In December 2020 I wrote a post about psychiatrist Kenneth Milner and his use of the barbiturate sodium amytal on children at Aston Hall. I was struck, in reading the police report on Aston Hall Hospital, by comments made by Professor Sir Simon Wessely about how sodium amytal was commonly used and how he remembers using it on children in the 1980s.
“Use of sodium amytal was common practice and [Wessely] remembers using it on children in the 1980s.”
It left me wondering what happened to barbiturates and to what extent they are still used.
The NHS Business Services Authority 2020 report on medicines used in mental health in England 2015/16 to 2019/20 said that there were 2,520 prescriptions in the community for barbiturates as hypnotics or anxiolytics in 2019/20, a decrease of nearly 50 per cent over a four year period. The report says:
“The low level of prescribing for barbiturates may reflect the National Institute for Health and Care Excellence (NICE)’s advice against the use of intermediate-acting barbiturates except in the treatment of severe intractable insomnia in patients already taking barbiturates. NICE also advises that use of long-acting barbiturates as a sedative is not justified.”
These figures do not include other uses of barbiturates, for example in anaesthesia or for the treatment of epilepsy. Neither do they include barbiturates dispensed in hospitals.
In 2001/02 there were 52,000 prescriptions for barbiturates in England, according to a written answer in Parliament.
In 1973/74 there were by contrast 8,348,900 prescriptions for barbiturates in England. This was nearly 15 years after the widespread introduction of benzodiazepines, which are always said to have replaced barbiturates. Minister of State Dr Owen said in a written answer in Parliament:
“Doctors who have prescribed barbiturates more heavily than their colleagues receive advice from my Department’s Regional Medical Service.”
Barbiturates had long been controversial. In the 1930s there was something referred to as “the battle of the barbiturates”, with the drugs being criticised by Home Office toxicologist Sir William Wilcox and defended by psychiatrists such as R.D. Gillespie, Maurice Craig and then William Sargant. But this did not stop their increasing use and by 1959 GPs in England were prescribing 162,000 lbs of barbiturates (representing 1620 million doses), up from 90,000 lbs in 1950. In terms of prescriptions, that represented over 14 million prescriptions or about 6.7 per cent GP prescriptions in the NHS in 1959. If you add in prescriptions for non-barbiturate sedatives and hypnotics, that figure becomes about 20 million. In 1959 there were 576 suicides and 232 accidental deaths associated with barbiturate poisoning.*
What strikes me about the figures for barbiturate use in the 1950s is that, although they don’t approach figures for the use of antidepressants today, it was nevertheless common in those days for people to be prescribed psychotropic drugs by their GPs.
As for use by psychiatrists of sodium amytal on children, the Journal of the American Academy of Child Psychiatry published an article, “Use of Sodium Amytal Interviews in Prepubertal Children: Indications, Procedure, and Clinical Utility”, in 1985, which lends support to Wessely’s recollection of using it on children in the 1980s. The authors of the article, from the University of Kansas, say in the abstract that “in certain clinical situations a properly performed sodium amytal interview is a useful tool in the diagnosis and treatment of prepubertal children.”
*The figures is this paragraph come from “The abuse of barbiturates in the United Kingdom”, by M. M. Glatt, Bulletin on Narcotics, 1962, published by the United Nations.