The justices voted 5-4 in a case from the state of Oklahoma that the sedative midazolam can be used in executions without violating a constitutional prohibition on cruel and unusual punishment.

The drug used in executions in Arizona, Ohio and Oklahoma in 2014 took longer than usual and raised concerns that it did not perform its intended task of putting inmates into a coma-like sleep.

In Oklahoma, state officials tried to halt the lethal injection after the inmate writhed on the gurney and moaned. He died 43 minutes after the process began.

Executions have been on hold in Ohio since a troubling 26-minute execution in 2014 during which a prisoner getting a first-ever two-drug combo repeatedly gasped and snorted. In Arizona, officials were cleared of any wrongdoing in an execution that lasted nearly two hours, but they nevertheless changed the drugs they use to put inmates to death.

Justice Samuel Alito said for a conservative majority Monday that arguments the drug could not be used effectively as a sedative in executions are speculative.

In dissent, Justice Sonia Sotomayor said, "Under the court's new rule, it would not matter whether the state intended to use midazolam, or instead to have petitioners drawn and quartered, slowly tortured to death, or actually burned at the stake."

Alito responded, saying "the dissent's resort to this outlandish rhetoric reveals the weakness of its legal arguments."

In a separate dissent, Justice Stephen Breyer said the time has come for the court to debate whether the death penalty itself is constitutional. Justice Ruth Bader Ginsburg joined Breyer's opinion.

The Supreme Court's involvement in the case began in January with an unusually public disagreement among the justices over executions. As the case was being heard, Justice Samuel Alito said death penalty opponents are waging a "guerrilla war" against executions by working to limit the supply of more effective drugs. On the other side, liberal Justice Elena Kagan contended that the way states carry out most executions amounts to having prisoners "burned alive from the inside."

In 2008, the court upheld Kentucky's use of a three-drug execution method that employed a barbiturate as the first drug, intended to render the inmate unconscious. But because of problems obtaining drugs, no state uses the precise combination at issue in that earlier Supreme Court case.

Meanwhile, the current court challenge has prompted Oklahoma to approve nitrogen gas as an alternative death penalty method if lethal injections aren't possible, either because of a court ruling or a drug shortage. (iik)(++++)

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