Problematic executions in Oklahoma, Arizona and other states have highlighted a patchwork approach states are taking with lethal drugs, with types, combinations and dosages varying widely.
Arizona announced Monday that it was switching from the two-drug method that led to a nearly two-hour execution earlier this year, while a federal judge in Oklahoma upheld the state's three-drug lethal injection protocol, which was adjusted recently after a botched execution in the spring.
How did the disparities in drugs come about after more than three decades in which all death penalty states used the exact same mixture?
Q: What are states currently using for lethal drugs?
A: Georgia, Texas and Missouri use single doses of compounded pentobarbital, an anesthetic similar to the drug used to put pets to sleep. Ohio, which has been unable to obtain compounded pentobarbital, uses a combination of midazolam, a sedative, and hydromorphone, a painkiller. Arizona said Monday it was switching from that same two-drug combination to a three-drug combination that includes midazolam. Florida uses midazolam, vecuronium bromide and potassium chloride. Oklahoma has authorized four different lethal injection protocols: a single, lethal dose of either pentobarbital or sodium pentothal, a two-drug procedure using midazolam and hydromorphone, or the same three-drug method used in Florida.
Q: All death penalty states used the same three-drug combo for lethal injection for more than three decades. Why isn't that done now?
A: Two reasons. First, supplies of the drugs started to run short as death penalty opponents in Europe put pressure on their drugmakers — which manufactured key anesthetics — to prohibit their use in executions. Secondly, states eager to avoid ongoing lawsuits alleging the old three-drug method caused inmates to suffer unconstitutional levels of pain looked for alternatives beginning about five years ago.
Q: Why don't all states follow the lead of Georgia, Missouri and Texas and use compounded pentobarbital?
A: The compounded version is difficult to come by, with most compounding pharmacists reluctant to expose themselves to possible harassment by death penalty opponents. Adopting it also raises the specter of lawsuits over its constitutionality, based on arguments that its purity and potency could be questioned as a non-FDA regulated drug. So far, Georgia, Missouri and Texas won't reveal their sources, while Ohio, whose protocol includes the option of compounded pentobarbital, hasn't been able to obtain it.
Q: Why can't states just find another drug as effective as pentobarbital?
A: Basically, options are running out. The leading candidate after pentobarbital was propofol, the painkiller known as the drug that caused pop singer Michael Jackson's 2009 overdose death. Missouri proposed using propofol but withdrew the idea over concerns the move would create a shortage of the popular anesthetic. Meanwhile, manufacturers are also starting to put limits on drugs in the old three-drug combo still in use in states like Florida.
Q: With all this uncertainty, why don't states return to the electric chair or other non-drug methods?
A: Most states retired their electric chairs or used them sparingly with the advent of the three-drug method introduced in the 1970s. Tennessee recently enacted a law allowing its use if lethal drugs can't be found, and other states are debating its reintroduction. But electric chairs come with their own constitutional problems, since they have produced a number of botched executions over the years, as did hanging decades ago. Lawmakers in Oklahoma also are considering the use of nitrogen gas to execute inmates. Many death penalty experts, and even some opponents, believe the quickest and most humane method is the firing squad. But it's unclear whether there's a public appetite for moving to that method.
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