Under California’s End of Life Option Act (EOLA), the medication most commonly associated with medical aid in dying is secobarbital, a fast-acting barbiturate that causes deep unconsciousness followed by death. However, the specific drug or combination prescribed has evolved since the law took effect in 2016, and today many patients receive a compounded mixture of multiple medications rather than a single pill. The medication must be self-administered by the patient, either by mouth, through a feeding tube, or rectally.
What the Medication Actually Is
When California’s law first went into effect, secobarbital was the standard prescription. It had a long track record in Oregon and Washington, where similar laws existed earlier. But the price of secobarbital skyrocketed to over $3,500 shortly after the California law launched, making it difficult for many patients to access. Supply shortages compounded the problem.
In response, physicians and compounding pharmacies developed alternative drug combinations. These typically include a mix of medications that work together to induce deep sedation, stop heart function, and suppress breathing. The exact formulation varies, and prescribing physicians have noted that identifying the right combination has been one of the more challenging aspects of implementing the law. Most patients today receive their medication from a compounding pharmacy rather than picking up a single brand-name drug off the shelf.
Regardless of the specific formulation, the medication is designed to cause a peaceful, painless death. After ingestion, patients typically fall into a deep sleep within minutes. Death follows, usually within a few hours, though the timeline can vary.
Who Qualifies for the Medication
California law sets specific eligibility requirements. You must be at least 18 years old, a resident of California (and physically in the state during the process), and have the mental capacity to make your own medical decisions. Two physicians must independently confirm a terminal diagnosis with a prognosis of six months or less to live.
A mental health evaluation is not automatically required by the law itself, though some hospitals initially adopted their own mandatory psychiatric screening policies. UCSF, for example, originally required a mental health assessment for every patient seeking aid-in-dying medication. After finding that no patients lacked decision-making capacity due to a psychiatric condition, the institution dropped the blanket requirement in favor of targeted referrals based on specific clinical concerns.
The Request Process and Waiting Period
Getting the prescription involves a structured series of steps. You make two separate oral requests to your attending physician, spaced at least 48 hours apart. That waiting period was shortened from the original 15 days when the law was amended in 2022. You also submit a written request, signed in front of two witnesses.
A second, consulting physician must independently confirm your diagnosis, prognosis, and mental capacity. Once both physicians agree you meet all criteria, your attending physician can write the prescription. The entire process, from first request to receiving the medication, typically takes at least a few weeks when accounting for scheduling appointments, obtaining the second opinion, and filling the prescription.
Self-Administration Is Required
California law is explicit: the patient must self-administer the medication. No physician, nurse, or family member can administer it for you. Self-administration means you physically take the medication yourself, whether by swallowing it, using a feeding tube you can operate, or administering it rectally. If you lose the physical ability to self-administer before using the medication, you can no longer legally take it under this law.
This requirement is a core distinction between medical aid in dying and euthanasia, which is not legal in California. The patient retains full control over whether and when to use the prescription.
Cost and Access Challenges
Cost remains a real barrier for some patients. The medication itself can range from several hundred to several thousand dollars depending on the formulation. Finding a participating pharmacy, particularly a compounding pharmacy willing and able to prepare the mixture, has been a persistent challenge. Not all pharmacists are willing to fill these prescriptions, and not all hospital pharmacies stock the necessary ingredients.
Insurance coverage varies. Some private insurers cover the medication, while others do not. Medi-Cal coverage for specific aid-in-dying drugs is not guaranteed, and patients may face out-of-pocket expenses for both the medication and the required physician consultations. Organizations that advocate for end-of-life options can sometimes help patients navigate insurance questions and locate participating pharmacies.
How Many People Use It
In 2024, 1,591 people in California received prescriptions under the End of Life Option Act. Of those, 982 (about 62%) were reported to have died after taking the medication. The remaining patients either died of their underlying illness before using the prescription, chose not to take it, or were still living at the time of the report. For many patients, simply having the medication available provides a sense of control, even if they ultimately never use it.
What Happens to Unused Medication
If the medication goes unused, it needs to be disposed of safely. The FDA recommends using a drug take-back program, either through a local drop-off location or a pre-paid mail-back envelope. If those options aren’t available, you can dispose of it at home by mixing it with something unpleasant like dirt, cat litter, or used coffee grounds, sealing the mixture in a plastic bag, and placing it in the trash. Any personal information on the prescription label should be scratched out or removed before discarding the packaging.