The drug at the heart of a botched lethal injection in Oklahoma isn't a household name for many, but on Wednesday, the powerful sedative was being debated in the Supreme Court as lawyers sparred over whether its use to execute prisoners is constitutional.
Midazolam may not sound familiar, but as a benzodiazepine, is in a class with other drugs that might, like Xanax and Valium.
The sedative is used to cause drowsiness, relieve anxiety before surgery or other medical procedures and prevent any memory of discomfort afterward, according to the federal government's medical library.
It's branded in the United States as Versed, the Mayo Clinic website says. Like other benzodiazepines, it works by slowing activity to the brain, letting patients relax and decreasing their consciousness, according to the website.
It is also used to decrease consciousness in seriously ill patients who are hospitalized on breathing machines, according to the website of the U.S. National Library of Medicine, a part of the National Institutes of Health.
The drug can also have serious side effects — including uncontrollable shaking, stiffening and jerking of the arms and legs, seizures, uncontrollable rapid eye movements and difficulty breathing or swallowing.
A year ago Wednesday, death row inmate Clayton Lockett was injected with the drug, the first of three that Oklahoma uses in its executions. He writhed and moaned as he took more than 40 minutes to die.
Lawyers for other death row inmates in the state argued Wednesday before the Supreme Court that midazolam is unsuited for executions because inmates might not be sedated sufficiently and could feel severe pain as the next two drugs are injected. The state counters that lower courts have ruled the dosage likely renders inmates unconscious.
The case has arrived at the Supreme Court as prisons are finding it increasingly difficult to buy drugs for lethal injections. Midazolam was chosen because pharmaceutical companies refused to supply previously used drugs. It has now been targeted, too.
States have begun looking for other methods of execution, with Oklahoma approving the use of nitrogen gas as a backup.