New drug combination for execution in US leaves hospitals in short supply

BMJ 2014; 348 doi: (Published 20 January 2014) Cite this as: BMJ 2014;348:g384
  1. Clare Dyer
  1. 1BMJ

US states are being accused of stockpiling drugs to use in executing prisoners on death row while hospitals face a shortage of the same drugs for surgery and other lifesaving treatment.

The issue has been highlighted by Ohio’s execution of Dennis McGuire, who took 25 minutes to die when he was given a new untested combination of the sedative midazolam and the opioid painkiller hydromorphone.

The American Society of Health System Pharmacists warned that the United States faced a shortage of both drugs because demand exceeded supply.

But prisons in the 32 states that still have the death penalty have been forced to seek new combinations of drugs since a European crackdown on drug companies that supply their products for use in executions.1 State correction authorities can no longer obtain thiopental sodium and pentobarbital, which were previously used in execution protocols. Ohio previously used the single drug pentobarbital.2

McGuire was executed on 16 January for the 1989 rape and murder of a pregnant 22 year old, whose unborn child also died. His lawyers tried to stop his execution with the untested drugs, which Harvard anesthesiologist David Waisel advised could lead to “the terror of air hunger,” but a court ruled that it could go ahead.

The execution was originally thought to have taken 15 minutes, but Ohio’s Department of Corrections later revised the official time to 25 minutes.

A reporter from the Columbus Dispatch who was present at the execution wrote that McGuire “started struggling and gasping for air, making snorting and choking sounds which lasted for at least ten minutes. His chest heaved and his left fist clenched as deep, snorting sounds emanated from his mouth.”

Florida uses 500 mg of midazolam as part of a three drug execution protocol. Joel Zivot, medical director of the cardiothoracic intensive care unit at Emory University Hospital in Atlanta, told the UK Guardian newspaper that the usual dose for a critically ill patient would be 5 mg.

He said he was “shocked and appalled” that vital drugs in short supply for medical use were being hoarded for use in executions. Midazolam is used for treating seizures, for sedation in patients needing mechanical ventilation, and for the induction of anesthesia in patients undergoing surgery and endoscopy.

The international charity Reprieve, which opposes the death penalty and has played a key role in the European boycott of execution drugs, said it was a “scandal” that Florida and Ohio were buying up supplies of drugs for executions that could be used to treat seriously ill patients.3


Cite this as: BMJ 2014;348:g384


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