Tag Archives: execution drugs

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.

Execution, Arkansas Style

The first death sentences in Arkansas occurred during the revolutionary war. Several soldiers were convicted of colluding with the British to kill Americans at Arkansas Post. The convicted were executed by firing squad at New Orleans. Death sentences and executions have come and gone, and methods changed but state sanctioned murder continues to this day.

From territorial times up to 1914 executions were carried out by hanging – hanged by the neck until dead. The intent was for the execution to be rapid. When the prisoner is “dropped” the rope is intended to sever the cervical vertebra which would make death essentially instantaneous. If the spine is not snapped death occurs slowly by strangulation, accompanied by fits and jerks before suffocation is complete.

To ensure more rapid execution, use of the electric chair was instituted in 1914. From this time to 1990 executions were conducted by strapping the convicted into a wooden chair, placing electrically conducting straps on the legs and skull cap over the head. A current of about 1500 volts at 10 amps for 30 seconds is sufficient to kill most but some have survived for as long as 30 minutes, causing smoke to emanate from the mouth and electrical contact points.

Seeking evermore efficient or cost effective or humane methods, the State of Arkansas has turned to lethal injection, using several lethal recipes over the years. Initially executions were conducted with a single drug, Sodium Pentothal. This a so called rapid acting barbiturate. Similar drugs in lower oral doses have been used as sleeping pills since the 1930s. For an execution, a large dose is injected into a vein resulting in its rapid distribution throughout the body. Sedation, and cessation of breathing and heart beat ensues.

Currently the legislature determines the drug cocktail for executions. A three drug mixture is used. The first drug administered is a mild sedative called Midazolam. This is the same drug which failed to do its job in a botched execution in Oklahoma last year. The convicted was apparently not sedated and cried out and writhed in pain for some time before dying.

Next in the cocktail is Vecuronium Bromide. This drug has a similar mechanism of action and in fact is modeled after Curare. This is the stuff of the poison darts used in Central and South America. It works by weakening or paralyzing skeletal muscles without any anesthetic effect. This drug alone is lethal but would take several minutes for death to occur after the breathing stops.

The coup de grace is accomplished with Potassium Chloride. Large intravenous doses of this agent stops the heart by interfering with nerve conduction. Interestingly KCl is used as a salt substitute for those who need to reduce the use of table salt, Sodium Chloride.

None of this addresses the why or more correctly the “should?” Should we execute murderers? Are executions conducted in the spirit of old Testament revenge? Must people die for justice? The innocence Project has exonerated over 300 wrongly convicted, some of those on death row. Considering the fallibility of jury trials, wouldn’t life in prison, with a chance of exoneration if new evidence comes to light be the more humane action?