More GDC Drug Problems

Posted in The Death Penalty by chamblee54 on August 3, 2012

We have more information today about why Georgia is going to a one drug, intentional overdose protocol, for execution of prisoners. It seems like the second drug of the procedure, pancuronium bromide, is in short supply. Georgia’s stash expired July 1.

The traditional method for poisoning prisoners involved three drugs. Sodium thiopental (later pentobarbital) was used as a sedative. Pancuronium bromide, or Pavulon, was used to paralyze the muscles. Potassium chloride tells the heart to stop beating, and is the actual cause of death.

“Richard Dieter of the Washington-based Death Penalty Information Center said a paralyzing drug like pancuronium bromide is used because it “freezes the muscles. But it’s more for the sake of those viewing executions, that it not appear to be disruptive, violent or painful in any way.”

When the Department of Corrections learned about the Pavulon problem, they decided to go to an overdose of pentobarbital. The lawyers got busy, and the execution of Warren Hill was delayed, until the courts could take a look at things.

Amnesty International has a fine article on the subject. Here are a few quotes.

Pancuronium bromide paralyzes the skeletal muscles but does not affect the brain or nerves. A person injected with it remains conscious but cannot move or speak. In Tennessee and about 30 other states, the chemical is used in combination with two others. The other chemicals can either ease or exacerbate the suffering the pancuronium bromide causes, depending on the dosages and the expertise of the prison personnel who administer them.

A judge here recently found that pancuronium bromide, marketed under the trade name Pavulon, has “no legitimate purpose.” “The subject gives all the appearances of a serene expiration when actually the subject is feeling and perceiving the excruciatingly painful ordeal of death by lethal injection,” the judge, Ellen Hobbs Lyle, wrote, describing the worst-case scenario. “The Pavulon gives a false impression of serenity to viewers, making punishment by death more palatable and acceptable.”

A simpler and more humane alternative to the three-chemical combination, many experts agree, is a method used in animal euthanasia: a single lethal dose of a barbiturate called sodium pentobarbital.

Dr. Sherwin B. Nuland, who teaches medicine at Yale and wrote “How We Die” (Knopf, 1994) said he was baffled to hear that pancuronium bromide was used in executions. “It strikes me that it makes no sense to use a muscle relaxant in executing people,” he said. “Complete muscle paralysis does not mean loss of pain sensation.” Dr. Nuland, who described himself as a cautious supporter of the death penalty, said a humane death could be achieved in other ways, including by using the other two chemicals in the standard method, without the pancuronium bromide. …

The American Veterinary Medical Association condemns pancuronium bromide when it is the sole chemical used or when it is used in combination with the usual animal euthanasia drug, sodium pentobarbital. That is because, an association report in 2000 said, “the animal may perceive pain and distress after it is immobilized.” … In 2001, it became a crime for veterinarians in Tennessee to use one of the chemicals in that standard method to euthanize pets.

A Tennessee challenge to the use of Pavulon was brought by lawyers for Abu-Ali Abdur’Rahman. “The state’s legal papers also argued that the ban on pancuronium bromide in pet euthanasia does not apply to Mr. Abdur’Rahman because he is not a “nonlivestock animal,” which the law says includes pets, captured wildlife, exotic and domesticated animals, rabbits, chicks, ducks and potbellied pigs.”

The reason for pancuronium bromide in the standard lethal injection method is not well understood. Judge Lyle found that Tennessee’s method “was developed simply by copying the same method used in some 30 other states.” … The earliest protocol, in Oklahoma, was based on advice solicited by a state senator from a professor in the state’s medical school. The professor, Stanley Deutsch, recommended an ultra-short-acting barbituate and a neuromuscular blocking drug like pancuronium bromide. “I can assure you that this is a rapid, pleasant way of producing unconsciousness,” Dr. Deutsch wrote in 1977. In a recent interview, Dr. Deutsch stood by his initial finding, saying his method does not cause suffering. “They use such a massive amount of the penthothal that I don’t think there is any chance that people will awaken,” he said. Other states, typically acting through their corrections departments and individual prison wardens, apparently copied Dr. Deutsch’s advice without subjecting it to independent medical scrutiny.

Pavulon is “a neuromuscular blocking agent that goes by the technical name pancuronium bromide (Pavulon ), which is curare-derived. (Curare was used on the tips of blowdarts to paralyze victims in the jungles of South America.) ”

Finding the manufacturer , and supplier, used by the State of Georgia is a challenge. It is not known why there is a shortage of this drug.

Pictures are from The Library of Congress.

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