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Anesthesia Shortage
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  1. #1
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    Oct 2010

    Anesthesia Shortage

    Anesthesia shortage may delay executions

    LOUISVILLE, KY. — A nationwide shortage of several anesthesia drugs has left several states scrambling to find enough doses to carry out lethal injections — potentially delaying executions well into next year.

    Kentucky announced this week that it would not be able to carry out two executions, despite pending death warrants, because the state has only enough sodium thiopental, also known as Pentothal, to perform a single lethal injection.

    "We have reached out to some other states, but that has not been fruitful," said J. Michael Brown, secretary of the Justice and Public Safety Cabinet. "We've had other states call us trying to find it."

    Oklahoma has also been forced to delay an execution after a federal judge said a hearing needs to be held before the state could substitute a drug for the state's remaining dose of sodium thiopental. That dose "wasn't at the quality we wanted," said Jerry Massie, a spokesman for the state Department of Corrections.

    Ohio prison officials have been closely watching the nationwide shortage after they feared they may not be able to carry out a lethal injection last spring because of limited supplies, according to Ohio corrections spokeswoman Julie Walburn.

    Hospira, based outside Chicago, the sole U.S. manufacturer of sodium thiopental, says manufacturing problems have hindered production of the drug, though spokesman Dan Rosenberg declined to elaborate.

    "We are working to get it back on the market as soon as possible," Rosenberg said.

    Rosenberg said Hospira won't have more of the drug available until sometime in the first quarter of 2011.

    The lack of sodium thiopental developed after a more commonly used anesthetic called Propofol grew scarce, said Bona Benjamin with the American Society of Health-System Pharmacists. The shortages have led to major disruptions for hospitals, doctors and patients, who have postponed some elective surgeries as a result.

    Benjamin said that with the shortage of Propofol it didn't take long to start seeing shortages in drugs that could be safely substituted. "It just sort of trickled down where anesthesiologists are being very challenged right now."

    Of the 35 states that allow the death penalty, nearly all use sodium thiopental as part of the lethal cocktail administered, according to the Death Penalty Information Center. New Mexico voted to abolish the death penalty in 2009, but the repeal was not retroactive, leaving two people on the state's death row, according to the Center's Web page.

    Both Ohio and Washington use a one-drug protocol using the sodium thiopental.

    In Kentucky, as in many states, the lethal injection protocol includes a combination of the sodium thiopental with pancuronium bromide and potassium chloride.

    Kentucky has 9.5 grams of sodium thiopental available, according to Department of Corrections documents. Execution requires 3 grams, plus an additional 3 grams for backup injection.

    Moreover, Kentucky's dose of sodium thiopental expires in October.

    Democratic Gov. Steve Beshear signed a warrant this week that sets an execution date of Sept. 16 for Gregory Wilson, who was sentenced in 1988 for the May 1987 murder and rape of Deborah Pooley.

    Brown said he recommended scheduling Wilson first because his case is the oldest of the three warrants requested. Warrants also were requested for Ralph Baze, who was convicted of killing a Powell County sheriff and deputy in 1992, and Robert Carl Foley, who was convicted in 1993 and 1994 of killing six people in two incidents.

    Richard Dieter, executive director of the Death Penalty Information Center, said the impact of the drug shortage is another example of how the questions around lethal injection are far from resolved.

    "We're trying to map a medical procedure onto an execution process, and the fit has not been very well," Dieter said. "You're using the drug not for the purpose it was originally created."

    It's unclear, Dieter said, how many states could be affected by the shortage.

    "This is certainly a quirky phenomenon," he said. "We're left with this medical approach, but it has been fraught with problems."


  2. #2
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    Oct 2010
    Version 2 of the Sodium Thiopental Article

    On October 26, Arizona executed Jeffrey Landrigan by lethal injection. One of the 3 drugs was imported from Great Britain, but does that really matter?

    Capital punishment by lethal injection in the United States is rife with irony. Death penalty proponents seek quick-acting and painless procedures, the courts debate the "safety" of lethal drugs, prisoners may undergo lengthy and excruciatingly painful deaths and the manufacturers of the drugs oppose this use of their own products.

