Why death penalty states may have harder time finding lethal-injection drugs

States that administer the death penalty could face additional obstacles after two groups representing pharmacists told their members to stop providing drugs for use in lethal injection.

On Monday, the American Pharmacists Association voted to oppose participation in executions, stating that to help put a person to death violates the goals of the profession. The move comes just one week after the International Academy of Compounding Pharmacists adopted a similar position. 

“It’s never been legal in the US to write a prescription to execute a person," William Fassett, the board member and professor emeritus of pharmacotherapy at Washington State University, Spokane, who drafted the policy, told The Huffington Post. "The basic federal law is that a prescription is to be used for medical proposes in the context of an established patient-physician relationship."

While neither policy is legally binding, experts suspect that the measures will dissuade specialty pharmacists, who recently became the only source for lethal injections in many states, from selling their products for use in executions. Moreover, the decision was made with almost no opposition within the association, as the lethal-injection cocktails has become both unprofitable and unpopular.

Compounding pharmacies, which combine, mix, or alter drugs to meet the needs of a patient with a specific prescription, only recently became involved in the execution-drug business.

For decades, pharmaceutical manufacturers sold the drugs used in lethal-injection cocktails directly to state officials. But in 2011, under pressure from anti-death penalty activists in the United States and abroad, the companies stopped selling their goods to correctional systems. That same year, the European Union instituted an export ban on lethal-injection drugs. It was then that the states turned to compounding pharmacies for the special orders.

But the cocktails produced by the compounding pharmacies are not approved by the US Food and Drug Administration, and critics have expressed doubts about the quality of the drugs. The Supreme Court is expected in April to hear arguments in a case weighing whether one drug used in used in Oklahoma executions violates the Eighth Amendment prohibition against cruel and usual punishment. Three states – Georgia, Alabama, and Ohio – have issued temporary moratoriums on executions this year.

Protesters also have targeted compounding pharmacies known to supply drugs for executions. As a result, several pharmacies have decided not to sell the drugs to prisons.

"Executions are bad for business for compounding pharmacies for the same reason they were bad for business for the pharmaceutical companies,” Corinna Lain, professor at the Richmond School of Law, told NBC News.

"The cost of these drugs has skyrocketed from something like $83 a vial to $1,200 to $1,500 a vial. But that's still a drop in the bucket for a pharmacy's total sales. And look at the downside – the negative publicity is tremendous,” Professor Lain said.

The attention from activists eventually led to the adoption of the new policy, observers say. Last year, after members of the activist group SumofUs.org noticed that pharmacists were not prohibited from participating in executions by professional oaths or organizations, they decided to lobby, the Huffington Post reported.

The organization partnered with Amnesty International, the NAACP, the National Council of Churches, and other groups to send a letter co-signed by 31 human rights organizations and religious denominations to the pharmacists' association, requesting that it take a stand against pharmacists participating in executions.

"The question about whether pharmacists should be involved in executions is a very recent one," Kelsey Kauffman, a senior adviser at the activist group SumofUs.org, told The Huffington Post. "The [American Medical Association] and nurses associations have had to deal with it for decades."

Doctors and anesthesiologists have long had national associations with ethics codes that restrict credentialed members from participating in executions. Now, the pharmacists have decided to join their ranks.

The American Pharmacists Association has more than 62,000 members, and its policies set the ethnical standards of its members.

"Now there is unanimity among all health professions in the United States who represent anybody who might be asked to be involved in this process," the American Pharmacists Association's Fassett told the Associated Press.

Several states have approved alternatives to lethal injection, such as the electric chair and the firing squad, as lethal-injection drugs became more difficult to acquire.