Seconal, the brand name for secobarbital sodium, was discontinued as a commercially manufactured product because the market for barbiturate sleeping pills effectively collapsed. Safer alternatives replaced it for insomnia decades ago, leaving demand so thin that maintaining production lines for a branded capsule made little business sense. The drug’s final chapter as a brand product was marked by dramatic price increases that drew national attention, particularly because secobarbital had found a second life in medical aid-in-dying protocols. Whether secobarbital is still available in any form depends on context, and the answer is more nuanced than a simple yes or no.
What Seconal Was and Why It Mattered
Seconal was a short-acting barbiturate introduced in the mid-twentieth century as part of a wave of barbiturate drugs developed for sedation and sleep. The history of barbiturates stretches back to 1864, with the clinical use of barbital beginning in 1903 and phenobarbital following in 1911. Secobarbital was among a group of compounds, including amobarbital and pentobarbital, that were gradually incorporated into clinical practice over subsequent decades.1PubMed Central. The history of barbiturates a century after their clinical introduction The distinctive red capsules earned the street nickname “reds” or “red devils,” and by the 1950s and 1960s, Seconal was one of the most widely prescribed sleeping pills in the United States.
Secobarbital worked by enhancing the activity of GABA, the brain’s main inhibitory neurotransmitter, which slowed neural activity and produced sedation. Its onset was fast and its duration relatively short, which made it appealing as a sleep aid for people who had trouble falling asleep rather than staying asleep. But that same pharmacological profile made it attractive for misuse, and barbiturates as a class became tightly regulated. Secobarbital was placed in Schedule II under the Controlled Substances Act, the same category as oxycodone and fentanyl, reflecting its recognized medical use alongside a high potential for dependence.
Why Barbiturates Lost Their Place in Medicine
The core problem with barbiturates is their narrow margin between a therapeutic dose and a lethal one. A person taking secobarbital for sleep might swallow a dose that was only a few times larger than normal and stop breathing. This made accidental overdose a genuine risk, and intentional overdose with barbiturates became a leading method of suicide through the mid-twentieth century. Tolerance developed quickly as well, so people who used Seconal regularly needed increasing amounts to fall asleep, pushing them closer to dangerous territory.
Benzodiazepines arrived in the 1960s and offered a substantially wider safety margin. Drugs like diazepam and later shorter-acting compounds like triazolam could produce sedation and reduce anxiety without the same degree of respiratory depression at moderate overdose levels. Physicians began switching patients from barbiturates to benzodiazepines for insomnia and anxiety, and by the 1970s and 1980s, barbiturate prescriptions for sleep had plummeted. The decline of barbiturate therapy was already well underway by the 1960s.1PubMed Central. The history of barbiturates a century after their clinical introduction
Later generations of sleep medications narrowed the field even further. Non-benzodiazepine hypnotics like zolpidem, zaleplon, and eszopiclone targeted the same GABA system but with more selective receptor binding, which meant fewer side effects and less residual grogginess. By the 2000s, prescribing a barbiturate for ordinary insomnia was considered outdated by most sleep specialists. Seconal still had a small number of prescribers, but the patient base had shrunk to a fraction of what it once was.
The Business Story Behind Discontinuation
A drug that almost nobody prescribes anymore does not generate enough revenue to justify large-scale pharmaceutical manufacturing. The facilities, quality testing, regulatory compliance, and distribution costs of producing a branded Schedule II capsule are substantial, and when monthly prescriptions number in the hundreds rather than the hundreds of thousands, the math stops working. Eli Lilly, the original manufacturer, had long since moved on from the product. Over time, the rights to the Seconal brand changed hands among smaller pharmaceutical companies.
The most visible chapter came when the brand’s price began rising steeply. By the mid-2010s, a bottle of Seconal capsules that might have cost a few hundred dollars was priced at several thousand. Because the drug was still used in a small but important niche, these increases attracted scrutiny from journalists, patient advocates, and legislators. The pricing controversy was especially sharp because many of the remaining Seconal prescriptions were being written for terminally ill patients under state medical aid-in-dying laws, and the cost of dying was being driven up by a drug with virtually no competition in that specific use case.2JAMA Oncology. Drug Price Inflation and the Cost of Assisted Death for Terminally Ill Patients—Death With Indignity
Eventually, branded Seconal capsules were discontinued entirely. The decision was not a single dramatic announcement so much as a quiet withdrawal from the market. Without the branded product available, and with no widely distributed generic equivalent filling the gap at pharmacies, secobarbital effectively vanished from the standard drug supply chain for most purposes.
