I have mixed feelings about death penalty---I feel many deserve it but that current process with delays, jury manipulation, corrupt labs, etc makes me skeptical government can carry them out in a manner I approve of. THAT SAID---we use propofol in 99% of all anesthetics performed--either in general anesthesia or in sedation. After state of MO changed their law to allow propofol use in executions due to shortage of any barbiturates, we expect SEVERE shortages. We have issued the following statement to inform public. ASA and State Societies Work to Avert Severe Propofol Shortage Many of you have been made aware that Missouri plans to use propofol in an execution, which could result in a dangerous shortage of propofol. ASA has been actively tracking and working on this important public health issue for several months. Below is a summary of the issue and ASA's actions to raise awareness about the dangers of a propofol shortage. Missouri plans to execute two inmates on October 23 and November 20 using propofol. Propofol has not previously been used in executions, but Missouri changed its lethal injection protocol due to market unavailability of a barbiturate that had been part of Missouri's previous protocol. European Union Council Regulation 1236/2005 prohibits "trade in certain goods which could be used for capital punishment..." Annex III contains a list of restricted products covered by this Regulation, and these products are subject to a case-by-case assessment for export. Should Missouri be the first state to use propofol in its lethal injection protocol, it is expected that propofol will be placed on the Annex III list of restricted products. Subsequently, for every shipment, the drug manufacturer would be required to apply to an export authority for an export license. Without a license, an export shipment would be blocked from leaving the European Union. It reportedly takes at least three to six months to obtain an export license because the export authority must determine that the end-user will not use the propofol for executions. For the first three to six months after propofol is listed on Annex III, it is possible that no propofol will be imported into the United States from Europe while drug companies apply for export licenses. Once valid licenses are obtained, shortages of propofol are expected to continue due to the strict export controls. This could be extremely problematic because the vast majority of propofol used in the United States is manufactured in Europe. Fresenius Kabi currently supplies 89 percent of all propofol infusions in the United States. Hospira is the only company that manufactures propofol in the United States, but does not have the capacity to meet demand during a shortage. Over the past several months, ASA has communicated extensively with Fresenius Kabi and other drug shortage stakeholders to learn more about the European Union's distribution controls and how they will affect the manufacturer's ability to supply propofol to the United States. Fresenius Kabi has launched a website that addresses the consequences of using propofol in an execution. ASA is actively monitoring this situation throughout the country and is working with the Missouri Society of Anesthesiologists to educate lawmakers on how a propofol shortage will jeopardize patient safety. ASA, over the past several years, has spoken regularly to the Food and Drug Administration (FDA) about drug shortages, and continues to speak to the Agency about the importance of preventing another propofol shortage. ASA will continue to work closely with the drug manufacturers, the state societies and the FDA to emphasize the importance of propofol to safe administration of anesthesia to patients.