COLUMBUS, Ohio (AP) — States not only are having an
increasingly difficult time getting the injectable drugs to carry out death
sentences, they’re also paying as much as 10 times more for the chemicals as in
only has 40 grams of pentobarbital, enough for seven executions scheduled
through February, meaning a likely scramble to find enough for the four
scheduled beyond that.
with the country’s busiest death chamber, says it has enough for eight more
executions but won’t comment on supplies past September. It used the drug
Thursday night for the execution of Mexican national Humberto Leal for the 1994
rape-slaying of a 16-year-old girl in San
Antonio, despite White House pleas for a Supreme Court
and several other states switched to pentobarbital from sodium thiopental this
year, after the only U.S.
manufacturer of sodium pentothal said it would discontinue production.
Lake Forest, Ill.-based Hospira, which strongly opposed the
drug’s use in executions, stopped manufacturing it altogether. Hospira said it
couldn’t promise authorities in Italy,
where the drug was to be produced, that it could control the product’s
distribution all the way to the end user to guarantee it wouldn’t be used in
States then switched to pentobarbital, but Denmark-based
Lundbeck Inc., the only U.S.-licensed maker of the injectable barbiturate, said
July 1 it would put the medication off-limits for capital punishment. It
announced a new, tightly controlled distribution system, intended to keep the
drug out of the hands of prisons while ensuring deliveries to hospitals and
treatment centers for therapeutic purposes, as in the treatment of epilepsy.
It’s unclear whether states will be able to stockpile any
remaining pentobarbital, which is marketed as Nembutal. Lundbeck says it
believes little inventory is left for states to purchase following the
announcement. And with an expiration date of about two years, states would have
to switch by 2013 anyway.
If pentobarbital supplies dry up, executions could be
delayed around the nation as states look for yet another alternative.
For many states, making a switch requires a lengthy
regulatory and review process. And any change typically leads to lawsuits from
inmates who claim the substance violates the ban on cruel and unusual
punishment. Lawsuits over pentobarbital are still being heard.
States got sticker shock when they switched to
used to spend $218 for 5 grams of sodium thiopental, which it used in
combination with two drugs and then, beginning in 2009, as a stand-alone
spends $2,158 for the same 5-gram dose of pentobarbital, or $6,474 for
executions in March, April and May.
prisons spokesman Carlo LoParo said the state had no alternative but to pay the
higher price. He wouldn’t comment on the state’s plans beyond the February
spent $1,273 on the pentobarbital used to execute Cary Kerr in May for raping
and killing a woman 10 years ago. That’s almost exactly how much the state
spent on sodium thiopental for 17 executions in 2010, or $1,224.
Mississippi, Oklahoma and South
Carolina are among other states that confirmed the
cost spike to The Associated Press.
Lundbeck a attributes the high cost to its contract with a
U.S.-based manufacturer that produces the drug, along with ongoing upgrades and
improvements to the drug.
Pentobarbital, available for use since 1930, is used by
doctors as a sedative in some surgeries, as a hypnotic for short-term treatment
of insomnia and to control certain types of seizures, such as those associated
with bouts of cholera, meningitis and an emergency state of epilepsy.
The drug in powdered form has also been used in legally
assisted suicides in Oregon and Washington. That form,
which is made by some companies for veterinary use, is not approved for FDA use
in humans. States are unlikely to pursue that as an option because of
inevitable lawsuits challenging the use of a non-FDA approved medication.
A chemically related version of pentobarbital marketed to
veterinarians is also used in combination with other drugs as Somnasol to
The drug’s veterinary use is a bargain compared to lethal
injection for humans. A dose of Somnasol capable of putting a 1,000-pound horse
to sleep costs about $28, said Dr. John Hubbell, professor of veterinary
clinical sciences at Ohio
It’s also more expensive to put someone to death with
pentobarbital than to use in assisted suicide. In Washington state, a typical dose of
pentobarbital in powdered form costs about $400 for a 10-gram dose, twice the
amount used in executions, according to Dr. Tom Preston, medical director of
Compassion and Choices of Washington, a group supporting assisted suicide .
Lundbeck’s announcement should end an increasingly ugly
public relations and investment campaign aimed at pressuring the company to
block pentobarbital’s use in executions.
Reprieve, a London-based human rights group, had urged
Lundbeck to ban use of pentobarbital in executions.
Lundbeck, which manufactures the drug at a U.S. facility
it won’t identify, said it will now sell directly to hospitals using its
previous distributor, Dublin, Ohio-based Cardinal Health, to ship the product.
Cardinal said it is working with Lundbeck to implement the system through a
Cardinal division, Specialty Pharmaceutical Services.
Cardinal will review all orders, something drug
manufacturers typically leave up to their distributors. Then hospital officials
will have to sign forms stating they won’t use the drug for capital punishment
or resell it. Violators would be blocked from future access to the drug.
Experts say the “drop-ship” system Lundbeck is
adopting is an established way to limit drug distribution.
“This in essence takes the drug out of the standard
distribution system and gives them more control over how the product is
used,” said health care analyst Dan Mendelson, founder and CEO of
Washington, D.C.-based Avalere Health.
Drug makers ship about 9 percent of their products this way,
according to data provided by the Healthcare Distribution Management
Drugs delivered via “drop-ship” typically include
expensive cancer treatments that are expensive, difficult to make, or not in
Such a system protects Lundbeck by letting it prove it’s
done everything it could to restrict pentobarbital’s use, said Dan Steiber,
editor of Specialty Pharmacy Times and principal of D2 Pharma Consulting in
Lundbeck’s action will create accountability in the
distribution system, said Nick Calla, vice president of industry relations for
Drexel Hill, Pa.-based Community Specialty Pharmacy Network.
“You’re putting someone on the hook, someone has to
testify this product is not being diverted to a site it’s not supposed to be at,”
Calla said. “For products like this, where there’s a direct need not to
send it to a certain place, I think it works very well.”
is the only state that uses pentobarbital as a stand-alone dose. Other states
use the drug to put inmates to sleep, followed by drugs that paralyze inmates,
then stop their hearts.
One possible alternative to pentobarbital is propofol, a
powerful anesthetic and one of the drugs implicated in the 2009 death of singer
The drug was mentioned as a possible option in documents and
testimony in the Kentucky
court case that led to the U.S. Supreme Court’s 2008 ruling upholding the
constitutionality of lethal injection.
also has a backup method that involves injecting two drugs directly into an
inmate’s muscles, bypassing the veins. Under that method, the sedative
midazolam would be followed by the painkiller hydromorphone.
The method has never been used, however, and it comes with
potential problems: state officials previously warned reporters that the drugs
could cause convulsions or vomiting in inmates.
Oklahoma became the first
state to use pentobarbital last year, and Georgia,
Ohio, South Carolina
were among states that soon followed suit.
The drug has been used in 18 executions this year.