    The Barbiturate Sodium Thiopental

    Sodium Thiopental, which was discovered at and patented by Abbott Laboratories (as Sodium Pentothal) in the U.S. in the 1930s, is a fast, but short, acting barbiturate. Also known as thiopental, thiopentone sodium and trapanal, the drug is or has been used to induce unconsciousness during general anesthesia, to induce medical comas, in psychiatric treatment, as a "truth serum" and in state-permitted euthanasia.

    Its use in anesthesia, where it largely has been replaced by the non-barbiturate Propofol (the drug that killed Michael Jackson), is limited to the induction of unconsciousness. It is not used to maintain unconsiousness, because inhaled anesthetic agents allow a more rapid return to consciousness than what would be experienced with larger doses of thiopental.

    Sodium thiopental is also used alone or in combination with two other drugs in the lethal injection method of executing prisoners. Its use in this context, particularly in the three-drug cocktail option, is under attack by dealth penalty opponents, and is at the heart of the Jeffrey Landrigan execution issue.

    The Role of Thiopental in Executions in the United States

    Currently, 34 states use sodium thiopental alone (Ohio and Washington) or in combination with two other drugs to execute prisoners through lethal injection. The three drugs are administered serially and separately. Thiopental is used first, typically in a 5-gram dosage that is approximately 5 times the amount used to induce medical comas and 3 times the amount used for euthanasia. Thiopental is used in the three-drug cocktail to induce unconsciousness, purportedly to spare the prisoner pain and suffering from the other two drugs. Pancuronium bromide (Pavulon) is administered second. Pavulon is related to the South American paralytic poison curare, and causes paralysis in less than a minute, including the paralysis of respiritory (breathing) muscles. The third drug administered is potassium chloride, which stops the heart, causing cardiac arrest.

    Beginning at the injection site, potassium chloride can be excruciatingly painful. One of the primary objections of Amnesty International and other death penalty opponents to this three-drug cocktail is that if the dose of short-acting thiopental has diminished by the time potassium chloride is administered, the prisoner will be subjected to unbearable pain, but unable to express it due to being paralyzed by the Pavulon. Considering reports by execution witnesses of gasping, grimacing and convulsing on the part of prisoners, this concern may be legitimate. Interestingly, the American Veterinary Medical Association rejects the use of Pavulon during animal euthanasia due to its pain masking, and it is banned outright for use on animals in Texas, the lead state in human executions.

    Sodium Thiopental and Arizona's Execution of Jeffrey Landrigan

    Landrigan's execution, which took place at 10:26 p.m. on Tuesday, October 26 (10-26 at 10:26), had been stayed on Monday in Phoenix by a federal judge who questionned the "safety" of the drug, a curious choice of words, but focused on Arizona's planned use of imported thiopental. This stay was upheld by the 9th U.S. Circuit Court of Appeals on Tuesday morning, but then reversed by the U.S. Supreme Court later that day, spurring Arizona to proceed with the execution that night.

    According to reporting from the Assiciated Press, the Supreme Court found no evidence that the drug, obtained from a British manufacturer, would be "unsafe", and that speculation was no substitute for evidence that "the drug is sure or very likely to cause serious illness and needless suffering." Thiopental is manufactured in the U.S. by a single company, Hospira, and has been in short supply since spring. "Use by" dates on existing supplies have been expiring, jeopardizing other U.S. executions, and, according to an article in the British newspaper, The Guardian, California may be next state to use thiopental from the U.K.

    The Guardian revealed that the British supplier of Arizona's thiopental is Archimedes Pharma UK (the only British manufacturer of the drug), a company that denied knowingly providing the drug, pointing out that it has no control over ultimate distribution of drugs that it sells into the pharmaceutical supply chain.

    Thiopental Suppliers' Position on the use of their Drugs in Lethal Injection

    Archimedes Pharma, a company specializing in pain relief, responded to calls for controls to prevent exportation of thiopental for use in executions. As reported in The Guardian, Richard Dieter of the Death Penalty Information Center in Washington called for Britain to prevent "outsourcing" of lethal injection drugs, and Amnesty International suggested implementation of EU controls.

