By 2017, there were six States in the US with laws that allow the prescribing of lethal drugs that the terminally ill may take orally to end their lives under special circumstances. This increase in the number of States was accompanied by a rapid rise in the cost of the barbiturates, long considered the best drugs for a peaceful death. The steep increase in the price of barbiturates in the US and Canada has not been duplicated in the European countries with end of life legislation, where the barbiturate Nembutal remains the drug of choice.
With the French manufacturer of Nembutal refusing to export the drug to the US for the purpose of execution, the supply re- striction led to a steep cost rise for this drug, and for an elective death the price reached a prohibitive ~$20,000. The second most suitable barbiturate, Seconal, manufactured by the Canadian company Valeant, also underwent a steep price rise, and by early 2015 was costing ~$1500/ death.
This led to pressure in the US to develop a cheaper alternative to the barbiturates, and in 2014, activist doctors in Washington State developed a new ‘3-Drug Protocol’ as a cheap alternative. Although effective, difficulties experienced in swallowing the drug combination led in late 2016 to an improved ‘4 Drug proto- col’, also known as ‘DDMP’. These mixtures are is now in com- mon use in the US for those using assisted suicide legislation.
* Exit acknowledges the assistance of Drs Robert Wood, Carol Parrot and Sally McLaughlin for providing detail on the mixed drug protocols