Tuesday, June 15, 2021

AMA Opposes Administration of Ketamine, Use of ‘Excited Delirium’ for Law Enforcement Purposes

The AMA opposes the use of ketamine and other sedative/hypnotic agents as a pharmacological intervention for agitated individuals in out-of-hospital settings to chemically restrain an individual solely for law enforcement purposes and not for legitimate medical reasons.

In addition, the AMA opposes the use of the term “excited delirium” as a medical diagnosis until a clear set of diagnostic criteria for the term is validated.

With strong support from APA and the Section Council on Psychiatry, the AMA House of Delegates yesterday approved a report by the AMA’s Council on Science and Public Health (CSAPH) addressing concerns about recent deaths of people—predominantly young Black men labeled as experiencing “excited delirium”—after ketamine was administered to restrain them. In December 2020, the APA Board of Trustees approved a position statement asserting that “excited delirium” lacks any clear diagnostic criteria and calling for evidence-based protocols for administration of ketamine in emergency medical situations outside the hospital.

At the AMA meeting, Ken Certa, M.D., senior delegate for APA, told the House that too many people have died after being administered ketamine by police or emergency medical technicians. Disproportionately, they have been people of color, he said.

“As psychiatrists, we take care of people in emergency situations; we have experience dealing with people brought in by the police in agitated states,” Certa told the AMA delegates. “That doesn’t mean they have ‘excited delirium’—we don’t know what that is. We have tried to find a coherent body of literature to support that diagnosis, and it is simply not there. … We need a strong statement from the AMA that it can’t be used. Out-of-hospital ketamine has the potential to kill people, especially people who have been marginalized.”

The new policy urges law enforcement and frontline emergency medical service (EMS) personnel to participate in training overseen by EMS medical directors that minimally includes de-escalation techniques and the appropriate use of pharmacological intervention for agitated individuals outside the hospital. The policy also urges medical and behavioral health specialists—instead of law enforcement—to serve as first responders and decision-makers in medical and mental health emergencies.

Laura Halpin, M.D., Ph.D., a member of the CSAPH and a child and adolescent psychiatry fellow at UCLA, said the recommendations are critical. “We have denounced the use of ‘excited delirium’ as a justification for use of force by law enforcement officers and recognize that this has devastatingly led to disproportionally high mortality among communities of color, and especially Black men,” she told Psychiatric News. “Our recommendation that physicians and mental health specialists, and not law enforcement, should serve as the first responders and decision-makers on crisis intervention teams will help protect our vulnerable patients.”

APA CEO and Medical Director Saul Levin, M.D., M.P.A., added, “We welcome the AMA’s strong statement and important recommendations on this matter, and we will continue to work with the AMA and other physician specialties to monitor this issue.”

For related information, see the Psychiatric News article “Board Adopts Position Against Diagnosis of ‘Excited Delirium,’ Police Use of Ketamine.”