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  1. #1
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    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."


    http://www.clarionledger.com/article...28014/1263/RSS

  2. #2
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    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
    randy.jumpnjaq
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    One of the many side effects of Pavulon (Pancuronium Bromide) is muscle fasciculations due to its cholinergic reaction. This in addition to Sodium Thiopental or Profofol are the best method of rendering unconsciousness and paralysis. Some prisoners dehydrate themselves in an attempt to make it harder for the personell to find a suitable vein. The drugs do have some drawbacks, such as the acronym SLUDGEM... saliviaton, lacrimation, urination, defication, gastric, emesis, and miosi. However, this would be much better way to die than the other alternatives.

  4. #4
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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.

    http://www.google.com/hostednews/can...?docId=5006025

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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)

  6. #6
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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.



    http://online.wsj.com/article/SB1000...googlenews_wsj

  7. #7
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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.

    http://www.dispatch.com/live/content...g.html?sid=101

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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."

    http://abcnews.go.com/US/oklahoma-pl...ry?id=12113350

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    U.K. To Halt Shipments of Execution Drug to U.S.

    The mechanics of capital punishment seem to grow more complicated by the week.

    On Monday, the U.K. announced that it would soon effectively ban the export of anesthetic thiopental sodium to the U.S. for use in lethal injections. The move was designed “to underline the United Kingdom’s moral opposition to the death penalty,” according to a London court filing by the U.K. office that oversees export controls.

    Here’s the story from WSJ.

    The news is important, because, as readers of this page know, there is a stateside shortage of thiopental, which is the key ingredient for lethal injection in all death-penalty states save Oklahoma, where a court recently approved the use of a substitute anesthetic for lethal injections.

    A new domestic batch of thiopental will not be available until the first quarter of 2011, at the earliest. In the meantime, Arizona, and possibly other states, have imported U.K.-made thiopental for executions.

    U.K.’s thiopental embargo follows a suit this month in the U.K. on behalf of condemned Tennessee inmate Edmund Zagorski, which alleges that Tennessee ordered thiopental from overseas, possibly in the U.K., to carry out Zagorski’s execution. The suit sought a U.K. ban on thiopental exports.

    The U.K. announcement Monday “will make things more difficult for states trying to obtain thiopental” for executions, said Jamie Beagent, a London attorney representing Zagorksi.

    In a possible harbinger of more trade limits, the U.K. also announced yesterday that it will seek European Union-wide limits on thiopental exports.

    Italy’s Green Party separately has sought limits on the drug’s export, contending it violates the Italian Constitution, the WSJ reports.

    http://blogs.wsj.com/law/2010/11/30/...on-drug-to-us/

  10. #10
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    Tenn. Receives Execution Drug Shipment----Drug In Short Supply Across Nation

    It appears Tennessee has received an overseas shipment of the death penalty drug that's in short supply across the nation.

    The Associated Press reported the state received at least one shipment of sodium thiopental, apparently from a British pharmaceutical company.

    Several states are running low on the drug, and the Food and Drug Administration ruled last week it would not block imports of the execution drug.

    All of Tennessee's scheduled executions are on hold until hearings move forward on whether the state's new lethal injection procedures are constitutional.

    (source: WSMV News)

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