What Is Ketamine, and Why Is This Drug Used During Police Calls?
When Abby Florence found her boyfriend, Max Johnson, seizing on their living room couch in their home in Minneapolis, she couldn't have expected what happened when she dialed 911.
According to a lengthy Facebook post Florence wrote on July 30, Johnson, who is a type 1 diabetic, was administered 500 mg of ketamine, a sedative often used for anesthesia, while physically restrained by an EMS after coming out of his seizure (which Florence said was likely caused by his diabetes). The EMS also gave him 20 mg of Versed, a pre-anesthesia drug, to prevent adverse side effects. Johnson was soon rushed to the ICU.
"Because of the ketamine, Max was on a ventilator in the ICU for a tortuous 2 days where we could not visit him, talk to him, or advocate for him. It was hell," Florence wrote in the post. Johnson, who is now home with his girlfriend, survived the ordeal.
Elijah McClain was not as fortunate. McClain, a 23-year-old massage therapist, had the police called on him to investigate his behavior while walking home in Aurora, Colorado in 2019. After being placed in a chokehold by police officers, he was given 500 mg of ketamine by a paramedic to sedate him while handcuffed. McClain soon went into cardiac arrest, then declared brain dead after arriving at a hospital. McClain's family has since filed a civil lawsuit against the city of Aurora.
McClain's case has put ketamine in the headlines, with some pointing out that the drug can come with a host of deadly side effects if improperly administered. In McClain's home state of Colorado, 427 people were given ketamine for agitation between August 2017 and July 2018, and about 20% had to be intubated at a hospital. In Minneapolis, where Johnson was given the drug, documented ketamine use in police settings rose from 3 cases in 2012 to 62 in 2017, according to the Minnesota Star Tribune.
What is ketamine?
Ketamine is a fast-acting general anesthetic and sedative administered either deep into muscles or through an IV. On its own, it can cause a person to hallucinate, so Versed, a benzodiazepine (aka, an anti-anxiety drug), is typically administered alongside it to reduce ketamine's hallucinogenic effect, Mark Pappadakis, DO, a New Jersey-based emergency medicine physician at Capital Health Regional Medical Center in Trenton, tells Health.
Approved by the FDA as an anesthetic in 1970, "ketamine antagonizes the function of certain receptors on the brain and puts them in a dissociative or trance-like state," Dr. Pappadakis tells Health.
What is ketamine used for?
Though primarily an anesthetic, ketamine is taken for other reasons:
As an emergency room anesthetic
"It's been used in the ER for sedation for children and adults getting medical procedures including intubation—or even in children for stitches," says Dr. Pappadakis. "Elsewhere, we use it for sedation or [on] agitated patients, but we do it in the sense that they're monitored for oxygen and blood pressure."
Dr. Pappadakis says that most hospitals have specific protocols when it comes to ketamine dosage. His hospital administers between 4-5 mg of the substance per kilogram of the patient's body weight, and ketamine is only used when other methods of restraint have been exhausted.
As a party drug
Ketamine is a hallucinogenic party drug known as "special K" or "cat valium" on the street. Given its sedative effects, ketamine has also been used to facilitate sexual assault as a "date rape" drug.
By EMS in police settings
Ketamine has been used in EMS or police settings to restrain agitated or potentially violent patients, and it's typically administered with a benzodiazepine like Versed to prevent any dangerous side effects. The use of ketamine as a means of restraint appears to be acceptable by many hospitals.
To treat depression
Ketamine's off-label use has been considered a "breakthrough therapy" by the FDA to treat depression, chronic pain, and a host of other mental health conditions. Ketamine clinics that administer the drug have popped up around the country, with ketamine IV infusions going for as much as $1000 a treatment.
Adverse effects of ketamine
According to the DEA, ketamine can induce a hallucinatory state called a "K-hole" that lasts anywhere from 30-60 minutes, as a well as a feeling of calmness or relaxation. Other reactions include distorted sight and hearing, an inability to move or a feeling of being out of control, amnesia, agitation, unconsciousness, flashbacks, and even depression. Nausea and vomiting are experienced by 6-12% of users, while more rare side effects can include an abnormal heart rhythm, breathing interruptions, and kidney swelling.
Can you overdose on ketamine?
Yes. "Too much ketamine could lead to cardiac instability, where someone could have their heart rate spike leading to cardiac damage and arrhythmias," says Dr. Pappadakis. "It could spike their blood pressure and cause a stroke. These are all potential side effects and unfortunately could cause death in certain circumstances."
Finding the proper dosage is crucial to prevent a patient from experiencing an adverse effect on ketamine, Glen Brooks, MD, an anesthesiologist and founder of NY Ketamine Infusions, a clinic that administers ketamine for mental health treatment, tells Health. "In the hands of well-trained physicians who have expertise in training and administering it, it's an extremely safe drug," says Dr. Brooks. "It's probably the safest general anesthetic agent we have."
It's also possible to underdose on ketamine, especially if the patient has a history of psychosis or undiagnosed schizophrenia, leading to increased anxiety levels and heart arrhythmia.
Why is ketamine used during police calls?
According to a study in the American Journal of Medicine, ketamine appears to be faster than other standard emergency room drugs at controlling agitation. But neither Dr. Brooks nor Dr. Pappadakis would consider it a first-line treatment for agitation.
"We've had situations where patients come in very anxious and need to be restrained chemically where they've received ketamine, where all other methods have been exhausted," says Dr. Pappadakis. "We go on to ketamine as a way to control the patient for their safety, we do it in a way that they're monitored medically."
In light of McClain's death, the use of ketamine by EMTs or paramedics during police calls is under debate. "There's a big difference between coming into my office for a slow intravenous infusion over the course of one hour for treating depression and anxiety compared to someone who's agitated for whatever reason being administered ketamine intravenously or intramuscularly," says Dr. Brooks. "I don't think EMTs should be using ketamine at all and I'm not sure why it would be used in the field. Valium or Ativan would work better."
"Not many EMS companies across the United States use ketamine or have a protocol around it. It's a controlled substance that should be used in a controlled setting, administered by trained professionals who can respond to any adverse reactions to it," says Dr. Pappadakis. "Without proper monitoring or training, it can be very deadly."
Update: An independent probe has accused Colorado police and paramedics of wrongdoing in the 2019 death of Elijah McClain. McClain's administered ketamine dosage of was "based on a grossly inaccurate and inflated estimate of Mr. McClain's size," according to a panel of medical and legal experts appointed by the Aurora City Council.
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