    The sole U.S. manufacturer of sodium thiopental, Hospira, has gone on record opposed to the use of its drugs in lethal injection (it makes all three of the lethal cocktail drugs). Doctor Kees Gioenhout, a vice president, wrote all state departments of correction on March 31, 2010, stating in a letter that Hospira provides these products to improve and save lives, and that the company "does not support the use of any of our products in capital punishment."

    Does the Source of Manufacture for Sodium Thiopental Matter?

    Although death penalty opponents appear to have a credible argument against the three-drug use of sodium thiopental in executions, the source of regulated manufacture under license seems of little consequence.

    Thiopental may fail to bring or maintain unconsciousness in a prisoner undergoing lethal injection. If that happens, the prisoner might well experience excruciating pain and suffering from the administration of potassium chloride, and be unable to reveal this suffering, having been paralyzed by the second drug, pancuronium bromide. Under these circumstances, does it really matter where the thiopental was made?

    Read more at Suite101: Version 2 of the Sodium Thiopental Article http://www.suite101.com/content/vers...#ixzz13mE9Eane

  3. #3
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    UK group says it's suing to stop the export of execution drug sodium thiopental to US

    A British rights group says it's suing to stop the export of a sedative used to execute prisoners to the United States.

    The U.S. is going through a national shortage of sodium thiopental, which is used as part of a three-drug cocktail administered to death row inmates.

    That has delayed executions and forced at least one state, Arizona, to go shopping abroad for the drug.

    The revelation by U.S. officials last week that they had sourced the drug from a British company was the source of considerable unease here.

    Britain bans the death penalty and lobbies forcefully against its use in other countries.

    Reprieve says is acting on a request by lawyers for Tennessee death row inmate Edmund Zagorski.


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    Drug used in recent Oklahoma execution was provided by Arkansas, dose also provided to Tenn.

    1 of the drugs used in the recent execution of an Oklahoma death row inmate was provided by Arkansas.

    Arkansas has extra supplies of sodium thiopental — which renders people unconscious — after 2 executions were stayed because of objections to changes in the lethal-injection law. The state provided the drug to Oklahoma for the Oct. 14 execution of Donald Ray Wackerly.

    An Arkansas Democrat-Gazette Freedom of Information Act request with the Arkansas Department of Correction produced e-mails showing Tennessee has also received a dose of the drug. A Tennessee Department of Correction spokesman declined comment on where the drug was acquired.

    The maker of the drug has said there is a shortage of it because of unspecified problems with its raw-material suppliers.

    (source: Associated Press)

  5. #5
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    Plea for Execution Drug

    Faced With Shortage of Anesthetic, Oklahoma Seeks Court Permission for New One

    Oklahoma is preparing to argue in court next week that a drug used to euthanize animals can also be used to execute death row inmates amid a nationwide shortage of an anesthetic used in executions.

    It is one of a number of states scrambling to find the drugs needed to perform capital punishment due to a shortage of thiopental sodium, the only anesthetic that states have so far used in lethal injections, according to lawyers.

    States tend to adopt the death-row methods used by other states, so the Oklahoma court decision could have an impact elsewhere in the U.S.

    Hospira Inc., the sole U.S. maker of thiopental, announced this summer that it had ceased production of the drug until 2011, citing a shortage in one of thiopental's raw ingredients.

    Oklahoma, which is scheduled to execute John David Duty on Dec. 16, has said that veterinarians regard pentobarbital, which it is proposing as a substitute anesthetic for death row inmates, "as an ideal anesthetic agent for humane euthanasia in animals," that is "substantially" similar to thiopental, according to a court filing last month.

    If approved, pentobarbital could be a new standard for lethal injections.

    Attorneys for Mr. Duty, who was sentenced to death for murdering his cell mate in 2001, have said in court papers they didn't want their client to be a guinea pig for pentobarbital. The drug "is untested, potentially dangerous, and could well result in a torturous execution," the attorneys stated in a court filing. Oklahoma City federal judge Stephen Friot is due to hear the arguments next week.

    The thiopental shortage has required some states to delay executions. Defense lawyers say their clients' lives now depend partly on whether prison personnel can find as little as three grams of the drug, which is used to render an inmate unconscious before other drugs are injected to cause paralysis and stop an inmate's heart.

