MONTREAL — 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.
Only 1,000 prescriptions sold in past year
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 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.
"It's greed, what else would it be?"
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.
The 'go-to option'
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.
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Here's a look at the state of Euthanasia laws in Canada and their history.
Suicide hasn't been a crime in Canada since 1972. (Shutterstock)
Doctor-assisted suicide is illegal, although the ruling of the B.C. Supreme Court will force Parliament to alter the law within one year. The Criminal Code of Canada states in section 241 that: "Every one who (a) counsels a person to commit suicide, or (b) aids or abets a person to commit suicide, whether suicide ensues or not, is guilty of an indictable offence and liable to imprisonment for a term not exceeding fourteen years." (Alamy)
Passive euthanasia involves letting a patient die instead of prolonging life with medical measures. Passive euthanasia is legal in Canada. The decision is left in the hands of family or a designated proxy. Written wishes, including those found in living wills, do not have to be followed by family or a proxy. (Alamy)
Sue Rodriguez, who suffered from amyotrophic lateral sclerosis (also known as Lou Gehrig's disease), launched a case asking the Supreme Court of Canada to allow her to end her own life on the grounds that the current law discriminated against her disability. Because suicide is legal in Canada and Rodriguez was unable to end her life because of a lack of mobility, she argued it was discriminatory to prevent her from ending her own life with the aid of another. The court refused her request in 1993, but one year later she ended her life anyway with the help of an unnamed doctor. (CP)
Robert Latimer was convicted of second-degree murder in the 1993 death of his severely disabled daughter Tracy. A lack of oxygen during Tracy's birth led to cerebral palsy and serious mental and physical disabilities, including seizures and the inability to walk or talk. Her father ended Tracy's life by placing her in his truck and connecting a hose to the vehicle's exhaust.The case led to a heated debate over euthanasia in Canada and two Supreme Court challenges. Latimer was granted day parole in 2008 and full parole in 2010. (CP)
Former Bloc Québécois MP Francine Lalonde tried repeatedly to get legislation legalizing euthanasia in Canada passed. Bill C-407 and Bill C-384 were both aimed at making assisted suicide legal. C-384 was defeated in the House 228 to 59, with many Bloc MPs and a handful of members from all other parties voting for the legislation. Tetraplegic Tory MP Steven Fletcher, pictured, made the following statement after C-384 was defeated: "I would like to be recorded as abstaining on this bill. The reason is I believe end of life issues need to be debated more in our country. I believe that life should be the first choice but not the only choice and that we have to ensure that resources and supports are provided to Canadians so that choice is free. I believe, when all is said and done, the individual is ultimately responsible. I want to make this decision for myself, and if I cannot, I want my family to make the decision. I believe most Canadians, or many Canadians, feel the same. As William Henley said in his poem Invictus, "I am the master of my fate: I am the captain of my soul."(CP)