Compounding Pharmacies Called On To Make Execution Drugs

Pharmaceutical companies in Europe are blocking the sale of drugs used for lethal injection in the U.S. That has states that use the drugs turning to compounding pharmacies to create them. David Miller, the CEO of the International Academy of Compounding Pharmacists, talks to Steve Inskeep about why that's problematic.

DAVID GREENE, HOST:

This week, a federal judge in Oklahoma is considering whether a particular drug used to carry out lethal injections amounts to cruel and unusual punishment. The drug in question is prepared by a compounding pharmacy, a business that's asked to mix specific drugs - in this case, with the intention of executing a prisoner. David Miller of the International Academy of Compounding Pharmacists says this is not a service they're eager to provide.

DAVID MILLER: I don't think it's a question that you're going to see compounding pharmacists storming Capitol Hill saying we want to be able to provide medications for lethal injections. That's actually contrary to what we do as a profession.

GREENE: And yet these pharmacies are increasingly being put in this uncomfortable position. European pharmaceutical companies used to provide this controversial drug, but now refuse to sell it to American prisons. Corrections departments are scrambling to make up for the shortage, and at times are turning to compounding pharmacists in the United States. Our colleague Steve Inskeep asked Miller if there's even a definition for a safe and effective drug for execution.

MILLER: For lethal injection purposes, I don't know what, quote, "safe and effective" means.

STEVE INSKEEP, HOST:

I'm thinking about some recent news stories that involve lethal injections that appear to be particularly difficult. There were a couple of cases in Oklahoma. There was a man who was executed, who spoke as he was being executed and said I feel my whole body burning. And these are cases where, although the state has somewhat obscured the record, it appears that compound pharmacies were the source of the drugs. Do you have any insight as to what happened there?

MILLER: We don't have any specific information about those cases. I think one of the things that, as a scientist, that I would be asking to see is: Were these unique situations associated with those particular executions? Or can I go back and take a look at other lethal injections during the course of the past 10, 15 years, where the manufactured product was made? If, indeed, it is shown that the manufactured drug is the preferable medication to use, then we as a society have to address the issue of why manufacturers have curtailed that access.

INSKEEP: There was a case in Ohio in January where a man was executed. It took something like 25 minutes...

MILLER: Correct.

INSKEEP: ...I believe, for him to die. And while it is somewhat obscure, again, where the medication came from, it may have been a compound pharmacy. And his lawyers said this man was basically killed with an experimental combination.

MILLER: Traditionally, when we had access to manufactured medications in the departments of corrections, there were specific protocols. You use X amount of this drug, Y amount of that drug. Now, because those medications aren't available, we're seeing corrections facilities and the physicians involved in that lethal injection beginning to develop new protocols, which may or may not have been tested. And that's one of the concerns that we have, also.

INSKEEP: But I raise the Ohio case for this reason: They said it took 25 minutes. They said this is one of the longest executions that we've ever had since the state resumed executing people in 1999.

MILLER: It does beg the question: If indeed lethal injection is part of the law within Ohio, should we not be pressuring the pharmaceutical industry to get those drugs that we have used in the past? We should not, certainly as pharmacists, be put in the position of having to prepare those medications without having direct input into what that protocol looks like.

INSKEEP: Is there a reason that compound pharmacies cannot mix the same combinations that have always been used?

MILLER: You have to recognize that a manufacturing process involves some proprietary steps. So, for example, the formulas that a compounding pharmacist uses, they may be different from those used by the pharmaceutical manufacturers, which maintains a certain level of confidentiality and privacy. So there might be buffering agents, for example, that a manufacturer uses. A compounding pharmacy may use a different kind of buffering agent.

INSKEEP: I use the phrase safe and effective. Is there some other standard like swift and painless, which might be what you'd prefer with an execution?

MILLER: If we are indeed involved in executions - and this is more personal than a pharmacy perspective - you would expect it to be swift and painless. In medication, there is no such thing. There is no definition as to what is swift and what is painless. Certain anesthesia drugs, obviously, are tested very specifically for how quickly you go under during an operation. One of the most commonly used medications in lethal injections is an anesthetic medication that has been tested for how quickly will it put you under. The medical literature, we've got access to that. Department of corrections prisons can't buy it because of who they are and the pharmaceutical company that makes it, saying we will not sell this to you.

GREENE: My colleague Steve Inskeep, speaking there to David Miller, the CEO of the International Academy of Compounding Pharmacists.

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