Valeant Pharmaceuticals, accused by U.S. politicians of price-gouging, is facing criticism from assisted-dying advocates across North America for doubling the price of a drug commonly used to hasten death soon after California legalized doctor-assisted suicide.
The barbituate, Seconal or secobarbital, isn't available in Canada, but one Canadian proponent of assisted suicide was harshly critical of the embattled Quebec-based company in a recent interview.
"It's greed, what else would it be?" said Maureen Taylor, the widow of Ontario microbiologist Donald Low, known for his work on SARS.
'It's a very quick, painless way to go. You just sort of fall asleep and drift off.' - Maureen Taylor, assisted-dying advocate
Valeant jacked up the price a year ago after purchasing a portfolio of drugs from Marathon Pharmaceuticals. The medication, developed in the 1930s as a sleeping pill, is mainly used for short-term insomnia, epilepsy and pre-operative anesthesia.
Once in the Valeant stable, the price jumped to US$3,000 per 100 capsules, double what it was selling for prior to the company's acquisition. In 2009, those 100 capsules cost less than US$200.
A full prescription of the pills, diluted in liquid, is needed to cause death.
The company said it doesn't promote the drug and has sold only about 1,000 prescriptions in the past year. It expects to receive less than US$3 million in sales in 2016.
Other drug prices raised even more
Other drugs included in the February 2015 Marathon acquisition were Isuprel and Nitropress, two life-saving heart drugs whose prices were tripled or increased six-fold. Valeant was called to defend its pricing strategy during testimony last month before a U.S. congressional committee investigating exorbitant price increases by several industry players.
"Valeant sets prices for drugs based on a number of factors, including the cost of the development or acquisition of a drug, the availability of substitutes or generics, and the benefits it offers versus alternative treatments that might be more costly," the company said in a statement.
The price increase went largely unnoticed until a National Public Radio report earlier this week highlighted the anger of U.S. families of patients that's spread north of the border.
Dr. David Grube, an Oregon physician who prescribes the drug, called it "unconscionable" that the price is so high when it costs just US$50 in Denmark. While some insurance companies may cover the increased price, it may be a barrier for others, he told NPR.
Taylor said her husband, who died in 2013 after suffering from brain cancer, wanted to use the drug to take his own life but couldn't acquire any and didn't want to put her in danger of criminal penalty by importing it from the U.S.
"It's a very quick, painless way to go. You just sort of fall asleep and drift off," she said of the drug, which is administered orally.
Taylor said Canadians should have the same right as Americans in Washington state, Oregon and Vermont to access medications that would allow them to take their own life at home, without tubes and the help of doctors.
Weak demand has prevented manufacturers from making a cheaper, generic version of the drug that went off-patent in the 1990s. Taylor hopes California and Canada's moves to legalize assisted suicide will spur change.
Dr. Ellen Wiebe, who helped a Calgary woman with ALS earlier this month to hasten her death, said the orally administered drugs secobarbital and Pentobarbital should be available in Canada at a reasonable cost.
"We have good drugs for the IV but we don't have good drugs for the oral," she said from Vancouver.
Wiebe said secobarbital used to be the sleeping pill of choice 40 years ago and is the "go-to option" for assisted suicide in the U.S.
Pentobarbital, a concentrated liquid that costs $23,000 a dose, is increasingly hard to come by in the United States because some states still administer the death penalty. Many big European drug-makers will not export it to the U.S. because they oppose its use in executions.
Last year, the Supreme Court of Canada struck down laws that bar doctors from helping someone die, but put the ruling on hold for one year.
In February, the court granted the federal government a four-month extension, but said the terminally ill could ask the courts for an exemption to the ban during that period.
A terminally ill elderly man died last week in Ontario after winning the right to a doctor-assisted death.
So far, two other patients — someone in Manitoba and a woman in Alberta who died in British Columbia — have also won such court approval, and another case is pending in Ontario.
Quebec put in place its assisted-death regime in December.