Student Post: Policing Term ‘Excited Delirium’ Should Not Justify Risky Ketamine Use

By De'Ja Wood

This summer, the murder of George Floyd seized national attention and sparked protests and discourse about police violence across the country. The ongoing discussion about police brutality led to an online petition calling for Colorado government agencies to reopen the investigation in the death of Elijah McClain, a 23-year old Black man in Aurora, Colorado who died after being placed in a chokehold and sedated by police.

After the petition received more than 3 million signatures, Governor Jared Polis of Colorado appointed a special prosecutor to investigate McClain’s death. In a statement, Polis said, “Elijah McClain should be alive today, and we owe it to his family to take this step and elevate the pursuit of justice in his name to a statewide concern.”

Elijah McClain’s death was the center of a 60 minutes episode on Sunday, Dec. 13, about “excited delirium” and the use of ketamine to subdue individuals. The episode broadcasted footage of Elijah McClain’s detainment, in which McClain pleads with the officers and tells them that he is unable to breathe properly. In a struggle to continue breathing, he vomits and loses consciousness at one point. According to their statements and the district attorney, the police and medical workers thought that Elijah McClain wasn’t making sense and showed super strength – signs of a struggle to survive in a life-threatening situation but symptoms that officials understood as signs of excited delirium.

Excited delirium is a controversial term used among law enforcement to describe a syndrome among people exhibiting wild behavior and extreme strength that could be life-threatening to themselves and their community. The Federal Bureau Investigation (FBI) defines “excited delirium syndrome” as “a serious and potentially deadly medical condition involving psychotic behavior, elevated temperature, and an extreme fight-or-flight response by the nervous system.” In order to subdue individuals experiencing excited delirium, law enforcement and emergency personnel are advised to use ketamine, a powerful anesthetic used in hospitals. But, of note, use of this powerful anesthetic is not approved by the Food and Drug Administration for sedation and whenever used should be accompanied by intensive medical monitoring.

In Elijah’s case, paramedics and police agreed to use ketamine to stabilize him. Elijah’s 140-pound body was injected with 500 milligrams of ketamine, which is the recommended dosage for a 200-pound person.

Medical professionals note that ketamine can be a useful drug when utilized in a proper hospital setting, as it is an FDA-approved medication for anesthesia and treatment-resistant depression treatment; however, it is not without risk. Ketamine must be distributed with careful monitoring, as the drug is associated with hallucinations or bad reactions when patients wake up after taking the anesthetic. Furthermore, ketamine is associated with effects on the respiratory and cardiac systems.

After being subdued by ketamine injection, Elijah McClain suffered respiratory and cardiac arrest and died just three days later.

Excited delirium has not been recognized by the American Medical Association, the World Health Organization, or the American Psychiatric Association. In fact, a recent official statement by the American Psychiatric Association asserted that “excited delirium” is not a legitimate medical diagnosis, as “the criteria are unclear and to date there have been no rigorous studies validating excited delirium as a medical diagnosis.” The APA statement goes on to say that use of these medications should only be “for treatment purposes in medically appropriate situations and should explicitly bar their use to achieve incapacitation solely for law enforcement purposes.”

Paul Appelbaum, the Chair of DSM Steering Committee for the American Psychiatric Association – psychiatry’s main diagnostic manual – called excited delirium “bad science” based on faulty studies that grew out of the 1980s cocaine epidemic.

Dr. Applebaum called excited delirium “a wastebasket phrase,” stating that “it also had utility for the police, since so many of the early cases, and some of the continuing cases occur, in police custody and result in death. It's a way of explaining what happened without necessarily bearing responsibility for it.” Dr. Paul Applebaum also noted excited delirium is a diagnosis disproportionately assigned to young, Black men during their encounters with the police.

The term appears to provide justification for police use of force, as officials can argue that people’s behavior when “experiencing” excited delirium is a threat to their safety. In the footage of the murder of George Floyd, former officer Derek Chauvin stated, “I am concerned about excited delirium,” as he knelt on George Floyd’s neck during the final eight minutes and 46 seconds of his life. This may become a part of Chauvin’s defense during his trial in 2021 to justify his use of force, as Chauvin’s attorneys can argue that Floyd exhibited wild behavior and extreme strength while officers tried to arrest him.

In Colorado, law enforcement and emergency personnel have used 900 doses of ketamine to subdue people since 2017, according to an aggregation of medical reports by the Colorado Department of Public Health and Environment. Officials there report an alarming 17% rate of complications.

Dr. Marvin Swartz, Professor in the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine and faculty member at the Wilson Center, has followed the use of excited delirium in policing. In an email, he wrote that excited delirium as a “diagnosis is a bogus one and the use of it to get medical personnel to justify medical interventions is illegitimate.

“Doctors treat medical disorders, not aid police in subduing subjects – [doctors] are not extensions of the police, should not be directed by police to administer so-called medical care and should not do the bidding of police for the purposes of incapacitating patients,” he added.

For this reason, Dr. Swartz noted, “it is urgent that we do not use medical practices to restrain or incapacitate people. It is only justifiable if the person has a treatable condition.”

Emergency medical personnel’s first priority should be to ensure people’s health and overall well-being rather than aid police in addressing crime or situations in which public safety is deemed “at-risk.” Ketamine should be a carefully controlled medical regimen used to treat people in need of medical assistance with a treatable condition, not a law enforcement tactic to aid in arrests.

De’Ja Wood is an undergraduate student at Duke University working this semester with the Wilson Center for Science and Justice.