The Missouri Department of Corrections said Tuesday that it is switching to the drug pentobarbital for lethal injections, and that it has an agreement with an unidentified “compounding pharmacy” to supply it. The decision comes less than two weeks after the governor halted executions until the state could find a replacement for the anesthetic propofol, which some drug makers do not want used to carry out the death penalty.
Compounding pharmacies process ingredients to fit the needs of individual patients and are regulated by individual states – not the stricter Food and Drug Administration, which regulates drug manufacturers.
One such pharmacy, the New England Compounding Center, made headlines last year when a fungal meningitis outbreak in Massachusetts was linked to it. The contaminated drugs were distributed to medical facilities in 23 states and killed 48 people. More than 700 others were treated for fungal infections.
Missouri turned to a new drug supplier in response to pressure from drug makers, especially in the European Union, not to carry out executions using the propofol they make. The state said earlier this month it was returning a supply of propofol to a U.S. distributor of the drug, after the European manufacturer suspended shipments to the United States to protest its use in executions.
Death Penalty Information Center director Richard Dieter said 13 states use pentobarbital for executions. He said every execution but one over the past two years in the U.S. used the drug.
Elizabeth Carlyle, a Kansas City attorney who represents several death row inmates, said the new protocol involving compounding pharmacies "is certainly something we have some concerns about, but I can't say much more than that until we've had a chance to talk to our experts and look into it some more."
Texas and Ohio area among other states that have turned to compounding pharmacies to prepare new batches of pentobarbital after large drug manufacturers balked.
For executions, Dieter said compounding pharmacies "work with the raw ingredients and are able to put together single dosages" of pentobarbital. Drugs manufactured by compounding pharmacies are not regulated by the FDA, raising questions among death penalty opponents and public health watchdogs.
"It's critical that the dosage be potent and pure," Dieter said. "You don't want ... a very lengthy process."
Compounding pharmacies also risk public backlash once their identities are revealed. A suburban Houston compounding pharmacy that supplied a special batch of pentobarbital to the Texas prison where an inmate was executed this month asked to have the drug returned after complaining about hate mail and negative publicity.
"Why should compounders be forced to now play henchman to the ever-hungry executioner," Maya Foa, director of Reprieve’s death penalty team, said in an email to Al Jazeera. "Good compounders want to improve the lives and health of patients; they don't wish to be mired in execution drug controversies, forced to mix drugs to kill prisoners in dangerous and experimental executions."
Missouri Gov. Jay Nixon on Oct. 11 halted the execution of Allen Nicklasson, convicted of the 1994 killing of Excelsior Springs businessman Richard Drummond, in part because the European Union was weighing export limits on propofol if it was used in a lethal injection. Propofol is a widely used anesthetic and is mostly made in Europe.
It was not clear if or when a new execution date would be set for Nicklasson, but the execution of Joseph Franklin on Nov. 20 is still on in Missouri, Tuesday’s news release from the Department of Corrections said. Franklin was convicted of killing Gerald Gordon in 1977 as a crowd dispersed from a bar mitzvah in suburban St. Louis. Two others were wounded. When he confessed 17 years later, Franklin was serving several life sentences in a federal prison for killing two black joggers in Salt Lake City and an interracial couple in Madison, Wis., and bombing a synagogue in Chattanooga, Tenn.
"Executioners everywhere need to learn that responsible pharma firms and pharmacies do not want to be involved in the death penalty," said Foa of Reprieve.
Ehab Zahriyeh contributed to this report. Al Jazeera and wire services