Medical Professionals Ask Death-Penalty States to Turn Over Execution Drugs Needed for Coronavirus Treatment

As hos­pi­tals through­out the coun­try face short­ages of cru­cial med­ica­tions need­ed to treat patients with COVID-19, a group of lead­ing anes­the­si­ol­o­gists, phar­ma­cists and med­ical aca­d­e­mics is ask­ing cor­rec­tions offi­cials in death-penal­ty states to turn over stock­piles of their exe­cu­tion drugs to hos­pi­tals so they can be used for therapeutic purposes. 

In an open let­ter from nine promi­nent pub­lic health experts released April 10, 2020, the med­ical experts explain that the seda­tives and par­a­lyt­ics states use in exe­cu­tions are in short sup­ply and are nec­es­sary to ​“con­nect patients to life‐​saving ven­ti­la­tors and lessen the dis­com­fort of intu­ba­tion” for the most severe­ly ill coro­n­avirus patients. ​“Our research,” the care providers say, ​“sug­gests that the drugs cur­rent­ly stock­piled by your states could be used to treat hun­dreds of COVID-19 patients.” They write, ​“In this time of cri­sis, these risks have nev­er been more acute, and our health sys­tem has nev­er more des­per­ate­ly need­ed the med­i­cines you cur­rent­ly hold for use in exe­cu­tions. Every last vial of med­i­cine could mean the dif­fer­ence between life and death.” 

To empha­size the imme­di­a­cy of the sit­u­a­tion, the sig­na­to­ries write, ​“Those who might be saved could include a col­league, a loved one, or even you.” 

The let­ter item­izes four spe­cif­ic drugs that many states use in exe­cu­tions that are ​“cur­rent­ly list­ed on short­age by the American Society of Health-System Pharmacists.” Those drugs – mida­zo­lam (a seda­tive), vecuro­ni­um bro­mide (a par­a­lyt­ic), rocuro­ni­um bro­mide (a par­a­lyt­ic), and fen­tanyl (an opi­oid pain reliev­er) – can be used to facil­i­tate intu­ba­tion and ven­ti­la­tion. The let­ter explains, ​“the med­i­cines your states are cur­rent­ly hold­ing for use in lethal injec­tion exe­cu­tions are in short sup­ply and des­per­ate­ly need­ed to treat patients suf­fer­ing from COVID-19.” 

While exe­cu­tion pro­to­cols vary from state to state, most states use either a one-drug pro­to­col involv­ing a lethal dose of an anes­thet­ic, or a three-drug pro­to­col involv­ing an anes­thet­ic or seda­tive, a par­a­lyt­ic, and potas­si­um chlo­ride, which stops the prisoner’s heart. Midazolam has been wide­ly used, though con­tro­ver­sial, as the first drug in three-drug exe­cu­tion pro­to­cols. Nebraska used a four-drug pro­to­col that includ­ed fen­tanyl in its most recent exe­cu­tion in 2018, but no oth­er state has used fen­tanyl in an execution. 

State secre­cy prac­tices pre­vent­ed the health providers from deter­min­ing the full extent to which hoard­ing of exe­cu­tion drugs is imped­ing the med­ical response to the coro­n­avirus. ​“Many states have refused to dis­close the num­ber of vials of poten­tial­ly life‐​saving med­i­cines that they are stock­pil­ing in their exe­cu­tion cham­bers,” the let­ter said. ​“Based on pub­licly avail­able infor­ma­tion from a hand­ful of states, stock­piled exe­cu­tion drug sup­plies could be used to treat over a hun­dred COVID-19 patients.” 

Florida’s sup­ply of rocuro­ni­um bro­mide, they esti­mate, could intu­bate approx­i­mate­ly 100 patients; Tennessee’s vecuro­ni­um bro­mide could help 27 COVID‐​19 patients, and Nevada’s fen­tanyl could help treat approx­i­mate­ly 10 COVID‐​19 patients over four days. ​“When one fac­tors in the drugs held by states that refuse to release details of their sup­plies, it is like­ly many times that num­ber of patients could ben­e­fit from their release.” 

Doctors and phar­ma­ceu­ti­cal com­pa­nies have been warn­ing states for years about the pub­lic health risks of stock­pil­ing execution drugs. 

In an April 2017 brief filed in the Arkansas Supreme Court in sup­port of a law­suit filed by drug sup­pli­er McKesson Medical-Surgical, Inc. against the State of Arkansas for obtain­ing exe­cu­tion drugs under false pre­tens­es, phar­ma­ceu­ti­cal man­u­fac­tur­ers Fresenius Kabi USA, LLC, and West-Ward Pharmaceuticals Corp. wrote: ​“Diverting the med­i­cines to exe­cu­tions and away from health­care cre­ates unnec­es­sary short­ages for patients who need them most. Medicines that could be used to pro­tect life are instead being used to end it. The unin­tend­ed con­se­quence could be to under­mine the sup­ply and to place patients in Arkansas and across the coun­try at risk.” In short, the com­pa­nies said, state exe­cu­tion poli­cies ​“cre­ate[ ] a pub­lic-health risk because [they] could result in the denial of med­i­cines from patients who need them most.” 

In July 2018, the Association for Accessible Medicines (AAM) — a pro­fes­sion­al asso­ci­a­tion rep­re­sent­ing gener­ic and biosim­i­lar drug man­u­fac­tur­ers and dis­trib­u­tors — and eigh­teen phar­ma­cy, med­i­cine, and health pol­i­cy experts filed briefs in the U.S. Supreme Court warn­ing state hoard­ing of drugs for use in exe­cu­tions jeop­ar­dizes the avail­abil­i­ty of some med­i­cines for their intend­ed therapeutic use. 

The AAM wrote that ​“despite many man­u­fac­tur­ers’ best efforts, drugs that are essen­tial to the health­care sys­tem — includ­ing some that are in short sup­ply — have been divert­ed to state prison sys­tems for use in cap­i­tal pun­ish­ment.” Some of these drugs, the AAM said, ​“are con­sid­ered ​‘essen­tial med­i­cines’ by the World Health Organization” but have been divert­ed from med­ical use by death-penalty states. 

The health pol­i­cy experts warned that ​“States have cre­at­ed seri­ous pub­lic health risks in their efforts to con­duct lethal injec­tions” and that con­tin­ued improp­er prac­tices ​“could lead to a pub­lic health crisis.” 

Dr. Joel Zivot, an Emory University anes­the­si­ol­o­gist and one of the sig­na­to­ries of the COVID-19 let­ter, said, ​“None of these med­i­cines were designed for exe­cu­tions. Stockpiling drugs intend­ed to save lives in order to kill peo­ple was nev­er accept­able, but that is espe­cial­ly the case now when it is actu­al­ly harm­ing the pub­lic in the face of the coronavirus crisis.” 

“At this cru­cial moment in our coun­try,” the let­ter con­cludes, ​“we must pri­or­i­tize the needs and lives of patients above end­ing the lives of prisoners.”