There are a great many myths surrounding the death penalty, and some of the most pervasive and powerful relate to the use of the lethal injection as a method of execution. It is regarded by many as the safest and most humane method of killing a person. It is neither safe nor humane – quite the reverse.
Even the Supreme Court of the Unites States of America has acknowledged that the potential for torture – should the first stage in the lethal injection process fail – is unacceptably high:
“It is uncontested that, failing a proper dose of sodium thiopental that would render the prisoner unconscious, there is a substantial, constitutionally unacceptable risk of suffocation from the administration of pancuronium bromide and pain from the injection of potassium chloride.”
Baze v. Rees, 553 U.S. 35, 53 (2008).
Because the drugs used in these executions were never designed to cause deadly harm and are administered in experimental dosages they are frequently botched, with examples including the disastrous executions of Brandon Rhode in Georgia, Dennis McGuire in Ohio, Clayton Lockett in Oklahoma, and Joseph Wood in Arizona.
Pharmaceutical manufacturers have always objected to the use of their medicines – which they have spent time and money developing to improve and save the lives of patients – in executions designed to end the lives of prisoners. Since 2010, over a dozen pharmaceutical manufacturers have chosen to put distribution controls in place on their medicines to prevent misuse in executions. These controls have been so effective that states are no longer able to purchase ‘traditional’ execution drugs. This has led a number to stop executing prisoners.
Other states, however, are turning to experimental new execution drug “cocktails”, which rely on medicines produced by a handful of manufacturers which do not yet restrict sales of drugs to prisons for use in executions. As the only manufacturers without distribution controls in place, these companies risk becoming US states’ “go-to” suppliers of execution drugs.
No pharmaceutical manufacturer would wish to be associated with lethal injections, particularly when the results are often so visibly barbaric. And beyond the ethical concerns associated with complicity in medical executions, there are also serious corporate commercial concerns to consider.
The US is a litigious society, and lethal injection court challenges cost pharmaceutical manufacturers a huge amount of time and money. The cost to a manufacturer’s reputation is even higher.
Reprieve works to empower the pharmaceutical industry and provide strategies that will allow medicines to be used for the purposes for which they were designed – to improve and save lives – not in order to facilitate cruel and unusual capital punishment.
Over a dozen manufacturers have now taken steps to prevent their medicines from being used in executions in the USA. At the same time, a number of bodies representing the pharmaceutical and pharmacy sectors have spoken out against involvement and executions.
Below is a selection of public statements made on this subject by manufacturers, distributors, industry associations, and professional representative bodies.
October 2016: “McKesson has entered into contractual arrangements with some manufacturers and suppliers that restrict the sale of medicines to prison systems and others for lethal injections. McKesson continually monitors developments regarding the use of medicines for lethal injections, and is committed to helping manufacturers and suppliers implement policies in this area”.
October 2016: “Hikma aims to improve lives by providing patients with access to high quality, affordable medicines. Our medicines are used thousands of times a day around the world to treat illness and save lives. We strongly object to the use of any of our products in capital punishment as it is inconsistent with our values and mission of improving lives and contrary to the intended label use for the products.
In order to safeguard Phenobarbital Sodium, Midazolam Hydrochloride and Hydromorphone Hydrochloride injection products from being used in lethal injection protocols, we have instituted several controls, including specific provisions in our template agreements and additional written assurances from certain purchasers that products will be used for medicinal, patient care not penal purposes.
We vigorously monitor the distribution of these products and support industry serialization efforts that will help enhance these controls while continuing to promote our values and mission.”
May 2016: “Pfizer makes its products to enhance and save the lives of the patients we serve. Consistent with these values, Pfizer strongly objects to the use of its products as lethal injections for capital punishment.
“Pfizer’s obligation is to ensure the availability of our products to patients who rely on them for medically necessary purposes. At the same time, we are enforcing a distribution restriction for specific products that have been part of, or considered by some states for their lethal injection protocols. These products include pancuronium bromide, potassium chloride, propofol, midazolam, hydromorphone, rocuronium bromide and vecuronium bromide.
“Pfizer’s distribution restriction limits the sale of these seven products to a select group of wholesalers, distributors, and direct purchasers under the condition that they will not resell these products to correctional institutions for use in lethal injections. Government purchasing entities must certify that products they purchase or otherwise acquire are used only for medically prescribed patient care and not for any penal purposes. Pfizer further requires that these Government purchasers certify that the product is for “own use” and will not resell or otherwise provide the restricted products to any other party.”
