Pharmacies Won't Compound Lethal Injection for Alabama Executions

Alabama recently executed its first inmate using a 3-drug cocktail containing midazolam in place of the more commonly used pentobarbital.

Alabama recently executed its first inmate using a 3-drug cocktail containing midazolam in place of the more commonly used pentobarbital.

This is because compounding pharmacies in Alabama were not willing to make pentobarbital for lethal injection, according to state officials.

Four other states’ pharmacies also declined to compound pentobarbital for the Alabama Department of Corrections, The Anniston Star reported.

Without access to pentobarbital, the state resorted to rocuronium bromide, potassium chloride, and midazolam—the latter of which has been at the center of much debate.

Death Row Inmates Fight Against Midazolam Use

Death row inmate Thomas Arthur, who was found guilty of killing Troy Wicker in the 1980s, is one of several inmates fighting against the use of midazolam as an alternative to pentobarbital.

Some have argued that midazolam is associated with botched executions, including 1 instance where it took more than 30 minutes for an inmate to die.

Now, Christopher Eugene Brooks, who died on January 21, 2016, was the first inmate to be executed in Alabama since the June 2015 Supreme Court’s controversial ruling that allows states to use midazolam. No one had been executed in Alabama since 2013.

Brooks, 43, was convicted of the rape and murder of a woman named Jo Deann, AL.com reported.

In November 2015, Brooks had joined a lawsuit that argued midazolam is not strong enough to put an individual in a deep enough sleep to not be affected by the 2 other drugs used for executions. Nevertheless, he became the first Alabama inmate to experience the 3-drug cocktail.

Around 6 PM on January 21, 2016, Brooks received 500 mg of midazolam. A few minutes later, a corrections officer performed a consciousness test, which involved saying Brooks’ name twice, lifting his eyelid back, and pinching his left arm, AL.com reported.

Brooks also received 600 mg of rocuronium bromide to stop his breathing and 240 mEq of potassium chloride to stop his heart. He did not struggle or move during the process, AL.com reported.

Alabama’s Efforts to Obtain Pentobarbital

The Alabama Department of Corrections maintains that it could not obtain pentobarbital for Brooks’ execution.

The state’s lawyers recently testified that they had contacted nearly 20 Alabama compounding pharmacies about making pentobarbital, but all of them declined.

On January 12, 2016, a Utah pharmacist named Gaylen Zenter, who was described by AL.com as an independent consultant for the pharmaceutical industry, said the state should be able to obtain pentobarbital. He argued that the materials needed to make the drug were accessible through at least 1 company and that pharmacies had the ability to make it.

“It’s a straight-forward process,” AL.com reported him saying.

However, Zenter conceded that he had not contacted pharmacies or companies to determine whether they would be willing to provide the drug to the state for lethal injection.

Alabama Department of Corrections attorney Anne Hill testified that no pharmacies in Alabama were willing, and compounding pharmacies in Texas, Georgia, Virginia, and Missouri had also declined to make pentobarbital.

Hill also stated that sodium thiopental could not be obtained, AL.com reported.

Several calls and e-mails from Pharmacy Times to the Alabama Board of Pharmacy went unreturned, and the Alabama Pharmacy Association declined to comment. The public information officer for the Alabama Department of Corrections also did not respond for comment.

Who Makes Midazolam?

Drug manufacturers Akorn, Hospira, and Becton Dickinson are some of the makers of midazolam.

In March 2015, Akorn issued a press release stating that it would not ship midazolam or hydromorphone hydrochloride products directly to prisons. It has also asked the Alabama Department of Corrections to return midazolam to the manufacturer.

“The employees of Akorn are committed to furthering human health and wellness through our vast portfolio of products. In the interest of promoting these values, Akorn strongly objects to the use of its products to conduct or support capital punishment through lethal injection or other means,” the statement read. “To prevent the use of our products in capital punishment, Akorn will not sell any product directly to any prison or other correctional institution, and we will restrict the sale of known components of lethal injection protocols to a select group of wholesalers who agree to use their best efforts to keep these products out of correctional institutions.”

Hospira, which manufactures midazolam along with propofol, pancuronium bromide, hydromorphone, rocuronium bromide, vecuronium bromide, and potassium chloride, has also restricted distribution of these products for “unintended uses.”

“Hospira makes its products to enhance and save the lives of the patients we serve, and therefore, we have always publicly objected to the use of any of our products in capital punishment,” the company’s policy states.

However, Hospira did acknowledge that it could not guarantee that prisons could not obtain the drugs used in executions through other channels outside the control of Hospira, due to the complexity of the drug supply chain.

Becton Dickinson is also opposed to the use of its midazolam for executions, and it has denied selling the drug directly to Alabama prisons, according to The Anniston Star.

Pharmacy Associations’ Stance on Compounding Lethal Drugs

Both the International Academy of Compounding Pharmacists (IACP) and the American Pharmacists Association (APhA) have issued statements discouraging pharmacists from participation in executions.

IACP said compounding lethal injection drugs goes against pharmacists’ focus on healing and care. It also pointed out that state boards of pharmacy could potentially seek ramifications against a pharmacy that knowingly prepares a drug that will cause harm.

IACP also stated that compounding lethal drugs could taint pharmacists’ reputation.

In March 2015, APhA’s House of Delegates approved a policy stating that pharmacist involvement in executions goes against the primary role of pharmacists as health care providers.

Alternative Methods for Executions

With manufacturers and compounding pharmacies’ resistance, state departments of corrections may have to turn to alternative methods for executions.

For example, in April 2015, Oklahoma approved the use of nitrogen hypoxia in a gas chamber if the state could not obtain lethal injection drugs.

In Utah, Governor Gary Herbert signed a law in March 2015 that allows for the use of a firing squad as a plan B.