Ketamine that's injected during arrests draws new scrutiny

Published by ABCNEWS.GO.COM

Summary generated on August 22, 2020

    DENVER - Police stopped Elijah McClain on the street in suburban Denver last year after deeming the young Black man suspicious.

    Paramedics inject it into people like McClain as a sedative, often at the behest of police who believe suspects are out of control.

    Officially, ketamine is used in emergencies when there's a safety concern for medical staff or the patient.

    An analysis by The Associated Press of policies on ketamine and cases where the drug was used during police encounters uncovered a lack of police training, conflicting medical standards and nonexistent protocols that have resulted in hospitalizations and even deaths.

    Police put him in a chokehold twice and multiple officers pressed their body weight into him.

    Paramedics were called and injected McClain with ketamine, but they incorrectly estimated his weight, giving him more than 1.5 times the dose he should have received.

    "The case where somebody's got six officers on them, in a chokehold, and needs ketamine is really pretty exceptional. That just doesn't happen very often," said Dr. George Lindbeck, chairman of the National Association of State EMS Officials medical director's council.

    Colorado's health department opened an investigation into the growing use of ketamine, first approved for use in 2013, after the case got new attention during nationwide protests seeking police reform.

    There are no federal standards for law enforcement or emergency medical personnel on the drug's use.

    State policies and reporting requirements vary, so it's not clear how regularly it's used during police encounters and why.

    Most states and agencies say ketamine may be administered when someone exhibits "Excited delirium" or agitation, which is typically associated with chronic drug abuse, mental illness or both.

    Medical professionals say excited delirium is a "Wastebasket term" and has no standard definition.

    "It's not at all clear that these people are delirious. Moreover, it seems pretty clear that they're not all one thing, that this term tends to be applied out in the field by police who are certainly not expert in diagnosis of neuropsychiatric syndromes," he said.

    Police are not trained on diagnosing any medical conditions, but most know first aid and CPR. Every police agency has different criteria for calling in paramedics, according to Jimmy Holderfield, secretary for the National Fraternal Order of Police.

    Emergency medical personnel administer ketamine when they believe it's necessary, police say.

    There's growing concern over whether officers are too involved in the decision and conflicting medical opinions on using it during arrests.

    The American Society of Anesthesiologists opposes it and other sedatives for law enforcement purposes, saying, "These effects can end in death when administered in a non-health care setting without appropriately trained medical personnel and necessary equipment."

    Those in favor of ketamine cite its fast-acting and short-lived effects as well as scientific reports that it doesn't cause severe respiratory problems compared with other sedatives.

    For police, the objective is to help deescalate a tense situation and lessen restraints they need to use, Lindbeck said.

    Vice president of law enforcement strategy for the Center for Policing Equity and a former Salt Lake City police chief is suspicious of the explanations for using it.

    The Food and Drug Administration approved ketamine in 1970, and its first major widespread use was as a battlefield anesthetic during the Vietnam War.

    Over the last decade, ketamine has been studied as a treatment for depression, and the FDA approved a nasal spray last year.

    In May 2016, Marine veteran Willard Truckenmiller got into a fight in a bar in Naples, Florida, and showed signs of "Alcohol-induced excited delirium." When emergency medical workers arrived, Truckenmiller was given 500 milligrams of ketamine, then suffered cardiac arrest and died.

    Another Colorado man, Elijah McKnight, 25, was given two doses totaling 750 milligrams of ketamine after a drunken altercation with police.

    An official autopsy found that ketamine in McClain's blood was at "Tolerable levels," but it couldn't rule out an unexpected reaction to the drug, asthma attack or irregular heartbeat.

    The lawsuit says the force officers used pushed McClain into medical distress, which compounded the "Substantial overdose" and led to his death.

    There were 902 reported instances of Colorado paramedics administering ketamine from 2018 to 2020, and almost 17% had complications, including cardiac arrest and oxygen deprivation, the state health department said.

    In other states, police were found to take part in the decision to use the drug.

    In Minneapolis, a report conducted by the Office of Police Conduct Review found eight of those cases between 2016 and 2018, ranging from officers requesting paramedics use the drug to emergency medical workers asking officers for their opinions on sedating someone.

    The report concluded that the lack of uniform policy on how police should interact with paramedics meant cops could potentially interfere in medical decisions.