    "It's like a game of Russian roulette," said Stephen Ferrell, counsel to Stephen Michael West, who is due to be executed on Nov. 30 by Tennessee, another state grappling with a shortage.


  6. #6
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    Ohio Running Out of Lethal Injection Drug

    Will a British-made drug be used in Ohio executions? Or will a dozen convicted killers get a temporary reprieve?

    A national shortage of thiopental sodium has prison officials in Ohio and three dozen other states scrambling to figure out how to carry out legally required lethal-injection executions.

    Arizona came up with its own solution, buying thiopental sodium from a British manufacturer so it could execute Jeffrey Landrigan, 50, last week.

    A British newspaper, The Guardian, said Arizona obtained the drug from Archimedes Pharma UK, the sole British manufacturer.

    Ohio Department of Rehabilitation and Correction officials say they have enough of the drug for the execution of Sidney Cornwell of Mahoning County, scheduled for Nov. 16. Beyond that, the supply is uncertain.

    Prisons spokeswoman Julie Walburn declined to say whether the state has considered or will consider buying from Great Britain or other foreign sources.

    No executions are scheduled in Ohio in December or January, but two are set after that: Frank Spisak of Cuyahoga County on Feb. 17 and Johnnie Baston of Lucas County on March 10.

    In addition, county prosecutors from across the state have petitioned the Ohio Supreme Court to set execution dates in 10 other cases. The court has not acted on the requests, but monthly dates throughout 2011 have been put "on hold" for possible executions.

    The problem is a result of a supply shortage from the sole U.S. manufacturer of thiopental sodium, Hospira Inc. of Lake Forest, Ill. The company said it doesn't expect to be able to resume production until the first quarter of next year because of a shortage from a supplier of raw material.

    Further, Hospira wrote to Ohio and all other states, objecting to the use of the drug for executions. The company said its product is intended to "improve or save lives," not to take them.

    In December, Ohio became the first state to switch to a single drug for executions, replacing a three-drug mixture that also uses thiopental sodium. Washington state followed suit.

    Although Ohio has an alternative method of execution involving intramuscular injections of strong painkillers, it will be used only as a backup when the single-drug method fails, officials said.

    Although the U.S. Supreme Court, in a 4-3 decision, cleared the way for Arizona to use the foreign-made drug, legal challenges are in the works.

    A lawsuit was filed in London on behalf of Edmund Zagorski, a Tennessee inmate scheduled to be executed in January. Tennessee is among several states looking into buying thiopental sodium from foreign sources.


  7. #7
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    Oklahoma Plans to Execute Convict Using Veterinary Drug

    Lawyers for a death row inmate in Oklahoma are protesting a state plan to kill their client using a drug typically used to put down animals amid a nationwide shortage of the anesthetic regularly used in executions.

    Oklahoma is considering the use of pentobarbital, a drug used to euthanize animals, in the upcoming execution of John David Duty, a convicted murderer scheduled to be executed on Dec. 12.

    Across the country, states that implement the death penalty by lethal injection are scrambling to determine alternative ways to kill convicts. Hospira, the maker of sodium thiopental, better known as Pentothal, has announced a suspension of production of the drug because of an unspecified supply problem with the drug's key ingredient.

    "We are probably going to look at a number of different options now that we can't use sodium thiopental," said Jerry Massie, spokesman for the Oklahoma Department of Corrections. "We are not sure yet what we'll end up using, but pentobarbital is a strategy we're looking at."

    In court documents requesting approval to use pentobarbital, the state called the drug "an ideal anesthetic agent for humane euthanasia in animals," comparing it to the sodium thiopental used as the first part of a three-drug cocktail administered during an execution.

    In federal court documents filed Monday, Duty's lawyers argued that using pentobarbital is potentially painful and would be tantamount to torture.

    "Pentobarbital is untested, potentially dangerous, and could well result in a torturous execution for Mr. Duty," his lawyers wrote.

    "There are risks associated with ... Pentobarbital, especially since the [state executioners] intend to use the drug as part of a 3-drug cocktail," they wrote. "Most notably, Pentobarbital is a slower acting barbiturate than Sodium Thiopental. ... This increases the risk to Mr. Duty of not being fully anesthetized at the time the Vecuronium Bromide and Potassium Chloride are administered, thereby increasing the risk of suffering excruciating pain."


