Lethal Injection Drug Shortages: Another Hurdle for Pharmacists

Lethal injection has been a means of execution for many decades within our judicial system. As pharmacists, we may have personal, religious or ethical reasons to either advocate or oppose lethal injection. However, no matter our position we are the primary health care provider responsible for procuring or compounding agents used for this purpose. The traditional drug cocktail for lethal injection included a neuromuscular blocking agent (pancuronium bromide), potassium salt (potassium chloride), and barbiturate or anesthetic (sodium thiopental). Pentobarbital has substituted for thiopental since the European Union barred German and Danish drug makers from selling sodium thiopental. In June 2013, the lone US supplier, Hospira, announced it will no longer produce the drug.¹
States have used compounding pharmacies in the past for drugs used for lethal injection, however the recent meningitis outbreak in Massachusetts that killed 64 people and sickened over 750 linked to the New England Compounding Center has driven some states to modify how these drugs are supplied and used. Some states are tinkering with lethal-injection methods, including using only one drug (pentobarbital) and some are using two drugs (midazolam and hydromorphone).² States are inconsistent in which drug or drug combinations should be used for lethal injection. Recently, another case has fueled the controversy.
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