What We Don’t Know About Lethal Injection Drugs

Drug doses and suppliers are sometimes kept secret, experts say.

— -- The prolonged execution of Joseph Wood has spotlighted the secrecy surrounding drugs used for lethal injection.

Inmate Dies 2 Hours After Execution Began in Arizona

Family of Victims Shows No Sympathy at Killer's Execution

Arizona Asks Top Court to Reverse Execution Ruling

"It's fair to say that those are drugs that would not expeditiously achieve [death]," Dr. Daniel Nyhan, a professor and interim director at the anesthesiology department at Johns Hopkins medical school, told the Associated Press.

Even in high doses, the lethality of midazolam and hydromorphone is uncertain, according to Dr. David Waisel, an anesthesiologist at Boston Children’s Hospital.

“One thing we know is that twice as much medication doesn’t mean twice the effect,” said Waisel, who has testified about the pitfalls of new lethal injection drugs in other death penalty cases. “Because we do not study and do not have clinical experience with these extraordinarily high doses, we do not know the effects of these doses.”

While anesthesiologists are the experts on the drugs used in lethal injections, they risk losing their certification if they consult or participate in an execution, according to a 2010 notice from the American Board of Anesthesiologists.

Charles Ryan, the director of the Arizona Department of Corrections, said a licensed physician was part of the team administering the drugs in Wood’s execution. But the doctor’s identity and specialty have not been disclosed.

Megan McCracken, a lawyer at the University of California, Berkeley, Law School’s Death Penalty Clinic, said 13 states have passed laws, introduced legislation or gone to court to keep aspects of the lethal injection process, including the sources of drugs, confidential. Arizona is one of them, she said.

“We’re well past the time where we can say that Mr. Wood’s execution was a wake-up call,” Mccracken said. “A court must start ordering the department of corrections to disclose relevant information.”

The U.S. Food and Drug Administration – the agency tasked with assuring the safety of drugs used in medical treatments – “does not approve drugs for use in lethal injection settings,” according to a spokeswoman.

Some drugs used in lethal injections are only available through compounding pharmacies that customize medications by mixing FDA-approved drugs, but aren’t regulated by the FDA. Waisel said the lack of oversight opens the door to drugs that aren’t as strong or effective as they should be.

McCracken said the source of drugs used in an execution – whether it’s a drug manufacturer or a compounding pharmacy – and the credentials of the people administering the drugs should be made public.

Ryan of the Arizona Department of Corrections denied in a statement that Wood’s execution was “botched,” explaining that Wood was deeply sedated and that his vein did not burst. But McCracken disagreed.

“It’s impossible to say that Mr. Wood’s execution proceeded as planned,” she said. “It took him two hours to die.”

The Associated Press contributed to this story.