Drug injected during arrests drawing scrutiny
Police stopped Elij ah McClain on the street in suburban Denver last year after deeming the young Black man suspicious. He was thrown into a chokehold, threatened with a dog and stun gun, then subjected to another lawenforcement tool before he died: a drug called ketamine.
Paramedics inject it into people likeMcClain as a sedative, often at the behest of policewho believe suspects are out of control. Officially, ketamineis used inemergencies when there’s a safety concern for medical staff or the patient. But it’s increasingly foundin arrestsandhas become another flash point in the debate over lawenforcement policies and brutality against people of color.
An analysis by TheAssociated 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.
It was a year agoMonday thatMcClain, 23, wasstopped by officers responding to a 911 call about a suspicious person wearing a ski mask andwaving his arms. Police puthimin a chokehold twice andmultiple officers pressed their bodyweight into him.
Paramedics were called and injected McClain with ketamine, but they incorrectly estimated hisweight, giving him more than 1.5 times the dose he should have received. He got 500 milligrams because they thought he weighed 220 pounds, but he was only 140 pounds and should have received 315 milligrams.
He suffered cardiac arrest, was later declaredbrain dead and taken off life support.
“The case where some
body’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. “The vast majority of these scenarios get managed at a much lower level withmuch less physical restraint, no need for chemical restraint or sedation.”
AfterMcClain’s death, Colorado’s health department opened an investigation into the growing use of ketamine, firstapprovedfor 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 typi
cally associated with chronic drug abuse, mental illness or both. The drug sedates them, is supposed to have limited side effects and isn’t intended to make someone lose consciousness.
Medical professionals say excited delirium is a “wastebasket term” andhasnostandard definition. The commonly cited characteristics include superhuman strength, imperviousness to pain and wild, uncontrollable behavior, said Dr. Paul S. Appelbaum, director of the Division of Law, Ethics & Psychiatry at Columbia University.
“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 policewho are certainly not expert in diagnosis of neuropsychiatric syndromes,” he said.
Police are not trained on diagnosing any medical conditions, but most knowfirst aid and CPR. Every police agency has different criteria for calling in paramedics, according to JimmyHol
derfield, secretary for the National Fraternal Order of Police.
“The best rule of thumb to apply here iswhat a ‘prudent and reasonable’ person would do,” Holderfield said by email. “Officers are chargedwith theduty ofprotecting lives and property.”
Emergency medical personnel administer ketamine when they believe it’s necessary, police say. But there’s growing concern overwhether officers are too involved in the decision and conflicting medical opinions on using it during arrests.
The American Society of Anesthesiologists op poses it and other sedatives for lawenforcement 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 shortlived effects aswell 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. Other options include drugs like Valium or Xanax and anti-psychotics.
But Chris Burbank, vice president of lawenforcement strategy for the Center for Policing Equity and a former Salt Lake City police chief is suspicious of the explanations for using it.
“I always go back to why are we doing the business thatwe’re doing,” Burbank said. “This goes to traffic stops, this goes to pedestrian stops, this goes to searchand seizure. There’s not a need for some of these things.”
The Food and Drug Administration approvedk eta mine in 1970, and its first major widespread usewas as a battlefield anesthetic during the Vietnam War.
In the 1980s, recreational use of the drug, as Special K, became popular for its hallucinogenic effects. Over the last decade, ketamine has been studied as a treatment for depression, and the FDA approved a nasal spray last year.
In July, a Blackmanin Minneapolis was injected and endedupin the hospital after his girlfriend believedhewas having a diabetic seizure.
But paramedics questioned which drugs Johnson had taken, apparently not believing her, AbbyWulfing wrote in a Facebook post that’s gotten widespread attention.
In May 2016, Marine veteranWillard 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. He ended up on a ventilator in August 2019, the same month McClain was injected in Aurora, Colorado.
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.
His parents sued this month, alleging that Aurora Fire Rescue’s unchecked policy and its de facto dose of 500 milligrams violated their son’s constitutional rights. The lawsuit says the force officers used pushed McClain into medical distress, which compounded the “substantial overdose” and led to his death.
Therewere 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, policewere foundtotake part inthe 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 medicalworkers asking officers for their opinions on sedating someone.
The report concluded that the lack of uniform policy on howpolice should interact with paramedicsmeant cops could potentially interfere in medical decisions.
“Even if it’s a homicide suspect, we would guard that person, butwe don’t get in the middle — nor should we — of how that person is treated for their injuries or crisis, whatever it may be that the doctor or paramedics de em appropriate to treat this person,” Burbank said.