Document ID: ./input/supremecourt_opinions/opinions/14pdf/14-7955_aplc.pdf
Page Number: 103.0

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

7 

SOTOMAYOR, J., dissenting 

cording to Dr. Lubarsky, would not have occurred “during 
extremely  deep  levels  of  anesthesia.”    Id.,  at  177.    Both 
experts also cited various scientific articles and textbooks 
to  support  their  conclusions.  For  instance,  Dr.  Lubarsky 
relied on a study measuring the brain activity of rats that 
were  administered  midazolam,  which  showed  that  the 
drug’s impact significantly tailed off at higher doses.  See 
Hovinga  et  al.,  Pharmacokinetic-EEG  Effect  Relationship 
of  Midazolam  in  Aging  BN/BiRij  Rats,  107  British  J.
Pharmacology 171, 173, Fig. 2 (1992).  He also pointed to a 
pharmacology  textbook  that  confirmed  his  description  of 
how  benzodiazepines  and  barbiturates  produce  their 
effects,  see  Stoelting  &  Hillier  127–128,  140–144,  and  a
survey  article  concluding  that  “[m]idazolam  cannot  be
used  alone  . . .  to  maintain  adequate  anesthesia,”  Reves, 
Fragen,  Vinik,  &  Greenblatt,  Midazolam:  Pharmacology 
and Uses, 62 Anesthesiology 310, 318 (1985) (Reves).  For 
his  part,  Dr.  Sasich  referred  to  a  separate  survey  article, 
which similarly recognized and described the ceiling effect 
to  which  benzodiazepines  are  subject.    See  Saari,  Uusi- 
Oukari,  Ahonen,  &  Olkkola,  Enhancement  of  GABAergic 
Activity: Neuropharmacological Effects of Benzodiazepines 
and Therapeutic Use in Anesthesiology, 63 Pharamacolog­
ical Rev. 243, 244, 250 (2011) (Saari). 

By contrast, Dr. Evans, the State’s expert, asserted that
a  500-milligram  dose  of  midazolam  would  “render  the
person  unconscious  and  ‘insensate’  during  the  remainder 
of  the  [execution]  procedure.”  App.  294.  He  rested  this 
conclusion on two interrelated propositions. 

First, observing that a therapeutic dose of midazolam to
treat  anxiety  is  less  than  5  milligrams  for  a  70-kilogram
adult,  Dr.  Evans  emphasized  that  Oklahoma’s  planned 
administration of 500 milligrams of the drug was “at least 
100  times  the  normal  therapeutic  dose.”    Ibid.    While  he 
acknowledged  that  “[t]here  are  no  studies  that  have  been 
done  . . .  administering  that  much  . . .  midazolam  . . .  to