History of Sodium Nitrite and Sodium Azide Suicide Methods

 ''“Nobody dast blame this man. You don’t understand: Willy was a salesman. And for a salesman, there’s no rock bottom to the life. He don’t put a bolt to a nut, he don’t tell you the law or give you medicine. He’s a man way out there in the blue riding on a smile and a shoeshine. And when they start not smiling back—that’s an earthquake. And then you get yourself a couple spots on your hat and your finished. Nobody dast blame this man. A salesman is got to dream boy, it comes with the territory.”''

 <span style="float: right; color: cornflowerblue">― Arthur Miller, Death of a Salesman</span>

With the purpose of fearmongering, an investigative, anti-choicer journalist, [https://www.ntvg.nl/artikelen/de-opkomst-en-ondergang-van-middel-x (Braam, 2019)], published a brief history of appearance of sodium nitrite and sodium azide suicide methods in 2017. The article mixed up two substances and dropped the role of Exit International. This page is a timeline of the history of those two suicide methods.

== Cooperative Last Will ==

On 1 September 2017, Cooperative Last Will (CLW), founded in 2013, introduced a substance whose required dose for suicide was only [https://nos.nl/nieuwsuur/artikel/2190853-cooperatie-laatste-wil-vindt-middel-voor-levensbeeindiging.html 2 grams]. Based on the description of the substance—namely, [https://www.trouw.nl/nieuws/cooperatie-laatste-wil-vindt-poeder-voor-vrijwillig-levenseinde~b0677d810/ the lethal dose, the safety concerns, and the usage in laboratories], the substance was later revealed to be sodium azide. Moreover, CLW announced that it would make a suicide powder available to some registered members. According to Dutch newspaper Trouw, the substance is made with legally available ingredients used to [https://www.reuters.com/article/us-netherlands-suicide/after-teens-death-dutch-investigate-group-promoting-suicide-powder-idUSKBN1GX2JV preserve food and combat bacteria and moulds in laboratories]. Because the article mentioned “preserving food”, which cannot apply to sodium azide, CLW was also referring to sodium nitrite on 1 September 2017.

In less than a fortnight, on 13 September 2017, [https://www.trouw.nl/nieuws/leverancier-wil-zijn-product-niet-verkopen-als-euthanasiepoeder~b12da20d/ chemical suppliers] started groaning about their role in supplying sodium azide as a euthanasia powder.

On 12 September 2017, ex-physician Philip Nitschke, the Australian founder of pro-euthanasia group Exit International, said that CLW in March 2017 had informed him about two substances: sodium azide and sodium nitrite. According to Philip Nitschke, the organization then had two drugs on their shortlist. Which of the two the Cooperative ultimately chose is not known to Nitschke. Nitschke included both powders, sodium nitrite and sodium azide, with all their pros and cons in September 2017 revision of the PPH. In September 2017, Nitschke [https://exitinternational.net/media/MRWAAug17.pdf enthusiastically welcomed the idea], but ignorantly joined the [https://www.artsenauto.nl/laatstewilmiddel-jezelf-vergiftigen/ FUD campaign] on [https://eenvandaag.avrotros.nl/item/run-op-zelfdodingsmiddel-cooeperatie-laatste-wil/ different occasions]—started as early as [https://www.trouw.nl/nieuws/met-het-euthanasiepoeder-moet-je-in-eenzaamheid-beslissen-om-eruit-te-stappen~b7232121/ 13 September 2017], held by [https://eenvandaag.avrotros.nl/item/zelfdodingspoeder-lijdt-waarschijnlijk-niet-tot-een-zachte-dood/ anti-choicers]. In [https://vimeo.com/264985884 NuTech Toronto Oct 2017], Nitschke discussed the use of lethal inorganic salts for euthanasia. He had [https://www.trouw.nl/nieuws/nieuw-euthanasiepoeder-kan-voor-een-afschuwelijke-dood-zorgen~b57ab4ff/ doubts] about the peacefulness and rapidness of both powders, as late as [https://www.finalexit.org/ergo_nutech_new_technology.html 2 April 2018].

