Colorado anesthesiology organization calls to suspend ketamine program for excited delirium

Problem Solvers

DENVER (KDVR) – The Colorado Society of Anesthesiologists is calling for the state health department to suspend the state waiver program that allows paramedics to sedate patients with the drug ketamine in cases of an extremely agitated condition called excited delirium while the state reviews the program.

“The Colorado Society of Anesthesiologists (CSA) has great concern about the use of the anesthetic agent ketamine for the treatment of ‘excited delirium’ by EMS personnel regulated by the Colorado Department of Public Health and Environment (CDPHE),” the group said in a Tuesday statement.   “Our concern stems from the reported large number of uses of ketamine for this purpose in the past 2 1/2 years (more than 902 uses), reported doses that are equal or greater to that used to produce general anesthesia, and the high reported complication rate (24% in 2019 including at least one death).”

The state health department announced in August that it would review the program that provides waivers to medical directors allowing agencies to administer the drug. This followed recent questionable incidents – including the case of Elijah McClain, who died after receiving the drug and after struggling with police officers – were brought to the state’s attention.

A coroner could not determine the cause of McClain’s death.

“Our agency will work with medical experts to study the use of ketamine in the field– as well as the state’s oversight mechanisms– and produce a public report. Patient safety and program transparency are top priorities,” said Jill Hunsaker Ryan, the executive director of CDPHE, in an August statement.

The Colorado Society of Anesthesiologists is asking CDPHE to include “unconflicted outside experts including anesthesiologists, psychiatrists, and public members,” in its review.  “This review should include indications for use including the ethics and legal authority for chemically restraining individuals against their will, dosing, monitoring after administration, and determining an acceptable complication rate.

The FOX31 Problem Solvers reached out to CDPHE about the CSA’s statement but have not yet received a response. However, the state previously said its review would be facilitated by CDPHE’s chief medical officer and include one or more people representing each of the following fields: EMS providers pharmacists, ER doctors, anesthesiologists, and others. 

“They have to take input from more than just the people that they’ve been listening to for the last seven years, and they have to take input from the public because they’re using very potent drugs in a way that has not been used prior to 2013 with very little public input, and so in light of all of that, we think they need to approach this in a different way,” said Dr. Randall Clark, a member of CSA’s board of directors.

Clark said emergency medical personnel would have other treatment options outside of ketamine, while the program is being reviewed. “These protocols that have allowed for ketamine use have only existed for seven years,” he said.

“Independent of the ‘excited delirium’ diagnosis, use of chemical incapacitation to treat agitation is demonstrably hazardous given the CDPHE data on complication rate associated with ketamine administration,” said CSA. “The use of anesthetics like ketamine should be used only as a last resort, in appropriate doses, only if the individual is an immediate and severe threat to themselves or others, and only if there is public acceptance of this technique.”

Meanwhile, a few Aurora City Council members have said they plan to call for a suspension of their own program at a meeting next week.

“I think this demonstrates taking the same action in Aurora would be appropriate and in line with what many experts in the medical field think is the right approach,” said Curtis Gardner, the council member who plans to introduce a similar resolution. “This isn’t about taking away a tool – however, taking a pause while we undergo a review of this drug is a reasonable approach, and I hope City Council supports what I am bringing forward. We’ve hired an expert to review the drug and our protocols in using it. We need to let that process play out.”

Gardner said he remains committed to working with the fire chief and medical director to ensure that the proposed moratorium takes effect when “medical protocols can be updated with an alternative drug and our firefighters can be properly trained in its use.”

Aurora Mayor Pro-Tem, Nicole Johnston, said she takes the CSA statement seriously. “The CSA are medical doctors who are subject matter experts in the field of ketamine.”

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