Industry statements and action on execution drugs
Over thirty global healthcare companies have now taken steps to prevent their medicines being misused in lethal injection executions across the USA. At the same time, a number of industry bodies representing the pharmaceutical and pharmacy sectors have spoken out against the diversion of medicines to death row for use in capital punishment.
Below is a collection of public statements made on this subject by manufacturers, distributors, industry associations, and professional representative bodies.
December 2017: “Custopharm Inc. (dba Leucadia Pharmaceuticals) is dedicated to improving the outcomes of patients treated by doctors, nurses, pharmacists and other healthcare professionals throughout the United States by supplying needed pharmaceutical products. To help ensure that our products are not used in capital punishment, Custopharm, Inc. is implementing appropriate distribution controls and other necessary measures. These include not accepting orders from correctional facilities and prison systems for products believed to be part of lethal injection protocols and asking our distributors and wholesalers to make commitments to not sell or distribute any such products to these facilities.”
November 2017: “We buy pharmaceuticals directly from manufacturers, and we adhere to their restrictions on the distribution of their products, including those that prohibit the sale of certain products to correctional facilities. We routinely audit our compliance with manufacturer contracts and policies. In this case, we had no reason to believe that these restrictions had been violated.”
Read more from the Washington Post here.
November 2017: “AbbVie’s mission is to address the world’s toughest health challenges. We focus on discovering, developing and delivering medicines where we have proven expertise. We strive to make a remarkable impact on the lives of patients. These principles are reflected in our company’s core values. As such, AbbVie strongly objects to any potential use of our products in lethal injection protocols for capital punishment.
We are committed to ensuring our products remain accessible to healthcare providers and patients who depend on them.”
November 2017: ”Athenex is dedicated to improving the health and well-being of patients by supplying an extensive portfolio of injectable pharmaceutical products. Athenex does not want any of our products used in capital punishment. Since inception of marketing these products, Athenex implemented appropriate distribution controls and other measures with our wholesaler partners to prevent our products being used in capital punishment. Athenex does not accept orders from correctional facilities and prison systems for products believed to be part of certain states’ lethal injection protocols. Further, Athenex distributors and wholesalers have agreements with Athenex not to sell or distribute any such products to these facilities. Athenex does not distribute these products through wholesalers unwilling to implement distribution control to prevent capital punishment.”
Click here to read Athenex’s statement published on their company website.
September 2017: “Jiangsui Hengrui is opposed to the misuse of medicines in executions.” – Correspondence with Reprieve
Johnson & Johnson (USA)
August 2017: “At Janssen, we are dedicated to preventing, intercepting, treating and curing some of the most devastating and complex diseases of our time. For nearly 60 years, Janssen scientists have devoted their lives to discovering and developing life-enhancing and life-saving medicines, and we continue that work today.
“Etomidate is a widely used intravenous anesthetic agent used in hospitals. It was discovered by Janssen scientists in the 1960s, and it is now off patent and distributed as a generic product by a number of companies worldwide.We do not distribute etomidate in North America, and in 2016 we divested the product in the rest of the world for strategic business reasons.
“Janssen discovers and develops medical innovations to save and enhance lives. We do not support the use of our medicines for indications that have not been approved by regulatory authorities, such as the US FDA. We do not condone the use of our medicines in lethal injections for capital punishment.”
Association for Accessible Medicines (USA)
The AAM represents manufacturers of generic medicines in the United States.
On 22 August 2017 a representative told CNBC it “opposes the use of members’ products in capital punishment.”
July 2017: “AuroMedics Pharma LLC is committed to improving the lives of patients treated by healthcare professionals throughout the United States. In order to help make certain that patients have access to our products for their intended uses while ensuring our products are not used in capital punishment, AuroMedics Pharma LLC has implemented distribution controls. In particular, AuroMedics Pharma LLC will not accept orders from correctional facilities and prison systems who intend to use products for lethal injection. AuroMedics Pharma LLC will also request distributors and wholesalers not to sell or distribute these products to facilities which are believed to be using them for lethal injection.”
May 2017: “Baxter is a healthcare company with a stated mission to save and sustain lives. For more than 85 years, we have offered products and therapies that advance patient care. To that end, Baxter has repeatedly expressed its longstanding opposition to the potential use of any of its products in lethal injection protocols for capital punishment, where such use is clearly outside of approved labeling and medical standards of care and directly conflicts with our corporate mission.
Our customer contracts prohibit the use, resale or distribution of our products for capital punishment, while helping to ensure our medically necessary products remain available to clinicians to save and sustain patient lives.”
