The almost two-hour execution of an Arizona death row inmate with a new, two-drug combination has highlighted the varied approach that U.S. states take with lethal injection drugs, with types, combinations and dosages varying widely. A question-and-answer look at how the disparity came about and why, following more than three decades in which all death penalty states used the same three-drug 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. Arizona and Ohio use a combination of midazolam, a sedative, and hydromorphone, a painkiller. Florida uses midazolam, vecuronium bromide and potassium chloride. Oklahoma has authorized five different lethal injection protocols: a three-drug method beginning with sodium thiopental, pentobarbital, or midazolam; a two-drug procedure using midazolam and hydromorphone; or a single, lethal dose of pentobarbital.
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, starting 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 problematic executions over the years, as did hanging decades ago. Many death penalty experts, 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.