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Lethal Injection - Will The Execution Be A Challenge?

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Pharmaceutical company Alvogen has accused the state of Nevada and the department of corrections for illegally acquiring Midazolam in the upcoming execution of Scott Raymond Dozier, slated to take place on Wednesday, July 11, 2018, at the Ely State Prison in Ely, Nevada.

In the lawsuit filed yesterday, Alvogen alleges that the defendants deceptively purchased Midazolam for lethal injection despite the company's warning that the drug cannot be acquired directly from Alvogen or from third-party distributors.

Midazolam, an injectable drug, is approved by the FDA for use in general anesthesia and as a sedative. So how did Midazolam become a part of the lethal injection?

Before we get into those details, here's what a lethal injection means in a nutshell.

The lethal injection is a series of three drugs - Sodium thiopental, Pancuronium bromide and Potassium chloride, administered one after the other in the same order.

Sodium thiopental, often referred to as "truth serum", and belonging to the family of barbiturate, acts as an anesthetic. Pancuronium bromide is a muscle-relaxant that stops breathing by paralyzing the diaphragm and lungs. Potassium chloride causes death by inducing cardiac arrest.

With Hospira Inc, the only company in the U.S. that was the source of Sodium thiopental facing manufacturing issues at its North Carolina plant, it suspended production of Sodium thiopental in 2009. It was around the same time that the European Union also blocked the export of Sodium thiopental to the U.S. on ethical grounds.

Hospira had planned to resume production of Sodium thiopental after shifting production from its North Carolina plant to its plant in Liscate, Italy, in the first quarter of 2011. But in January 2011, Hospira announced its decision to cease production and exit the Sodium thiopental market altogether.

With supplies of Sodium thiopental drying up, there was a dire shortage of the drug in the U.S., which delayed executions, and even resulted in postponement of signing death warrants in several states. It was during this time i.e., towards the end of 2010 that correctional facilities in several states switched to Lundbeck-made Pentobarbital, sold under the name Nembutal, from Sodium thiopental.

However, in July 2011, Lundbeck overhauled the distribution of Pentobarbital in order to restrict its application as part of lethal injection in the U.S.

When Pentobarbital became unavailable to prisons in U.S. states currently active in carrying out the death penalty by lethal injection, Midazolam became part of the three-drug lethal injection.

Florida was the first state to use Midazolam in the three-drug lethal injection on October 15, 2013. According to the Death Penalty Information Center, 6 states, i.e., Florida, Ohio, Oklahoma, Alabama, Virginia, and Arkansas have used Midazolam as the first drug in the three-drug lethal injection, and 2 states, Ohio and Arizona, have used Midazolam in a two-drug protocol consisting of Midazolam and Hydromorphone.

The use of Midazolam as part of the lethal injection has been extremely controversial because of botched executions.

For example in one of the cases, in April 2014, a prisoner, who was administered the 3-drug lethal injection containing Midazolam, regained consciousness midway through his execution, and he died of a heart attack approximately 40 minutes after the execution began.

Similarly, the Arizona execution in July 2014, where the two-drug protocol of Midazolam and Hyrdromorphone was used, was also bungled. The execution, which was supposed to take just 10 minutes, took nearly two hours, with the gasping and snorting over 600 times during the procedure.

The first known infliction of death as a punishment in American colonies was reportedly that of Captain George Kendall, which occurred in Jamestown Colony (present day Virginia near Williamsburg) in 1608. In the U.S, the death penalty was suspended for a brief period in the 1970s. However, it was reinstated in 1976.

Since 1976, a total of 1,477 executions have been carried out in the U.S., including 12 so far this year. In the U.S., the death penalty is in place in 31 of the 50 states. (Source: DPIC)

The Nevada death row inmate Scott Raymond Dozier, who is slated for execution today, will be administered the lethal injection cocktail of Midazolam followed by high doses of Fentanyl, a synthetic opioid, and Cisatracurium, a neuromuscular blocking agent that can cause respiratory paralysis, according to reports.

Now that Alvogen has sued the state of Nevada to stop the use of its drug Midazolam in the lethal injection cocktail, it remains to be seen if the execution will go ahead as planned.

Updated at 7.55 pm

The execution of the convicted killer Scott Raymond Dozier has been halted until further notice as the District Judge Elizabeth Gonzalez who presided over the case has issued a temporary restraining order from using Midazolam in the lethal injection cocktail.

This is the first time that an execution has been halted because of a drugmaker's lawsuit against a state alleging misuse of its drug in executions.

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