SAN DIEGO >> With the American Pharmacists Association taking a stance this week, the medical community is now united in its opposition to playing any role in capital punishment killings.

That could make it increasingly difficult for corrections departments to obtain the already scarce drugs for lethal injections and prompt death penalty states to return to previously shunned methods like firing squads, gas chambers and electric chairs, people on both sides of the issue said Tuesday.

"What happens in the course of an execution can be extremely ugly and excruciatingly painful," said Cheryl Pilate, a Kansas City, Missouri, attorney who has represented two inmates in that state who were executed and another whose death sentence is on hold pending appeals.

"Alternative methods tend to make more plain what is actually happening when an execution occurs: It extinguishes a human life," she said. "Frankly, there is no pretty way to do it."

The pharmacists’ association on Monday adopted a resolution saying participation in executions goes against its members’ core values as health care providers.

That echoes ethics codes adopted by associations for doctors, nurses and anesthesiologists on the issue. The decision came a week after the International Academy of Compounding Pharmacists adopted a similar policy for its 4,000 members.

Officials in the death penalty states of Texas and Oklahoma declined to comment on the potential impact of the health community’s stance.

While not legally binding, the policies likely will decrease the number of businesses willing to sell such lethal injection drugs to prison departments.

States already have been scrambling to find suppliers since major drugmakers stopped selling to corrections agencies. Many have been turning to compounded pharmacies, which make made-to-order drugs for clients and are less regulated than the large manufacturers.

Georgia’s Department of Corrections spokeswoman Joan Heath said only time will tell what the fallout will be.

"It is simply too soon to predict if this will cause concern," she said when asked whether the pharmacy group’s decision could affect the state’s ability to get lethal injection drugs.

Some say the pressure mounting on businesses to not partake in executions could simply drive more of them underground, with states offering to protect their identities. Judges have said such laws are unconstitutional.

Attorney Pilate said Missouri closely guards information about its executions and where it is getting the drugs, leaving unanswered questions.

"It makes you wonder if the drug is coming from an unsavory origin or some dark corner of the Internet," she said.

An execution scheduled for March 2 in Georgia, which also does not release such information, was halted at the last minute after corrections officials said the execution drug — compounded pentobarbital — appeared cloudy. The state has suspended all executions while officials analyze the cloudy drug.

Death penalty supporter Kent Scheidegger of the Criminal Justice Legal Foundation said the increasing challenges might spell the end for lethal injections — but not for capital punishment.

The medical community’s involvement has made legal injections appear as a medical procedure and not as a punishment, he added.

"The whole business of involving the medical profession and pharmacies is unnecessary," Scheidegger said. "We’d be better off without it."

Some death penalty states are preparing for that.

Tennessee passed a law last year to reinstate the electric chair if it can’t get lethal drugs, and Utah has reinstated the firing squad as a backup method.

Republican Rep. Paul Ray, who sponsored the Utah bill, said he knew the announcement from the pharmacists association was coming, which contributed to his urgency in getting a backup plan in place.

"If they don’t want to sell the drug cocktail, fine," he said Tuesday. "We’d prefer it, but now we have a means to carry out our executions."

Oklahoma Attorney General Scott Pruitt has urged legislators to consider the creation of a state compounding pharmacy to make its own drugs. The U.S. Supreme Court is reviewing how Oklahoma conducts executions, which are on hold in the state, following the botched injection of an inmate last year.

Meanwhile, legislation that would make that state the first to allow use of nitrogen gas to execute death-row inmates has gained preliminary approval.

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Contributing to this report were AP writers Justin Juozapavicius, Sean Murphy and Tim Talley in Oklahoma; Brady McCombs and Brian Skoloff in Salt Lake City; Kate Brumback in Atlanta; Meg Kinnard in Columbia, S.C.; Mike Graczyk in Houston; and William Draper in Kansas City, Mo.