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Botched Tennessee Execution Draws Scrutiny of Lethal Injection Drugs
States’ methods for obtaining drugs for executions are shrouded in secrecy
By Lizzy Lawrence and Alex Janin, WSJ
Oct. 3, 2026 10:00 am ET
Tennessee’s failed execution of Christa Pike this week has resulted in fresh scrutiny of the shaky and secretive supply chain for lethal injection drugs.
Pharmaceutical companies no longer provide drugs for executions. So U.S. states have turned to loosely or even unregulated sources for the deadly cocktails, which experts say make lethal injections less reliable.
Here’s what we know about Pike’s botched execution:
What went wrong?
Pike, who was sentenced to death in 1996 for the murder of Colleen Slemmer, got two doses of pentobarbital, a sedative that at least 17 states use for capital punishment.
Officials had to call Pike’s procedure off and send her to a hospital because she was still alive after the injections. As of Thursday evening, Pike’s attorneys said she is unconscious and on a ventilator.
The Tennessee Department of Correction said they followed established protocol and that the drug has consistently been effective. The department declined to answer questions about where the drug was sourced.
It is the second failed execution attempt in Tennessee this year. In the attempted lethal injection of a different inmate in May, a medical professional failed to establish the IV correctly. The provider said in a deposition last year that he hadn’t done a procedure like that in over a decade and didn’t have hospital privileges.
Major medical groups condemn lethal injections so the people administering the drugs often have limited medical qualifications, experts said.
Why don’t drug companies supply drugs for lethal injections?
Lethal injections date to the late 1970s. The goal was to offer convicted criminals a quicker and more painless death than the electric chair or hanging. Oklahoma introduced the practice in 1977, and other states quickly followed. Capital punishment is currently legal in 27 states and injections are the most common form of execution.
Looking for a way to halt the death penalty, anti-capital punishment activists have successfully pressured pharmaceutical companies over the years to place restrictions on their drugs for this use.
Despite these restrictions, pharmaceutical companies have still found their drugs being used in some executions and have sued states as a result. Alvogen sued Nevada in 2018 for using its sedative midazolam to carry out executions, prompting Nevada to return its unused supply. Fresenius Kabi sued Nebraska the same year for obtaining its medicines, including potassium chloride, for a planned execution. A judge ultimately allowed the execution to go forward.
Where do states get their drug supply from instead?
Some states have since turned to compounding pharmacies, which make customized, non-FDA-approved versions of prescription medicines. Compounded drugs aren’t subject to the same review for safety, effectiveness and quality as approved pharmaceuticals.
States often buy a powdered form of pentobarbital in bulk directly from domestic or overseas suppliers, which compounding pharmacies turn into injectable solutions, according to a 2025 review of execution protocols from the Justice Department. One court filing says Tennessee spent more than $1 million on pentobarbital for executions over two years, though it didn’t name the suppliers.
States often pay cash for drugs to use in executions, making it harder to trace the supply chain, said Deborah Denno, a Fordham University law professor who has studied lethal injection for 33 years. Corrections departments may buy them from compounders, or even each other.
Has the drug regimen used in lethal injections changed?
For years, states used the anesthetic sodium thiopental for lethal injections. But Hospira, a manufacturer later bought by Pfizer, halted production of that drug due to raw material issues in 2010. Activists capitalized on the moment to target other drug companies whose products were used in executions as part of an effort to end the death penalty.
Initially states used a three-drug protocol for lethal injections: one to cause unconsciousness, another to stop a person’s breathing, and a third to stop their heart. Now, because of supply issues with these drugs, some just use pentobarbital.
Nine inmates in Tennessee sued the state, saying its lethal injection protocol causes “a high risk of torturous death,” in reference to pentobarbital.
A Justice Department review highlighted concerns about the drug being linked to a condition which causes fluid to rapidly fill the lungs, leading recipients to feel like they are suffocating or drowning. Experts disagreed as to whether people who received the drug could feel pain or suffering.
In legal filings before her execution date, Pike’s attorneys argued that because of a blood disorder, using pentobarbital exacerbated her risk of developing the condition. “The sensation of pulmonary edema will be like ‘drowning in one’s own blood,’ ” her lawyers wrote.
The federal government adopted pentobarbital for executions during President Trump’s first term. The Biden administration then issued a federal moratorium on capital punishment in 2021. The second Trump administration reinstated the practice and in April, said it would allow pentobarbital and executions by firing squad.
What are states doing about this?
Tennessee hasn’t given a reason yet as to why Pike’s injections were ineffective, but the governor paused executions for the rest of this year and ordered an independent review.
Some states are revisiting alternative methods for execution. Idaho, Mississippi, Oklahoma, South Carolina and Utah permit executions by firing squad in certain circumstances. Alabama, Arkansas, Mississippi, Oklahoma and Louisiana allow executions by nitrogen gas.
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