8 AUGUST 15-21, 2024 westword.com WESTWORD | MUSIC | CAFE | CULTURE | NIGHT+DAY | NEWS | LETTERS | CONTENTS | to interfere. “I thought they were taking him to a squad car,” she says. “But they had normalized this so much in their minds. They saw it as their right to knock people out so they wouldn’t have to deal with them on an ambulance ride.” Axtell has no recollection of that ride, or anything else until he woke up in the hospital seven hours later, still feeling the effects of his sedation. In a civil law- suit he fi led against the City of Lakewood and West Metro Fire, he claimed that police used excessive force in his unwarranted arrest and that the hefty dose of ketamine he received, along with other sed- atives administered at the hos- pital without his consent, have caused ongoing physical and psychological trauma, from memory issues and urinary tract problems to insomnia and PTSD. “It messed me up,” Axtell told state lawmakers at a hear- ing in 2021. “I can’t do any- thing right anymore.” For years, emergency- medicine professionals have extolled ketamine as a safe, effective tool for dealing with combative or delusional pa- tients, with reported medi- cal complications in only a small percentage of cases. But Springsteen, who repre- sented Axtell in his lawsuit, soon discovered that Colorado paramedics were routinely using ketamine as a “chemi- cal restraint” in hundreds of purported excited delirium cases a year — 902 times over thirty months, or about once a day, according to a 2020 KUNC report — and that the practice had been linked to several deaths. One of the most shocking encounters occurred fi ve months before Axtell’s ar- rest, on August 24, 2019, when 23-year-old Elijah McClain was accosted by three Aurora police offi cers responding to a call about a “suspicious person.” McClain objected to the offi cers’ attempts to detain him, insisting, “I have a right to go where I’m going.” He was wrestled to the ground and placed in a carotid control hold, while offi cers ignored his cries of pain and complaints about not being able to breathe. Summoned by police, paramedics then injected McClain with 500 milligrams of ketamine. Minutes later, McClain’s heart stopped beating. He was declared brain dead and removed from life support several days later. McClain’s death initially attracted little public scrutiny; the highly equivocal autopsy report from the Adams County Coroner’s Offi ce listed cause and manner of death as undetermined. But in the wake of the 2020 George Floyd protests, the McClain case became one of several in-custody deaths drawing international attention and outrage. The harsh spotlight eventually led to a revision of the offi cial autopsy report, which now concludes that McClain died from “complications of ketamine admin- istration following forcible restraint.” It also prompted an unprecedented criminal prosecution of police and paramedics who were on scene. Last spring, Peter Cichuniec, the paramedic who authorized the dose of ketamine McClain received, was sentenced to fi ve years in prison for negligent homicide, while another paramedic, Jeremy Cooper, got probation; police offi cer Randy Roedema was sentenced to fourteen months in jail. Two other police offi cers were acquitted of all charges. The fallout of the McClain case extended well beyond those involved in the fatal en- counter. In 2021, new state legislation set tough restrictions on the use of ketamine outside of a hospital setting, prohibited po- lice offi cers from infl uencing paramedics to sedate a suspect, and declared that the controversial “diagnosis” of excited delirium couldn’t be used to justify ketamine use. The Colorado Department of Public Health and Environment also suspended the issuing of waivers that allow local EMS agencies to ad- minister ketamine to sedate unruly patients. As the fi ve-year anniversary of the Mc- Clain tragedy approaches, Colorado is widely regarded as being in the vanguard of efforts to reform the use of chemical restraint. But critics of the state’s regulatory process point out that ketamine is still being administered by paramedics across the state hundreds of times a year — albeit in smaller dosages than those given to Axtell and McClain, and for purposes other than excited delirium. But Springsteen believes the CDPHE hasn’t done enough to restore public confi dence, investigate abuses by emergency medical personnel or hold medical directors ac- countable for what she suspects are more deaths, injuries and adverse outcomes from ketamine use than offi cials want to admit. “I would really like to see somebody clean house at CDPHE,” she says. “But in order to have ac- countability, you fi rst have to have acknowledgement that something went wrong.” For a drug that has found so many different applications over the past half-century, from pain management to psyche- delic exploration to the treat- ment of depression, ketamine has a curious origin story. It was first synthesized in 1962 by a Detroit chem- ist seeking to develop a safer anesthetic for surgery — one without the hallucinations, amnesia and other unpleas- ant effects of more established alternatives. But ketamine, a chemical analog of angel dust, also has dissociative proper- ties. Initially used as a horse tranquilizer and as a battlefi eld anesthetic during the Vietnam War, it was championed by counterculture guru John C. Lilly for his psychic experi- ments, adopted by Hunter S. Thompson for recreational use and dubbed “Special K” by head-trippers and ravers. How ketamine became the wonder drug for emergency medical services is a bit more complicated. As far back as the early 2000s, fi rst responders began grappling with an increasing number of calls involving agitated and possibly psychotic individuals, fueled by some combination of street drugs — meth, cocaine, opioids — and mental illness. A few prominent agencies began looking into their pharmaceutical cornucopia for answers. Ketamine was extolled as safer and faster-acting than other sedation options, sparing police and paramedics as well as pa- tients the risks of a physical takedown. Soon ketamine was the go-to knockout punch across most of the country. Unfortunately, the drug was not the ideal solution it was made out to be. Some of its most vocal advocates had fi nancial ties to the company that made tasers; a “tase and sedate” strategy was one scenario that researchers promoted as less lethal than other alternatives. And it’s doubtful that the ketamine movement would have been so widely embraced if not for the rise of a bogeyman the drug seemed designed to address: excited delirium syndrome. Strictly speaking, EDS isn’t a diagnosis at all. The term was coined in an attempt to ex- plain why certain people suddenly die after a struggle with law enforcement, even though there isn’t evidence of trauma or disease that would account for the death. One 2006 book on the subject by a highly respected patholo- gist contends that many deaths blamed on police excessive force are actually the result of EDS. In most of the cases cited, the victim was resisting restraint, high or disoriented, exhibiting extraordinary strength and, after a period of overheated and violent exertion, collapsed and died. Such delirium was a convenient excuse for police agencies looking to elude liability for in-custody deaths. It also became a ready- made justifi cation for paramedics to bring out the ketamine. But over time it became clear that EDS was being “diagnosed” in numerous individuals who didn’t fi t the EDS criteria (like Elijah McClain, who wasn’t on drugs or mentally ill); that the EDS label was disproportionately being applied to young Black men (like McClain); that it was, in ef- fect, junk science with an agenda. In 2020, the American College of Emer- gency Physicians issued a statement caution- ing against using ketamine “to chemically incapacitate someone solely for a law en- forcement purpose.” Three years later, ACEP withdrew its approval of the term “excited delirium” altogether. Both actions came too late for McClain, whose case was a textbook example of misuse of the drug. The dosage he received was higher than it should have been because paramedics badly overestimated his weight. Ketamine increases the risk of stroke and irregular heartbeat and can lead to vomiting and respiratory problems; McClain had already vomited The Big Sleep continued from page 7 continued on page 10 Elijah McClain, a 23-year-old violinist, was stopped by Aurora police offi cers on August 24, 2019. Body camera video shows Elijah McClain pinned to the ground while Aurora paramedics prepare to inject him with ketamine. ELIJAH MCCL AIN FAMILY AURORA POLICE DEPARTMENT