April 2017: “Lilly does not supply our medicines for use in lethal injections, and we have not engaged on the issue with state legislators.”
2017: “McKesson has contractual arrangements with some manufacturers that restrict the sale of certain medicines to certain customers, such as prison systems and others, for lethal injections. McKesson is committed to helping manufacturers implement their policies in this area. The needs and requirements of manufacturers vary; therefore, our contractual commitments, controls and processes also vary by manufacturer. McKesson has processes and systems to enable manufacturers to validate McKesson’s performance against our contractual arrangements.”
May 2013: “Hikma strongly objects to the use of any of its products in capital punishment. The Company is putting in place concrete steps to restrict the supply of its products for unintended uses. It has ceased the direct sale of injectable phenobarbital to US departments of corrections and will work directly with its distribution partners to add restrictions for unintended use to its distribution contracts.”
October 2016: “Hikma aims to improve lives by providing patients with access to high quality, affordable medicines. Our medicines are used thousands of times a day around the world to treat illness and save lives. We strongly object to the use of any of our products in capital punishment as it is inconsistent with our values and mission of improving lives and contrary to the intended label use for the products.
In order to safeguard Phenobarbital Sodium, Midazolam Hydrochloride and Hydromorphone Hydrochloride injection products from being used in lethal injection protocols, we have instituted several controls, including specific provisions in our template agreements and additional written assurances from certain purchasers that products will be used for medicinal, patient care not penal purposes.
We vigorously monitor the distribution of these products and support industry serialization efforts that will help enhance these controls while continuing to promote our values and mission.”
“West-Ward Pharmaceuticals, and our parent company Hikma, aims to improve lives by providing patients with access to high quality, affordable medicines. Our medicines are used thousands of times a day around the world to treat illness and save lives.
We object in the strongest possible terms to the use of any of our products for the purpose of capital punishment. Not only is it contrary to the intended label use(s) for the products, but it is also inconsistent with our values and mission of improving lives by providing quality, affordable healthcare to patients.
While none of our products should ever be used for the purpose of capital punishment, in the table below, we have identified certain products that carry heightened risk of misuse for lethal injection protocols. Accordingly, to prevent these products from being used for the purpose of capital punishment, we will not accept orders for these products directly from any Departments of Correction or correctional facilities in the United States, unless accompanied by an original, raised seal copy of an affidavit signed by the state attorney general (or governor), certifying under penalty of perjury that the product(s) will not be used for capital punishment. Further, we will only sell these same drugs to pre-selected commercial customers who agree that they will not then sell them to Departments of Corrections/correctional facilities, or to secondary distributors or retail pharmacies.
We vigorously monitor the distribution of these products and support industry serialization efforts that will help enhance these controls while continuing to promote our values and mission.”
May 2016: “Pfizer makes its products to enhance and save the lives of the patients we serve. Consistent with these values, Pfizer strongly objects to the use of its products as lethal injections for capital punishment.
“Pfizer’s obligation is to ensure the availability of our products to patients who rely on them for medically necessary purposes. At the same time, we are enforcing a distribution restriction for specific products that have been part of, or considered by some states for their lethal injection protocols. These products include pancuronium bromide, potassium chloride, propofol, midazolam, hydromorphone, rocuronium bromide and vecuronium bromide.
“Pfizer’s distribution restriction limits the sale of these seven products to a select group of wholesalers, distributors, and direct purchasers under the condition that they will not resell these products to correctional institutions for use in lethal injections. Government purchasing entities must certify that products they purchase or otherwise acquire are used only for medically prescribed patient care and not for any penal purposes. Pfizer further requires that these Government purchasers certify that the product is for “own use” and will not resell or otherwise provide the restricted products to any other party.”
“Pfizer’s Position on Use of Our Products in Lethal Injections for Capital Punishment Pfizer’s mission is to apply science and our global resources to improve health and well-being at every stage of life. We strive to set the standard for quality, safety and value in the discovery, development and manufacturing of medicines. Pfizer makes its products to enhance and save the lives of the patients we serve. Consistent with these values, Pfizer strongly objects to the use of its products as lethal injections for capital punishment.
Pfizer’s obligation is to ensure the availability of our products to patients who rely on them for medically necessary purposes. At the same time, we are enforcing a distribution restriction for specific products in the same class of drugs that have been part of, or could be considered by some states, for their lethal injection protocols. These products include atracurium besylate, etomidate, hydromorphone, midazolam, pancuronium bromide, potassium acetate, potassium chloride, potassium phosphates, propofol, rocuronium bromide and vecuronium bromide.
