Yes, lethal injection is still the primary method of execution in the United States. Through 2025, the vast majority of the 46 executions carried out used lethal injection, with only a small number using alternatives like nitrogen gas or firing squad. It remains the default method in every state that actively carries out the death penalty.
How Often Lethal Injection Is Used Today
Executions in the U.S. nearly doubled in 2025, rising to at least 46 from 25 in 2024, driven largely by a dramatic increase in Florida. Of those 46 executions, all but two used lethal injection. The exceptions were a nitrogen gas execution in Alabama and a firing squad execution in South Carolina. States that carried out lethal injections in 2025 include Florida, Texas, Oklahoma, Mississippi, Tennessee, Indiana, and others.
The pace marks the highest execution count in over 15 years, and lethal injection accounts for roughly 95% of those deaths. There is no serious legislative movement in any state to replace it entirely.
The Two Main Drug Protocols
States no longer use a single standardized protocol. Instead, two broad approaches have emerged: a one-drug method and a three-drug method.
The one-drug protocol uses a large dose of pentobarbital, a powerful sedative that suppresses breathing and heart function until death occurs. Texas, Oklahoma, Tennessee, Indiana, and South Carolina all used this approach in 2025. It’s generally considered simpler to administer and less prone to error because there’s only one drug to inject correctly.
The three-drug protocol uses a sequence: the first drug renders the person unconscious, the second paralyzes all muscles (including those used for breathing), and the third stops the heart. Florida’s version begins with etomidate, a fast-acting sedative, while Mississippi and Oklahoma have used midazolam, an anti-anxiety drug, as the first agent. The original three-drug protocol, designed in the 1970s by an Oklahoma medical examiner and an anesthesiologist, used thiopental as the sedative, pancuronium bromide as the paralytic, and potassium chloride to stop the heart. Each drug was intended to be lethal on its own, with the combination meant to ensure rapid, sequential failure of consciousness, breathing, and cardiac function.
The critical concern with the three-drug approach is what happens if the first drug doesn’t work well enough. The paralytic agent prevents the person from moving, crying out, or showing any visible signs of distress, even if they can still feel the burning sensation caused by potassium chloride flooding the bloodstream. A continuous, deep level of unconsciousness is necessary to prevent suffering, but confirming that depth of sedation during an execution is difficult.
Why the Drugs Keep Changing
The original protocol relied on sodium thiopental, a surgical anesthetic that had been manufactured for decades. In 2010, Hospira, the only U.S. manufacturer, stopped producing it rather than have its product associated with executions. The company said its drugs were made to help people, not kill them. European manufacturers and regulators followed suit, and the European Union effectively blocked exports of execution drugs to the United States.
What followed was a scramble. State corrections departments initially tried importing thiopental from overseas. At one point, several states sourced the drug from Dream Pharma, a small British wholesaler operating out of the back room of a London driving school. The FDA eventually blocked those imports. Major pharmaceutical companies including Pfizer imposed distribution restrictions to prevent their products from reaching execution chambers. A German investment firm divested $70 million from one pharmaceutical company after learning it produced pancuronium bromide, the paralytic agent.
Cut off from mainstream pharmaceutical supply chains, states turned to compounding pharmacies: small, local operations that mix drugs to order. These pharmacies aren’t subject to the same FDA oversight as large manufacturers, and states passed secrecy laws to shield the identity of their drug suppliers from public scrutiny. Confidentiality agreements, cash payments, and redacted records became standard practice. This shift to unregulated sources is one of the main reasons execution protocols now vary so much from state to state, and it has contributed directly to a rise in problematic executions.
When Lethal Injections Go Wrong
Botched lethal injections are not rare outliers. Alabama alone had three failed or deeply troubled executions in a span of months during 2022.
In September 2022, Alan Miller was strapped to a gurney with his arms outstretched while prison staff spent nearly two hours trying to find a usable vein, puncturing his arms, hands, and feet repeatedly. When they couldn’t establish access, they tilted the gurney upright so Miller hung vertically, strapped in a crucifixion-like position for 20 minutes while blood leaked from his wounds. The execution was eventually called off. He was offered no medical care afterward.
Two months later, Kenny Smith went through a similar ordeal. Staff jabbed needles into his arms, hands, legs, and ankles before attempting to insert a large needle near his collarbone to access a deeper vein. Smith told them they were hitting muscle, not veins. He writhed in pain throughout. That execution was also called off before midnight. When Smith was later executed using nitrogen gas instead, witnesses reported that he thrashed against his restraints for several minutes, his body jerking violently, followed by heaving and retching inside the gas mask. He was not declared dead for 32 minutes.
These failures typically stem from the same basic problem: establishing reliable intravenous access. Execution teams are not composed of experienced medical professionals, since medical ethics codes prohibit doctors and nurses from participating in executions. The people inserting the needles often have limited training, and many inmates have veins damaged by age, illness, or past drug use.
Alternatives Gaining Ground
A handful of states have authorized alternatives to lethal injection, though none have abandoned it outright. Four states (Alabama, Louisiana, Mississippi, and Oklahoma) specifically allow nitrogen hypoxia, which works by replacing the oxygen a person breathes with pure nitrogen. Proponents argue that the person loses consciousness within seconds and dies shortly after, though Alabama’s first use of the method in early 2024 raised serious questions about that claim.
South Carolina carried out a firing squad execution in April 2025, the first in the state in decades. A few other states retain older methods like electrocution or lethal gas as backup options, typically available only if lethal injection is ruled unconstitutional or if drugs are unavailable.
The push toward alternatives is driven almost entirely by drug access problems. Ohio, for example, has considered legislation to add nitrogen hypoxia after repeatedly postponing executions because it couldn’t obtain lethal injection drugs. The underlying dynamic is straightforward: pharmaceutical companies don’t want their products used for executions, and states are looking for methods that don’t depend on a pharmaceutical supply chain that has turned against them.
The Federal Level
The federal government resumed executions in 2020 after a 17-year pause, using a one-drug pentobarbital protocol. Thirteen federal executions were carried out in the final months of the Trump administration. Federal executions have not continued at that pace since, but lethal injection remains the authorized federal method. Whether federal executions resume at scale depends largely on political decisions by the sitting administration and the availability of death-eligible cases that have exhausted their appeals.