In March of 2013, the Colorado Department of Corrections Director Tom Clements contacted 97 compounding pharmacies in that state with an unusual request: "I am reaching out to compounding pharmacies throughout the state of Colorado in order to comply with state law that the CDOC acquire sodium thiopental or other equally or more effective substance to cause death." That represented the first instance in what would become a more and more frequent question for the Academy and its members – how and should a compounding pharmacist be involved in the preparation of drugs for lethal injection?
The International Academy of Compounding Pharmacists (IACP) Board of Directors established a formal policy, pointing out the well-recognized Pharmacist’s Conscience Clause as a guiding principle and identifying the unilateral decision by pharmaceutical companies to restrict the sales of their products to Departments of Correction. Additionally, the Academy recommended a series of self-assessment questions for a compounding pharmacist to consider when requested to be involved in a capital punishment case when commercially manufactured drugs were intentionally withheld. Those included: verifying the legality of preparing a dispensing a drug that will knowingly cause harm with a state Board of Pharmacy, confirming that professional and business practice insurance covers such compounding, and to assess the potential impact on the individual staff members, and the pharmacy’s security and reputation from potential negative publicity surrounding the controversy of capital punishment.
Over the past year, as supplies of manufactured drugs for capital punishment dwindled and more states sought compounded preparations as an alternative, five state legislatures have taken up bills that would provide for confidentiality to potential pharmacy suppliers. That has been in direct response to media attention, court challenges, and reports of so-called “botched” executions that alleged the compounded medications used were “deficient” in quality.
After much consideration, and recognizing that more and more IACP members are asking for guidance and a clear position to assist them, the Academy’s Board of Directors has updated its position with the following statements:
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. IACP believes that a national discussion needs to be conducted on whether a pharmaceutical manufacturer can restrict the use of FDA-approved products only to purposes that adhere to their corporate values.
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.