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The lethal injection room at San Quentin State Prison (Credit: CACorrections)

The Problem Ingredient in Lethal Injections

A new drug being used in lethal injections has caused a number of agonizing deaths. Find out how it works in the body.

| 3 min read

A new drug being used in lethal injections has caused a number of agonizing deaths. Find out how it works in the body.

After a number of death row inmates suffered unusually agonizing deaths, the ethics behind the lethal drug combinations used were brought before the Supreme Court. On June 29, 2015, the Supreme Court upheld the constitutionality of these lethal procedures in a divided vote of 5 to 4.

The decision ignited controversy across the nation as it followed a series of botched cases in which inmates reportedly suffered extremely cruel and unusual deaths. Clayton Lockett, an Oklahoma inmate, died of a heart attack 43 minutes after the lethal injection process started. The drug trifecta was supposed to make him unconscious, but Lockett began convulsing and writhing in pain on the gurney after it was administered. Months earlier, Ohio inmate Dennis McGuire struggled and choked for several minutes before he took his last breath nearly 25 minutes after the lethal injection was given. In a third case in Arizona, Joseph R. Wood took nearly two hours to die, and witnesses reported that he died gasping for air and making snorting noises.

All three of these mishandled cases shared a common factor: each toxic combo contained Midazolam (pronounced mi-DAZE-oh-lam), a sedative drug in the class of benzodiazepines.

Typically, three drugs are used in lethal injection, but new lethal injection protocols are switching up the norm. For years, the standard procedure involved sodium thiopental to induce unconsciousness, pancuronium bromide to cause muscle paralysis and respiratory arrest, and potassium chloride to stop the heart. Now, Midazolam is taking the place of sodium thiopental. But how does the drug actually affect the body?

According to the National Institutes of Health, Midazolam slows brain activity, allowing for relaxation and sleep. It’s been used in medical procedures before anesthesia is given in order to cause drowsiness, minimize anxiety, and prevent memory of the procedure.

Midazolam produces a sedative effect because it facilitates the binding of a brain chemical, GABA, to brain receptors. This hinders the flow of electrical impulses to the brain. But unlike sodium thiopental, Midazolam is unable to mimic GABA’s effects, which have greater effects on the brain.

In the Supreme Court’s transcript of the trial, Dr. David Lubarsky, head of the anesthesiology department at the University of Miami, explained that Midazolam is a “ceiling drug,” which means that at a certain point, increasing the dose won’t increase effectiveness because the maximum effect has already been reached. With Midazolam, this ceiling effect is reached before full anesthesia can be achieved— so in Lubarsky’s view, it’s sufficient for minor procedures, but incapable of keeping someone sedated throughout the extreme pain and discomfort associated with the second and third drugs in the lethal injection protocol.

Lubarsky also testified that, to his surprise, when filing for written summaries of the lethal injection processes, some states didn’t even have a written document that outlined the protocol to be followed during a lethal injection. Therefore, it’s impossible to determine if states are actually following the processes they claim to use, or if death row inmates are becoming the guinea pigs of an inhumane testing ground for toxic drugs.

Lubarsky revealed that, based on research, his team believes that post-mortem levels of a drug in the body represent the levels at death. His team analyzed 49 death row inmates, and concluded that over half of them had levels that were consistent with being fully conscious, and that the majority had levels that weren’t even enough to produce anesthesia for a surgical process.

The science behind it all presents solid evidence to incite further questioning into the ethics of Midazolam use in lethal injections. The way Midazolam works in the human body challenges whether this method does, in fact, adhere to the Eighth Amendment which prohibits, “cruel and unusual punishment.” While capital punishment stirs a lot of controversy, its primary goal is to implement justice for the victims of heinous crimes, not to seek revenge or retribution by putting an inmate through torture.

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