Inside the calamitous execution drug that failed to kill Christa Pike - and why America is set to use it again tonight

Inside the calamitous execution drug that failed to kill Christa Pike - and why America is set to use it again tonight Christa Pike survived a botched execution using pentobarbital, exposing the disturbing reality of America’s lethal injection system and raising the prospect that they may try to kill her again. Christa Pike was supposed to be dead. Instead, days after Tennessee strapped her to a gurney and pumped her with enough pentobarbital to kill her, the 50-year-old is awake in a hospital bed, conscious and talking. She is also still handcuffed and shackled. It is an extraordinary scene: doctors working to keep alive a woman the state had just tried to kill, while prison restraints remain fixed to her body as she receives critical medical care. And even survival may not save her. Pike’s death sentence remains in place and, unless she is left medically incapacitated, Tennessee could attempt to execute her again once its current suspension of executions is lifted. But as Pike continues to recover in hospital, some 600 miles away, America is tonight set to resume its use of the failed drug pentobarbital used in her botched execution. Texas is scheduled to execute Jamaal Howard, 46, who was convicted of capital murder in the 2000 killing of Vickie Swartout, who was shot once in the chest at the store where she worked. What happened to Pike inside Riverbend Maximum Security Institution was supposed to be clinical, controlled and final. Instead, witnesses heard Pike crying and whimpering as executioners repeatedly struggled to find a vein. Her arms swelled. Blisters appeared. At one point, she complained that one felt as though it was about to burst open. Then came two doses of pentobarbital - enough, according to an anaesthesiologist advising her lawyers, to have certainly killed her had the drug entered her bloodstream properly. But Pike did not die. She had been sentenced to death for the 1995 torture and murder of 19-year-old Colleen Slemmer, a crime of appalling brutality. Nothing about the failed execution changes that crime or the suffering endured by Slemmer’s family. But Pike’s survival has exposed something else: the increasingly disturbing reality behind America’s supposedly clinical machinery of death. At the centre of it is pentobarbital, a drug with a history stretching back more than a century and purposes its creators could scarcely have imagined. Pentobarbital belongs to a family of medicines called barbiturates, powerful drugs which slow activity in the brain and central nervous system. It was developed in the 1920s by Abbott Laboratories chemist Ernest Volwiler and marketed under the name Nembutal. At therapeutic doses, it could sedate patients, induce sleep, control serious seizures and be used before anaesthesia. At much higher doses, however, barbiturates suppress breathing, lower blood pressure, induce coma and can eventually stop the heart. That lethal quality also made pentobarbital useful to vets. For decades, it has been widely used to put seriously ill or injured animals to sleep. The US Food and Drug Administration describes pentobarbital as a drug used in animals for sedation, anaesthesia and euthanasia. A medicine intended to relieve suffering gradually became useful to American states seeking a chemical with which to end human life. That transformation accelerated around 2010. For years, lethal injection usually depended on another barbiturate, sodium thiopental, as the first element in a three-drug cocktail. But supplies dried up as manufacturers objected to their medicines being used in executions and European governments tightened export controls. Britain banned exports of pentobarbital and other execution medicines to America in 2011. Then Business Secretary Vince Cable said: “We oppose the death penalty in all circumstances.” European restrictions followed. Pentobarbital manufacturer Lundbeck introduced controls designed to prevent its Nembutal from reaching American prisons. Other pharmaceutical companies imposed similar restrictions. Death penalty states began looking elsewhere. Some turned to specialist compounding pharmacies - businesses which prepare medicines for individual requirements and which have historically operated under a different regulatory regime from large pharmaceutical manufacturers. The identities of suppliers have frequently been hidden behind execution secrecy laws. In Tennessee, the origin of the pentobarbital used on Pike has not been publicly disclosed. It has produced an extraordinary contradiction: a procedure presented as clean and medical taking place within a supply system deliberately shielded from the normal transparency surrounding medicines. Pentobarbital has another, darker life outside prisons. Because an overdose can cause unconsciousness followed by death, Nembutal became sought after in the illicit market by people seeking to end their lives. It has appeared on underground websites and black-market networks, particularly in countries where assisted dying was illegal or tightly restricted. Before the Silk Road internet marketplace was closed by the FBI in 2013, campaigners for assisted dying spoke openly about people using the site to seek Nembutal. More recently, Australian police alleged an illegal “end of life” operation had obtained veterinary pentobarbital through what investigators said was a bogus whale