmen, very seldom hgve need of them. But professional men who work under a heavy nervous and mental strain often make use ,of them. In normal society, the habitual user of sleeping pills is an intelligent, sensitive, ambitious, idealistic, often artistic personality. He (or mpre likely she) is probably between 40 and 60, is easily hurt or discouraged apd probably dissatisfied with his lot in life. He has all the makings of an alcoholic and he may have been one: many people now dependent on barbiturates learned to use them whjle tapering off from alcohol. Barbiturism seems to be a kind of escape from instability or strain.
At first worry and anxiety produce insomnia. The victim takes one pill at first to produce slumber but finds it has no effect. Soon he’s taking two or three—then as many as two dozen. The danger comes when, half-drugged and groggy, he reaches for more and more pills from the box at his bedside
I table, not realizing how many he has swallowed. The reaction becomes ! automatic. Many people take pills in the daytime to perpetuate a groggy world of semidreamland.
Some time ago a prominent. Torontonian came to his physician and complained that his wife was spending $50 a month on sleeping pills. The doctor knew the case and correctly diagnosed it. She was a bright, intelligent, ambitious woman who wanted social position and recognition. She felt that her husband was not as bright as she and hadn’t gone far enough in the world. She felt, too, that he was taking the credit for her ambitions:
! that people were paying more attention j to him than to her. In her youth when things went wrong she simply got I sick. When she grew older her sickness ; took the form of insomnia. She used j so many sleeping pills that she stagj gered and fell on the street and it took j hospitalization to cure her. But her j basic personality couldn’t be cured.
; Later, she resumed her doses and they finally resulted in her death.
The sleeping-pill habituate can be a sorry sight. Take the case of a Toronto pharmacist who swallowed six Nembutal tablets a day. In six months his friends noticed an alarming change in his appearance. His face had taken on a yellow, sickly look. He had lost weight and appeared emaciated. His features were blank and he looked and acted stupidly. His eyes were dull and listless and when he talked it was with a slow, slurred, thick speech, monotonous, without inflection. His hair was prematurely grey and he walked with a stumbling gait, almost as if he were drunk. His hands and lips trembled, he was extremely irritable and meantempered, his clothing was untidy, his appearance neglected and he paid little or no attention to his family.
Sometimes barbiturates can lead to greater dangers. One Toronto man started as an alcoholic, then began to take the pills to make him sleep after drinking. Soon the pills became more important than the alcohol. He became unsteady, his speech grew thick, he behaved like a drugged person—and graduating to morphine, finally did become a dope addict.
Sleeping pills can he introduced very easily into your life. A Winnipeg housewife is typical of a good many middle-aged women who become worried about overweight. She asked her doctor to give her thyroid tablets and put her on a diet. This caused a nervous condition which resulted in a lack of sleep. To stop this, her doctor prescribed sleeping pills. Soon she was going to several doctors and hoarding the pills in order to take more and more when a small dose failed to work. She was hooked.
Every newspaper reader is familiar with the phrase “an overdose of sleeping pills.” Only last March, the British inventor of the amphibious jeep or weasel killed himself with an overdose. Sleeping pills put evangelist Aimee Semple McPherson to sleep for good —-accidentally, a coroner’s jury found. Movie star Lupe Velez killed herself with a handful. Holly wood’s Kay Francis hovered between life and death for two days after taking too large a dose early this year.
Yet, despite the toll they take, sleeping pills offer a clumsy method of suicide. Although in rare cases (especially in cases of chronic liver, kidney or heart ailments) a slight overdose can kill, in healthy people it takes 10, 20 30 times the normal dose to cause death —and even then the odds are the doctors can bring the victim around.
A dose varies from one quarter of a grain to five grains. People have taken 90 to 150 grains and lived, with the help of a physician. The reason is that sleeping pills act slowly and death, if it takes place, doesn’t usually occur until the second or third day. Some medical men think that barbiturates are a good thing because they frustrate so many suicides.
At present, no country in the world controls barbiturates as morphine is controlled, although the Ways and Means Committee of the U. S. Congress is now considering a bill which would give the Bureau of Narcotics strict control over barbiturates. In Canada, opinion among the medical profession about the value of more stringent regulations regarding the sale of barbiturates is divided.
Those who’d like to see barbiturates dealt with by the RCMP narcotics squad insist that at present these drugs are too easy to obtain, too convenient to prescribe. They say that people aren’t fully aware of the dangers of sleeping pills (the manufacturers aren’t compelled to mark any printed warning on the box) and that the capsule form (Iho most widely used form of the drugs) is at best a clumsy method of taking medicine: one capsule may not he enough, two may be too many. They point out that it takes half a
bottle or more of alcohol to put a normal person to sleep, but a single pill can do the same thing: and many people are taking much more than a single pill. And they make the point that barbiturates, especially when used to relieve pain, do not get at the cause of pain.
Those on the other side of the fence stress that barbiturates have a very definite place in medicine and any further restriction on their sale or use would cause annoying and unnecessary frustrations. Epileptics, for example, who need the pills, would be unable to get the large prescriptions they need and would have to run to their doctor daily to get new prescriptions. They suggest that the present restrictions are quite effective enough (Saskatchewan druggists estimate the sale of barbiturates fell off 25% after the Federal Food and Drug Act covered them in 1941). They point out that despite stringent restrictions on narcotics there are as many dope addicts in Canada today as there were at the time the international narcotic laws went into effect.
Moreover, they insist that the effect of barbiturates isn’t any worse than the effect of extreme alcoholism—and that barbiturism can be cured easily, for it does not produce the painful effects that morphine does when the
drug is withdrawn. People can kill themselves with overdoses of some kinds of toothpaste or aspirin, they point out (aspirin is the drug most frequently used by suicides in England). And certain types of people can become addicted to anything. One Ottawa doctor had a patient who was addicted to Bromo-Seltzer; he had more than 200 empty bottles in his basement and swallowed the stuff a bottle at a time.
On one point all medical men are agreed: no normal person needs bar-
biturates except in rare instances and then only a single dose at a time. And no abnormal person should depend on them. Barbiturate intoxication is only an outward sign of a psychological sickness. Many people taking sleeping pills today are only getting their slumber through the power of suggestion. Not long ago a doctor replaced the veronal in a supply of tablets a patient was hoarding with harmless sugar of milk. The patient took the tablets and slept like a top. Anyway, as a British physician pointed out recently, it’s not the actual lack of sleep that does the damage—it’s the lying awake worrying about it. Insomnia is the danger signal for a deeper psychological ailment which can’t be cured simply by purchasing slumber in bottles, it