In February 2018, CLW introduced two safe and humane euthanasia agents to its members: [https://www.nrc.nl/nieuws/2018/02/23/zo-zacht-is-de-dood-niet-na-slikken-van-giftig-poeder-a1593424 Middel X1 and Middel X2]. CLW named both of them Middel X, but, without mentioning their names, CLW gave the description of two substances—not one. Based on the basis of instructions published by CLW on its website, soon it became clear to the public that the former was sodium nitrite and the latter was sodium azide. Till [https://www.dutchnews.nl/news/2018/02/suicide-powder-in-homes-of-300-reports-nrc/ 9 February 2018] more than 300 people had ordered sodium azide to their homes. In [https://www.reuters.com/article/us-netherlands-euthanasia/substance-x-furor-rekindles-dutch-debate-on-loosening-euthanasia-rules-idUSKBN1HP0VY February 2018], CLW proclaimed it would make good on its promise to help members buy a cheap and painless suicide powder dubbed “Middel X” (i.e., Substance X). Based on the [https://www.reuters.tv/v/ueh/2018/04/19/substance-x-reignites-dutch-euthanasia-debate pale yellowish color] of the substance, CLW [https://twitter.com/deLijfarts/status/970392648136773632 probably] started ordering sodium nitrite (not sodium azide) in bulk amount from China, although CLW had [https://www.nrc.nl/nieuws/2018/03/03/waarom-meldde-nrc-niet-wat-middel-x-precies-is-en-arts-en-auto-wel-a1594272 switched] a lot between the two salts.

As early as [https://eenvandaag.avrotros.nl/item/leden-cooeperatie-laatste-wil-willen-geen-overheidsbemoeienis/ 1 March 2018], Minister of Health De Jonge conveyed his worries about the purpose of CLW. By [https://www.trouw.nl/nieuws/leverancier-stopt-leveringen-van-poeder-van-drion-aan-particulieren~bc5df26e/ 10 March 2018], suppliers of sodium nitrite had completely stopped selling sodium nitrite to private individuals. This decision was made after a dramatic appeal from the parents of 19-year-old Ximena Knol, who had used it to kill herself on 22 February 2018. Her death accelerated the case against CLW.

CLW made the headlines again on [https://www.ad.nl/binnenland/ouders-doen-oproep-na-zelfmoord-ximena-19-verbied-levenseindemiddel~a42988dc/ 14 March 2018] when Ximena’s father said on television the group should be shut down after his daughter’s suicide. Her parents blamed CLW on the grounds that its announcement made her aware of the existence of the chemical she used to kill herself. CLW, however, denied any responsibility in the teenager’s death. Prosecutors determined there was no direct link and said no charges would be brought. Meanwhile, prosecutors who have been looking at CLW since September 2017, on [https://www.reuters.com/article/us-netherlands-suicide/after-teens-death-dutch-investigate-group-promoting-suicide-powder-idUSKBN1GX2JV 21 March 2018], prompted to act due to suspicions that the group was about to order enough powder for use by some 1,000 members and had announced that [https://www.volkskrant.nl/nieuws-achtergrond/ook-zonder-laatste-wil-komen-leden-aan-zelfmoordpoeder~b35b679b/ buyers] could order the product in small amount through its site, although [https://www.rtlnieuws.nl/nieuws/nederland/artikel/4727461/cooperatie-laatste-wil-zelfmoordpoeder-euthanasie-poeder sodium nitrite] was available in small amounts through retail stores; shortly after, CLW refrained from [https://eenvandaag.avrotros.nl/item/overheid-moet-zelfdodingsmiddel-gereguleerd-beschikbaar-stellen/ supplying the powders] to its members in order to to prevent the criminal prosecution of its members. On [https://eenvandaag.avrotros.nl/item/cooeperatie-laatste-wil-wel-verantwoordelijk-voor-acties-kwetsbare-mensen-met-zelfdodingsmiddel/ 23 March 2018], when CLW felt threatened, it started threatening to publicly reveal the name of the substance, which by that time everybody knew. Contrary to what the CLW itself stated, the [https://www.trouw.nl/nieuws/cooperatie-laatste-wil-wordt-niet-vervolgd-voor-zelfdodingspoeder~b1057fdac/ prosecutor] thinks that facilitating assisted suicide in an organized context is punishable, but the organization has never implemented those plans.

Because of (1) death of [https://www.rtlnieuws.nl/nieuws/nederland/artikel/4206281/leden-cooperatie-laatste-wil-zelfmoordpoeder-moet-legaal-worden Ximena Knol], (2) [https://www.trouw.nl/cultuur-media/naamloos-poeder-voor-zelfdoding-verschilt-niet-van-een-anonieme-bron~bf811030/ availability], and (3) having no danger for first responders—Middel X1 (nitrite) became famous, and Middel X2 (azide) gained less attention. The judicial investigations was still going on in [https://nos.nl/nieuwsuur/artikel/2240550-leden-cooperatie-laatste-wil-kopen-zelfdodingspoeder-op-eigen-houtje.html July 2018], and CLW [https://eenvandaag.avrotros.nl/item/cooeperatie-laatste-wil-verstrekt-nog-dit-jaar-informatie-over-zelfdodingspoeder/ defended] itself by saying that the powder it had in mind was sodium azide—not [https://www.omroepbrabant.nl/nieuws/3005496/Zelfdodingspoeder-Zeker-1500-Nederlanders-hebben-het-omstreden-middel-in-huis sodium nitrite] that Ximena had used.