Pfizer’s distribution restriction limits the sale of these eleven products to a select group of wholesalers, distributors, and direct purchasers under the condition that they will not resell these products to correctional institutions for use in lethal injections. Government purchasing entities must certify that products they purchase or otherwise acquire are used only for medically prescribed patient care and not for any penal purposes. Pfizer further requires that these Government purchasers certify that the product is for “own use” and will not resell or otherwise provide the restricted products to any other party.
Pfizer will consistently monitor the distribution of these eleven products, act upon findings that reveal noncompliance, and modify policies when necessary to remain consistent with our stated position against the use of our products in lethal injections. Importantly, this distribution system is also designed to ensure that these critical medications will remain immediately available to those patients who rely on them every day.”
October 2015: “It is important to note that rocuronium bromide is not approved for, labeled for, or marketed for use in lethal injections. Mylan does not distribute this product to prisons, nor does the company condone its product being distributed by any third party for use outside of the approved labeling or applicable standards of care.
“Recently Mylan received information indicating that a department of corrections in the U.S. purchased Mylan’s rocuronium bromide product from a wholesaler for possible use outside of the labeling or applicable standard of care. Mylan takes very seriously the possibility its product may have been diverted for a use that is inconsistent with its approved labeling or applicable standards of care. As such, Mylan conducted its own investigation into the matter and took direct action by sending several letters to the department of corrections seeking prompt assurances that it has not purchased any Mylan product for use outside the bounds of its approved therapeutic purpose, approved labeling and applicable standards of care. When Mylan received no response to its inquiries and therefore was unable to ensure appropriate use of its product, Mylan took further action by demanding the return of the Mylan product.
“Mylan is taking steps to prevent similar future issues. Specifically, Mylan is contractually restricting its distributors from distributing Mylan products, including rocuronium bromide, for use in lethal injection or for any other use outside of the approved labeling or applicable standards of care”.
“Mylan is committed to setting new standards in healthcare and providing access to more affordable medicines for the world’s 7 billion people. We are dedicated to upholding the highest standards of quality and integrity in everything we do.
Mylan only distributes its products through legally compliant channels. All of its products are intended for prescription by healthcare providers consistent with approved labeling and applicable medical standards of care.
No Mylan products are approved for, labeled for, or marketed for use in lethal injections. Mylan does not distribute products that could be so used to prisons, nor does the company condone its products being distributed by any third party for use outside of the approved labeling or applicable standards of care. Mylan has taken steps to prevent the misuse of its products. Specifically, Mylan has implemented restricted distribution protocols for certain products to help preclude their unauthorized use for capital punishment.
Our distribution restrictions limit the sale of such products to a select group of direct customers and prohibit their resale to correctional facilities for use in lethal injections or to any other unauthorized purchasers. Customers have been informed that if they do not comply with these restrictions, Mylan will no longer supply them with these products. Mylan takes this matter seriously and will continue to work with distributors and other interested parties to ensure that its products are used appropriately.”
October 2015: “Gland makes its products to enhance and save the lives of patients worldwide. Drugs such as Rocuronium bromide are relied upon by doctors and patients as a muscle relaxant during surgery. Gland does not support the use of any of its products for the purpose of capital punishment”
Becton, Dickinson and Company
September 2015: “BD Rx has specifically elected to focus on acute care settings for the use of our products. All of our distributor partners had previously received formal notification on behalf of BD Rx that our products are not intended for use in US prisons including state and federal penitentiaries. BD Rx is committed to ensuring the proper use of our products, to improving injectable drug delivery and helping to manage medication error risk for patients, hospitals, nurses and pharmacists”.
October 2017: “All of our distributor partners have previously received formal notification … that our products are not intended for use in U.S. prisons including state and federal penitentiaries,”
American Pharmacists Association (APhA)
March 2015: “The American Pharmacists Association discourages pharmacist participation in executions on the basis that such activities are fundamentally contrary to the role of pharmacists as providers of healthcare.
- APhA opposes the use of the term “drug” for chemicals when used in lethal injections.
- APhA opposes laws and regulations which mandate or prohibit the participation of pharmacists in the process of execution by lethal injection.”
International Academy of Compounding Pharmacists (IACP)
March 2015: “While the pharmacy profession recognizes an individual practitioner’s right to determine whether to dispense a medication based upon his or her personal, ethical and religious beliefs, IACP discourages its members from participating in the preparation, dispensing, or distribution of compounded medications for use in legally authorized executions.
