Baja — Tijuana has long attracted people seeking medicine and medical procedures unavailable or unaffordable in their home countries. They've been joined recently by people seeking the means to kill themselves. And some of them are coming from 8000 miles away. It’s being called suicide tourism, and Tijuana is one of its hottest destinations, so hot that one of the men who put Tijuana on the suicide tourism map now says he’s directing people to Mexican border towns to the east.

Dr. Philip Nitschke could be described as the Jack Kevorkian of Australia. He’s been nicknamed Dr. Death in his country for his very public championing of what he terms “end-of-life choices.” He performed the first legal physician-assisted suicides in the world in 1996, when the Northern Territory, a province of Australia, legalized the practice. Within months of passing, the law was overturned, but Nitschke has remained active in the issue. He’s the president of a group called Exit International and the coauthor of a book called The Peaceful Pill Handbook that details ways in which people can kill themselves peacefully and painlessly. The book, which gained notoriety when it was banned in Australia and New Zealand, offers tips on traveling to Mexico to buy pentobarbital — also known as Nembutal.

“The history of the drug is interesting,” said Nitschke, reached by phone in Australia. “It used to have a bit of a role as a sleeping tablet. It was one of the barbiturate sleeping tablets, and it was implicated in Marilyn Monroe and Judy Garland ending their lives by having an overdose of sleeping tablets. But it’s fallen away…it’s almost a non-prescribed drug for human use. But it’s still used in veterinary practice. That’s the one people are seeking out in Mexico.”

Asked why Mexico, Nitschke responds, “Convenience. It’s relatively easy for people to access the country from as far away as Australia. It’s not just a matter of distance but a matter of the ability to simply fly into America and cross the border. And the cost of the travel is relatively cheap. Those are the main considerations. There have been other places. But Mexico became the most well known, and partly because we included a chapter about it in my book. What we were trying to do is take away some of the difficulty and make it a much more straightforward process in terms of obtaining what it is people need. To do that, you’ve got to make it clear what it is people are trying to do so that they’re not just wandering in a foreign country making all sorts of mistakes. They need to know exactly what they’re trying to do and that the product they’re getting is what they want. So we were able to find out what all those processes are and write about them. That book was published a couple of years ago, and since, there’s been quite an increase in the number of people traveling into Mexico for this reason.”

Recently, at Star Pet veterinary pharmacy on the west side of Avenida Revolución just south of Second, the clerk on duty, when asked for pentobarbital, said in fluent English, “We’re all sold out. We’ll get more in about a month and a half.”

The clerk recommended another veterinary pharmacy “a block and a half down Second.” On the south side of Second, between Negrete and Ocampo, stands Granero Los Alazanes. The store is stuffed with handmade wooden doghouses, leashes, muzzles, shampoos, and pet food. Behind the counter, a couple in their mid-30s watch a soap opera playing on a wall-mounted television. Asked for pentobarbital by a customer, the woman looks a bit nervous and glances at the man to her left. He nods his head almost imperceptibly, and she grabs a bottle down from a high shelf behind her. It’s 100 milliliters of Pentovet NRV brand pentobarbital. “Forty-five dollars,” she says.

Dr. Luis Guerra operates a veterinary practice in Colonia Libertad, a neighborhood that clings to the hills between the river and the border about five miles east of downtown. “What are those veterinary pharmacies doing down there in a tourist area?” he asks rhetorically. “They’re not there for pets.”

Guerra says he’s heard about people coming to Mexico to obtain pentobarbital but says none have ever come to him asking for it. “I wouldn’t sell it to them if they did,” says Guerra, a gregarious man in his mid-50s with thick black hair and the gray-flecked brush mustache common to middle-aged Mexican men. Dressed in tan slacks, blue polo shirt, and a white apron, he stands behind the glass display case of what he calls his “pharmacy.” “I sell shampoos, soaps, flea medicines, things like that,” Guerra explains, “nothing that requires a prescription, and certainly no anesthetics such as pentobarbital.”

Guerra says he understands why someone who wanted to die would want to use pentobarbital, because of the peaceful nature of death caused by the barbiturate. “They would fall asleep and not wake up.”

In his veterinary practice, Guerra administers pentobarbital by injection in order to tranquilize and anesthetize animals before he performs surgery on them. “I give the proper dosage, and the dog goes to sleep. If I give any more, the breathing will stop.”

Though he knows the death would be peaceful, Guerra doesn’t think pentobarbital makes a good suicide drug because “I think it would take more than one person. In order to die peacefully, they have to inject first to sleep, and then the second, fatal dose, and somebody has to help at that point. Let’s say I wanted to do it by myself. As I inject myself, I start getting drowsy, and most likely, before I finish a fatal dosage, I’m asleep. If I tried quickly to inject enough to be fatal, there are two risks: the needle might pop out or you might get a huge concentration of the liquid in one spot, and that doesn’t bring about the desired effect.”

