From curing insomnia to executing death row in the United States

Midazolam, a sedative alternative to the famous Diazepam or Valium, has ended up having a use not intended by its creator: helping to contribute to the death penalty.

During the 1970s, the chemist Armin Waiser and his colleagues managed to invent an alternative that is more powerful than the famous Diazepam (better known by its brand name Valium), and very useful for use as an intravenous sedative: Midazolam. Unfortunately, Waiser’s invention has ended up having a use for nothing foreseen by its creator; And it is that today Midazolam is one of the essential components to carry out executions under death penalty in the United States According to the newspaper The New York Times, Midazolam has already been used in up to 20 injections lethal throughout the North American country, despite the fact that initially Dr. Waiser and his team wanted its use to be restricted to sedation in procedures such as colonoscopies or cardiac catheterizations, among others. Spain This drug is widely used for its sedative powers and its security, as long as the doses are managed well. As with the entire group of drugs called “benzodiazepines”, there are risk tolerance, dependence and respiratory failure if the dose is not properly administered.

Arkansas and the Midazolam controversy

The controversy about Midazolam is not new, in fact although its patent came a few years after its invention by Waiser, and that even in 2011 the World Health Organization added it to its list of “Essential Medicines” , Midazolam has been used together with other medications in lethal injections since 2009 when the state of Ohio adopted this drug as part of its execution protocol, with the aim that it would serve precisely as a sedative and reduce the sensation of pain during the execution. Subsequently, other drugs are administered with the aim of stopping breathing and pumping of the heart. Later, other states jumped on the bandwagon and began to use Midazolam in their execution protocols as well. In 2013 it was Florida who added this drug to its protocol, being the first state to carry out an execution with this drug. Arkansas who has set off the controversy, as he intends to execute eight of his inmates in just 10 days during the next month of April. The reason? Your stock of Midazolam is about to expire, and the manufacturers of this drug have refused to continue to sell this drug for use in lethal injections. For this reason, Arkansas intends to advance all possible executions, despite the fact that the last time a lethal injection was used in this state was in November 2005.

Why Midazolam May Fail A Lethal Injection

Although Midazolam has been shown to be a powerful, safe and effective benzodiazepine in terms of its use as a sedative, critics of the death penalty claim that there are risks of unconstitutionally painful executionsSince there have already been cases – in Arkansas, Virginia and other states for example – where this drug has not had all the effect that was expected. As it is produced with other drugs of this type -diazepam for example-, in some cases the doses have to be adjusted depending on whether a person has previously taken benzodiazepines, as there may be tolerance. In these cases, Midazolam would fail, without completely sedating an individual as intended in lethal injections.

In fact, according to The New York Times, there is even a case -the execution of Joseph R. Wood III-, where they were necessary up to 15 doses of midazolam and a pain reliever, for almost two hours, to carry out a lethal injection. However, an external report commissioned by the Arizona Department of Corrections found no flaws in Mr. Wood’s procedure, concluding that the sedation was correct and the convict suffered no pain. But, despite that, Arizona agreed never to use Midazolam or any other benzodiazepines again. in their lethal injection protocols.

Pharmaceutical companies against the use of Midazolam in the death penalty

Additionally, Arizona announced in December 2015 that its stockpiles of Midazolam had expired, and the pharmaceuticalthey are reluctant to sell this drug for it to be used in lethal injections: “Medications should be used to heal and help people, not to kill them,” says Dale A. Baich, Phoenix federal defender and witness to Mr. Woods’ execution.

For the moment, the Supreme Court of the United States has refused to hear cases from Alabama and Arkansas where Midazolam was included in its execution protocols, something that has reinforced the critics with the use of this drug for those procedures.

For their part, some defenders of the death penalty they continue to defend the use of lethal injection and any kind of pain in violent offenders who must receive it. Likewise, on the other hand, other defenders of this practice recognize that Midazolam is not the ideal drug to be used as a sedative in executions, and that other options should be sought, although they believe that abolitionists are to blame for the lack of other drugs , like barbiturates, and that is why the various states of the country have begun to use benzodiazepines.

Be that as it may, the creator of the drug, Dr. Waiser, was not aware of the use that was being given to his invention until a reporter from Oklahoma told him last year 2015. Waiser does not feel well about this use, but he admits that doctors can do whatever they want with this drug.