PHOENIX – Public health officials who use certain “execution drugs” to treat COVID-19 patients face competition from states that use those drugs to end lives rather than save them.
The sedative and paralytic drugs are in high demand because they’re used to treat COVID-19 patients who rely on ventilators in intensive care units, a group of pharmacists, frontline ICU doctors and other public health experts said in an open letter April 9 to 17 death penalty states, including Arizona. In the face of high demand and short supply, the group asked that drugs the states have in store be sent to health care providers in their respective states.
However, Arizona Department of Corrections officials told Cronkite News via email Tuesday that the state is “not in possession of such drugs,” which include medicines used for pain relief or sedation, like fentanyl and midazolam, as well as vecuronium bromide and rocuronium bromide.
The U.S. Food and Drug Administration reports a national shortage of midazolam, which Arizona previously used in Arizona lethal injections. Arizona stopped using vecuronium bromide and rocuronium bromide in 2017.
“Sedatives are in short supply because of the extraordinary demand created by the pandemic and, unlike ventilators, these are not supplies that you can create in assembly line and manufacture,” according to Robert Dunham, executive director of the Death Penalty Information Center.
“The pharmaceutical plants are often sized to produce a fixed amount each year.”
The current drugs used in Arizona executions, sodium pentothal or pentobarbital, aren’t often used in ICU, however. Sodium pentothal, also known as sodium thiopental and “truth serum,” is no longer available for patients in the United States, according to an American Society of Anesthesiologists statement in 2011, six years before Arizona adopted the anesthetic into its execution process.
Since the Supreme Court’s 1976 ruling in Gregg v. Georgia that capital punishment is constitutional under certain circumstances, and since 1991 Arizona has executed 37 people, and 119 inmates are on death row, according to the Death Penalty Information Center.
The execution process in Arizona stopped using midazolam and hydromorphone after the 2014 execution of Joseph Wood, which took almost two hours, according to Dale Baich, one of Wood’s attorneys who witnessed the execution.
“The state’s expectation was that the execution using midazolam and hydromorphone would be completed in less than ten minutes,” Baich stated in an email. “Instead it took Joe Wood one hour and fifty-seven minutes to die; gasping, gulping, and struggling to breathe most of that time.”
Arizona’s execution protocol switched a three-drug formula, which included midazolam, in 2015. The next year, the state agreed not to use midazolam or any other benzodiazepine for execution purposes. By July 2017, Arizona adopted the current one-drug system of either sodium pentothal or pentobarbital, neither drugs requested for release in the letter.
One co-signer of the open letter urged the death-penalty states to “leave medicine out of” executions.
“The states have selected a method of execution that happens to impact an area in which I am an expert, the practice of medicine,” said Joel Zivot, associate professor of anesthesiology and critical care at Emory University. “Execution does not require by law the use of pharmaceuticals, and that is a choice of the state. I would say to leave medicine out of it.”
Another signer, David Waisel, associate professor of anaesthesia at Harvard Medical School, said the letter does not address capital punishment itself and is not intended to spark debate over the death penalty.
“The pandemic has created extraordinary circumstances where more patients than we could ever imagine need critical care,” Waisel said. “Some of these medications could save lives. I can only speak for myself, but this is not about the death penalty. This is about a national all hands on deck response to a crisis.”