After a year that CLW ceased its activities owing to initiation of criminal investigation, on 24 March 2019, Philip Nitschke called agent X1 (nitrite) as agent X—[https://www.facebook.com/video.php?v=10157114552563048 originally his idea]—and agent X2 (azide) as agent Y—CLW’s idea. To back up his claim, Nitschke mentioned the use of nitrite as feral pig poison in Australia.

In [https://www.volkskrant.nl/nieuws-achtergrond/de-jacht-op-het-zelfdodingspoeder-gaat-door-maar-nu-ondergronds~b7c163b74/ May 2019], CLW started to endorse only sodium azide as Middle X on the annual meeting held for its members.

On 27 June 2019, while the Ministry of Health, Hugo de Jonge, was restricting the sale of the powder, CLW was in favor of making suicide drugs available for adults through its website. By doing so, CLW, calling Minister Hugo de Jonge’s decision [https://eenvandaag.avrotros.nl/item/cooeperatie-laatste-wil-verstrekt-nog-dit-jaar-informatie-over-zelfdodingspoeder/ patronizing], wished to be the only distributor. Certainly, CLW didn’t see the hypocrisy in their own condescending intentions and price gouging in nascent euthanasia business: only adults who be member of CLW for 6 months can receive the powder with a safe that opens with fingerprint—for a price higher than in free market.

Most of anti-choicers’ strategies were [https://www.artsenauto.nl/natriumazide-dood-in-de-pot/ fearmongering] based on anonymous testimonies, as well as advertising and marketing pentobarbital as the only substitute last resort. “I told you we should have bought a well-advertised machine.”

== Exit International ==

Since [https://twitter.com/philipnitschke/status/903748662769074176 1 September 2017] Exit International admittedly named nitrite and azide Dutch euthanasia peaceful pill. On [https://twitter.com/philipnitschke/status/904142927542198272 4 September 2017], Exit International held a workshop to discuss new Dutch suicide drugs. [https://twitter.com/philipnitschke/status/906286824297029632 Soon] Exit claimed sodium nitrite as Australian feral pig control. And [https://twitter.com/philipnitschke/status/906624295648088065 peaceful]. Nitschke was happy with the [https://twitter.com/philipnitschke/status/907158257977970688 sales] of the PPeH in September 2017 edition. There were times that Philip Nitschke mentioned the salts, the [https://twitter.com/philipnitschke/status/917630528303566848 Dutch lethal salts], but, when the [https://twitter.com/philipnitschke/status/918793078571503616 demand] was high, Nitschke called it Dutch (pig) #euthanasia powder. On 24 October 2017, Exit International question was that which one of the salts were [https://twitter.com/philipnitschke/status/922801564649181185 reliable], before giving talk in [https://twitter.com/philipnitschke/status/924341736243113984 Toronto Studio] about Pig Poisons. When his doubt grew, Nitschke went back to [https://twitter.com/philipnitschke/status/934014176296566785 inorganic lethal Dutch salts]. Philip Nitschke felt that pentobarbital sale was in danger, so his strategy on 2 December 2017 was [https://twitter.com/philipnitschke/status/936924716715204609 lowering the rankings] of sodium nitrite and sodium azide, in addition to questioning the [https://twitter.com/philipnitschke/status/938739189679640576 effectiveness] of them. On [https://twitter.com/philipnitschke/status/947061844677742592 30 December 2017], his subjective view was that nitrite was better than azide. On [https://twitter.com/philipnitschke/status/951372474188431360 11 January 2018], Nitschke started spreading doubt about sodium azide and went back to calling them [https://twitter.com/philipnitschke/status/954674478214246401 Dutch legal lethal salts], again. In March 2018, Nitschke revealed that he hadn’t done [https://twitter.com/philipnitschke/status/970288553912651776 complete research] on the inorganic salts. On [https://twitter.com/philipnitschke/status/977486668520460289 24 May 2018], he called sodium azide a second-rate end of life option—and, [https://twitter.com/PeacefulPill/status/978370545812230144 2 days later], drew a number out of thin air for the peacefulness of nitrite and azide. Of course, he had [https://twitter.com/exit_nederland/status/983400617455611904 no source] to back up his claims. On [https://twitter.com/philipnitschke/status/989948510035431425 27 April 2018], Nitschke accused CLW to switching from sodium azide to his idea—sodium nitrite. In [https://twitter.com/philipnitschke/status/1007569169599123456 June 2018 revision of the PPeH], Nitschke updated the PPeH with first monitored suicide with nitrite. On 24 June 2018, he [https://www.facebook.com/philip.nitschke/videos/vb.581108047/10156463089898048/ endorsed] nitrite as a peaceful method but not as peaceful as Nembutal. On [https://twitter.com/philipnitschke/status/1076449028819300352 22 December 2018], Nitschke, in order to improve advice, urged Exit members who were planning to use the readily available inorganic salts (sodium nitrite or sodium azide) to record their deaths and arrange for the film to be returned to Exit International.

