by Prahsant Yadav
When we’re sick, we are at our most vulnerable. So, it’s vitally important that we can trust the medicines our doctors prescribe us. In the United States, we take it for granted that drugs won’t be counterfeit, contaminated or past their use-by date. But what if we couldn’t count on that?
Earlier this month, BuzzFeed News reported that Texas gets drugs to use in executions from a compounding pharmacy in Houston that has repeatedly fallen foul of regulators for doing sloppy and dangerous work. The risks this poses to public health are enormous and poorly understood.
If BuzzFeed’s report is accurate — and the pharmacy denies it — the state has made a poor choice in a partner. Greenpark Compounding Pharmacy was put on probation by the Texas State Board of Pharmacy for two years in November 2016, after it mixed the wrong drug, sending a child to a hospital. Over eight years, BuzzFeed News reported, it has been cited for 48 safety violations by the Texas State Board of Pharmacy and the Food and Drug Administration.
They apparently also compounded fatal doses of pentobarbital to be used in lethal injections alongside medicines destined for hospitals and bathroom cabinets all over Texas. The pharmacist in charge denies that, but BuzzFeed also reported that the company submitted a declaration in a civil suit admitting its role, though under the pseudonym Pharmacy X.
Texas keeps the names of the execution-drug suppliers secret , so this may never have come to light were it not for the work of a dogged reporter.
A pharmacy capable of such recklessness should not be compounding deadly drugs alongside your grandma’s arthritis pills or your daughter’s epilepsy medication. But even that appalling prospect pales in comparison with the greater risk Texas is taking with the integrity of its drug stocks.
Once an illicit supply channel is established with a pharmacy willing to sell lethal drugs, shielded from scrutiny by a secrecy law, there is little to stop other illegal and unsafe drugs flowing through it. This would effectively create a state-sponsored black market and endanger patients and the public.
I have spent my whole career studying the supply chain for medicines and how slightest vulnerabilities in the system pose significant dangers to public health. In recent years, I have watched in alarm as states have torn holes in the regulatory safety net to get around the pharmaceutical industry’s unanimous opposition to its products being used in executions.
This fall, with a group of fellow experts, including a former FDA commissioner, I signed a legal brief in a case under review by the U.S. Supreme Court, warning that it is only a matter of time before the lack of transparency in sourcing of lethal injection drugs leads to a large-scale public health crisis.
The case, Bucklew v. Precythe, was brought by a prisoner on death row, but our brief is not about capital punishment. It’s about patient safety.
We argue that states should not be permitted to endanger public health in order to source execution drugs, whether by buying them from “seedy individuals on the backstreets of the Indian subcontinent,” as Oklahoma’s prisons director colorfully put it, or secretly cooking them up close to home in poorly-regulated labs.
Compounding pharmacies play a vital role in our communities by producing drugs in small quantities for patients with special needs. Just as big pharmaceutical firms will not countenance their products being used to kill, most reputable compounders won’t make drugs for use in lethal injections.
The few that are prepared to supply deadly drugs have repeatedly been exposed as unscrupulous profiteers out to make a quick buck, heedless of the risks to public health. For instance, the Apothecary Shoppe, an Oklahoma company that compounded execution drugs for three states, was found to have committed 1,892 violations of state pharmacy guidelines.
If the danger seems remote to you, consider the New England Compounding Center crisis that left more than 70 people dead and hundreds sick across the country when a batch of sloppily prepared medicines became infected with fungal meningitis.
Texas is putting the public at risk by doing business with operators such as Greenpark and deliberately creating a regulatory vacuum that enables them to mix drugs free from meaningful oversight. Based on my two decades of professional experience, that gravely concerns me, and it should worry every Texan.
Prashant is a lecturer on global health and social medicine at Harvard Medical School.