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    Execution drug fight continues in Arizona

    PHOENIX - Attorneys for three convicted killers on Arizona's death row are challenging the state's use of a sedative drug in executions, after a similar effort on behalf of another inmate failed in recent weeks.

    The defense attorneys in the latest case hope to force the state to disclose where it got the lethal injection drug sodium thiopental. They want to be assured that the drug the state is using doesn't cause needless suffering or serious illness.

    "Why is the state being so secretive? What does the state have to hide?" said Dale Baich, whose office represents the inmates.

    State's attorneys say the drug came from Great Britain, but have not disclosed the company manufacturing it. They say anti-death penalty groups would likely pounce on the company and potentially cause them to stop making the drug.

    Arizona had to go to outside the U.S. because a shortage of the drug slowed executions nationwide in the spring.

    Corrections spokesman Barrett Marson said his agency will not disclose where the drug came from or who made it, citing a state law that says the identity of anybody who participates or performs ancillary functions in an execution are confidential.

    Baich's effort comes after he fought for Landrigan's execution to be delayed because of questions over the drug.

    A federal judge ordered a stay the day before the Oct. 27 execution and a three-judge panel upheld the ruling, which delayed the execution by 12 hours before the U.S. Supreme Court lifted the stay, and Landrigan was executed. The high court ruled there was no evidence the drug was likely to cause needless suffering.

    A Landrigan lawsuit over the drug is still pending before Judge Roslyn Silver. The judge asked defense attorneys to prove the case is not moot in light of Landrigan's execution; they have until Monday to file. Baich's office filed paperwork on Oct. 29 for the other three inmates to join Landrigan's lawsuit, arguing that questions over the drug pertain to them.

    Kent Cattani, chief counsel for the criminal appeals section at the Arizona Attorney General's Office, said he and his office are confident that the corrections department obtained the drug from Great Britain legally and that the drug is safe.

    "We trust it," Cattani said. Landrigan's execution "went off without any problems."

    Baich, who witnessed Landrigan's execution, said "you just can't tell by looking."

    Landrigan's lawyers had argued he could be suffocated painfully if the sodium thiopental didn't render him unconscious. In lethal injections, the drug makes an inmate unconscious before a second drug paralyzes him and a third drug stops his heart.

    There are no FDA-approved overseas manufacturers of the drug.

    Baich is hoping that the state will be ordered to disclose where the drug came from, and the issue over its safety and effectiveness can be properly addressed after that.

    The next inmate to be executed could be Daniel Wayne Cook, one of the three inmates seeking to join Landrigan's lawsuit. Cook was convicted of second-degree murder in 1987 stemming from the strangling deaths of two men in Lake Havasu City after prosecutors say Cook tortured and raped them.

    Prosecutors have asked the state Supreme Court to schedule the execution, while defense attorneys are asking the judges to wait until the issues over the drug are resolved.

    By: Associated Press

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    Lawyers for 2 on death row try to block U.K. drug export

    Lethal injection drug at heart of court fight
    A drug used in lethal injection executions in the United States has become the focus of a British court fight over export controls.

    The drug, sodium thiopental, is one of three used in such executions, a painkiller that first renders death-row inmates unconscious. There's a shortage of this drug in the United States, and some executions have been delayed, but it is still available in Britain.

    However, opponents of the death penalty argue that the export of the drug violates human rights, particularly given the British government's commitment to abolishing executions.

    In November, a human rights group in London sued the government, arguing that a death row inmate in Tennessee, Edmund Zagorski, will be executed if the drug is exported. The court fight in London today involves both Zagorski and Ralph Base, both of whom are on death row.

    Earlier this month, Britain's Business Secretary Vince Cable refused to ban the export of the drug under the Export Control Act, saying it was medicine whose primary use was as an anaesthetic and that "legitimate trade of medical value would be affected by any restriction on the export of this product from the U.K."

    Today at London's High Court, according to The Press Association and other reports, lawyer Nathalie Lieven argued that Mr. Cable's refused to ban the export was irrational.

    “There are strong grounds for fearing that the U.K. will be, or already has been, the source of drugs used in the claimants’ proposed executions, and for many other persons on death row in the U.S.,” Ms. Lieven said, according to Bloomberg News.

