The use of ketamine by paramedics and police departments to subdue people under arrest is extremely controversial - so much so that Jeremy Cooper and Peter Cichuniec, the Aurora Fire Rescue medics who injected Elijah McClain with the drug during a police investigation in 2019, were indicted on charges of manslaughter and criminally negligent homicide along with three officers by a Colorado grand jury on September 1.
Most people have seen the awful video of Aurora police taking down McClain for "suspicious behavior" on Aug. 24, 2019. While on the ground, a medic stabbed him with a ketamine injection, a poweful anesthetic used both medically and recreationally. After the jab, according to the 32-page indictment, McClain, who weighed just 143 pounds (the amount given was for a 200-pound person), "appeared unconscious, had no muscle tone, was limp and had visible vomit coming from his nose and mouth." They performed CPR on McClain, who had no pulse. After three days, life support was removed. McClain was 23.
Anesthesiologist Dr. Glenn Brooks takes issue with the use of ketamine during police investigations. "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 the founder of NY Ketamine Infusions. "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."
Dr. Mark Pappadakis, an emergency medical physician at Capital Health Regional Medical Center in Trenton, adds: "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. Without proper monitoring or training, it can be very deadly."
The American Society of Anesthesiologists "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. Ketamine is a potent analgesic, sedative and general anesthetic agent which can elevate blood pressure and heart rate, and can lead to confusion, agitation, delirium and hallucinations. These effects can end in death when administered in a non-health care setting without appropriately trained medical personnel and necessary equipment."
Dr. Glenn 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."
On the other hand, the Journal of Emergency Medical Services (JEMS) favors its use, especaily in the case of excited delirum syndrome (ExDS), which is how the medics viewed McClain. "Patients with ExDS require rapid-acting pharmacologic restraint to ensure the safety of responders, law enforcement and the patient themselves," the website states. "Antipsychotic agents don’t typically produce behavioral control quickly enough when given IM (intramuscularly)... In contrast, ketamine can provide rapid sedation without the loss of airway reflexes, hypoventilation or un-wanted hypotension. A dose given IM should generally be expected to produce sedation within a minute with a duration of at least 20-30 minutes."
JEMS claims ketamine is safe for use in these situations: "Ketamine has an excellent safety profile when given appropriately. It’s been advocated as one of the safest and most versatile anesthetic agents for battlefield medicine; for emergencies in space exploration missions; and even for emergency surgeries, including cesarean deliveries, when no anesthetist is available."
Ketamine was synthesized for Parke-Davis by Calvin Stevens in 1962 and patented by Parke-Davis for both human and animal use in 1966. By 1969 it was being sold under the name Ketalar by prescription. The FDA appoved ketmaine in 1970. The drug was commonly used to treat soldiers in Vietnam.
The European Journal of Anesthesiology (EJA) website explains why ketamine was scheduled: "Concerns over the so-called psychedelic effects of ketamine and the arrival of new intravenous hypnotics such as propofol prompted a marked decrease in the use of ketamine in the affluent world. Moreover, ketamine abuse appeared during the Vietnam war and on the East Coast of the United States and increased from 1978 onwards following the publication of two books; Marcia Moore's Journeys into the Bright World and John C. Lilly's The Scientist put forward the authors’ psychedelic experiences. Because of this abuse, ketamine was placed among the class III substances of the U.S. Controlled Substances Act in 1999. An interesting collateral effect of the psychedelic properties of ketamine, especially the induction of near-death experiences, was the development of a therapeutic use of ketamine in palliative medicine. In his book Ketamine: Dreams and Realities, Dr. Karl Jansen, an English psychiatrist, suggested that under medical supervision, the drug's potent healing powers could be used to treat certain mental distresses (the so-called KPT: Ketamine Psychedelic Therapy)."
Journal of Emergency Medical Services: "Ketamine has an excellent safety profile when given appropriately."
During the '90s and 2000s, ketamine became a popular club drug, with users going into what's called the k-hole. "The k-hole offers a temporary escape from the stresses of life reducing their existence to almost nothing," reports the website Very Well Mind. "Research shows that at least 50% of people who use ketamine experience some pleasant effects, most commonly, feeling happy, feeling laidback, being relaxed and having enhanced perceptual abilities... For these people, a k-hole is a kind of oblivion that gives them a temporary escape from the world."
Now ketamine has morphed into treating depression. "Contrary to ordinary antidepressants, ketamine does not act within weeks, but within only a few hours," the EJA notes. "It has been proposed as a potential fast antidepressant in patients with high suicidal risk."
Ketamine has come a long way from general anesthetic to club drug to therapeutic psychedelic. Only the authorities would use it for the wrong reasons.