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OU professor says midazolam is an ineffective anesthetic in state lethal injections as Julius Jones execution approaches

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Oklahoma State Capitol (copy) (copy)

The Oklahoma Capitol building Jan. 20, 2019. A group of OU students met with legislators here on Feb. 11, 2020, to discuss higher education.

With less than 24 hours remaining until the state of Oklahoma is scheduled to execute Julius Jones, an OU professor said the 500 milligram dose of midazolam administered in state executions lacks data to support its effectiveness as a anesthetic. 

Jones — a former OU student who was convicted of the 1999 murder of Paul Howell in 2002 — has received two clemency recommendations from the Oklahoma Pardon and Parole Board. On Sept. 13, the board voted 3-1 to commute his sentence to life with the possibility of parole. Stitt declined to make any decisions on the vote, stating a clemency hearing was the “appropriate venue for our state to consider death row cases.” On Nov. 1, the board again voted 3-1 to recommend clemency for Jones. Stitt has yet to comment on the second recommendation. 

The Oklahoma Department of Corrections uses a three-drug protocol, including 500 milligrams of midazolam, 100 milligrams of vecuronium bromide and 240 milliequivalents of potassium chloride. Midazolam serves as a anesthetic, vecuronium bromide as a paralytic and potassium chloride stops the heart. Sixty milliliters of heparin/saline, which prevents blood clots, is administered between each drug.

Kelly Standifer, a professor of pharmacology and chair of pharmaceutical sciences at the OU Health and Sciences Center, was one of 16 professors who filed a brief with the Supreme Court related to the 2014 execution of Oklahoma inmate Clayton Lockett, who died of a heart attack in the execution chamber at the state penitentiary in McAlester. The brief noted that midazolam alone is “incapable of rendering an inmate unconscious prior to the injection of the second and third drugs.”  

Midazolam is a benzodiazepine, Standifer said, a class of CNS depressant drugs that produce sedation, relieves anxiety and muscle spasms and reduces seizures. She said midazolam is a short-acting benzodiazepine that is classified as an anesthetic adjunct, used for sedation, anxiety and amnesia. 

A clinical IV dose of midazolam, Standifer said, is 10 to 50 microgram/kgs, and the sedation may last for up to 30 min. She said midazolam is not a general anesthetic in any case, especially in one that could result in an individual regaining consciousness. 

“That's the problem with this drug. It doesn't provide sufficient sedation so that you won't be aroused if there's some stronger stimulation going on,” Standifer said. “So, in order to be considered an effective general anesthetic, it has to put the patient under enough that, if there is a painful stimulus, like when you're taking your scalpel and cutting the patient open, that they're not going to arouse from the sedation that it’s producing. Benzodiazepines cannot do that.”

Vecuronium bromide is normally administered to a patient before surgery to paralyze or relax the intercostal muscles, which are situated between the ribs, so a patient could receive intubation during surgery, Standifer wrote in a follow-up email. Because death row inmates are not intubated at the time of execution, they lose their ability to breathe as their muscles are paralyzed. 

Standifer wrote that vecuronium bromide could produce malignant hyperthermia, which is a painful, life-threatening event that involves muscle rigidity and heat production, if not treated. 

On Oct. 29, Oklahoma death row inmate John Grant was executed for the 1998 murder of a prison cafeteria worker. He was the first death row inmate in six years to be executed following an execution moratorium put in place after an incorrect drug was used to execute death row inmate Charles Warner in 2015

AP journalist Sean Murphy reported that Grant “convulsed and vomited” after midazolam was administered. Murphy, who said he has witnessed “around 14” executions, added he’s never seen an inmate vomit during an execution.

Midazolam is meant to have anticonvulsant properties, Standifer said, but it can cause nausea and vomiting in some patients. She said Grant’s reaction to the drug is likely a result of the high dosage he received. 

Standifer said she doesn’t agree with the Oklahoma Department of Correction’s statement that Grant’s execution was carried out in accordance with its protocols and “without complication.” 

“If your only outcome was he died, and you saw to it that he died, yes, that happened,” Standifer said. “But I would say there were complications if he experienced any pain or suffering in that process.” 

The Oklahoma Pardon and Parole Board voted 3-2 Wednesday to recommend clemency for Bigler Stouffer, who was convicted of the 1985 murder of Putnam City School teacher Linda Reaves, according to The Frontier. Parole board members agreed that though they believe Stouffer is guilty, they were concerned about the method Oklahoma uses to conduct executions following Grant’s execution. 

The inherent issue in this process, Standifer said, is that evaluation of drugs like midazolam are limited to their therapeutic outcomes, not lethal doses. She said because not enough research has been conducted, the state cannot properly address the problem that caused executions to be put on hold in the first place. Capital punishment is currently authorized in 27 states.

“I didn't understand why on earth they decided to charge forward (with executions) and expect any different result than what had been seen before,” Standifer said. 

Ultimately, Standifer said she is not a proponent of the death penalty and fails to understand how Oklahoma’s three-drug lethal injection protocol is humane. She said it saddens her that science has “taken a beating” over the past few years, as she believes data clearly states that midazolam “is not the drug we should be using.” 

“I think that this just sort of tears the soul out of a lot of different people,” Standifer said. “And not just the life out of that one person, at a time, that goes through it.” 

News managing editor

Jillian Taylor is a journalism junior and news managing editor at The Daily. Previously, she served as a summer editor-in-chief, assistant news managing editor, news editor, senior culture reporter and senior news reporter.

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