Category Archives: Pharmacology

Executions and Midazolam

It appears that the State of Arkansas plans to perpetuate its inhumane misunderstanding of pharmacology – again. It has secured a supply of Midazolam for use in executing those convicted of capital crimes.

Over the years Arkansas has shot, hanged,electrocuted, and now poisoned convicts. The last hanging was in 1914 – John Tillman was executed for killing his girlfriend and throwing her body down a well. John Swindler became the last to be electrocuted in 1990. Charles Singleton, whose appeal took 24 years due to schizophrenia, was the first to be executed by lethal injection in 2004.

The standard protocol is to use a three drug cocktail. First, Sodium Thiopental (a rapid acting barbiturate) is given to induce deep anesthesia. Second, Pancuronium Bromide is used to cause paralysis of skeletal muscles which stops breathing. This drug is similar in chemical structure and mode of action to Curare, the famous dart frog poison of the Amazon. Lastly a massive dose of Potassium Chloride stops the heart.

If one can describe any execution as humane, this is supposed to be. First you’re made completely insensate (comatose) then and only then your breathing and heart are stopped. You’re dead and it’s over. A problem in the protocol arose when drug companies decided they didn’t want to be associated with (or there was insufficient profit connected to) providing drugs for the executioner. First the European Union banned the export of Sodium Thiopental to the US, and then the only US manufacturer refused to sell it to states for execution.

Enter, arm right, Midazolam. Some states, including Oklahoma and Arkansas were unable to obtain Sodium Thiopental. They decided to stay with the three drug protocol but substitute Midazolam for the anesthetic drug. The problem is that Midazolam is not, nor was it ever intended to be an anesthetic. Midazolam is a sedative, and a mild one at that. In surgical procedures, it is use as a per-anesthetic. It can make you drowsy but not insensate. If a person is not insensate when injected with the muscle blocker trouble ensues.

There have been errors during surgeries where patients were given insufficient amounts of anesthetics, then administered Pancuronium Bromide. They report extreme pain and even terror during surgery because this drug has no effect on the central nervous system. They were awake but completely incapable of reacting physically.

In Oklahoma in 2014, an execution begun with Midazolam never finished the complete protocol. Clayton Lockett struggled, convulsed, and 14 minutes into the procedure spoke and tried to get off the executioner’s table. 43 minutes later he died of a heart attack, without ever receiving the heart stopping drug.

In April 2017 Kenneth Williams was executed with Midazolam as the initial sedative. He convulsed violently even before the administration of the muscle blocker. It is quite conceivable that he was fully aware of his circumstances but unable to react after the administration of the second drug. There are sufficient questions about the efficacy of Midazolam to induce a coma and therefore reason to question the humanity of this method of execution.