In Exit International Workshop, held on 6 April 2019, Philip Nitschke suggested the use of beta blockers such as propranolol before sodium nitrite, while the method had been officially reported to be peaceful by Exit International.

If only Nitschke had done research before jumping the media hype, he could have given facts to Exit members. Exit members could have self-record or ask some one to record their death in Switzerland, if only he hadn’t fallen for the FUD, started by anti-choicers. Besides, because sodium nitrite is completely reversible, Nitschke could have attempted suicide using sodium nitrite in a controlled environment like a clinic or a hospital. In a controlled environment, he could have asked to be injected with the antidote, methyleyne blue, and fully recover in a day. Then, he would be able to share the video record of his experiment, not suicide attempt, with the world.

After Exit tour in 2019, Philip Nitschke went back to his [https://twitter.com/philipnitschke/status/1199701214453219328 impossible] 3D printed Sarco that required [https://twitter.com/philipnitschke/status/1204142649810259970 4 laborers to carry it], because the man wanted to create something as his own, [https://twitter.com/philipnitschke/status/931991656475385857 an open source, unrestricted machine]. The DIY suicide activist later started endorsing a new [https://twitter.com/philipnitschke/status/1186275185684557824 assisted suicide service]. At the end of 2019, he was against [https://twitter.com/philipnitschke/status/1208356351052861441 creativity and innovation] in DIY suicide. 15 days later, he introduced a creative and innovation idea: [https://twitter.com/PeacefulPill/status/1214532921899585536 DeBreather]. In [https://vimeo.com/393254796 Exit LiveChat] that Nitschke uploaded on 23 February 2020, he still insisted that sodium azide (according to him, middle X) was CLW’s idea and sodium nitrite was his. Also, he invited new ideas for NuTech 2020 conference.

== Learning Points ==

<div style="text-align: center; font-weight: bold; margin: 15px 0">“When he had received the drink, Jesus said, ‘It is finished.’ With that, he bowed his head and gave up his spirit.” ― John 19:30</div>

While the same events that lead to spread of 2 suicide methods will never be repeated, it’s worth mentioning some educational points regarding the role of Cooperative Last Will and Exit International.

'''Cooperative Last Will'''

* Doubting the peacefulness of the inorganic salts at the beginning
* Lack of dopamine blocker antiemetic on CLW’s guideline
* Switching from nitrite to azide and vice-versa, not clearly introducing them as two substances, possibly for legal reasons
* Setting up purchasing groups, possibly illegal, as a result of moral restrictions on purchasing the salts
* Heedless to law, decision to provide substance knowing that it will only be used for suicide

'''Exit International'''

* In the early days, expressing doubts about inorganic salts despite not having done through research
* Incorrectly recommending sodium bicarbonate for sodium nitrite
* Recommending Tagamet for sodium nitrite and sodium azide
* Calling sodium nitrite his idea, pig poison
* CLW change of direction and working with sodium nitrite again, sticking with sodium azide this time
* Diluting sodium nitrite and sodium azide, not as good as Nembutal, in his subjective tables
* Superfluously suggesting beta blockers
* Moving on with impracticable project Sarco (high-priced, requires industrial 3D printer, logistics challenges, untested)
* Endorsing euthanasia companies by [https://www.facebook.com/philip.nitschke/videos/vb.581108047/10156480184768048/ DIY activist]

== References ==

* Braam, S. (2019). De opkomst en ondergang van ‘middel X’. ''Ned Tijdschr Geneeskd, 163'' pii: D3923 [Full Text: [https://www.ntvg.nl/artikelen/de-opkomst-en-ondergang-van-middel-x 1]|[https://postimg.cc/xknRdbm0 2]|[https://ibb.co/GCvqnHq 3]|[https://s16.directupload.net/images/190330/l6qxkfhh.jpg 4]]


[[Category:Thoughts]]