# E-DRUG: NON -E DRUGS: Barbiturates regulated in Germany

**URL:** https://talk.edrugplus.org/t/e-drug-non-e-drugs-barbiturates-regulated-in-germany/51
**Category:** e-drug
**Created:** [November 17, 1995, 2:41pm UTC](https://talk.edrugplus.org/t/e-drug-non-e-drugs-barbiturates-regulated-in-germany/51 "1995-11-17T14:41:54Z")
**Posts on this page:** 1
**Page:** 1

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### Author: ![drossdeg](https://avatars.discourse-cdn.com/v4/letter/d/73ab20/32.png) [@drossdeg](https://talk.edrugplus.org/u/drossdeg)
#### Post date: [November 17, 1995, 2:41pm UTC](https://talk.edrugplus.org/t/e-drug-non-e-drugs-barbiturates-regulated-in-germany/51/1 "1995-11-17T14:41:54Z")

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Re: Barbiturates regulated in Germany

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Dear colleagues,

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;I applaud your efforts to improve drug use, and acknowledge your  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;serious concerns about the dangers of barbiturates. However, I think  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;we must be very cautious about feeling completely satisfied with  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;product withdrawals alone as a solution to the underlying drug use  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;problems represented in this example without sufficient evidence that  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;all the effects of limiting access to barbiturates were positive ones.  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;My areas of concern are the following:

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;1. Patients use drugs, and doctors prescribe them, for real reasons,  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;both medical and non-medical. The drugs may be the "wrong" ones  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;biomedically, but they nonetheless are serving a real purpose.  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Suddenly removing drugs can have both intended and unintended  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;consequences. It is important to critically assess these consequences  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;-- both the medical consequences and, especially in cases like this,  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;the psychosocial ones -- to fully understand the impacts of product  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;withdrawal.

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;2. Preventing the choice of specific products does not necessarily  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;make doctors better prescribers. The products they select as  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;substitutes -- and they will indeed substitute other products -- may be  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;as harmful, or more so. Compared to older drugs like barbiturates,  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;they will certainly be more expensive. Unless doctors are educated in  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;WHY withdrawn drugs were not indicated, and what the DESIRED  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;ALTERNATIVES might be, the market as a whole (and specific  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;patients) might not be better off. There are numerous papers from our  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;group at Harvard and elsewhere that have demonstrated specific examples  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;of this.

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;3. When widely-used products are withdrawn for safety reasons, both  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;the companies and the national regulatory authority have the  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;responsibility to adequately educate both prescribers and consumers  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;about the reasons for withdrawal, and also the preferred alternative  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;therapies.

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;I urge you to evaluate in more depth the impacts of discontinuing  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;barbiturates in Germany, to examine changes in utilization of the  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;barbiturate products which remain on the market (especially regarding  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;use for unlisted indications), and to ensure that the appropriate  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;education of prescribers and consumers is carried out.

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Good luck, and please keep us informed about your progress.

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Dennis Ross-Degnan  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Assistant Professor  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Drug Policy Research Group  
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Harvard Medical School