007Bob
Member
- May 31, 2024
- 86
We would like DIY versions of DDMA/DDMP to work, as the last thing we want is for it to fail and wake up damaged from the attempt. So please share your knowledge and advice with us.
Questions to the SS Community:
—————————————————-
#1] Overall problem: in the official MAiD protocol, the lethal drug mixture is made by a compounding pharmacy, so it's just the raw powder versions of each medication, therefore much less volume versus crushing pills.
=> Doing it as a DIY method means crushing tablets of each medication and in tablet version there are fillers and binders added to the raw powdered medication, hence will result in a much larger volume of overall powder when crushing tablets into the required dosages of the actual medication required. Doesn't necessarily mean it won't work, but the result of DIY version means much more overall powder.
#2] MAiD Protocol asks for 100mg Digitalis powder. Only Digoxin pills can be obtained. To make it equivalent to 100mg Digitalis powder, over 300 pills need to be crushed into powder. It's a lot of powder (almost half of cup). Is this going to be a problem with regurgitation and vomiting (note that antiemetic drugs will be taken 1 h prior to ending-of-life cocktail)
#3] What do you think of the 30 minutes gap between Digoxin and the other meds? Should we still follow that recommendation or not? The reason given is that the tiny bits of Digitalis (100mg) otherwise get lost in the larger volume of the other meds (>20g) and don't get well absorbed. Here the problem is that in the DIY version, we are using Digoxin pills (>20g of small concentrations of 0.25mg) and that makes up a lot of inactive powder. What's your views on this problem? Comment: taking 30 minutes before the other meds may be advisable, especially as we are using crushed Digoxin tablets and not Digitalis powder. Likely to absorb better and also much less overall powder to consume all in one go.
#4] MAiD Protocol asks for instant Morphine. Only Slow Release (SR) capsules can be obtained. SR Morphine presents as 200mg of gel coated microbeads to slow release in the gut. You can somehow break down the gel by crushing the microbeads into fine powder. But the gel will be embedded in the powder and the gel will take some volume in the stomach. Do you think it's a problem and how to get around?
#5] Because the instant release Morphine is impossible to get ahold of, we are left with using SR Morphine. The bioavailability of Morphine is only 30% by the gut (it's much higher by intravenous injection but we can't do that). What's your views on this problem? How do you think powderized SR Morphine will work in the DIY version?
#6] It's advisable not to mix Propanolol with Amitripyline. The two medications work differently, one slows down the heart (Propranolol) and the other speeds it up (Amitriptyline), hence using both may be counter productive. Probably best using one or the other, but not both together. Do you agree? What do you think?
____ MAiD = Medical Aid in Dying ___
SUMMARY OF MAiD PROTOCOLS
(Least Pain and Max Speed to Death)
Anti-Nausea Drugs
(1 hour prior to end-of-life mixture)
- Haloperidol 2mg
- Metoclopramide 20mg
END-OF-LIFE MIXTURES
DDMP: Digoxin 50 mg, Diazepam 1 gm, Morphine 15 gm, Propranolol 2 gm.
Time to death: 2h (average) to 39h (max)
D-DMP2: As above, but digoxin is given separately, 30 minutes before the other medications.
Time to death: 1.5h to 13h
DDMA: Digoxin 100 mg, Diazepam 1 gm, Morphine 15 gm, Amitriptyline 8 gm.
Time to death: 1.5h to 12.5h
D-DMA: As above, but digoxin is given separately, 30 minutes before the other medications.
Time to death: 1.5h to 4h
DDMAPh: Digoxin 100 mg, Diazepam 1 gm, Morphine 15 gm, Amitriptyline 8gm, Phenobarbital 5 gm.
Time to death: 1.1h to 5.1h
D-DMAPh: As above, but digoxin is given separately, 30 minutes before the other medications.
Time to death: 1.1h to 3.8h
DDMP2 vs D-DMP2: The dash in D-DMP2 signifies a pause of 30 minutes between giving
the digitalis and the morphine/diazepam/propranolol. The reason is that without giving digitalis separately, the tiny amount of digitalis
(100 milligrams) gets lost amid the huge mass of the other meds (18,000 milligrams)—and the digitalis doesn't get absorbed. By using pre-digitalis, i.e. dig alone for
30 minutes, the dig is rapidly absorbed—providing more rapid and thorough digitalis toxicity.
