The use of the powerful anesthetic ketamine by emergency medical personnel, often at the behest of law enforcement, to sedate individuals in mental health crises is facing increased scrutiny and calls for tighter regulation. This practice, frequently justified by the controversial diagnosis of “excited delirium,” has been linked to a number of deaths and serious complications, prompting a national debate about the weaponization of medicine in policing and the need for clear protocols to protect vulnerable individuals.
While proponents argue that ketamine can be a life-saving tool in situations involving highly agitated individuals who pose a danger to themselves or others, opponents point to the lack of scientific evidence for “excited delirium” and the disproportionate use of this label on Black men. The death of Elijah McClain in Aurora, Colorado, after being injected with an excessive dose of ketamine, has become a focal point in this debate, leading to legal challenges, legislative changes, and a re-examination of the role of paramedics in law enforcement encounters.
The Rise of a Controversial Diagnosis
The term “excited delirium” is not recognized as a formal diagnosis by the American Psychiatric Association or the World Health Organization, and it does not appear in the Diagnostic and Statistical Manual of Mental Disorders. Despite this, it is frequently used by law enforcement and paramedics to describe a state of extreme agitation, aggression, and apparent superhuman strength. The term gained prominence in the 1980s and has been used to explain the deaths of individuals in police custody, particularly young Black men. Critics argue that “excited delirium” is a pseudoscientific label that is used to justify the use of force and to absolve law enforcement officers of responsibility for deaths that occur during arrests.
A Shield for Excessive Force
The use of the “excited delirium” diagnosis has been criticized as a way to provide legal cover for the use of force by police. By labeling an individual’s behavior as a medical crisis, the focus can shift from the actions of law enforcement to the pre-existing condition of the person being restrained. This can make it more difficult to hold officers accountable for their actions, as the cause of death can be attributed to the individual’s “excited delirium” rather than the use of force or chemical restraints. The case of George Floyd, where the arresting officer mentioned “excited delirium,” highlights how this term can be used in an attempt to justify actions that lead to a person’s death.
Ketamine: From Anesthetic to Chemical Restraint
Ketamine is a powerful dissociative anesthetic that is used in hospitals for anesthesia and pain relief. It is also used in the treatment of depression. However, its use as a chemical restraint in the field is not an FDA-approved indication. When used outside of a hospital setting, ketamine can have serious side effects, including respiratory distress, cardiac arrest, and death. Despite these risks, the use of ketamine by paramedics to sedate individuals in police custody has been on the rise. In Colorado, for example, there were 902 documented cases of ketamine being used for “excited delirium” in a two-and-a-half-year period, with a complication rate of 17%.
The Role of Paramedics
Paramedics are the ones who administer ketamine in the field, but they often do so at the request of law enforcement. This raises questions about the independence of medical professionals in these situations and whether they are acting in the best interest of the patient or as an extension of law enforcement. In some cases, paramedics have administered ketamine to individuals who were already restrained and no longer posed a threat. The American Society of Anesthesiologists has stated its firm opposition to the use of ketamine or any other sedative to chemically incapacitate someone for a law enforcement purpose and not for a legitimate medical reason.
The Case of Elijah McClain
The death of Elijah McClain in 2019 brought national attention to the issue of ketamine use by police. McClain, a 23-year-old Black man, was stopped by police in Aurora, Colorado, while walking home. He was placed in a chokehold and, despite being subdued, was injected with a dose of ketamine that was appropriate for a man much larger than him. He went into cardiac arrest and died a few days later. The paramedics and police officers involved have since been indicted on charges of manslaughter and criminally negligent homicide. McClain’s family was awarded $15 million in a civil lawsuit against the city of Aurora.
A Push for Regulation and Reform
In the wake of Elijah McClain’s death and other similar incidents, there has been a growing movement to regulate the use of ketamine as a chemical restraint. In 2021, Colorado passed a law banning the use of ketamine for “excited delirium” and clarifying that police should not influence medical professionals’ decisions. A similar bill has been introduced at the federal level. These legislative efforts are aimed at ensuring that ketamine is only used for legitimate medical purposes and that individuals in mental health crises are treated with care and not subjected to dangerous and unnecessary chemical restraints.
The Future of Pre-Hospital Sedation
The debate over the use of ketamine in policing is part of a larger conversation about how law enforcement responds to mental health crises. Many experts argue that police are not the right people to be responding to these situations and that a more appropriate response would involve mental health professionals. The use of ketamine as a first-line treatment for agitation is also being questioned, with some calling for a greater emphasis on de-escalation techniques and other less invasive interventions. The goal is to create a system where individuals in crisis receive the medical care they need without being subjected to the risks of chemical restraints and the trauma of a law enforcement encounter.
