Controversial Lethal Injection Drug Upheld by Supreme Court

The Supreme Court has ruled to allow states to continue using the controversial lethal injection drug, midazolam.

Although it has been linked to seemingly botched executions, midazolam has been incorporated in lethal injections due to shortages of traditionally used sodium thiopental and pentobarbital.

In the case of Glossip v. Gross, a trio of death row inmates sought to bar midazolam use for executions on the basis that it leaves inmates at risk for excruciating pain, thereby violating the Eighth Amendment prohibiting cruel and unusual punishment.

An amicus brief filed by 16 pharmacology professors argued that midazolam does not reliably render the inmate unconscious prior to administering 2 other chemicals in the lethal cocktail: a paralytic agent to stop respiration and potassium chloride to cause cardiac arrest.

Although the professors stopped short of using supportive language for either party in the case, they noted that midazolam, a sedative in the benzodiazepine class, does not have the same pharmacological effects as barbiturates, which can induce coma.

“This pharmacological distinction explains why midazolam cannot induce unconsciousness at any dose,” they wrote. “It is not an appropriate substitute for either thiopental or pentobarbital as the first drug in a 3-drug lethal injection protocol.”

In a 5-4 decision, however, the Supreme Court affirmed the ruling of a lower court denying the petitioners their injunction on the basis of their failure to prove that midazolam is ineffective.

“First, the prisoners failed to identify a known and available alternative method of execution that entails a lesser risk of pain,” the High Court’s opinion said. “Second, the District Court did not commit clear error when it found that the prisoners failed to establish that Oklahoma’s use of a massive dose of midazolam in its execution protocol entails a substantial severe risk of pain.”

The American Pharmacists Association (APhA) House of Delegates adopted a policy in March officially discouraging pharmacists from dispensing or otherwise participating in lethal injections “on the basis that such activities are fundamentally contrary to the role of pharmacists as providers of health care.”

“Pharmacists are health care providers, and pharmacist participation in executions conflicts with the profession’s role on the patient health care team,” stated APhA Executive President and CEO Thomas E. Menighan, BSPharm, MBA, ScD (Hon), FAPhA.

The APhA’s stance aligns with that of other pharmaceutical associations, including the International Academy of Compounding Pharmacists and the American Society of Health-System Pharmacists.

In her impassioned dissent, Justice Sonia Sotomayor said the use of midazolam was presented as “the chemical equivalent of being burned alive.”