Document ID: ./input/supremecourt_opinions/opinions/14pdf/14-7955_aplc.pdf
Page Number: 101.0

Cite as:  576 U. S. ____ (2015) 

5 

SOTOMAYOR, J., dissenting 

things,  that  the  State’s  intended  use  of  midazolam  would
violate  the  Eighth  Amendment  because,  unlike  sodium
thiopental  or  pentobarbital,  the  drug  “is  incapable  of 
producing  a  state  of  unawareness  that  will  be  reliably 
maintained  after  either  of  the  other  two  pain-producing
drugs . . . is injected.”  Amended Complaint ¶101.

The  District  Court  held  a  3-day  evidentiary  hearing,  at 
which  petitioners  relied  principally  on  the  testimony  of
two experts: Dr. David Lubarsky, an anesthesiologist, and 
Dr.  Larry  Sasich,  a  doctor  of  pharmacy.    The  State,  in 
turn, based its case on the testimony of Dr. Roswell Evans, 
also a doctor of pharmacy.

To  a  great  extent,  the  experts’  testimony  overlapped. 
All three experts agreed that midazolam is from a class of
sedative  drugs  known  as  benzodiazepines  (a  class  that 
includes  Valium  and  Xanax),  and  that  it  has  no  analge­
sic—or pain-relieving—effects.  App. 205 (Lubarsky), 260– 
261 (Sasich), 311 (Evans).  They further agreed that while 
midazolam can be used to render someone unconscious, it 
is not approved by the Federal Drug Administration (FDA)
for  use  as, and  is  not  in  fact  used  as,  a  “sole drug  to  pro­
duce  and  maintain  anesthesia  in  surgical  proceedings.” 
Id., at 307, 327 (Evans); see id., at 171 (Lubarsky); id., at 
262  (Sasich).    Finally,  all  three  experts  recognized  that 
midazolam is subject to a ceiling effect, which means that 
there  is  a  point  at  which  increasing  the  dose  of  the  drug
does  not  result  in  any  greater  effect. 
Id.,  at  172 
(Lubarsky), 243 (Sasich), 331 (Evans). 

The  experts’  opinions  diverged,  however,  on  the  crucial
questions of how this ceiling effect operates, and whether
it  will  prevent  midazolam  from  keeping  a  condemned 
inmate  unconscious  when  the  second  and  third  lethal 
injection  drugs  are  administered.  Dr.  Lubarsky  testified 
that  while  benzodiazepines  such  as  midazolam  may,  like
barbiturate  drugs  such  as  sodium  thiopental  and  pento­
barbital,  induce  unconsciousness  by  inhibiting  neuron