A Brief History of Pentobarbital Executions, as Ivan Cantu and Thomas Creech's Dates Loom
Chosen for convenience rather than effectiveness, the barbiturate hasn't changed much about lethal injection's record.
Ivan Cantu and Thomas Creech will almost certainly die tomorrow night.
Theoretically, either could receive any of multiple gestures of available to the states of Texas or Idaho, respectively, or the federal government, and each has filed a petition for a stay of execution, the finer points of which are described elsewhere much more fluently than I could.
With the post-Burger Court taking a dim view of procedural arguments against capital punishment like Creech’s, or even credible innocence claims like Cantu’s, however, it seems a near-certainty that both will die by lethal injection tomorrow1.
The two men share another macabre commonality: they will be put to death via a single-drug protocol using the barbiturate phenobarbital. What began as a blind-guess alternative to the suddenly unavailable “classic“ formula has become increasingly popular: seven of the 26 states performing lethal injections (not including South Carolina, which does not disclose its formula) use a single-drug pentobarbital protocol. As you might expect with prison wardens playing anesthesiologists or complicated pharmacology being decided by “well, what do you got,“ the results have not been pretty.
How Pentobarbital Came to the Death Penalty
When lethal injection was first conceived by Oklahoma state lawmaker Bill Wiseman and pathologist Jay Chapman, the formula consisted of a common surgical cocktail: sodium thiopental (to sedate) and pancuronium bromide (to paralyze the muscles and respiratory system), along with potassium chloride (to stop the heart and ensure death). In 2010, however, contamination problems at the North American manufacturing plants for thiopental manufacturer Hospira forced the company to produce the sedative elsewhere. Facing regulatory and activist pressure to stop complicity in executions, Hospira announced it would no longer sell thiopental in America, even for its legitimate medical uses.
States soon began scrambling for a substitute for thiopental, and pentobarbital was high on the list. Pentobarbital is, like thiopental, a barbiturate, and the drug was both cheaply available in America and generally well-understood, meaning the state could rely on compounding pharmacies as an end-around to bypass morally conflicted drug companies. Moreover, pentobarbital already had a good record in single-drug pet euthanasia, making single-drug protocols even more resilient against the shortages that were rocking the lethal injection world (Texas would ultimately move to a single-drug protocol after a shortage of pancuronium bromide).
How Pentobarbital Was Supposed to Work
As mentioned before, pentobarbital is a barbiturate, meaning that it works by acting on receptors for the neurotransmitter GABA, which inhibits neuronal and muscular action. Essentially, GABA puts you to sleep; barbiturates hold open the channels that allow for GABA transmission longer than normal. In an overdose, they also suppress the body’s response to elevated carbon dioxide, producing respiratory depression and, ultimately, death. Pentobarbital has the advantage over thiopental in that its duration of action—how long it works—is much longer (more than a day), though thiopental’s 30-minute duration should be enough for the states’ estimates of how long a lethal injection will take.2
How Pentobarbital Has Actually Worked
However well a drug might work in healthcare settings overseen by physicians, there’s no guarantee its success will transfer to an execution. Putting people to sleep involves the longest, most rigorous training in medicine and still goes wrong in more than 1% of cases; expecting only the expected when working with people who aren’t uniformly guaranteed even to be healthcare workers is a fool’s errand. And pentobarbital has been no exception.
There are inherent challenges in understanding just how often lethal injection goes wrong. Even when using single-drug protocols or multi-drug cocktails that don’t involve paralytics (which would mask reactions from the subject by, as the name suggests, paralyzing their body’s responses), sedatives by nature make it harder for those overdosed to express pain. However, anesthesiologist Joel Zivot found that in more than two-thirds of cases, autopsies of deaths by single-drug pentobarbital injection showed pulmonary edema, or a buildup of fluid in the lungs. Dr. Zivot characterized his findings as suggesting the condemned were essentially drowned to death.
We don’t always have to take the autopsies’ word for it. Multiple men executed by pentobarbital have spent the last moments of their life screaming about the burning throughout their body, a possible consequence of lax regulation surrounding compounding pharmacies and subsequent degraded or contaminated drugs.
Why None of This Matters
While Cantu and Creech maintain the dim hope that their factual and procedural claims, respectively, might win them a reprieve, there is little hope for them in challenging the single-drug method on Eighth Amendment grounds. The Supreme Court, in the words of John Roberts, “has never invalidated a State’s chosen procedure for carrying out a sentence of death as the infliction of cruel and unusual punishment.” Roberts wrote that as the plurality opinion in Baze v. Rees, a challenge to lethal injection; in the subsequent Glossip v. Gross, his conservative colleagues Samuel Alito and Antonin Scalia, considering Oklahoma’s infliction of the cruelest lethal injection protocol ever devised, decided the whole thing was the fault of activists waging a “guerilla war against the death penalty” by blocking access to the “100-percent sure drugs“ (even though the first-ever lethal injection showed the same problems).
Texas, for its part, is content to dismiss these objections as “speculation upon speculation,“ its prison officials apparently knowing better than some of the best physicians on earth. Thus passes yet another chapter in the sordid history of the quiet death.
Notwithstanding the possibility that either or both states try to perform a lethal injection and fail, as Alabama did three times in four years.
Lippincott’s Pharmcaology, 6th ed., 127-28
This is utterly sick and barbaric. I just can't 😔