Overview of Lethal Injection Protocols

Until 2009, most states used a three-drug com­bi­na­tion for lethal injec­tions: an anes­thet­ic (usu­al­ly sodi­um thiopen­tal, until pen­to­bar­bi­tal was intro­duced at the end of 2010), pan­curo­ni­um bro­mide (a par­a­lyt­ic agent, also called Pavulon), and potas­si­um chlo­ride (stops the heart and caus­es death). Due to drug short­ages, states have adopt­ed new lethal-injec­tion meth­ods, including:

ONE DRUG: Eight states have used a sin­gle-drug method for exe­cu­tions – a lethal dose of an anes­thet­ic (Arizona, Georgia, Idaho, Missouri, Ohio, South Dakota, Texas, and Washington). Six oth­er states have at one point or anoth­er announced plans to use a one-drug pro­to­col, but have not car­ried out such an exe­cu­tion (Arkansas, California, Kentucky, Louisiana, North Carolina, and Tennessee).

PENTOBARBITAL: Fourteen states have used pen­to­bar­bi­tal in exe­cu­tions: Alabama, Arizona, Delaware, Florida, Georgia, Idaho, Mississippi, Missouri, Ohio, Oklahoma, South Carolina, South Dakota, Texas, and Virginia. Five addi­tion­al states plan to use pen­to­bar­bi­tal: Kentucky, Louisiana, Montana, North Carolina, and Tennessee. Colorado includes pen­to­bar­bi­tal as a back­up drug in its lethal-injection procedure.

MIDAZOLAM: Seven states have used mida­zo­lam as the first drug in the three-drug pro­to­col: Florida, Ohio, Oklahoma, Alabama, Virginia, Arkansas, and Tennessee. Oklahoma used mida­zo­lam in the botched exe­cu­tion of Clayton Lockett in April 2014, and Lockett died after the pro­ce­dure was halt­ed. Alabama’s use of mida­zo­lam in the exe­cu­tion of Ronald Smith in December 2016, result­ed in near­ly fif­teen min­utes of Smith heav­ing and gasp­ing for breath. Arkansas’s use of use mida­zo­lam in four exe­cu­tions in April 2017 raised con­cerns and in the exe­cu­tion of Kenneth Williams, wit­ness­es report­ed cough­ing, con­vuls­ing, lurch­ing and jerk­ing. In January 2017, Florida aban­doned its use of mida­zo­lam as the first drug in its three-drug pro­to­col and replaced it with eto­mi­date. Two states have used mida­zo­lam in a two-drug pro­to­col con­sist­ing of mida­zo­lam and hydro­mor­phone: Ohio (Dennis McGuire) and Arizona (Joseph Wood). Both of those exe­cu­tions, which were car­ried out in 2014, were pro­longed and accom­pa­nied by the pris­on­ers’ gasp­ing for breath. After its botched exe­cu­tion of McGuire, Ohio aban­doned its use of mida­zo­lam in a two-drug pro­to­col, but then in October 2016 decid­ed to keep mida­zo­lam in a three-drug pro­to­col. In December 2016, Arizona aban­doned its use of mida­zo­lam in either a two-drug or a three-drug pro­to­col. Three states have, at some point, pro­posed using mida­zo­lam in a two-drug pro­to­col (Louisiana, Kentucky, and Oklahoma) but none of those states has fol­lowed through with that for­mu­la. Some states have pro­posed mul­ti­ple pro­to­cols. Missouri admin­is­tered mida­zo­lam to inmates as a seda­tive before the offi­cial exe­cu­tion protocol began.

FENTANYL: Nebraska first used fen­tanyl in the August 14, 2018 exe­cu­tion of Carey Dean Moore. Nevada has also announced that it will use fen­tanyl in com­bi­na­tion with oth­er drugs to car­ry out executions. 

COMPOUNDING PHARMACIES: At least ten states have either used or intend to use com­pound­ing phar­ma­cies to obtain their drugs for lethal injec­tion. South Dakota car­ried out 2 exe­cu­tions in October 2012, obtain­ing drugs from com­pounders. Missouri first used pen­to­bar­bi­tal from a com­pound­ing phar­ma­cy in the November 20, 2013 exe­cu­tion of Joseph Franklin. Texas first used pen­to­bar­bi­tal from a com­pound­ing phar­ma­cy in the exe­cu­tion of Michael Yowell on October 9, 2013. Georgia used drugs from an unnamed com­pound­ing phar­ma­cy for an exe­cu­tion on June 17, 2014. Oklahoma has used drugs from com­pound­ing phar­ma­cies in exe­cu­tions, includ­ing in the botched exe­cu­tion of Lockett. Virginia first used com­pound­ed pen­to­bar­bi­tal obtained through the Texas Department of Criminal Justice in the exe­cu­tion of Alfredo Prieto on October 1, 2015. Ohio announced plans to obtain drugs from com­pound­ing phar­ma­cies in October, 2013. In March 2014, Mississippi announced plans to use pen­to­bar­bi­tal from a com­pound­ing phar­ma­cy. Documents released in January 2014, show that Louisiana had con­tact­ed a com­pound­ing phar­ma­cy regard­ing exe­cu­tion drugs, but it is unclear whether the drugs were obtained there. Pennsylvania may have obtained drugs from a com­pounder, but has not used them. Colorado sent out inquiries to com­pound­ing phar­ma­cies for lethal injec­tion drugs, but all exe­cu­tions are on hold.

ALTERNATE METHODS: Several states have laws allow­ing for alter­na­tive exe­cu­tion meth­ods if lethal-injec­tion drugs are unavail­able. Alabama (effec­tive July 2018), Mississippi (effec­tive April 2017), and Oklahoma (effec­tive November 2015) all have laws that allow for use of nitro­gen hypox­ia. Tennessee​’s law allows for the use of the elec­tric chair. Utah​’s law allows the fir­ing squad to be used if the state can­not obtain lethal-injec­tion drugs 30 days before an exe­cu­tion. New Hampshire allows for hang­ing ​“if for any rea­son the com­mis­sion­er [of cor­rec­tions] finds it to be imprac­ti­cal to car­ry out the pun­ish­ment of death by admin­is­tra­tion of the required lethal sub­stance or sub­stances.” For detailed infor­ma­tion about states’ meth­ods of exe­cu­tions, see Methods of Execution.

In fed­er­al exe­cu­tions, the method is lethal injec­tion, which was the method used in all three of the fed­er­al exe­cu­tions in the mod­ern era have been by lethal injec­tion car­ried out in a fed­er­al facil­i­ty in Indiana. The fed­er­al gov­ern­ment used pen­to­bar­bi­tal. The U.S. Military has not car­ried out any exe­cu­tions since rein­state­ment. It plans to use lethal injection.

For the spe­cif­ic drug for­mu­las used in indi­vid­ual exe­cu­tions, see: Executions Overview