States Study Use of Fentanyl as Execution Drug

By Christopher Zoukis

Faced with pharmaceutical supplier refusals, states are having serious difficulty obtaining the lethal drugs used for current execution protocols, so they are increasingly examining alternatives — including fentanyl, the synthetic drug that is in large part responsible for the nation’s deadly opioid epidemic.

Nevada and Nebraska have developed execution protocols including fentanyl, and plan to employ them early in 2018. But those plans are drawing strong opposition from death penalty opponents and some physicians, who caution the powerful painkiller — whose overdoses kill many thousands in this country every year — might cause excruciating or prolonged deaths. They also call attempts to use a drug untested for executions as akin to conducting experiments on humans.

But proponents argue fentanyl is a widely available surgical anesthetic and anti-pain treatment for advanced cancer patients, and states have thus far had no problems obtaining ample supplies of the drug. It’s also extremely potent — in fact, 50 times stronger than heroin.

Nevada had planned to carry out its first execution making use of a three-drug protocol using fentanyl in November. Developed by a team that included the state’s former chief medical officer, the protocol starts with injecting the sedative diazepam, better known by the trade name Valium, followed by fentanyl, to bring on unconsciousness.

If the first two drugs work as planned and are administered properly and in large enough doses, they ought to be sufficient to stop the condemned inmate’s breathing. But the state plans to add a third drug, cisatracurium, a paralyzing drug discovered in South America, to hasten death in case the first two drugs work too slowly. Concerns about the third, paralyzing drug caused a state judge to postpone the execution last month, and the Nevada Supreme Court is currently considering the case.

Nebraska plans to roll out its new fentanyl-aided execution method as early as January 2018. It would use the same three drugs as in Nevada’s protocol, followed by an injection of potassium chloride, designed to stop the heart. That has also raised concerns, since even in smaller doses, potassium chloride causes a burning sensation; opponents argue the procedure might leave the injected person conscious of feelings of torture-like burning but too sedated and semi-paralyzed to be able to alert to their ordeal.

The difficulty obtaining chemicals needed for current execution protocols has also led some of the 31 states still authorizing capital punishment not only to search for new options, but also to consider reviving older ones. For example, Mississippi and Oklahoma have authorized use of nitrogen gas as an alternative execution method.

While lethal injection is the primary method of execution in every state authorizing the death penalty, some states may look to earlier alternatives. Nine states continue to permit electrocution as an alternative method to lethal injection, six allow use of gas chambers, three permit firing squads, and two allow hanging. Some Death Row inmates, including the one awaiting fentanyl-aided execution in Nevada, have indicated they would prefer to face a firing squad, and some state legislatures have been considering proposals to add such mostly abandoned alternatives as fallbacks if lethal injection becomes impossible due to court rulings or the inability to obtain the necessary chemicals.

Christopher Zoukis is the author of Federal Prison Handbook: The Definitive Guide to Surviving the Federal Bureau of Prisons, College for Convicts: The Case for Higher Education in American Prisons (McFarland & Co., 2014) and Prison Education Guide (Prison Legal News Publishing, 2016). He can be found online at ChristopherZoukis.com and PrisonerResource.com.