Why Did Nebraska Use Fentanyl in an Execution for the First Time?

Nebraska has become the first U.S. state to use fentanyl in a prisoner's execution, provoking controversy: The drug is synonymous with the nationwide opioid epidemic.

On Monday at 10:24 a.m., officials at Nebraska State Penitentiary injected Carey Dean Moore with a combination of drugs: The anxiety medication diazepam; cisatracurium besylate to paralyze and gradually stop his breathing; potassium chloride to halt his heart; and the potent opioid fentanyl.

He was pronounced dead at 10:47 a.m. according to the Nebraska Department of Correctional Services.

Moore was sentenced to death for the 1979 murder of Reuel Van Ness Jr. and Maynard Helgeland, two taxi drivers in Omaha. Prior to his execution, he had been on death row longer than any other inmate in Nebraska. This was the first execution carried out by the state since 1997, and its sole case of lethal injection.

Experts have questioned why Nebraska chose to use fentanyl, a narcotic 30 to 50 times more potent than heroin, to kill Moore. Clinicians use fentanyl in a medical setting to treat severe and chronic pain in patients who have already been dosed with other powerful painkillers.

But fentanyl has earned a reputation as a dangerous killer for its role in the opioid crisis. The powder is favored by drug traffickers, who make it into fake prescription drugs and use it to lace heroin due to its high profit margins. According to the latest official figures, deaths caused by fentanyl and its analogs doubled in 2016 to 19,000.

Carey Dean Moore
Carey Dean Moore was sentenced to death for murdering two taxi drivers in 1979. He was executed with a combination of drugs, including fentanyl. Nebraska Department of Correctional Services/Reuters

Dr. Jonathan (Josh) Bloom, director of chemical and pharmaceutical sciences at the American Council on Science and Health, said the use of fentanyl ​was "ironic" in a climate in which illicit forms of the drug are killing tens of thousands of people a year in the U.S.

Nebraska Department of Correctional Services did not immediately respond to a request for comment. Bloom argued the state most likely chose fentanyl out of necessity as pharmaceutical companies in recent years have refused to supply prisons with drugs, such as barbiturates, to administer to death row prisoners.

"As a result, executions have either been postponed or other drugs used, sometimes with disastrous consequences. Fentanyl is an effective substitute," Bloom told Newsweek. Officials have therefore been forced to mix together lethal cocktails of drugs to execute death row inmates.

"Prisons have been unable to obtain lethal drugs while one, fentanyl, is so easily available on the street that hordes of people are dying from it every year, either mixed with or replacing heroin. And President Trump has called for the death penalty for fentanyl dealers. If that's not irony I don't know what is."

Robert Dunham, executive director of the nonprofit Death Penalty Information Center, echoed Bloom's remarks.

"At the same time that the Justice Department and states are talking about how dangerous fentanyl is when it is improperly used, the states are now touting it in untested and experimental execution protocols as a supposedly safe way of killing prisoners," he told Newsweek.

He suggested it is hypocritical for states to excoriate drug manufacturers and distributors for breaks in the supply chain that see the drug land on the black market for nonmedical uses.

"So what do they do here? They [officials] either buy the drug under false pretenses, and divert it from a legitimate medical use to the nonmedical use of killing prisoners, or they get some government official to issue a false prescription for the drug. They're attacking a black market in the drug out of one side of their mouth, while encouraging improper sales out of the other."

"Fentanyl wasn't Nebraska's—or any other state's—first choice of drug to use in executions," he claimed. "If it was, it wouldn't have taken thirteen hundred executions by lethal injection before some state tried to use the drug."

But to Dr. Joel Zivot, associate professor of anesthesiology and surgery at Emory University School of Medicine, a motivation more disturbing than necessity may be at play. He called the choice of fentanyl "symbolic in a sinister way." And the combination of drugs used on Moore can't be ignored.

"[The use of fentanyl] capitalizes on the public understanding that people can die from opioids," he told Newsweek.

"The Eighth Amendment of the U.S. Constitution opposes cruel punishment in any form," Zivot said. Yet, no one can be certain Moore wasn't suffering as potassium chloride burned through his body to make his heart stop contracting. Moore was paralyzed by cisatracurium, which Zivot says would not have dampened his senses but rendered him unable to struggle or express discomfort as he choked to death.

"The state here has successfully created a combination of drugs that will cause maximum pain. But outwardly it will look as if the prisoner is OK," he claimed. "And that I think is a clear violation of the Eighth Amendment of the U.S. Constitution, and is unambiguously cruel."

This article was updated to clarify that potassium chloride was used in the execution.