Munch says that one of the drugs used on the victims was Pavulon, which is the brand name for Pancuronium bromide, an amniosteroid muscle relaxant. It works by blocking the neurotransmitter acetylcholine in the nervous system. Acetylcholine acts as a signaling agent; when it is present in the synapse, it tells muscles to contract, and if there is no acetylcholine the muscles stay relaxed. In standard doses pancuronium affects only the peripheral and voluntary nerve functions, but in large doses it will also affect the autonomic and central nervous system and prevent the heart and lungs from functioning. Pancuronium bromide is mainly used to relax muscles to aid in intubation, often when general anesthesia is being administered. It is also the second drug in the three-drug cocktail used for lethal injections in certain countries, including the United States. The first drug administered is used to sedate the inmate, usually a fast, ultra-short acting barbiturate like sodium thiopental or pentobarbital. This causes unconsciousness within 30 seconds, and though the dosage is high enough to cause fatal respiratory depression even in the absence of the other two drugs, the process would take too long. The second drug administered, pancuronium bromide, paralyzes the skeletal muscles (mainly to prevent muscles spasms and "death throes"), and also the diaphragm, which helps to quickly cease all respiratory function. The third drug administered is potassium chloride which causes the potassium levels in the blood to rise drastically, which causes cardiac arrest within seconds. The combination of the three drugs causes total brain death in less than four minutes.
In this episode it is mentioned that drugs like potassium chloride, pancuronium bromide (Pavulon) and sodium thiopental are used as a cocktail in lethal injections in the United States. Some time after this episode aired, the US was forced to change the drug cocktail used in executions when the United Kingdom outlawed the export of all drugs to be used in executions (the main manufacturers of barbiturate drugs like sodium thiopental and pentobarbital are all in the UK). Several cocktails have been tried in different states, such as phenobarbital and Midazolam, but these caused a few executions to become botched through unexpected drug interactions. Due to these interactions some states tried a single drug for executions, and this has proven more effective than cocktails. Now the type of drug used in most lethal injections are opioids. Hydromorphone (Dilaudid), which is a semi-synthetic opioid roughly five times more potent than morphine, has been used to execute several people in a few different states. After an IV is inserted, 500 mg of hydromorphone is injected into the inmate's veins (roughly five times the median lethal dose), causing death within two minutes. In 2018 the state of Arkansas became the first state to execute an inmate with fentanyl, a synthetic opioid 100 times more potent than morphine that has a rapid onset of action. On August 14, 2018 Carey Dean Moore became the first person to be executed with fentanyl, he was convicted of two counts of first degree murder in 1978 after murdering two taxi drivers. Moore died less 90 seconds after being injected with an unknown dosage of fentanyl; due to this drug working rapidly and with no adverse reactions or problems other states are now adopting Nebraska's drug cocktail for executions. Eight states (Arizona, Georgia, Idaho, Missouri, Ohio, South Dakota, Texas, and Washington) have used the single-drug execution protocol. Five additional states (Arkansas, Kentucky, Louisiana, North Carolina, and Tennessee) have announced that they are switching to a single-drug protocol.
Orlagh Cassidy has played three different characters over the course of the series:
- Episode 18.19 Conversion (2017) - Cheryl Davenport
- Episode 11.11 Quickie (2010) - Mrs. Christensen
- Episode 3.2 Wrath (2001) - Valerie Plummer
John Doman previously appeared in season 1 episode Limitations (2000) as Dan Latimer. In this episode he played Special Agent Franklin.
Actor John Doman has played 13 characters across the L&O franchise, appearing in:
- The Blue Wall (1991) as Bailiff
- We Like Mike (1997) as Sgt. Frank Gottlieb
- Is It a Crime? (1997) as Richard Coates
- True North (1998) as Mr. Stephens
- Limitations (2000) as Dan Latimer
- Wrong Is Right (2000) as Much's Informant
- Wrath (2001) as Special Agent Rod Franklin
- The Extra Man (2001) as Roy Markham
- Maritime (2003) as Howard Ridgeway
- Blue Wall (2005) as Defense Attorney Tim Grace
- Scheherazade (2007) as Mike Mollinax
- Political Animal (2008) as Jim Gilles
- Official Story (2012) as William Rand