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.”


Charles Davis, Doctors are ask­ing states to use their lethal-injec­tion drugs to treat patients with COVID-19, instead, Business Insider, April 10, 2020; Vanessa Taylor, Doctors ask state pris­ons to donate lethal injec­tion drugs to help treat coro­n­avirus, Mic, April 10, 2020; Linh Nguyen, Healthcare Workers and Experts Ask for Lethal Injection Drugs to Care for COVID-19 Patients, The Davis Vanguard, April 13, 2020; Ed Pilkington, Death penal­ty states urged to release stock­piled drugs for Covid-19 patients, The Guardian, April 13, 2020; Asher Stockler, HEALTH CARE WORKERS ASK STATES TO HAND OVER DEATH PENALTY DRUGS NEEDED TO FIGHT COVID-19 PANDEMIC, Newsweek, April 10, 2020; Keri Blakinger, Twitter, The Marshall Project, April 92020

Read the let­ter from med­ical pro­fes­sion­als to state prison direc­tors. See Death Penalty Information Center, Behind the Curtain: Secrecy and the Death Penalty in the United States, at 26 – 27 (Nov. 2018).