Most three-drug protocols use an anesthetic or sedative, followed by a drug to paralyze the inmate, and finally a drug to stop the heart. The one and two-drug protocols typically use an overdose of an anesthetic or sedative to cause death. Although the constitutionality of lethal injection has been upheld by the Supreme Court, the specific applications used in states continues to be widely challenged prior to each execution. Because it is increasingly difficult to obtain the drugs used in earlier executions, states have resorted to experimenting with new drugs and drug combinations to carry out executions, resulting in numerous prolonged and painful executions.
States are also turning to previously discarded forms of execution, such as the electric chair and gas chamber, in the event that lethal drugs cannot be obtained. Even though the issues surrounding lethal injection are far from settled, states are attempting to cut off debate by concealing their execution practices under a veil of secrecy. Recently passed laws bar the public from learning the sources of lethal drugs being used, making it impossible to judge the reliability of the manufacturer or the possible expiration of these drugs.
At this stage, the inmate should be fully unconscious and no longer breathing. However, their heart may still be beating as it isn't affected by vecuronium bromide in the same way. To stop the heart, potassium chloride is administered directly after the vecuronium bromide.
Without proper sedation, this stage would be extremely painful. The feeling has been likened to 'liquid fire' entering veins and snaking towards the heart. If the inmate is not fully paralysed, their muscles will also spasm uncontrollably, causing them to buck on the gurney, according to Dr Morley. This is because potassium sends signals to every muscle in the body to contract. If the procedure goes according to plan, the inmate should be dead less than 10 minutes after the first drug enters their system.
If there is a problem injecting the drugs, such as a blown vein or drugs being accidentally injected into muscle - or if the inmate regains consciousness - the procedure is stopped, the curtain for observers is closed, and staff work to restore the infusion site.
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Missouri first used pentobarbital from a compounding pharmacy in the November 20, execution of Joseph Franklin. Texas first used pentobarbital from a compounding pharmacy in the execution of Michael Yowell on October 9, Georgia used drugs from an unnamed compounding pharmacy for an execution on June 17, 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, Ohio announced plans to obtain drugs from compounding pharmacies in October, In March , Mississippi announced plans to use pentobarbital from a compounding pharmacy.
Documents released in January , 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. Alabama effective July , Mississippi effective April , and Oklahoma effective November all have laws that allow for use of nitrogen hypoxia.
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