As Vermont’s only medical aid-in-dying pharmacist, Steve Hochberg hand-delivers nearly every end-of-life prescription to patients across the state.
In Vermont, there is only one facility licensed to dispense the prescription medications used for medical aid in dying: Rutland’s Smilin’ Steve Pharmacy, operated by Steve Hochberg, along with his sons and other family members. However, the location’s monopoly on the service isn’t by design, so much as by default. Not only does physician-assisted death remain controversial, but the medication itself is complex to prepare and distribute, as the process requires additional staff training and capacity. And although the medication can legally be delivered by mail in the state, Hochberg hand-delivers nearly all of them. He told Mikaela Lefrak with Vermont Public, “I don’t mind the driving, and I think this is way too personal of a medication to just drop it in the mail to you.” Read the full article below:
On Delivery With Vermont’s Only Pharmacist For Aid In Dying Prescriptions
By Mikaela Lefrak, Published April 14, 2023 at 5:00 AM EDT
On an overcast spring day in Williston, Steve Hochberg waited outside an apartment building. After a few moments, Edie Novicki buzzed him in.
They went into Novicki’s apartment and settled in at a small table. After some small talk, Hochberg placed a brown paper bag on the table.
Inside was a prescription, strong enough to lead to death.
The Rutland location of Hochberg’s family business, Smilin’ Steve Pharmacy, is the only pharmacy in the state that fills prescriptions for the medical aid in dying medications. (The practice has been legal in Vermont since 2013.) Hochberg runs the business with his sons and other family members.
Instead of mailing the medications or waiting for the patient to pick them up, Hochberg hand-delivers almost every one, no matter where in the state the person lives.
“I don’t mind the driving, and I think this is way too personal of a medication to just drop it in the mail to you,” he told Novicki. If he can’t make the drive, one of his sons will step in.
‘It’s totally up to you’
Hochberg doesn’t rush these visits. He explains everything frankly — there’s no sugarcoating this topic — but pauses often to see if the patient or their family members have any questions. He always hands out his personal cell number and encourages patients to call with questions.
He’s met with patients and their loved ones in all the different stages of grief, from anger to apathy. At this visit, Novicki was calm, clear-eyed and resolute. She even made a couple jokes.
“My undertaker’s named Steve too,” she said. “What are the chances?”
Hochberg started by reminding her that she’s not under any obligation to use the medications. “It’s totally up to you,” he said. He then explained how to dispose the medications if she does change her mind.
Novicki nodded, and assured him that this was what she wanted. She was diagnosed a few months ago with stage 4 stomach cancer, with a prognosis of less than six months to live. After getting two doctors to confirm her terminal diagnosis, and making a written request in accordance with Vermont law, Novicki was able to get this prescription.
“My doctors are supporting me, my family is supporting me,” she said. “They’re still in denial, thinking I’m not going to be using it for a long time. But they’re not here with me.” She said her two sons and a hospice worker will be with her on the day she takes the medications.
‘A chilling effect’
There are a couple of reasons why the Rutland location of Smilin’ Steve Pharmacy is the only pharmacy in the state that fills these prescriptions.
For one, the original version of Vermont’s medical aid in dying law always extended legal immunity to prescribing doctors, but pharmacists and other health care workers didn’t have those same protections. That could have led to “a chilling effect,” said Lauren Bode, the executive director of the Vermont Pharmacists Association.
That changed last year, when Vermont’s Legislature updated the law to protect pharmacists and other health care workers involved in the process.
Secondly, the medication can’t be prepared at your average pharmacy.
“Clinically, medical aid in dying can be somewhat complex,” explained Bode. Only pharmacists at compounding pharmacies have the access and skills to prepare the drugs, and there are only two compounding pharmacies in the state — Hochberg’s business, and Vermont Family Pharmacy in Burlington. Big national chains like CVS and Walgreens don’t run compounding pharmacies in Vermont.
The owner of Vermont Family Pharmacy, Lynne Vezina, said she has no moral objections to medical aid in dying. Her business doesn’t fill prescriptions for it simply because it would take a lot of staff training and additional capacity to do what Hochberg does. The demand for the medications is low enough that his business can handle all the requests that come in.
“For us, it would be very challenging to do what they’re doing,” Vezina said. “And Steve is doing a really good job. But if there was a need, we could certainly visit that to see if it makes sense. But it would be a little challenging for us as we’re set up now.”
Only 173 Vermonters used medical aid in dying between May 2013 and December 2022, according to the Vermont Department of Health. It’s possible demand could increase soon, though. State lawmakers are currently considering modifying the law to allow people who don’t live in Vermont to come here and use it.
‘A very difficult choice to make’
For now, Steve’s got it covered. At Edie Novicki’s apartment, he methodically talked her through the process of taking the medications — first, the pills to help reduce any nausea or issues swallowing, then the lethal powder. “This powder can be very bitter,” he noted. He recommended mixing the powder with apple juice, and suggested having a popsicle nearby to help numb the throat.
“One you finish this, within a couple of minutes you will actually fall asleep,” he said. “You will not wake up. You’ll be be at peace at that point.”
Novicki took this in. Her eyes welled up for the first time in their nearly hour-long visit. “I’m too young,” she said quietly.
Hochberg nodded. “It’s a very difficult choice to make,” he said.
“The choice wasn’t difficult,” Novicki said. “The cancer was.”
Once Novicki assured him she had no more questions, Hochberg hugged her goodbye. He headed outside to his red pickup truck to make the drive back to Rutland. He said had another delivery tomorrow.
“We go to school to learn how to help people,” he said. “That was always my view of what pharmacy is. And this is the ultimate help.”