On 15 October, after running out of pentobarbital, Florida executed William Happ using midazolam as the sedative. But midazolam, which is similar to diazepam (Valium), had never been used in an execution, and, according to media reports, Happ was still blinking and moving his head minutes after the injection.
Nobody knows whether midazolam is appropriate for lethal injections, says Lubarsky. “We’ve turned this into a circus of experimenting on prisoners,” he says. “The state is playing doctor without any regard for efficacy. It changes protocols willy-nilly.” The drug is not a good anesthetic, he says, and it may not shield prisoners from the pain of the final injection.
Although midazolam has now entered the realm of capital punishment, it is unlikely that surgical supplies will be affected. Hospira is one of many companies that makes midazolam and has no plans to stop, says Dan Rosenberg, a company spokesman. Rosenberg would not say where Hospira makes midazolam, but he says that European regulations “aren’t an issue”.
Meanwhile, Missouri has suspended another execution, scheduled for 20 November, while it tries to find an alternative to propofol. Lubarsky notes that although a single, large dose of propofol could work as a method of execution, its use in US prisons would be problematic because it could be complex to administer and physicians are generally not willing to participate in the process (see Nature 441, 8–9; 2006). “Putting together a foolproof protocol that could be carried out by prison guards with high-school educations is another matter entirely,” he says.