Arkansas Has An Alternative Lethal Injection? Dead Wrong

The state of Arkansas just announced that it was able to obtain a drug that would enable lethal injections to proceed. Man, do they need a pharmacology lesson because this is going to be ugly.

My recent piece Chemistry, Politics, And The Death Penalty discussed how capital punishment by lethal injection was impacted by of a shortage of the drugs necessary to carry out the procedure. Although shortages of drugs for lethal injection began around 2009, these drugs became almost impossible to get in 2012. At that time, the European Union, which is firmly opposed to capital punishment, banned the sale of several drugs to the US unless the drug companies that sold them first received assurance that they would not be used to carry out lethal injections. 

Even before the EU ban, Hospira, the only US manufacturer of sodium thiopental, stopped making the drug. Sodium thiopental, a fast-acting general anesthetic which induces unconsciousness—the first step in the three-step lethal injection process—became impossible for prisons to obtain. Although laws regarding methods of execution vary from state to state, thiopental (1), was the standard drug used to induce unconsciousness (2).   

This ban created a problem for prisons (3). In the absence of sodium thiopental, even the most strident proponents of lethal injections would probably not approve of the alternative— the administration of the second (pancuronium bromide) and third (potassium chloride) drugs to a conscious prisoner. Pancuronium bromide is a powerful muscle relaxant which causes paralysis and stops breathing (4), and potassium chloride stops the heart. 

Yet, this is exactly what happened earlier in 2014 in Oklahoma:

"Convicted murderer [Clayton] Lockett, however, was not unconscious. He writhed, groaned and convulsed on the table in agony, acid and fire pumping though his body. An excruciating 43 minutes passed, Lockett would scream and twitch, fighting against the restraints as the poison slowly took hold. Death would finally arrive via heart attack, possibly resulting from the overwhelming pain rather than the chemical cocktail itself." 

Richard Avis, "Top 10 Horrifically Botched Lethal Injections."

What went wrong? Obviously, Locklett was awake during the execution. And it was because of pharmacological ignorance of Oklahoma prison officials. Unable to obtain thiopental, the state used an "alternative" called midazolam, aka Versed. Midazolam, which is a member of the same class of drugs as Valium, is a fine drug for certain procedures, but it is a sedative, not a general anesthetic (See: Versed: The Second Coolest Drug Out There). If you are given Versed during or before surgery (5), everything will be just fine, assuming that you are later put out with general anesthesia. Skip this step and you will wake up as soon as the scalpel touches you.

Guess what drug Arkansas is planning on using in place of sodium thiopental or another general anesthetic. Yes—Versed. How stupid can you be? It's bad enough not to know that the drug being used isn't going to do what it's supposed to do but to repeat the same ghoulish experiment that failed spectacularly three years ago defies logic. 

My own opinions regarding capital punishment are my own, and irrelevant here. But the science is relevant. If lethal injection is intended to be a "humane" method of executing prisoners, then prison officials ought to get the damn science right, because as things stand now, it is anything but humane. 

(1) A lethal injection consisted of three drugs given in sequence: 1. thiopental to induce unconsciousness, 2. pancuronium to paralyze the muscles necessary for breathing, and 3. potassium chloride, which causes the heart to stop beating. All three drugs are routinely used for medical procedures, not just executions. 

(2) Pentobarbital is another general anesthetic which is similar to thiopental. It is also difficult to obtain.

(3) In 2016 Pfizer announced that none of its products could be used for lethal injections, and enacted strict rules to ensure this.

(4) You may have read about cases in which patients received inadequate general anesthesia and were given pancuronium bromide, which facilitates intubation but does not induce unconsciousness. Surgical patients have reported that they were awake and experienced the pain of the surgical procedure but were unable to inform the surgeon or anesthesiologist that they were awake. A 2010 CNN article entitled "Awake during surgery: 'I'm in hell'" describes the experience of one such patient. Not for the faint of heart. 

(5) Versed is commonly used to treat pre-surgical anxiety. It works very well for this.