Why botched lethal injections are becoming more common

Tennessee’s Failed Execution Raises New Questions About Lethal Injection

Activelifezero.com – Christa Pike’s survival after a lethal-injection attempt in Tennessee on Wednesday night has renewed attention on the growing difficulties states face when trying to carry out executions with drugs. The incident was not Tennessee’s first failed lethal injection, nor was it the state’s only such case this year.

Lethal injection was introduced as an alternative intended to appear less violent than methods such as hanging, firing squads, gas chambers and electrocution. Nearly five decades later, critics argue that the process has become increasingly uncertain as states struggle to obtain drugs, recruit qualified participants and maintain reliable procedures.

Austin Sarat, an Amherst College professor of jurisprudence and political science who has written extensively about capital punishment, said the number of people who survive attempted executions has risen as problems surrounding lethal injection have multiplied.

“The incidence of people surviving executions has certainly increased as states have encountered more difficulties with lethal injection.”

A procedure built on a medical model without medical participation

Oklahoma developed lethal injection in 1977, while Texas carried out the first execution using the method five years later. The original three-drug sequence used sodium thiopental as an anesthetic, pancuronium bromide as a paralytic and potassium chloride to stop the heart. Each substance was administered at levels far above ordinary medical doses.

Yet the procedure depends on equipment, medications and technical decisions associated with health care while being performed outside ordinary medical practice. Major professional organizations, including the American Medical Association and the American Nurses Association, have long opposed or barred member participation in executions.

Corinna Barrett Lain, a University of Richmond School of Law professor and author of the 2025 book Secrets of the Killing State: the Untold Story of Lethal Injection, has described the system as a distorted use of medicine.

“It’s a highly delicate, error-prone procedure that is done by people who are not trained.”

Lain has also warned that execution drugs may be acquired through opaque channels, creating risks from the beginning. The absence of medical professionals does not eliminate the clinical complexity of establishing intravenous access, preparing drugs and monitoring a person through the process. It can instead make those tasks more difficult.

Failure rates have risen

A botched execution is one that does not unfold as planned. It can involve lengthy delays, serious pain, repeated attempts to establish an IV line or other disturbing outcomes. Data compiled by Sarat and published by the Death Penalty Information Center found that lethal injections failed at a rate of roughly 7% between 1890 and 2010. Across all execution methods over that period, the rate was 3.2%.

Since 2010, Sarat said the problem has become more frequent. The failure rate for lethal injections has moved closer to 8%, including multiple cases in which prisoners survived attempted injections. He links the increase largely to barriers involving drug suppliers.

For readers, the numbers underscore a central issue in the debate: an execution method can be presented as controlled and clinical, while the actual process remains dependent on fragile supply chains, technical competence and undisclosed decisions about medications.

Drug restrictions transformed the system

For many years, states obtained drugs used in executions through conventional pharmaceutical channels. That began changing in 2010, when the UK human rights organization Reprieve led a campaign urging European companies to halt exports of drugs for use in US executions.

Some companies initially argued that they could not fully control how products moved after sale to American distributors. They also emphasized that the medications served important therapeutic purposes. Over time, however, manufacturers imposed restrictions. The United Kingdom and European governments adopted export controls, and US drug makers eventually placed limitations on the use of their products in executions as well.

“Drug companies began to say, ‘We don’t want this negative publicity.’”

Those restrictions reduced the availability of drugs historically used in execution protocols. States then turned to other sources, including compounding pharmacies.

Compounding pharmacies generally prepare customized medications for individual patients, such as when a person cannot tolerate an ingredient in a commercially manufactured drug. They are not regulated by the US Food and Drug Administration in the same manner as traditional pharmaceutical manufacturers.

Concerns about compounded drugs

As states increasingly sought compounded drugs, the Alliance for Pharmacy Compounding issued a 2015 statement discouraging the practice. The organization acknowledged that individual practitioners could make their own decisions based on personal, ethical or religious beliefs.

The group did not frame its position as a moral judgment about capital punishment. Instead, it pointed to a broader question about whether pharmaceutical manufacturers can limit FDA-approved medications to uses consistent with corporate values.

Lain has said that some pharmacies willing to provide execution drugs had deeply troubling records. Problems involving potency, handling or storage can affect how a drug performs. In an execution setting, such uncertainty can have grave consequences, particularly where there is limited outside visibility into the source and condition of the substances used.

The failed attempt involving Pike now places those concerns at the center of Tennessee’s capital-punishment system. Her case may prompt closer scrutiny of the state’s protocol, its drug procurement practices and the safeguards meant to prevent a person from enduring an execution attempt that does not achieve its intended result.

More broadly, the episode illustrates why lethal injection remains contentious. The method was designed to replace visibly harsh forms of execution, but shortages, secrecy and medical opposition have made its operation increasingly complicated. As states pursue a procedure that requires precision, they continue to confront the consequences of performing it with limited drugs, limited transparency and limited medical involvement.