Additional ressources:
- https://www.acamaid.org/wp-content/...on-Protocols-for-Medical-Aid-in-Dying-1-1.pdf
- https://www.acamaid.org/wp-content/uploads/2021/12/12-5-19-DDMA-instead-of-DDMP2.pdf
- https://endoflifewa.org/wp-content/...r-Taking-Life-Ending-Medications-Jan-2020.pdf
In the pharmacy compounded version, I believe they use crushed pills as well except from the Digitalis powder because it mentioned in one of the MAiD to use Digitalis powder and not crushed pills. Plus I also read that the MAiD as qualified as blue-whale mixture in reference to the amount of powder that needs to be ingested. That being said, we don't have access to Digitalis powder and need to replace it with Digoxin pills. That equates to over 300 pills and take a huge volume for a fetal mixture (half a cup of powder). In comparison, when powderized the remaining pills (diazepam, morphine and propanolol) only fill 1/4 of a cup. So we are dealing with a large volume of powder to be ingested. The risk of vomiting and regurgitation is lowered of course by taking strong antiemetics prior to the end-of-life cocktail. Nonetheless, with D-DMP/A protocols, we are required to actually drink 2 mixtures: first a mixture of Digoxin pills and 30 minutes later, a second mixture of the remaining drugs. Hence, we need very powerful antiemetics to control vomiting and regurgitation. The official MAiD protocol asks for 2ml haloperidol and 20mg metroclopramide: but will this be sufficient for the DYI version? I read in one SN protocol on SS to start taking antiemetics 2 days before SN. Would that make sense? Note that the antiemetics are Neurolpetics and they make you feel down. There is no perfect solution but I am trying to find something that would be acceptable and that would increase the chances of the DYI version to work. It's just a shame we don't have access to a doctor or a pharmacist to help us with these vital questions. I do believe that it's a fundamental right to end one's life when we are no longer able to enjoy life.
Questions to the SS Community:
—————————————————-
#1] Overall problem: in the official MAiD protocol, the lethal drug mixture is made by a compounding pharmacy, so it's just the raw powder versions of each medication, therefore much less volume versus crushing pills.
=> Doing it as a DIY method means crushing tablets of each medication and in tablet version there are fillers and binders added to the raw powdered medication, hence will result in a much larger volume of overall powder when crushing tablets into the required dosages of the actual medication required. Doesn't necessarily mean it won't work, but the result of DIY version means much more overall powder.
#2] MAiD Protocol asks for 100mg Digitalis powder. Only Digoxin pills can be obtained. To make it equivalent to 100mg Digitalis powder, over 300 pills need to be crushed into powder. It's a lot of powder (almost half of cup). Is this going to be a problem with regurgitation and vomiting (note that antiemetic drugs will be taken 1 h prior to ending-of-life cocktail)
#3] What do you think of the 30 minutes gap between Digoxin and the other meds? Should we still follow that recommendation or not? The reason given is that the tiny bits of Digitalis (100mg) otherwise get lost in the larger volume of the other meds (>20g) and don't get well absorbed. Here the problem is that in the DIY version, we are using Digoxin pills (>20g of small concentrations of 0.25mg) and that makes up a lot of inactive powder. What's your views on this problem? Comment: taking 30 minutes before the other meds may be advisable, especially as we are using crushed Digoxin tablets and not Digitalis powder. Likely to absorb better and also much less overall powder to consume all in one go.
#4] MAiD Protocol asks for instant Morphine. Only Slow Release (SR) capsules can be obtained. SR Morphine presents as 200mg of gel coated microbeads to slow release in the gut. You can somehow break down the gel by crushing the microbeads into fine powder. But the gel will be embedded in the powder and the gel will take some volume in the stomach. Do you think it's a problem and how to get around?