October 2015: “It is important to note that rocuronium bromide is not approved for, labeled for, or marketed for use in lethal injections. Mylan does not distribute this product to prisons, nor does the company condone its product being distributed by any third party for use outside of the approved labeling or applicable standards of care.
“Recently Mylan received information indicating that a department of corrections in the U.S. purchased Mylan’s rocuronium bromide product from a wholesaler for possible use outside of the labeling or applicable standard of care. Mylan takes very seriously the possibility its product may have been diverted for a use that is inconsistent with its approved labeling or applicable standards of care. As such, Mylan conducted its own investigation into the matter and took direct action by sending several letters to the department of corrections seeking prompt assurances that it has not purchased any Mylan product for use outside the bounds of its approved therapeutic purpose, approved labeling and applicable standards of care. When Mylan received no response to its inquiries and therefore was unable to ensure appropriate use of its product, Mylan took further action by demanding the return of the Mylan product.
“Mylan is taking steps to prevent similar future issues. Specifically, Mylan is contractually restricting its distributors from distributing Mylan products, including rocuronium bromide, for use in lethal injection or for any other use outside of the approved labeling or applicable standards of care”.
October 2015: “Gland makes its products to enhance and save the lives of patients worldwide. Drugs such as Rocuronium bromide are relied upon by doctors and patients as a muscle relaxant during surgery. Gland does not support the use of any of its products for the purpose of capital punishment”
Becton, Dickinson and Company
September 2015: “BD Rx has specifically elected to focus on acute care settings for the use of our products. All of our distributor partners had previously received formal notification on behalf of BD Rx that our products are not intended for use in US prisons including state and federal penitentiaries. BD Rx is committed to ensuring the proper use of our products, to improving injectable drug delivery and helping to manage medication error risk for patients, hospitals, nurses and pharmacists”.
American Pharmacists Association (APhA)
March 2015: “The American Pharmacists Association discourages pharmacist participation in executions on the basis that such activities are fundamentally contrary to the role of pharmacists as providers of healthcare.”
“Pharmacists are health care providers and pharmacist participation in executions conflicts with the profession’s role on the patient health care team. This new policy aligns APhA with the execution policies of other major health care associations including the American Medical Association, the American Nurses Association and the American Board of Anesthesiology.
International Academy of Compounding Pharmacists (IACP)
March 2015: “IACP discourages its members from participating in the preparation, dispensing, or distribution of compounded medications for use in legally authorized executions.
“The issue of compounded preparations being used in the execution of prisoners sentenced to capital punishment continues to be a topic of significant interest. It is important to first understand the origin of this issue: states are turning to compounded preparations for this purpose because the companies that manufacture the products traditionally used have unilaterally decided to stop selling them for use in executions…
“Pharmacy, and compounding in particular, is a profession of healing and care that is focused on individual patients and providing the best and most appropriate medications at all times”.
March 2015: “The use of midazolam and/or hydromorphone for lethal injection is clearly contradictory to the FDA approved indications for both products and – as controlled substances – the procurement or use ofthese products for executions may be in violation of the Controlled Substances Act. Additionally, such use is contrary to Akorn’s commitment to promote the health and wellness of human patients.
“Akorn strongly objects to the use of its products in capital punishment. To align with industry standards and to prevent midazolam and hydromorphone from being used for purposes outside FDA approved indications, Akom will not accept direct orders from departments of correction for any product and we plan to implement additional distribution controls on midazolam and hydromorphone products in the near future. To reduce the possibility that Akorn midazolam and hydromorphone vials reach correctional facilities for use outside their labeled indications, these distributors will not sell these products directly to departments of correction or secondary distributors and distributors will use their best efforts in other distribution channels to keep the products out of prison systems”.
Roche Pharma (Switzerland)
January, 2015: Roche is aware of the use of the benzodiazepine midazolam as part of a drug combination for executions under the death penalty in the U.S. Roche did not supply midazolam for death penalty use and would not knowingly provide any of our medicines for this purpose. We support a worldwide ban on the death penalty.