Seconal’s Role in Medical Aid in Dying
Oregon became the first U.S. state to legalize medical aid in dying in 1997, and secobarbital quickly became the drug of choice for that purpose. The pharmacological properties that made it dangerous as a sleeping pill, its fast onset and its ability to suppress breathing at higher doses, made it effective in a completely different clinical context. A lethal dose of secobarbital, typically around 9 grams dispensed in capsule form, was prescribed to terminally ill patients who met stringent legal criteria. For years, secobarbital accounted for the majority of prescriptions written under Oregon’s Death with Dignity Act and similar laws in Washington, Vermont, California, Colorado, and other states that followed.
This is where the pricing issue hit hardest. Terminally ill patients and their families, already dealing with the emotional and financial weight of end-of-life care, were asked to pay thousands of dollars out of pocket for a drug that cost very little to manufacture. Insurance coverage for aid-in-dying medications was inconsistent. The situation created pressure on prescribing physicians and pharmacists to find alternatives, and it became one of the forces pushing the medical aid-in-dying community away from secobarbital and toward combination drug protocols.
What Providers Prescribe Instead
The shift away from secobarbital in aid-in-dying practice has been substantial. The drug combination known as DDMAPh, a multi-drug cocktail, is now the predominant regimen prescribed by medical aid-in-dying providers in the United States. A recent study of U.S. providers found that more than half modify their regimens by adjusting dosages, using alternate drug combinations, or adding agents like certain antibiotics that slow drug metabolism and increase effectiveness.3PubMed Central. Clinical practice and pharmacology decisions of medical aid-in-dying providers in the United States DDMAPh functions more as a backbone that individual providers adapt than as a rigid standard order.
The move to combination protocols was driven partly by cost and partly by practical experience. Some providers and pharmacists found that multi-drug combinations could be compounded more affordably than a large quantity of secobarbital, and the clinical outcomes were considered comparable. The combinations typically include drugs from several classes, each contributing to sedation, cardiac suppression, or respiratory depression, so the overall effect is achieved through multiple mechanisms rather than a single massive barbiturate dose.
Pentobarbital, another barbiturate, has also been used in some aid-in-dying and veterinary euthanasia contexts, though its availability has faced its own supply and regulatory constraints. The landscape is far more varied now than it was in the early years of legal aid in dying, when secobarbital was essentially the only option most prescribers considered.
Is Secobarbital Still Available at All?
Secobarbital has not been removed from the FDA’s list of approved drugs. It remains a legal, Schedule II substance in the United States. What has disappeared is the branded commercial product sitting on pharmacy shelves. This distinction matters because it opens the door to other pathways.
Compounding pharmacies, which prepare customized medications to order rather than dispensing pre-manufactured products, can still legally prepare secobarbital if they obtain the raw active ingredient and have the appropriate DEA registration for handling Schedule II substances. In states where medical aid in dying is legal, compounding pharmacies have been a primary source for secobarbital prescriptions, though the availability and cost of the raw powder have fluctuated. Some compounding pharmacies specialize in aid-in-dying medications and maintain the necessary supply chains.
For clinical purposes outside of aid in dying, secobarbital is essentially gone. No mainstream pharmacy stocks it, and no physician treating insomnia or anxiety would prescribe it when dozens of safer, cheaper, more readily available alternatives exist. If a hospitalized patient needed a barbiturate for a specific indication like refractory seizures, physicians would almost certainly turn to phenobarbital, which remains in wide clinical use and is manufactured at scale.
So the honest answer to “is it still available?” depends on why you are asking. For sleep, no, and no doctor would prescribe it. For medical aid in dying in states where it is legal, sometimes, through compounding pharmacies, though most providers have shifted to other protocols. For any other clinical use, only in exceptional circumstances and not through normal pharmacy channels.
