June 18, 2014
Vol: 21 No: 25

Community & Editorial

Terminally-ill patients face shortage of right-to-die drug amid controversy over capital punishment

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A spat between a drug manufacturer and states that use the death penalty could soon be impinging upon Washington residents’ right to die.

Pharmacists I’ve spoken with from Portland to Seattle report that the manufacturer of pentobarbital, the drug used under Washington state’s Death with Dignity law, has halted sales to the United States in protest of the drug’s diversion for use in state executions. With pharmacy supplies of pentobarbital now virtually nonexistent, aid-in-dying advocates are scrambling to find a reasonable alternative for those seeking to use Washington’s Death with Dignity Act.

Aid-in-dying became state law in 2009 with the passage of the I-1000, or the Death with Dignity Act. Passed with nearly 60 percent of voter approval, the act allows mentally competent adults with a life expectancy of six months or less to obtain a prescription for a medication to end their lives. Data from the Washington State Department of Health show that pentobarbital has become drug of choice for use in aid-in-dying.

Only recently have state executions interfered with the terminally-ill individual’s right to die.

Prior to the current drug shortage, sodium thiopental was the staple of a three-drug cocktail used in executions, according the Death Penalty Information Center. This changed when the U.S.-based manufacturer moved production to Italy. Unable to meet the Italian government’s demand that their product not be used in capital punishment, the company announced in a press release in early 2011 that it would halt production of the drug.

U.S. prisons found an alternative drug produced by Lundbeck, a Danish pharmaceutical company. Outraged at what Lundbeck CEO Ulf Wiinberg deemed a “distressing misuse” of their product, the company moved to curtail its use. By July 2011, the New York Times reported Lundbeck had established a distribution policy that effectively restricted prisons. These efforts were bolstered by the European Union, which later voted to ban the export of drugs used in executions.

Prisons found themselves unable to replenish their supplies. Undeterred, they turned to compounding pharmacies, which specialize in making drugs not otherwise available. 

Compounding pharmacies began using the same drug, pentobarbital, for executions and for aid-in-dying. This is where the trouble for aid-in-dying began.

The manufacturer apparently caught wind of prisons’ plans to use the drug for executions. In what appears to have been an attempt to thwart prisons’ misuse of the drug without endangering access to those with a genuine need, compounding pharmacies found themselves required to sign a contract stating they would not supply the drug for executions. One Seattle-based compounding pharmacy owner — who wishes to remain anonymous due to the contentious nature of aid-in-dying — told me they received this request in the summer of 2013.

States determined to move forward with executions turned to bribery. St. Louis Public Radio reported that prison officials began paying thousands of dollars in cash and ensuring pharmacies’ identities remained secret in return for the drug; some pharmacies couldn’t resist. With the assumption of anonymity and an ample profit, a compounding pharmacy in Oklahoma provided a Missouri prison with a dose of pentobarbital, according to the St. Louis Public Radio report.

Pharmacists I work with tell me that in response to such transgressions, the manufacturer struck back, halting sales of the drug entirely. As a result, supplies of the drug are dwindling. After delaying executions due to the shortage, the state of Oklahoma was forced to use a new cocktail of medications in the recent botched execution of Clayton Lockett, according to the Death Penalty Information Center. 

For Washingtonians seeking to use the Death With Dignity Act, the situation is dire. Pentobarbital is no longer available.   

An alternative drug exists, but it costs nearly $1,800 per dose.

It is also troublesome is that there are intermittent shortages of that drug. So when supplies run out, the Death with Dignity Act may become a casualty.

It is ironic that the state’s right to kill jeopardizes the rights of those with terminal illnesses.

Until legislative bodies address this conflict, those hoping to use Death with Dignity Act may find themselves sentenced to a lifetime of pain and suffering — a cruel and unusual punishment.

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