Three-drug lethal injection (etomidate)

This article explains how the method works at the level reported in court records and the news. It does not include doses or technical instructions.

Overview

This is the lethal injection method used by Florida, the only state that uses it. Florida adopted it in 2017, when the anaesthetic etomidate replaced midazolam, which had become harder to obtain after drug companies refused to supply it for executions. Every Florida execution in 2026 has used this protocol, and Florida has carried out more executions this year than any other state.

How it works

Three drugs are given one after another, each with a different job:

1. Etomidate, a short-acting anaesthetic used in hospitals to sedate patients briefly, is intended to make the prisoner unconscious.
2. Rocuronium bromide, a muscle relaxant, paralyses the body, including the muscles used for breathing.
3. Potassium acetate disrupts the heart's electrical signals and stops it.

How it is administered

The drugs are given intravenously, through lines placed in the prisoner's veins, at Florida State Prison near Starke. Under the protocol, after the etomidate a member of the execution team must check that the prisoner is unconscious before the second and third drugs are given, typically by touching the face, shaking the shoulders and calling the person's name. The drug suppliers' identities are confidential under Florida law.

What the prisoner may experience

This is disputed. The state's lawyers have cited medical testimony that a large dose of etomidate keeps a person unconscious for up to 30 minutes, longer than the process takes, so the prisoner should not feel the paralytic or the final drug. Critics point out that etomidate's effects are normally short-lived, that it has been associated with pain and involuntary movement in some patients, and that a person who is paralysed but not fully unconscious could not show distress. Court filings in 2025 also raised problems with how the protocol was carried out, including executions that used expired etomidate.

How long it takes

Most Florida executions take less than 15 minutes from the start of the procedure. For example, in October 2026 William Reaves Jr.'s execution began at 6:00 pm and he was pronounced dead at 6:12 pm.

Cost

Florida does not publish what it pays for its execution drugs. The suppliers, quantities held and expiry dates are kept confidential by state law.

Availability

Etomidate, rocuronium and potassium acetate all have ordinary medical uses, which has made them easier to obtain than some other execution drugs. However, the sources are secret, and courts have heard evidence of expired supplies being used. Florida's high execution rate in 2025 and 2026 depends on a steady supply.

Where it is used

Florida only. Prisoners in Florida can also choose the electric chair, but must make that choice in writing within 30 days of the Florida Supreme Court upholding their sentence; otherwise lethal injection is used.

Legal challenges

Florida courts have consistently rejected challenges to the protocol, including arguments that etomidate may wear off too quickly. Challenges continue, often focusing on how the protocol is carried out in practice rather than the drugs themselves.

Sources

1. Tallahassee Democrat (via Yahoo News): Could what happened to Christa Pike happen in Florida?
2. Death Penalty Information Center: report on Florida's execution pace and protocol
3. Death Penalty Information Center: executions in 2026
4. Al Jazeera: Florida first uses etomidate (2017)
5. LegalClarity: Florida lethal injection process
6. CBS12: execution of William Reaves Jr.