Fentanyl executions pose public health risk – campaigner

The state of Nebraska’s decision to use fentanyl in an execution by lethal injection could worsen the opioid public health crisis, a human rights organisation has warned.

Human rights charity Reprieve said that aside from the ethical issues surrounding the lethal injection as a means of capital punishment, there are also concerns that use of the synthetic opioid fentanyl in the injection could indirectly contribute to the opioid crisis in the US.

Pharma companies such as Fresenius Kabi, and several generics companies, have publicly opposed use of their medicines in lethal injections, and taken steps to ensure that their supply chains are secured so that prisons cannot buy them for unlicensed uses.

In the execution of Carey Dean Moore, Nebraska used an experimental lethal injection cocktail as the drugs favoured in the established recipe are harder to come by because of the actions of pharma companies.

The four-drug cocktail contained the tranquiliser diazepam, fentanyl citrate, the muscle relaxant cisatracurium besylate, and potassium chloride, to stop the heart.

But Reprieve’s director Maya Foa argued in an interview with pharmaphorum that the actions of the state could mean that dangerous drugs like fentanyl could get into the wrong hands and worsen the problems already experienced with opioids in the US.

Fentanyl is already implicated in around 90-100 deaths per day, Foa noted, adding that the state has not yet revealed how it acquired the fentanyl used in the execution of Moore.

Maya Foa
Maya Foa

Describing the actions of Nebraska as “reckless”, Foa told pharmaphorum: “They create a state-sanctioned black market for drugs of abuse.”

“Once you establish an illicit supply chain there is no visibility. How can we know what is passing through?”

Nebraska has opted to reinstate the death penalty following a referendum led by governor Pete Ricketts after state lawmakers decided to repeal it in 2015.

Capital punishment has been restored in Nebraska following a referendum funded by Ricketts, and Moore, who was convicted of murder, was the state’s first execution in 21 years and the first by lethal injection.

Foa cited the example of Oklahoma, which is keeping the death penalty but abandoning the lethal injection, opting instead to use nitrogen hypoxia as a method of execution. Alabama and Mississippi have also authorised use of nitrogen asphyxiation as a method of execution.

pharmaphorum has contacted governor Ricketts’ office for comment.

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