May 2014: “Brevital is a medically important anesthetic that physicians and hospital pharmacies have relied upon for more than 50 years. The state of Indiana’s proposed use of Brevital is inconsistent with its medical indications as outlined in its U.S. Food and Drug Administration reviewed and approved product labelling. Brevital® is intended to be used as an anesthetic in life-sustaining procedures. As a pharmaceutical company, Par’s mission is to help improve the quality of life. The state of Indiana’s proposed use is contrary to our mission. Par is working with its distribution partners to establish distribution controls on Brevital® to preclude wholesalers from accepting orders from departments of correction”.
May 2014: Tamarang publically opposes any medication supplied for use in capital punishment. […] Despite the complexities of the supply chain and the USA market Tamarang will take additional measures to ensure that the supply chain is transparent so that it is known with certainty where the product and been delivered, with the prohibition to supply to penitentiary hospitals in the USA.
– Extract from letter held on file at Reprieve
May 2013: “Hikma strongly objects to the use of any of its products in capital punishment. The Company is putting in place concrete steps to restrict the supply of its products for unintended uses. It has ceased the direct sale of injectable phenobarbital to US departments of corrections and will work directly with its distribution partners to add restrictions for unintended use to its distribution contracts.”
March 2014:“[…]In order to help ensure that patients have access to our products for use in accordance with the products’ labels but to ensure our products are not used in capital punishment, Sagent is implementing appropriate
distribution controls and other measures. In particular, Sagent will not accept orders from correctional facilities and prison systems for products believed to be part of certain states’ lethal injection protocols. Also, each of Sagent’s distributors and wholesalers will be asked to make commitments not to sell or distribute any such products to these facilities.”
March 2013: “Hospira makes its products to enhance and save the lives of the patients we serve, and, therefore, we have always publicly objected to the use of any of our products in capital punishment. […] Hospira has implemented a restricted distribution system under which Hospira and its distributors have ceased the direct sale to U.S. prison hospitals of products, specifically pancuronium bromide, potassium chloride and propofol, that we believe are part of some states’ lethal injection protocols.”
March 2010: “Hospira provides these products because they improve or save lives and markets them solely for use as indicated on the product labelling. As such, we do not support the use of any of our products in capital punishment procedures.”
March 2013: “[Teva is] limiting the sale and distribution of [propofol] to customers who agree to use best efforts not to sell or distribute to correctional facilities”
August 2012: “Fresenius Kabi (APP) objects to the use of its products in any manner that is not in full accordance with the approved indications. […] To prevent Propofol from being used for purposes other than its approved indications, Fresenius Kabi (APP) does not accept orders for Propofol from any departments of correction in the U.S., nor will we do so, and we have voluntarily instituted tighter distribution controls on all forms of our [Propofol].”
Ganpati Exim (India)
2012: “We at Ganpati Exim are committed to providing access to medicines for the purposes of improving the lives of patients around the world. We are deeply opposed to the use of medicines in killing prisoners and wish to have no part in facilitating capital punishment in the USA or elsewhere. We never indulge in this type of medicines which takes HUMAN LIFE and will never in Future also.”
Shrenik Pharma (India)
2012: “We are aware of the use of Thiopental Sodium in killing of prisoners in USA and have often wondered why the US-Govt. does not simply out-law the practice altogether.
November 2011: [Letter from Naari CEO to Chief Justice Heavican of the Nebraska Supreme Court]: “I am shocked and appalled by this news. Naari did not supply these medicines directly to the Nebraska Department of Correctional Services and is deeply opposed to the use of the medicines in executions.”
August 2011 “[Lundbeck] is opposed to the use of its products for the purpose of capital punishment. Use of our products to end lives contradicts everything we’re in business to do – provide therapies that help improve people’s lives. Lundbeck adamantly opposes the distressing misuse of our product in capital punishment. Since learning about the misuse we have vetted a broad range of remedies – many suggested during ongoing dialogue with external experts, government officials, and human rights advocates. After much consideration, we have determined that a restricted distribution system is the most meaningful means through which we can restrict the misuse of Nembutal.”
April 2011: “In view of the sensitivity involved with sale of our Thiopental Sodium to various Jails/Prisons in the USA and as alleged to be used for the purpose of Lethal Injection, we voluntarily declare that we as Indian Pharma Dealer who cherish the Ethos of Hinduism (A believer even in non-livings as the creation of God) refrain ourselves in selling this drug where the purpose is purely for Lethal Injection and its misuse.”
Abbott Laboratories (USA)
December 2001: “Abbott does not support the use of Pentothal in capital punishment. In fact, [we] communicated with departments of corrections in the United States to request that this product not be used in capital punishment procedures.”