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Facing a shortage of mass-produced drugs, Missouri will rely on a private compounding pharmacy to make the state's lethal injection drug. That means the state will resume executing prisoners after Gov. Jay Nixon put the capital punishment schedule on hold earlier this month. The drug, pentobarbital, is used in 13 other states to execute prisoners. Facing pressure from several different groups, Nixon had backed away from a controversial plan announced earlier this spring to start using propofol for executions, a drug that's never been used in capital punishment before. 

Other states have been more successful in attempts to experiment with new, untested drugs for executions to make up for dwindling supplies from large manufacturers. Florida tried out a new lethal drug last week during the execution of William Happ, who is now the first person to die from a state-sanctioned lethal injection of midazolam hydrochloride. But Missouri faced additional pressure from doctors in the state against its decision to use a new drug in lethal injections. Here's, in part, why: propofol is an extremely popular anesthetic in the U.S., and its top manufacturer is German. In response to Missouri's flirtation with the drug for executions, many worried that the E.U. would impose sanctions on its export to America, limiting the supply across the board. Missouri ended up promising to return its European supply of propofol to ease concerns that it could be used in the U.S. for capital punishment. 

So now, Missouri will join a handful of other states turning to compounding pharmacies for pentobarbital, a move that's controversial because of the increased secrecy — and decreased regulation — implicit in it. Unlike drugs made by larger manufacturers, compounding pharmacy products, usually mixed for individual patients, aren't regulated by the Food and Drug Administration. Texas, Ohio, Pennsylvania, and South Dakota now rely on compounding pharmacies for execution drugs, while Georgia and Colorado have indicated their intent to do so in the future. It's one of a dwindling number of options available for states set on continuing to use capital punishment. 

Anti death-penalty activists have adapted a pretty successful strategy to minimize the supply of lethal drugs for executions: by encouraging large drug manufacturers to take sides on the issue and refuse to sell their products for that purpose. Many manufacturers, especially those in the UK and Europe, have done exactly that. As stockpiles of existing drugs, including pentobarbital, expire, states are forced to find alternatives that are both constitutional and available. Missouri was almost immediately sued after altering its capital punishment regulations to allow propofol, otherwise known as the drug blamed for Michael Jackson's death. In response to that suit, the state's Attorney General threatened to start executing prisoners with the only other method allowed by state law — the gas chamber. That idea never materialized. Missouri's next scheduled execution is on November 20th. The Missouri Department of Corrections declined to comment to the Atlantic Wire on the state's current supply of pentobarbital, or to provide additional details on its relationship with the compounding pharmacy. 

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