“The issue of compounded preparations being used in the execution of prisoners sentenced to capital punishment continues to be a topic of significant interest. It is important to first understand the origin of this issue: states are turning to compounded preparations for this purpose because the companies that manufacture the products traditionally used have unilaterally decided to stop selling them for use in executions…
“Pharmacy, and compounding in particular, is a profession of healing and care that is focused on individual patients and providing the best and most appropriate medications at all times”.
March 2015: “The use of midazolam and/or hydromorphone for lethal injection is clearly contradictory to the FDA approved indications for both products and – as controlled substances – the procurement or use ofthese products for executions may be in violation of the Controlled Substances Act. Additionally, such use is contrary to Akorn’s commitment to promote the health and wellness of human patients.
“Akorn strongly objects to the use of its products in capital punishment. To align with industry standards and to prevent midazolam and hydromorphone from being used for purposes outside FDA approved indications, Akom will not accept direct orders from departments of correction for any product and we plan to implement additional distribution controls on midazolam and hydromorphone products in the near future. To reduce the possibility that Akorn midazolam and hydromorphone vials reach correctional facilities for use outside their labeled indications, these distributors will not sell these products directly to departments of correction or secondary distributors and distributors will use their best efforts in other distribution channels to keep the products out of prison systems”.
March 2015: “The employees of Akorn are committed to furthering human health and wellness through our vast portfolio of products. In the interest of promoting these values, Akorn strongly objects to the use of its products to conduct or support capital punishment through lethal injection or other means. To prevent the use of our products in capital punishment, Akorn will not sell any product directly to any prison or other correctional institution and we will restrict the sale of known components of lethal injection protocols to a select group of wholesalers who agree to use their best efforts to keep these products out of correctional institutions.
Akorn has dispatched a letter to the attorneys general and heads of departments of correction of the states that currently execute inmates or have prisoners on death row along with the United States Attorney General, the United States Secretary of Defense, the Director of the Federal Bureau of Prisons and the Chairman of the Department of Defense Corrections Council reiterating the company’s policy on the appropriate use of its products. In addition, Akorn is seeking the return of any the company’s products that may have been inappropriately purchased to aid in the execution process.”
Roche Pharma (Switzerland)
January, 2015: “Roche is aware of the use of the benzodiazepine midazolam as part of a drug combination for executions under the death penalty in the U.S. Roche did not supply midazolam for death penalty use and would not knowingly provide any of our medicines for this purpose. We support a worldwide ban on the death penalty.”
“Off Label Use of Midazolam Roche is aware of the use of the benzodiazepine midazolam as part of a drug combination used for executions under the death penalty in the U.S.
Roche did and does not supply Midazolam for use under the death penalty and would not knowingly provide any of our medicines for this purpose. Roche’s focus is on developing innovative medicines and diagnostic tests that help patients live longer, better lives.
Roche discovered Midazolam in the 1970s as a treatment for acute seizures, moderate to severe insomnia, and for inducing sedation and amnesia before medical procedures. In 2004, Roche discontinued the manufacture and distribution of Midazolam in the U.S. for business reasons during a reevaluation of our product portfolio of medicines that are now available from generic manufacturers.”
May 2014: “Brevital is a medically important anesthetic that physicians and hospital pharmacies have relied upon for more than 50 years. The state of Indiana’s proposed use of Brevital is inconsistent with its medical indications as outlined in its U.S. Food and Drug Administration reviewed and approved product labelling. Brevital® is intended to be used as an anesthetic in life-sustaining procedures. As a pharmaceutical company, Par’s mission is to help improve the quality of life. The state of Indiana’s proposed use is contrary to our mission. Par is working with its distribution partners to establish distribution controls on Brevital® to preclude wholesalers from accepting orders from departments of correction”.
May 2014: Tamarang publically opposes any medication supplied for use in capital punishment. […] Despite the complexities of the supply chain and the USA market Tamarang will take additional measures to ensure that the supply chain is transparent so that it is known with certainty where the product and been delivered, with the prohibition to supply to penitentiary hospitals in the USA.
– Extract from letter held on file at Reprieve
Sagent/ Sagent (USA)
March 2014:“Sagent is dedicated to improving the outcomes of patients treated by doctors, nurses, pharmacists and other healthcare professionals throughout the United States by supplying an extensive portfolio of injectable pharmaceutical products. In order to help ensure that patients have access to our products for use in accordance with the products’ labels but to ensure our products are not used in capital punishment, Sagent is implementing appropriate distribution controls and other measures. In particular, Sagent will not accept orders from correctional facilities and prison systems for products believed to be part of certain states’ lethal injection protocols. Also, each of Sagent’s distributors and wholesalers will be asked to make commitments not to sell or distribute any such products to these facilities.”
