Tennessee officials are still investigating why death row inmate Christa Pike survived an execution attempt after receiving two doses of pentobarbital, a drug intended to render a person unconscious and ultimately cause death. While the immediate focus has been on what went wrong inside the execution chamber, experts say Pike’s case has also renewed scrutiny of a problem that has been building for more than a decade: how states obtain lethal injection drugs after pharmaceutical companies moved aggressively to keep their products from being used in executions. Despite those efforts, pentobarbital remains the primary execution drug used by many death-penalty states, making questions about sourcing, testing and oversight especially significant. The issue has reshaped how many states carry out executions, forcing them to change drug protocols, seek alternative suppliers and adopt increasingly secretive procurement practices. “Drug shortages have devastated this country’s execution process to an unparalleled degree,” Deborah Denno, a Fordham University law professor who has studied lethal injection for decades, told Newsweek on Saturday. How Pharmaceutical Companies Changed the Death Penalty For years, states relied on commercially manufactured drugs obtained through traditional pharmaceutical channels. That began to change after major drug manufacturers objected to having medicines designed to treat patients used in executions. According to Corinna Barrett Lain, a University of Richmond law professor and author of Secrets of the Killing State: The Untold Story of Lethal Injection, pharmaceutical companies have spent years trying to prevent their products from reaching execution chambers. “The bottom line is these drug companies, from the start, did not want their drugs being used in lethal injections with executions,” Lain told Newsweek on Saturday. Drugmakers increasingly adopted distribution controls and contractual restrictions barring execution use. The result, according to Lain, is that states seeking lethal injection drugs are now forced to look elsewhere. “Now states trying to buy drugs for lethal injection are stuck either intentionally breaching private contracts, and getting sued when they are discovered doing so, or buying compounded drugs from whatever compounding pharmacy is willing to sell a sterile injectable barbiturate without a prescription for cash in an under-the-table transaction,” she said. The Rise of Secret Supply Chains As pharmaceutical companies tightened restrictions, states increasingly turned to alternative methods of obtaining execution drugs. Some relied on compounding pharmacies, which create customized formulations of drugs rather than mass-produced pharmaceutical products. Others sought alternative suppliers or adopted increasingly secretive procurement practices. Lain said those shifts have fundamentally changed the execution-drug market. Joel Zivot, a professor at Emory University School of Medicine, said the restrictions imposed by drug manufacturers forced states to seek alternative sources of execution drugs. “A gray market usually means legal goods moving through channels the manufacturer never authorized,” he told Newsweek on Saturday. “None of the pathways states now use to obtain execution drugs is a white market. Some fit the gray description. Others have crossed into unlawful territory.” Asked whether the term “gray market” accurately describes the current system, Lain replied: “Gray market and black market. Absolutely.” Federal authorities have previously blocked or seized imported execution drugs intended for several states, while courts have reviewed disputes involving overseas suppliers and execution-drug imports. The problem, according to experts, is that secrecy makes it difficult to know exactly how states obtain many of the drugs they use. Why Secrecy Has Become So Important States generally argue that supplier secrecy is necessary because manufacturers and vendors could face public pressure, boycotts or litigation if their identities become public. Critics say secrecy serves another purpose. “States can’t fix what’s broken with lethal injection, and if you can’t fix it, the other option is to hide it,” Lain said. “It is actually easier for states to fight over secrecy than to reveal the indefensible details of the suppliers they’ve used.” Zivot likewise argued that secrecy itself has become central to the system. “Secrecy makes independent evaluation impossible, and that is its purpose,” he said. Without public information about suppliers, storage methods and testing procedures, outside experts cannot independently evaluate the quality or reliability of execution drugs, he said. “Without knowing who made a drug, how it was stored and whether it was tested, no one, including the courts, can judge whether it will work as the state claims,” Zivot said. Denno said secrecy has steadily expanded over the past two decades. “The secrecy prevents a systematic analysis,” she said. “Yet, all of my research suggests these efforts to get drugs are more opaque and unconventional than ever.” The Quality-Control Question In conventional medicine, intravenous drugs undergo extensive testing and quality-control reviews. Potency, sterility, stability and contamination levels are all subject to regulatory scrutiny. Questions about execution drugs extend beyond where they come from. Execution drugs often operate under a different system. “The question uses the language of medicine, and these chemicals are not medicine,” Zivot said. “They are intended as poisons, which turns the usual safety questions upside down.” The distinction matters, he said. With medicine, regulators worry a drug may be too potent. In an execution setting, a drug that is weaker than expected may fail to kill. “Because sourcing, storage and testing are kept secret, no one outside the process can say what standards, if any, apply,” Zivot said. “That uncertainty is itself the problem.” Tennessee has faced similar questions before. In 2022, Governor Bill Lee paused executions and ordered an independent review after officials discovered the state had failed to follow its own lethal injection procedures. The review later found that drugs prepared for executions had not consistently received all required testing, prompting Tennessee to revise its protocols before executions resumed in 2025. Yet the state’s handling of execution drugs has remained under scrutiny. What Christa Pike’s Case Reveals Lain said she was unaware of another modern case in which an inmate appeared to survive after lethal-injection drugs had actually been administered. Based on publicly reported evidence, she said IV infiltration appears the most likely explanation, meaning the pentobarbital may have entered surrounding tissue rather than the bloodstream. Pike’s attorneys have similarly argued that execution personnel failed to recognize that IV lines were improperly placed or that veins had blown during the procedure. Tennessee’s official review remains ongoing. Regardless of the ultimate findings, both Lain and Zivot say the episode highlights broader vulnerabilities in the lethal-injection process. “The death row population is a geriatric population with histories of poor health and often IV drug use,” Lain said. “This is a demographic with notoriously weak veins. That’s a problem inherent to lethal injection. You’re not going to be able to fix that.” Zivot pointed to similar concerns. “The execution team must place and maintain an IV line in a person who may have difficult veins,” he said. “And there is no medical plan for when things go wrong.” Will Anything Change? Despite the attention surrounding Pike’s case, experts disagree about whether it will lead to major reform. Denno noted that execution failures have repeatedly generated public outrage only for states to continue using lethal injection afterward. “Unfortunately, yes,” she said when asked whether states can continue relying on lethal injection despite mounting procurement problems. “Lethal injection botches are a never-ending story in the United States.” States may continue searching for drugs, altering protocols and defending secrecy measures, she said. But the underlying problem is unlikely to disappear. Tennessee’s investigation may ultimately determine what happened in Pike’s execution attempt. But experts say the episode has also highlighted a separate question: whether states can continue relying on drugs that have become increasingly difficult to obtain, test and scrutinize. Denno argued that a system originally intended to make executions appear more clinical and humane is now confronting a fundamental contradiction: It depends on drugs that the companies producing them increasingly do not want associated with executions.