Why the DEA Has Not Pulled Its Approval
People sometimes wonder why, if Seconal is so dangerous and so rarely used, regulators have not revoked its approval entirely. The short answer is that the FDA does not typically withdraw approval from a drug just because the market has moved on. Withdrawal usually happens when new safety data reveals a risk that was not known at the time of approval, or when a drug is found to be ineffective for its labeled indication. Neither applies here. Secobarbital works exactly as described. It is genuinely effective as a sedative-hypnotic. The reason physicians stopped prescribing it is that better options came along, not that the drug itself was found to be defective.
Schedule II classification already imposes heavy restrictions on manufacturing, prescribing, and dispensing. Every prescription requires a new written order from a physician, refills are not permitted, and the quantities a pharmacy can stock are monitored by the DEA. These controls were considered sufficient to manage the risks of diversion and misuse, especially as prescribing volume fell to negligible levels. Formally withdrawing FDA approval would also eliminate the legal pathway for compounding pharmacies to prepare the drug for aid-in-dying use, which would have significant implications in the states that have legalized that practice.
Barbiturate Dependence and Withdrawal
One reason barbiturates disappeared from routine prescribing so quickly once alternatives existed is that physical dependence develops rapidly and withdrawal can be life-threatening. Unlike opioid withdrawal, which is deeply unpleasant but rarely fatal on its own, barbiturate withdrawal can produce seizures, delirium, and cardiovascular collapse. A patient who had been taking Seconal nightly for several weeks could not simply stop without medical supervision.
This withdrawal profile made barbiturates a uniquely difficult class of drugs to manage in outpatient settings. A physician prescribing Seconal for insomnia was implicitly accepting the possibility that the patient would develop dependence within weeks, and that discontinuing the drug would require a carefully supervised taper. Benzodiazepines share some of these risks but to a lesser degree at typical prescribed doses, which is one reason the transition happened so readily once the newer drugs became available.
For the small number of people who were still using barbiturates recreationally by the time Seconal left the market, the disappearance of a reliable pharmaceutical supply did not necessarily mean the end of barbiturate use. It meant a shift to less predictable sources and, in some cases, to other central nervous system depressants. The public health implications of removing a regulated product from the market are always more complicated than they appear on the surface.
Forensic Detection After Death
Secobarbital has a long history in forensic toxicology, both because of its association with overdose deaths and because of its use in aid-in-dying cases where post-mortem confirmation of the drug is part of the medicolegal process. One challenge that forensic pathologists face is that barbiturate concentrations in the body change after death. Research using animal models has shown that the concentrations of secobarbital found in blood and tissues at the time of autopsy can differ from the concentrations present at the time of death.4Forensic Science International. Post mortem kinetics of secobarbital
This phenomenon, known broadly as post-mortem redistribution, affects many drugs and is not unique to barbiturates. But it has practical consequences. A forensic toxicologist interpreting secobarbital levels in a death investigation has to account for the possibility that the drug has migrated between compartments, that bacterial activity has altered concentrations, or that the time between death and specimen collection has introduced measurement error. In legal aid-in-dying cases, this is largely a documentation issue rather than a mystery. In unattended deaths or suspected overdoses, the interpretation is more fraught, and forensic experts rely on multiple specimen types and contextual evidence to reach conclusions.
How Seconal Compares to Other Discontinued Barbiturates
Seconal is far from the only barbiturate to vanish from pharmacy shelves. Amobarbital (Amytal), pentobarbital (Nembutal), and butabarbital (Butisol) have all seen their commercial availability shrink dramatically or disappear entirely. The pattern is the same in each case: clinical use dried up as safer drugs took over, manufacturers stopped production, and the drugs became available only through specialty channels if at all.
Phenobarbital is the major exception. It remains in wide use for seizure disorders, particularly in resource-limited settings where newer anticonvulsants are too expensive. Phenobarbital is on the World Health Organization’s List of Essential Medicines, which reflects its continued importance in global health even as other barbiturates have faded. Its long duration of action makes it poorly suited for use as a sleeping pill, so it never competed directly with Seconal for the insomnia market, but it occupies a secure niche that the shorter-acting barbiturates lost.
Thiopental, a barbiturate used intravenously for anesthesia induction, has its own discontinuation story intertwined with the death penalty. The sole U.S. manufacturer stopped production, and European export restrictions made it unavailable for lethal injection protocols. The parallels to Seconal’s story are striking: a drug with a legitimate medical history becomes entangled in end-of-life politics, supply dwindles, and the resulting scarcity forces institutions to find alternatives or change their practices entirely.