Last week, Oklahoma state officials drew the criticism of two former attorneys general for their hasty selection of midazolam for the state's lethal injection protocol. Now Oklahoma's choice of midazolam is coming under fire from another direction: pharmacologists, experts in the effects of drugs on the human body.
Dr. Ellen M. Unterwald, a professor of pharmacology at the Temple University School of Medicine, writes in ACSblog that Oklahoma's use of midazolam makes no sense from a scientific perspective:
Imagine a hospital administering a drug protocol devised without consideration of its scientific properties, selected by individuals without medical training. It's unthinkable, but in the state of Oklahoma, prison officials without any pharmaceutical or medical training selected a combination of drugs to cause death. They elected to use midazolam as the first drug in the state's three-drug lethal injection protocol despite the fact that there is overwhelming scientific consensus, including among pharmacologists like myself, that midazolam is incapable of inducing a deep, coma-like unconsciousness characteristic of general anesthesia and required for a humane and constitutional execution.Dr. Unterwald explains the science behind why midazolam, which has been used in several botched executions in the last year alone, was a poor choice:
Midazolam relaxes a patient, relieves anxiety, and induces drowsiness prior to the administration of a different drug that achieves the deep unconsciousness of anesthesia. But midazolam alone cannot produce and maintain general anesthesia, even at an excessive dose. The reason for this is referred to as the "ceiling effect" of the benzodiazepine response. As the dose of benzodiazepine increases, the biological response to the drug reaches a plateau or "ceiling" before general anesthesia can be obtained. Increasing the dose of the benzodiazepine beyond this plateau will not increase its effectiveness as an anesthetic agent.So what does this mean for the upcoming U.S. Supreme Court case Glossip v. Gross, a case challenging the use of midazolam in executions? Dr. Unterwald writes:
As a pharmacologist who studies drugs, I strongly believe the Supreme Court should prevent Oklahoma from using midazolam in lethal injection executions, and encourage states to base lethal injection protocols on all available scientific knowledge and research.