Cecil missed a couple of points in his somewhat recent article Why isn’t heroin used for lethal injections? regarding why opiates in general and heroin in specific aren’t used in lethal injection, chief among which is that high potency opiates actually are currently being used for executions in some states.
Heroin is a schedule one drug with no legitimate legal use in the U.S., and states having trouble importing legal anesthetics like propofol will find it next to impossible to import pharmaceutical grade heroin. There’s absoulutely no avenue to import it or syntesize it legally, and the feds don’t necessarily look the other way when exectuion drugs are imported by shady methods. In 2011 the DEA seized the State of Georgia’s supply of sodium thiopental after defense attorneys claimed it was both imported illegally and sold illegally to Kentucky: Georgia May Have Broken Law By Importing Drug. If you think the DEA takes illegal importation of a legally prescribable schedule II drug like sodium thiopental seriously, imagine the shit to hit the fan when they start trying to illegally import schedule I heroin. No state official, compounding pharmacy or pharmaceutical company wants or needs that kind of heat.
State’s aren’t likely to make a workaround of using seized street heroin left over from evidence lockers, either - even if that were possible the public and defense attorney outcry about using legal drugs imported or made by compounding pharmacies for executions would be nothing compared to the breaking news that that they’re going to use some smack cut with God-knows-what they got when they busted some guy named “Skinny Johnny.” Even if it were possible to make, import or use pharmaceutical grade heroin, doing so would be a PR nightmare as soon as “STATE OFFICIALS PLAN TO USE HEROIN” hit the headines in all caps. “Heroin” is one of those buzzwords that always generates negative publicity. There are a lot of reasons for states not to use heroin, not all of which have to do with effectiveness.
So heroin has certain legal problems and distasteful connotations that make it less than ideal for use in executions, but there are other equally powerful and legally prescribable opiods that don’t have the same high profile and name recognition as heroin. Hydromorphone, trade name Dilaudid, is one of these, a high potency derivitave of morphine but much more powerful - if you remember the movie Drugstore Cowboy, Dilaudid is the drug the addicted main characters spent much of the movie trying to steal. Due to difficulites in obtaining other drugs traditionally used in lethal injections, some states plan to use or have been using a two drug protocol with midazolam and hydromorphone, either using the hydromorphone IV as one of the main agents or IM as a backup drug if the primary drug fails.
The first of these was in Ohio in January 2014 in the execution of Dennis McGuire. It didn’t go smoothly; news reports say thaappeared to “gasp and convulse for roughly 10 minutes before he died.” Arizona was next to use midazolam and hydromorphone in July of 2014 in the execution of Joseph Wood, which didn’t go well either; observers say Wood “gasped and snorted” for the two hours it took him to die. That notwithstanding, Arizona, Kentucky, Ohio, and Oklahoma currently have hydromorphone as a primary or alternate drug protocol in lethal injections. More may consider it as an option if other drugs continue to become scarce.
That’s fascinating, pravnik. Do you know why they use hydromorphone specifically instead of just morphine or, heck, something like etorphine? I would have thought etorphine would be more readily available since it is sometimes used to tranquilize large animals, but maybe it’s not very available in the United States.
As Cecil notes, opioids are, IMHO, a shitty drug for causing abrupt cessation of life. Give enough and they’ll surely cause a respiratory arrest, but the heart keeps chugging away for a while, and in a certain percentage of the individuals semi-effective gasping respiratory efforts will still occur sporadically for a time. This will also tend to contribute to spontaneous reflex regurgitation as the body struggles to live. Seizures often occur too. Far too prolonged and messy a demise.
Does it that kind of opioid-induced prolonged asphyxiation cause any suffering (pain / fear / dyspnea / whatever) for the person it’s happening to? Do we have any data on that? I suppose the only way to find out that kind of thing would be to ask people who have overdosed, gone far enough to start reflexive gasping and vomiting, and then been revived before their brain has been damaged too much to allow them to relay the experience. And that’s assuming they can remember the experience at all…
Hydromorphone is probably chosen over morphine because of potency. Hydromorphone is about 7 or 8 times the potency of morphine, so officials wanting to make sure they’re getting the job done are likely to gravitate to the more potent drug. Potency is also likely a concern for maintaining an adequate supply of the drug; if they only have to use a fraction of it compared to morphine, an equal amount will last them longer. Solubility may also be a concern - hydromorphone is more soluble in water, meaning they can inject a smaller liquid volume to get the desired amount into the bloodstream. An easily soluble powder form might allow them to use their supply more efficiently as well.
As to etorphine, it’s probably not used due to availability, federal concerns, safety in handling, media backlash, etc. Some hydromorphone is manufactured in the U.S. but no etorphine is, which means officials strying to import it for lethal injection would soon be running into the same problems they’re running into with other drugs imported for lethal injection. Trying to use veterinary etorphine already in this country would cause a shitstorm when news media and the defense bar caught wind that state officials wanted to use veterinary medicine not approved for use on humans. Nobody wants to see their name in the paper under “STATE OFFICIAL SAYS ELEPHANT DOPE TO BE USED IN EXECUTION.” That brings up safety as another possible concern; hydromorphone is about 7-8 times more potent than morphine, but etophine is several thousand times stronger, making it so dangerous to handle it’s packaged with an antidote for humans. It would probably be a hard sell to try to get the execution guy to use a drug that will OD him if he gets a few drops on his finger, and a domestic mom & pop compounding pharmacy that might be inclined to whip up a few grams of hydromorphone for the state might be a little hesitant to try to make an equal amount of etorphine.
Fentanyl, on the other hand, is a mere hundred or so times more potent than morphine and is very fast acting, so it would seem to be an obvious middle gound. I can’t tell you why it’s not being used instead of or in addition to hyrdomorphone. Possibly because it offsets more quickly, possibly because hydromorphone is more readily available, maybe solubility is an issue, etc.
I see your point about the public relations problems with animal tranquilizers. Is it etorphine that’s used to euthanize cats and dogs? Has anyone had a bad experience with their pet? Are there any Vet’s on here that could chime in? The real question here is why can’t the same simple procedure used for pets be used on the human animal?
For years anti-death-penalty worshippers kept finding excuse after excuse to deny justice; the opioid idea wasn’t a bad one, but not perfect enough to satisfy them. While recognizing that the enemy of good is perfect, it looks like we’re finally making progress, complete with a test case arena. Also for years, every1 has been hearing cases of scuba divers needing to be careful to delay a day flying back from vacation; it was even a major plot on an episode of House, MD. So if NO2 can cause so many deaths accidentally, why not intentionally when merited? It’s painless and victims of NDEs with it report feeling sleepy & drifting off to a calm, restful state. Obviously justice demands capital punishment for heinous (or legally, capital) crimes, but if we can do it painlessly for the perp, why not? alabama nitrogen execution
