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Page Number: 102.0

6 

GLOSSIP v. GROSS 

SOTOMAYOR, J., dissenting 

function, they do so in a materially different way.  Id., at 
207.  More  specifically,  Dr.  Lubarsky  explained  that  both
barbiturates  and  benzodiazepines  initially  cause  sedation 
by facilitating the binding of a naturally occurring chemi­
cal  called  gamma-aminobutyric  acid  (GABA)  with  GABA
receptors,  which  then  impedes  the  flow  of  electrical  im­
pulses through the neurons in the central nervous system. 
Id., at 206.  But at higher doses, barbiturates also act as a
GABA  substitute  and  mimic  its  neuron-suppressing  ef­
fects.  Ibid.  By  contrast,  benzodiazepines  lack  this  mim­
icking  function,  which  means  their  effect  is  capped  at  a 
lower  level  of  sedation.  Ibid.    Critically,  according  to  Dr. 
Lubarsky,  this  ceiling  on  midazolam’s  sedative  effect  is
reached  before  full  anesthesia  can  be  achieved.    Ibid. 
Thus,  in  his  view,  while  “midazolam  unconsciousness  is 
. . . sufficient” for “minor procedure[s],” Tr. of Preliminary 
Injunction  Hearing  132–133  (Tr.),  it  is  incapable  of  keep­
ing someone “insensate and immobile in the face of [more] 
noxious  stimuli,”  including  the  extreme  pain  and  discom­
fort associated with administration of the second and third 
drugs  in  Oklahoma’s  lethal  injection  protocol,  App.  218.
Dr.  Sasich  endorsed  Dr.  Lubarsky’s  description  of  the 
ceiling effect, and offered similar reasons for reaching the 
same conclusion.  See id., at 243, 248, 262. 

In  support  of  these  assertions,  both  experts  cited  a 

variety of evidence.  Dr. Lubarsky emphasized, in particu­
lar,  Arizona’s  2014  execution  of  Joseph  Wood,  which  had 
been conducted using midazolam and the drug hydromor­
phone  rather  than  the  three-drug  cocktail  Oklahoma
intends  to  employ.1  Id.,  at  176.  Despite  being  adminis­
tered  750  milligrams  of  midazolam,  Wood  had  continued 
breathing  and  moving  for  nearly  two  hours—which,  ac­

—————— 

1 Hydromorphone is a powerful analgesic similar to morphine or hero­
in.  See R. Stoelting & S. Hillier, Pharmacology & Physiology in Anes­
thetic Practice 87–88 (4th ed. 2006) (Stoelting & Hillier).