    “Such executions would be a clear violation of fundamental human rights principles to which the U.K. has consistently, and very recently, affirmed its commitment.

    Zagorski, convicted of two murders, has been on death row since 1984, while Baze, convicted of killing two police officers, is on death row Kentucky, where he has been for 17 years.

    "Having failed to persuade Vince Cable that it is wrong for the U.K. to be facilitating the death penalty in the U.S., we hope that the High Court will now compel him to exercise the powers of export control which parliament has granted him to prevent just this sort of violation of human rights," Richard Stein, of the law firm Leigh Day & Co., told The Independent.

    "There is a list which covers guillotines, gas chambers and electrocution equipment."


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    Texas Must Disclose Source of Execution Drug

    Texas must disclose the source of a controversial drug used in capital punishments, according to the state attorney general, in a move that could prompt other states to be more transparent about their drug supplies.

    The ruling concerns thiopental sodium, a drug used to render inmates unconscious during lethal injections; a nationwide shortage of the anesthetic has caused delays in capital punishment and has made states search far and wide for backup supplies, including purchasing thiopental made overseas.

    Criminal-defense lawyers and advocacy groups have pushed states to divulge the steps they have taken to acquire thiopental, citing concerns that inmates could suffer severe pain during executions if states acquire thiopental overseas that is less effective or powerful than the domestic variety.

    Texas and other states, meanwhile, have resisted disclosure, claiming that suppliers could suffer retribution from death-penalty opponents if their identities are disclosed. The Texas Department of Criminal Justice, for example, has stated that the debate over the death penalty is similar in its ferocity to the abortion wars and that protests over executions could turn violent.

    But the attorney general in Texas, the nation's most active death-penalty state, sided in favor of transparency Thursday, ruling that the state's correctional department must disclose the quantity of execution drugs in its supply and the names of the suppliers. Texas has had 41 executions in the past 2 years, according to the Death Penalty Information Center. Ohio is second with 13 executions.

    "This is information the public has a right to know," said Jennifer Moreno, an attorney with a death-penalty legal clinic at the University of California, Berkeley, School of Law, which had filed a request with the Texas Department of Criminal Justice to disclose the information. "We need to know where [thiopental] is coming from to make an assessment about the quality of the drug and whether it will be effective," she said.

    The Texas Department of Criminal Journal didn't respond to a request for comment.

    Defense lawyers hope other states follow Texas's lead. "Once [thiopental] information is disclosed in one state, it will be harder for other states to keep it secret," said Natasha Minsker, a death-penalty specialist with the American Civil Liberties Union of Northern California, which filed suit this week to seek disclosure of the source of California's supply of thiopental.

    The California Department of Corrections and Rehabilitation has declined to divulge sourcing information other than to say that it has obtained thiopental lawfully in the U.S. The department declined to discuss the ACLU suit.

    A similar disclosure fight is under way in Arizona. The state has disclosed that it obtained thiopental from Britain, but not the supplier.

    "To protect our ability to get these drugs, we want to be sure we protect our sources," said a spokeswoman with the Arizona Attorney General's Office, which used imported thiopental to perform the Oct. 26 execution of Jeffrey Landrigan. The U.S. Supreme Court signed off on the state's use of imported thiopental.

    "Arizona should follow Texas's lead on this," said Dale Baich, an Arizona federal public defender who represented Mr. Landrigan and is counsel to other death-row inmates in the state. " The lack of transparency by Arizona continues to be troubling and is not good government," he said.

    Tennessee, meanwhile, is at the center of a lawsuit pending in London, which alleges that the state has sought to obtain thiopental overseas to carry out the scheduled January execution of inmate Edmund Zagorski.

    The London suit, filed by the human-rights group Reprieve and a London law firm, seeks to block U.K. shipments of thiopental to the U.S. on the grounds that the drug will be used for executions, which are banned in Europe.

    Tennessee, like other states, has been somewhat circumspect about its efforts to locate a supply of thiopental. "We have looked at a number of different providers of thiopental sodium in the United States, some of which have sources overseas," said Dorinda Carter, a spokeswoman for the Tennessee Department of Correction, who declined to provide other details.


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