As Colorado鈥檚 aid-in-dying law takes effect this month, proponents say they鈥檒l make sure terminally-ill patients have access to a new, affordable drug concoction that will avoid the $3,000 cost of a common lethal sedative that has skyrocketed in price.
Officials with , an advocacy group, are reaching out to pharmacies statewide to confirm that they鈥檒l stock components of a lethal four-drug cocktail to substitute for secobarbital, known as Seconal, the pricey sleeping pill most often prescribed to induce death.
It鈥檚 the second time in a year that right-to-die advocates have come up with a substitute for Seconal after Canadian drugmaker Valeant Pharmaceuticals International Inc. acquired the medication in February 2015 鈥� and the $1,500 retail price.
鈥淲e were looking for something more affordable and available,鈥� said Kat West, an attorney and policy expert with Compassion & Choices.
The new law, , was signed into law on Dec. 16 by Gov. John Hickenlooper. Colorado joins five other states 鈥� Oregon, Washington, Vermont, Montana and California 鈥� in which terminally ill patients, usually those expected to live six months or less, can choose to take doctor-prescribed drugs to end their lives. In Oregon, at least 991 patients have died after taking drugs prescribed since the law took effect in 1997. In Washington state, at least 917 have died under terms of the law enacted in 2009.
Access to the medications can depend, in part, on cost. Many health insurance plans pay for aid-in-dying drugs, advocates said, but some don鈥檛, and the medications aren鈥檛 covered by federal programs such as Medicare or Catholic-run health care systems. Medicaid programs for the poor and disabled in Oregon and California will pay, but not those in Washington state, Vermont or Montana. In Colorado, it鈥檚 still unclear.
That can create a barrier for terminally ill patients who want to use the law, said Beth Glennon, a client-support coordinator for End of Life Washington, an advocacy group.
鈥淭he cost does affect people鈥檚 decisions,鈥� Glennon said.
As of March, the latest data available, a bottle of 100 capsules of 100-milligram Seconal had a retail price of $3,082, according to data from Truven Health Analytics. Ten grams is a lethal dose.
When Oregon鈥檚 law began, the cost was about $150, recalled Dr. David Grube,聽national聽medical director for Compassion & Choices and a family doctor who has practiced in the state for nearly 40 years. He calls the price hikes 鈥渁n almost-evil practice of greed.鈥�
鈥淚 think it鈥檚 the black side of capitalism,鈥� he said. 鈥淚t really breaks my heart.鈥�
Valeant officials didn鈥檛 respond to requests for comment, but in March firm officials saying that secobarbital is approved only for treating short-term insomnia, epilepsy and for use in pre-operative anesthesia.
鈥淚f it is being prescribed for off-label uses, it is not something for which the product is manufactured or intended,鈥� the statement said.
To fight the high prices, doctors in Washington state experimented last year with a cheaper mixture that included three drugs 鈥� phenobarbital, chloral hydrate and morphine sulfate. The components are widely available and cost about $500 for a lethal dose. But the combination turned out to be too harsh, said Dr. Robert Wood, a volunteer medical adviser for End of Life Washington.
鈥淭he chloral hydrate mixture was too caustic for some folks and our volunteers didn鈥檛 like using it,鈥� because some patients became distressed, Wood said.
Most doses of lethal medication are bitter, often requiring patients to take anti-nausea drugs. But the new mixture was not only bitter but also caused a burning sensation in the mouths of some patients, said Glennon. 鈥淭here was some profound burning,鈥� she said. 鈥淲e didn鈥檛 like working with it. As a volunteer, you want to reassure people. We鈥檙e about a peaceful, dignified death.鈥�
Wood and his colleagues came up with a new option this summer, a four-drug mixture that includes diazepam, digoxin, morphine and propranolol, known as DDMP. It costs between $300 and $600.
The mixture, which puts patients to sleep and then halts their heartbeat and breathing, has been used 38 times so far, Wood said.
鈥淚t is no more difficult than Seconal to ingest and it seems to work quite well,鈥� he added.
The mixture has been used 鈥渁 fair amount鈥� in California, where , said Grube. It鈥檚 not yet known how many terminally-ill patients have died under that state鈥檚 law, but dozens have requested prescriptions, officials said.
Valeant was widely criticized for raising the price of secobarbital, a popular sedative in the 1960s and 1970s that lost its patent status in the early 1990s. It has been used for aid-in-dying patients since Oregon passed the first U.S. law in 1997, which was modeled on similar action in the Netherlands, where secobarbital was the drug of choice.
Another sedative, pentobarbital, was also frequently used, but supplies in the U.S. became expensive and scarce after European drugmakers objected to its use as an execution drug in death penalty cases.
Doctors and pharmacists are not obligated to participate in aid-in-dying treatment under existing laws, including the Colorado action. In a recent poll, about 40 percent of more than 600 doctors surveyed said they would be willing to prescribe lethal medication, 42 percent said they wouldn鈥檛 and 18 percent weren鈥檛 sure, noted Dr. Cory Carroll, a solo practice family physician in Fort Collins, Colo., who endorsed the measure.
鈥淭he docs that are in opposition have a right to their beliefs, but they don鈥檛 have the right to control others,鈥� Carroll said in a recent press conference.
West of Compassion & Choices anticipates that Colorado鈥檚 law will be used immediately, as similar laws in other states have been.
鈥淲e鈥檙e already getting calls from terminally ill people in Colorado who want to access this law,鈥� she said. 鈥淚 fully expect people to begin requesting prescriptions.鈥�
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