March 2013: “Hospira makes its products to enhance and save the lives of the patients we serve, and, therefore, we have always publicly objected to the use of any of our products in capital punishment. […] Hospira has implemented a restricted distribution system under which Hospira and its distributors have ceased the direct sale to U.S. prison hospitals of products, specifically pancuronium bromide, potassium chloride and propofol, that we believe are part of some states’ lethal injection protocols.”
March 2010: “Hospira provides these products because they improve or save lives and markets them solely for use as indicated on the product labelling. As such, we do not support the use of any of our products in capital punishment procedures.”
March 2013: “[Teva is] limiting the sale and distribution of [propofol] to customers who agree to use best efforts not to sell or distribute to correctional facilities”
August 2012: “Fresenius Kabi (APP) objects to the use of its products in any manner that is not in full accordance with the approved indications. […] To prevent Propofol from being used for purposes other than its approved indications, Fresenius Kabi (APP) does not accept orders for Propofol from any departments of correction in the U.S., nor will we do so, and we have voluntarily instituted tighter distribution controls on all forms of our [Propofol].”
Ganpati Exim (India)
2012: “We at Ganpati Exim are committed to providing access to medicines for the purposes of improving the lives of patients around the world. We are deeply opposed to the use of medicines in killing prisoners and wish to have no part in facilitating capital punishment in the USA or elsewhere. We never indulge in this type of medicines which takes HUMAN LIFE and will never in Future also.”
Shrenik Pharma (India)
2012: “We are aware of the use of Thiopental Sodium in killing of prisoners in USA and have often wondered why the US-Govt. does not simply out-law the practice altogether.
November 2011: [Letter from Naari CEO to Chief Justice Heavican of the Nebraska Supreme Court]: “I am shocked and appalled by this news. Naari did not supply these medicines directly to the Nebraska Department of Correctional Services and is deeply opposed to the use of the medicines in executions.”
August 2011 “[Lundbeck] is opposed to the use of its products for the purpose of capital punishment. Use of our products to end lives contradicts everything we’re in business to do – provide therapies that help improve people’s lives. Lundbeck adamantly opposes the distressing misuse of our product in capital punishment. Since learning about the misuse we have vetted a broad range of remedies – many suggested during ongoing dialogue with external experts, government officials, and human rights advocates. After much consideration, we have determined that a restricted distribution system is the most meaningful means through which we can restrict the misuse of Nembutal.”
April 2011: “In view of the sensitivity involved with sale of our Thiopental Sodium to various Jails/Prisons in the USA and as alleged to be used for the purpose of Lethal Injection, we voluntarily declare that we as Indian Pharma Dealer who cherish the Ethos of Hinduism (A believer even in non-livings as the creation of God) refrain ourselves in selling this drug where the purpose is purely for Lethal Injection and its misuse.”
February 2011: “Sandoz and Novartis support only the authorized use of injectable thiopental, which is primarily indicated for the induction of anesthesia, and do not support the sale of this or any product for use in non‐approved treatments. […]Sandoz has also advised all of its subsidiaries with locally approved marketing authorizations for sodium thiopental to not sell the product to distributors or third parties that may be selling it into the U.S.”
Abbott Laboratories (USA)
December 2001: “Abbott does not support the use of Pentothal in capital punishment. In fact, [we] communicated with departments of corrections in the United States to request that this product not be used in capital punishment procedures.”
A major supplier to the NHS is at risk of becoming involved in American executions, after Alabama altered its lethal injection ‘cocktail’ to include a drug for which they are the only US supplier yet to put in place sufficient distribution controls.
Two pharmaceutical companies, one of which describes itself as “one of the biggest…in the UK,” are facing urgent calls to put in place new controls on drugs which could be used in executions.
South Dakota is joined by Pennsylvania, now the second state set to kill a prisoner using so-called ‘DIY drugs’ – produced in a compounding pharmacy of the same type thought to be responsible for the recent meningitis outbreak in the US.
Prison authorities in South Dakota are refusing to release information on contaminated drugs made to order for an execution tonight (Tuesday 30 October).
A prisoner who died this week in a potentially botched lethal injection was killed using drugs from a compounding pharmacy, it has emerged.