charity. The very same characteristics that make the drug useful to doctors and vets - rapid sedation and profound suppression of the central nervous system - make uncontrolled pentobarbital exceptionally dangerous. Yet the controversy surrounding executions runs deeper than whether the drug is genuine or sufficiently potent. Researchers examining autopsies after lethal injections have repeatedly found evidence of pulmonary oedema - fluid flooding into the lungs. One study of 43 executions involving either pentobarbital or another sedative, midazolam, found pulmonary oedema in 33 cases. A larger investigation examining more than 200 autopsies found signs of the condition in 84 per cent. Dr Joel Zivot, the anaesthesiologist advising Pike’s defence team, has described findings suggesting some prisoners may effectively experience sensations associated with suffocation while outwardly appearing unconscious. In Pike’s case, however, the immediate problem appears to have been more basic. Her lawyers say executioners used at least seven needles while trying to establish intravenous lines. They believe the veins ruptured and the pentobarbital leaked into the tissue in her arms rather than circulating properly through her bloodstream. Zivot said the quantity administered should have killed her if delivered correctly. Her swollen and blistered arms, he believes, point towards the drug entering surrounding tissue. One witness, reporter Tori Gessner, said afterwards: “Nothing about today was normal, typical - at all.” Pentobarbital is only the latest chapter in America’s troubled experiment with execution chemicals. Perhaps no drug better illustrates that history than midazolam. Midazolam is a benzodiazepine sedative widely used legitimately in medicine, including before medical procedures. But several states adopted it for executions as traditional barbiturates became difficult to obtain. Its use soon became deeply controversial. Unlike drugs used to induce full surgical anaesthesia, critics argued midazolam has a “ceiling effect”, meaning increasing the dosage does not necessarily produce ever-deeper unconsciousness. The issue reached the US Supreme Court after Oklahoma adopted a protocol using 500mg of midazolam followed by a paralysing drug and then potassium chloride, which stops the heart. The Supreme Court ruled in 2015 that Oklahoma's protocol could continue. But by then, a series of executions had created worldwide alarm. In 2014, Oklahoma prisoner Clayton Lockett writhed and groaned during an execution involving midazolam before dying 43 minutes after the process began. That same year, Arizona inmate Joseph Wood took almost two hours to die after repeatedly gasping during an execution involving midazolam. Then came Arkansas. In April 2017, the state announced one of the most extraordinary execution schedules in modern American history: eight prisoners were to be put to death over just 11 days. There was a brutally mundane reason for the rush. Arkansas's stock of midazolam was due to expire at the end of the month. The proposed executions were arranged in four groups over April 17, 20, 24 and 27, effectively creating an assembly line of death before the date stamped on the medicine bottles ran out. Amnesty International called it a “conveyor belt of death”. Its Americas director, Erika Guevara Rosas, said the schedule showed how far Arkansas was “out of step” with much of the world. Court battles followed. Drug companies fought to stop their products being used. Medical supplier McKesson said Arkansas had acquired vecuronium bromide - the paralysing second drug in its cocktail - for medical purposes and had not been told it would be used in executions. Ultimately, four men were executed. The episode illustrated the increasingly extraordinary lengths to which death penalty states were prepared to go as pharmaceutical companies attempted to shut down the supply chain. Nearly a decade later, the argument has returned to Tennessee. Pike, who was sentenced after Slemmer's skull was crushed with a chunk of asphalt and a piece of it kept as a trophy, had spent more than three decades on death row. Nothing about the botched execution changes the brutality of that crime or the suffering endured by Slemmer's family. But what happened inside Riverbend raises a separate question about what a government is entitled to do in the name of punishment. Tennessee Governor Bill Lee has called the failed execution “deeply disturbing”, ordered an independent investigation and stopped the state's remaining executions this year. The prisons commissioner has resigned. And Pike's lawyers have demanded that every syringe, document and piece of evidence from the death chamber be preserved. America adopted lethal injection partly because it offered the appearance of medicine: needles, drips, drugs and a prisoner apparently falling asleep. Four decades later, the reality has become much harder to disguise. Manufacturers refuse to supply the drugs. States hide where they obtain them. Pharmacies compound them behind secrecy laws. Prison teams struggle to insert intravenous lines. Autopsies reveal damaged, fluid-filled lungs. Pik now lies awake, talking in hospital, critically ill, handcuffed and shackled to the bed. Yet the most extraordinary part may still be to come. Because once Tennessee’s suspension of executions is over, the state that failed to kill Christa Pike once may decide to strap her to a gurney and try all over again.