The Consumers Union Report on Licit and Illicit Drugs
by Edward M. Brecher and the Editors of Consumer Reports Magazine, 1972
Part IV - Alcohol, Barbiturates, Tranquilizers
Two of the most common afflictions for which human beings through the centuries have sought relief in drugs are anxiety and insomnia. During much of the nineteenth century, the opiates were prescribed to relieve those symptoms; but they were addicting. The bromide salts were also often used to induce sleep or "calm the nerves"; but they gradually lost popularity because of the risk of chronic bromide poisoning. Chloral hydrate and paraldehyde, both quite effective as sedatives and hypnotics (sleeping potions), have an objectionable taste and smell. Thus many conservative physicians, even after the turn of the century, continued to prescribe alcohol as the sedative and hypnotic of choice-a glass of wine in midmorning and midafternoon, perhaps, plus the traditional nightcap to induce sleep.
Chapter 28. The barbiturates for sleep and for sedation
But a growing number of patients in need of sedatives and hypnotics were also ardent "teetotalers," who had "taken the pledge" of total abstinence from intoxicating beverages. Other patients didn't like the taste or smell of alcohol. Still others tended to take more alcohol than prescribed. Hence, despite the wide range of sedatives and hypnotics available at the end of the nineteenth century, the search for a better drug continued. It was in the course of this search that two German scientists, von Mering and Fischer, synthesized a new chemical called barbital, a derivative of barbituric acid.
Tested on both animals and humans, barbital seemed to have precisely the desired qualities. When a patient complaining of insomnia, for example, was given a capsule containing a moderate dose of barbital and told that it would facilitate sleep, the patient promptly fell asleep. Nervous, anxious patients given much smaller doses for daytime use and told the drug would "calm their nerves" found that it did. In 1903 barbital was introduced into general medical practice under the trade name Veronaland soon became very popular.
A second barbituric acid derivative, phenobarbital, was introduced under the trade name Luminal in 1912. More than 2,500 other barbiturates were subsequently synthesized, and some fifty of them were accepted for medical use-as sedatives, as sleeping pills, and for other purposes. Long-acting barbiturates were developed for daytime sedation; shortacting barbiturates followed for prompt sedation and for inducing sleep without delay.1 Combinations were also introduced-a short-acting barbiturate to put you to sleep combined with a long-acting one to keep you asleep.
These new drugs seemed to have notable advantages over their predecessors, including alcohol. They were odorless and tasteless. Precise quantities could be dispensed in capsule or tablet form. When barbiturates were taken as directed, in small doses for sedation and moderate doses for sleep, few side effects were noted. True, the short-acting barbiturates carried some risk of addiction, but there was no evidence that the long-acting barbiturates were addicting. After taking small daily doses for weeks or even months, a patient could discontinue without discomfort-much as most people can take a daily alcohol cocktail or nightcap without becoming addicted. It was hardly surprising, therefore, that the barbiturates became so popular among physicians and patients alike. By the end of the 1930s an estimated billion grains were being taken each year in the United States alone .2
The barbiturates remain exceedingly useful today. "Phenobarbital is one of our mainstays in the treatment of epilepsy and is almost irreplaceable for this purpose," a professor of internal medicine wrote in 1971. "Phenobarbital and . . . Librium [chlordiazepoxide, a tranquilizer] in small doses are extremely valuable in the management of high blood pressure, peptic ulcer, and anxiety. The majority of people who are given these drugs (it must be nearly 99.9 percent) never develop any dependence on them, so that in a relative sense they are quite safe."*4 Short-acting barbiturates, such as secobarbital and pentobarbital, he added, are another matter.
*Dr. Jerome H. Jaffe wrote (1970): "It has been found that 0.2 grams of pentobarbital [a short-acting barbiturates] per day can be ingested over many months without the development of any tolerance or physical dependence." 3