The sedative is used more often on Black people – and justified after the fact with questionable claims of ‘excited delirium’
In the summer of 2019, 23-year-old Elijah McClain was stopped by the Aurora, Colorado, police while walking home, after someone called 911 saying he looked suspicious.
The incident quickly turned violent, with three police officers piling on the 140lbMcClain, twice putting him in a chokehold that has since been banned. After vomiting, coming in and out of consciousness and pleading for breath, paramedics arrived and injected McClain with an excessive dose of ketamine, a powerful sedative.
He immediately went limp and went into cardiac arrest on the way to the hospital, dying a few days later.
The three police officers and two paramedics have since been charged with criminally negligent homicide, and the family of McClain – who was Black – was recently awarded $15m in a civil lawsuit against the city of Aurora, the second largest of its kind, just behind the one awarded to George Floyd’s family.
McClain’s death magnified the American reckoning with racism and police brutality but it has also sparked a national debate about the use of ketamine – a medical anesthetic, popular club drug, and psychotherapy tool – in law enforcement situations, leading to its ban in the state of Colorado, and possibly across the nation.
“What we’re talking about is the weaponization of medicine,” says Mari Newman, the lawyer representing McClain’s family. “It might as well be a taser or a gun.”
Newman says that McClain was exhibiting none of the signs of “excited delirium syndrome” – a controversial diagnosis that legally warrants a ketamine injection – and that police officers erroneously employed “code words like ‘he had superhuman strength’” that she says were an attempt to influence paramedics to give the injection (and justify their own use of excessive force).
Police are not legally allowed to administer ketamine. Paramedics can, but only if a patient is exhibiting symptoms of “excited delirium”. The controversy surrounding this diagnosis – characterized by aggressive behavior, superhuman strength and hyperthermia – comes in part from its emergence during the war on drugs in the 1980s, and is applied disproportionately in the post-mortem of Black men killed by police. The condition is not recognized by the Diagnostic Statistical Manual of Mental Health Disorders, or the American Medical Association.
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A report by public radio station KUNC revealed that in the past 2.5 years, Colorado medics injected 902 people for excited delirium, leading to serious complications in 17% of cases. The American Society of Anesthesiologists recently stated it “firmly opposes the use of ketamine or any other sedative/hypnotic agent to chemically incapacitate someone for a law enforcement purpose and not for a legitimate medical reason”.
A Minnesota medic filed a whistleblower lawsuit last year claiming police had pressured him to inject someone with ketamine during an arrest, adding that such acts are not uncommon (in Minneapolis, ketamine use grew from an average of four law enforcement incidents a year, to 62, from 2015 to 2017).
After the death of McClain – and a similar incident involving Aurora police – the state of Colorado passed legislation last June banning the use of ketamine for excited delirium, and clarifying that police should never influence medics to use it. “EMS is responsible for patient care, not law enforcement,” Governor Jared Polis said in a signing statement. “Ketamine should not be used for law enforcement purposes.”
A similar federal bill was introduced shortly after, and is being considered by Congress.
Emergency Medical Services Association of Colorado president, Scott Sholes, says that, when used according to protocol, ketamine is the safest alternative to violence or other sedatives available to paramedics, and removing it from their toolbox puts them at a serious loss.
“I can tell you horror stories about physically restraining people for hours, back in the day,” says Sholes. “For the first ten years of my career it was strapping people to back-boards, sometimes flipping the board over and sitting on it in order to control people, and eventually we got some medications we could use.”
Starting in the early 1990s, Shole says, medics could use antipsychotics like Haldol, and later benzodiazepines like Valium or opioids like fentanyl, to subdue those who pose a threat to themselves or others. But these drugs could often take 30 minutes to take effect, and sometimes delivered the opposite effect intended.
“In comparison, ketamine takes three to four minutes, is easy to dose, has the safest profile, and has remarkable success with sedation,” Sholes says. “With everything we’ve seen in the media on ketamine, no one is looking at the data.”
Sholes points to a study released last summer revealing that, of the 11,291 instances of patients being injected with ketamine by paramedics, “patient mortality was rare. Ketamine could not be ruled out as a contributing factor in 8 deaths, representing 0.07% of those who received ketamine.”
Sholes stresses a kind of church-and-state separation between medics and law enforcement, and that paramedics should never be collaborating with police in the execution of their duties. However, he admits, there have been instances where this line has been blurred, violating EMS protocol.
And in the case of Elijah McClain, he says that Aurora paramedics failed to follow basic practices in the administration of ketamine.
“I’ve been a paramedic for 40 years, and that video [of McClain’s death], if you think it’s bad from a layman perspective, it’s astonishing to me,” says Sholes. “That’s not how ketamine is commonly used … In that video, I see paramedics who did not assess the patient. By the time they injected him, he wasn’t moving, certainly wasn’t fighting. He was given way more [ketamine] than protocol called for. ”
First approved by the FDA for use as an anesthetic in 1970, ketamine has been a popular medical tool for pain relief and sedation in humans and animals for decades.
In the 80s and 90s, illicit use of ketamine (or “special K”) was popularized by the rave scene of New York City’s club kids, who took it for its euphoric, hallucinogenic properties. In recent years, it has shown remarkably promising results in the treatment of mental health disorders, spawning an industry of “ketamine clinics” around the US.
“Ketamine’s effects operate on a spectrum,” says Desmond Wallington, a psychologist and Colorado mental health director for Klarisana, a ketamine clinic. “On the low-dose end it’s a psycholitic; so time, space and reality briefly dissolve around you. And then there’s a psychedelic experience, where those effects will last for an hour or so, and on the far end there’s an anesthetic [unconscious] experience. We operate in the first two realms.”
Wallington says he “cringes” at the idea of ketamine being used in a law enforcement context, particularly because of its growing association with police brutality against young Black men.
“You don’t want to give ketamine to someone with schizophrenia or schizoaffective disorder – you could send them into a delusional headspace and leave them worse than you found them,” he says. “If they’re already on a stimulant, you’re putting them at risk for a stroke.”
McClain’s family attorney, Mari Newman, says that she believes ketamine injections are being used by law enforcement simply to silence an unruly suspect.
“If someone’s disagreeing with an officer, what better way to shut them up than to knock them right out?” she says.