“That’s right,” says Nitschke, “so you don’t inject it. You drink it. It comes in 50- or 100-milliliter bottles, and in a 100-millileter bottle you get six grams. I’ve never seen anyone drink six grams of that and finish their whiskey, if they’re drinking whiskey afterwards.”

Part of the reason The Peaceful Pill Handbook was banned in Australia and New Zealand was because of the helpful hints on traveling to Mexico to obtain pentobarbital with the intent to bring it back to Australia. “You can’t legally import the drug into Australia,” Nitschke says. “It’s a class A drug, as they say here, the same as heroin.”

But it’s not only Australian law that Nitschke’s suicide-tourist countrymen are breaking, it’s U.S. law as well. Exit International and The Peaceful Pill Handbook suggest that people stay in U.S. cities such as San Diego, cross into Mexico, and cross back into the U.S. carrying the pentobarbital, which is illegal. An Australian television news report from April 2008, available on YouTube (youtube.com/watch?v=EheK5vmInOE), shows a seriously ill couple from Australia traveling to San Diego, checking in at the Harborview Inn on Grape Street in Little Italy, enjoying a few sights in San Diego, and conferring with Nitschke in their hotel room as to where in Tijuana to find the suicide drugs they want. Next, they’re in Tijuana buying the pentobarbital at a veterinary pharmacy on Revolución. A sign hangs in the window of the pharmacy. It says: Australian Veterinary Supplements. They make their purchase, cross back into the U.S., and fly back to Australia. Asked if he’s aware of the illegality of crossing the U.S. border with pentobarbital, Nitschke chuckles. “Look,” he says, “we understand that you’re crossing several boundaries there. And we’ve had a couple of instances where people have been picked up at the U.S. border. We’ve had, interestingly, no example of people that have been picked up at the Australia or New Zealand port. But elderly people think, ‘What have I got to lose?’ And quite possibly they have a lot to lose, but they do it anyway. You’ve got an increasing number of elderly folk who are prepared to take this chance. That speaks for itself.”

Faye Girsh, vice president of the Hemlock Society of San Diego, knows that Exit International has been publicizing the Mexico option for its members. “But we do not send people to Tijuana, because it’s not a legal thing to do,” she explains. “We want people to be able to die peacefully, and quickly, and gently, and with certainty, and those drugs are a way to do it. But we don’t want to jeopardize people’s legal status. We support legal physician-aided dying. We’re also very supportive of the Final Exit Network, an organization that was founded by me and some other people in 2005. [Final Exit] provides support to people who have terminal or hopeless diseases who are considering hastening their death. If they qualify for the program, then our volunteers, who are called exit guides — I am one — go to their home to talk about options. If they do decide to hasten their dying, the exit guides are with them when they do it, although they can’t provide physical assistance and they can’t provide the means.”

Girsh describes the experience as “peaceful, quick, and certain. Generally, loved ones are there. Generally, these people are extremely sick, not always terminal but sometimes terminal. When a death is planned that way, there’s often less grieving, less trauma than when a death occurs after a long period of suffering or when it occurs suddenly, of course. Most of the people that I’ve worked with have had hospice care, but it’s not enough, so they choose to hasten their death.”

Asked what death-hastening methods she recommends, Girsh responds, “Well, the best drugs are really not available to people, and that’s why they go to Mexico. The best drugs are short-acting barbiturates. Pentobarbital — Nembutal, we call it.”

But because of the illegality of importing and possessing pentobarbital, Girsh favors another option, “Inhalation of inert gas.”

Nitschke describes the gas-inhalation method, in which a plastic bag full of helium is worn over the head, as “very quick, very peaceful. It requires no drugs. It’s completely lawful. You don’t need any help, and suicide is not a crime. But you’ve still got to mess around with cylinders of gas, there needs to be some way to control the flow of the gas, and you’ve got plastic bags over their heads. Many people do it, especially when they realize that it’s as peaceful, quick, and reliable as it is. [The Hemlock Society] is very keen on that [method]. I think if they were honest and asked their own membership, ‘Do you want a plastic bag over your head or do you want to drink this little drink?’, they’ll find 90 percent of people would say, ‘I’d rather drink the drink, thank you very much.’ ”

But the trick is acquiring the drink. And for the mostly Australian, New Zealander, and British membership of Nitschke’s Exit International, the easiest option is to travel to the U.S. and make a brief foray into Mexico to obtain the pentobarbital. “My usual route,” says Nitschke, “is through Los Angeles and then down. But increasingly, nowadays, we’d be more inclined to travel across to other cities in Mexico rather than into the increasing scrutiny that Tijuana is being subjected to. We’re increasingly suggesting the El Paso, Laredo, Mexicali options.”