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CNN  — 

Supplies of lethal injection drugs are running low and new sources are becoming increasingly difficult for states to come by. Pfizer, the second-largest pharmaceutical company in the world, just made the job even more challenging by blocking its drugs from being used in executions.

Here is how the United States got to this point:

Opposition to the death penalty is rising …

In 1994, Gallup found that 80% of Americans supported the death penalty. Fast-forward to today: A poll last October showed the support had fallen to 61%.

… and more states are putting executions on hold

Those are in addition to the 19 states and the District of Columbia, which have outlawed capital punishment. Since 2009 alone, Connecticut, Illinois, Maryland, Nebraska and New Mexico have abolished the death penalty.

But capital punishment isn’t on its way out

Not by a long shot. In just the last six years, 17 states have executed 247 inmates. That’s as of May 11. Three states account for more than half of those: Texas, Florida and Oklahoma.

The most common method? Lethal injection

Lethal injection is the primary means of execution in all 31 death penalty states. In 1982, Texas became the first state to execute an offender via lethal injection. Since then, the United States has carried out 1,425 executions, and only 171 have relied on another method.

But the drugs are drying up …

There are 61 women on death row across the country, according to the Death Penalty Information Center, making up only 2% of the 3,125 inmates on death row across the country.  Take a look at all the women sentenced to death in the United States.  Source: Death Penalty Information Center
Lethal injection explained (2014)
01:27 - Source: CNN

Lethal injection initially required a three-drug cocktail: The first (sodium thiopental or pentobarbital) puts the prisoner to sleep, the second (pancuronium bromide) brings on paralysis, and the final agent (potassium chloride) stops the heart.

In 2010, European drug manufacturers began to ban exports of the cocktail ingredients to the United States. The following year, concerned about the use of sodium thiopental in executions, Illinois-based Hospira stopped making the drug, and Denmark-based Lundbeck banned U.S. prisons from using its pentobarbital. The United Kingdom also introduced a ban on exporting sodium thiopental, and the European Union took an official stance in 2012 with its Regulation on Products used for Capital Punishment and Torture.

… forcing states to scramble for new cocktails

SCOTUS mullery
Lethal injection at the Supreme Court in two minutes
02:04 - Source: CNN

Death penalty states began looking for alternatives. Among them: procuring the drugs from alternative sources, devising a one-drug method, employing other drugs such as midazolam or propofol, and using controversial compounding pharmacies to manufacture the drugs.

This has spurred a cascade of lawsuits

Such lawsuits saw a significant uptick in 2014. That’s the same year numerous executions, all employing midazolam, were widely considered botched. In Ohio, Dennis McGuire gasped and convulsed for 10 minutes before dying. In Arizona, Joseph Wood snorted and gulped for air as he died over a period of two hours. And in Oklahoma, Clayton Lockett writhed for 43 minutes before succumbing to a heart attack.

After each of those cases, states issued holds on capital punishment while the processes were reviewed. Attorneys for death row inmates in several states have also used these botched efforts to challenge the constitutionality of their clients’ executions.

Now, states are looking at alternatives …

In 2014, Tennessee said that when lethal injection drugs can’t be found, the state can use the electric chair. The next year, Utah successfully passed legislation to reintroduce firing squads.

Fourteen other states have a secondary means – Oklahoma actually has three – but in those states, inmates must opt for them.

… which brings us back to Pfizer

Megan McCracken, a death penalty expert from University of California, Berkeley, said the company’s decision is significant.

“From the stance of a company making a stand it’s a big deal,” she said. “It’s more than a PR move, because they’ve put in place a restrictive distribution system.”

McCracken said it’s difficult to determine how much impact the Pfizer decision will have because of secrecy on the state level about lethal injection drugs.

But, with drugs becoming increasingly harder to come by, more states will have start looking for alternatives.