Universal consensus is a rare thing. Universal consensus amongst rivals companies in a highly competitive industry is almost unheard of. So the point we have now reached in the debate about the lethal injection within the pharmaceutical sector is something to be celebrated.
Since 2011, when the global drug maker Lundbeck became the first company to comprehensively restrict the sale of its medicines to death rows, more than 30 pharmaceutical manufacturers and distributors have introduced supply chain controls to stop their drugs being misused in executions.
Last month, we reached a new milestone in this industry-led effort against the misuse of medicines. On 27th September, the Organisation for Economic Co-operation and Development (OECD) in the Netherlands published its assessment of the pharmaceutical giant Mylan’s work to restrict distribution in executing states. In the process, new standards of industry best practice have been set.
The OECD dialogue started in March 2015 after the prominent Dutch lawyer, Bart Stapert, raised concerns that Mylan, headquartered in the Netherlands, was not implementing the same strict controls on the distributions of its medicines as competitors. Mylan manufactures the anaesthetics midazolam and etomidate, and the paralytics rocuronium bromide and vecuronium bromide, all which have been sought for use in US capital punishment.
The unique thing about this process was that it brought a whole range of interested parties together. The discussions, facilitated by the OECD in the The Hague, involved not only Mylan and Mr Stapert, but also the major investors and expert stakeholders.
Things moved quickly. Six months after the process began, in September 2015, Mylan released a statement making clear for the first time that it did not approve or authorise the use of its products in lethal injections. Mylan also pledged to change its contracts to legally restrict distributors from selling medicines to executing states.
But distribution controls are only effective if they are implemented properly. Especially with US states looking for new drugs as current stocks run out and often actively trying to bypass controls through secretive procurement.
In its evaluation of Mylan, the OECD recommended steps that all pharmaceutical companies should follow.
Firstly, companies should be proactive about adding drugs to restricted lists as lethal injection protocols change. Secondly, compliance should be monitored through the supply chain using sales data with checks on a monthly or bimonthly basis. Thirdly, companies should adopt a ‘clear and unequivocal position’ against the secrecy laws, used by US states to hide the source of their execution drugs. And fourthly, manufacturers should contact officials in executing states to inform them of their position.
I have worked with and consulted for almost every global pharmaceutical company on lethal injection issues. The real lesson I take from this process is that constructive collaboration and dialogue are the most effective ways to achieve the ends we all seek. The positive engagement by Mylan and its shareholders in the establishment of these standards of industry best practice shows we can overcome the problem of the misuse of medicines together
Maya Foa is director of Reprieve, an international organisation that acts as a consultant to the pharmaceutical industry on issues relating to the lethal injection and capital punishment in the US and around the world