#5] Because the instant release Morphine is impossible to get ahold of, we are left with using SR Morphine. The bioavailability of Morphine is only 30% by the gut (it's much higher by intravenous injection but we can't do that). What's your views on this problem? How do you think powderized SR Morphine will work in the DIY version?
#6] It's advisable not to mix Propanolol with Amitripyline. The two medications work differently, one slows down the heart (Propranolol) and the other speeds it up (Amitriptyline), hence using both may be counter productive. Probably best using one or the other, but not both together. Do you agree? What do you think?
____ MAiD = Medical Aid in Dying ___
SUMMARY OF MAiD PROTOCOLS
(Least Pain and Max Speed to Death)
Anti-Nausea Drugs
(1 hour prior to end-of-life mixture)
- Haloperidol 2mg
- Metoclopramide 20mg
END-OF-LIFE MIXTURES
DDMP: Digoxin 50 mg, Diazepam 1 gm, Morphine 15 gm, Propranolol 2 gm.
Time to death: 2h (average) to 39h (max)
D-DMP2: As above, but digoxin is given separately, 30 minutes before the other medications.
Time to death: 1.5h to 13h
DDMA: Digoxin 100 mg, Diazepam 1 gm, Morphine 15 gm, Amitriptyline 8 gm.
Time to death: 1.5h to 12.5h
D-DMA: As above, but digoxin is given separately, 30 minutes before the other medications.
Time to death: 1.5h to 4h
DDMAPh: Digoxin 100 mg, Diazepam 1 gm, Morphine 15 gm, Amitriptyline 8gm, Phenobarbital 5 gm.
Time to death: 1.1h to 5.1h
D-DMAPh: As above, but digoxin is given separately, 30 minutes before the other medications.
Time to death: 1.1h to 3.8h
DDMP2 vs D-DMP2: The dash in D-DMP2 signifies a pause of 30 minutes between giving
the digitalis and the morphine/diazepam/propranolol. The reason is that without giving digitalis separately, the tiny amount of digitalis
(100 milligrams) gets lost amid the huge mass of the other meds (18,000 milligrams)—and the digitalis doesn't get absorbed. By using pre-digitalis, i.e. dig alone for
30 minutes, the dig is rapidly absorbed—providing more rapid and thorough digitalis toxicity.
Additional ressources:
- https://www.acamaid.org/wp-content/...on-Protocols-for-Medical-Aid-in-Dying-1-1.pdf
- https://www.acamaid.org/wp-content/uploads/2021/12/12-5-19-DDMA-instead-of-DDMP2.pdf
- https://endoflifewa.org/wp-content/...r-Taking-Life-Ending-Medications-Jan-2020.pdf
In the pharmacy compounded version, I believe they use crushed pills as well except from the Digitalis powder because it mentioned in one of the MAiD to use Digitalis powder and not crushed pills. Plus I also read that the MAiD as qualified as blue-whale mixture in reference to the amount of powder that needs to be ingested. That being said, we don't have access to Digitalis powder and need to replace it with Digoxin pills. That equates to over 300 pills and take a huge volume for a fetal mixture (half a cup of powder). In comparison, when powderized the remaining pills (diazepam, morphine and propanolol) only fill 1/4 of a cup. So we are dealing with a large volume of powder to be ingested. The risk of vomiting and regurgitation is lowered of course by taking strong antiemetics prior to the end-of-life cocktail. Nonetheless, with D-DMP/A protocols, we are required to actually drink 2 mixtures: first a mixture of Digoxin pills and 30 minutes later, a second mixture of the remaining drugs. Hence, we need very powerful antiemetics to control vomiting and regurgitation. The official MAiD protocol asks for 2ml haloperidol and 20mg metroclopramide: but will this be sufficient for the DYI version? I read in one SN protocol on SS to start taking antiemetics 2 days before SN. Would that make sense? Note that the antiemetics are Neurolpetics and they make you feel down. There is no perfect solution but I am trying to find something that would be acceptable and that would increase the chances of the DYI version to work. It's just a shame we don't have access to a doctor or a pharmacist to help us with these vital questions. I do believe that it's a fundamental right to end one's life when we are no longer able to enjoy life.
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