There is something seriously wrong in our society. I mean seriously wrong. The other night, I learned paramedics can inject ketamine at the request of the police in some states in people suffering “excited delirium”. F*cking ketamine! Before 2017, I was only passingly familiar with what ketamine was… A zoonotic tranquilizer that is sometimes used as a club drug known as Special K because of a side effect known as a K-Hole. Then I got diagnosed with CRPS and I learned an awful lot about ketamine, because it is one of the only medications that helps with CRPS pain.
Ketamine is literally the only medication EVER found to seriously help with CRPS pain. I was given it in 2018 when I had my gallbladder removed because not only does it decrease the pain of CRPS, it can prevent the spread of it. For the two weeks after the surgery; my pain was negligible, I even played in a dart tournament and enjoyed going grocery shopping. But I had some side effects, which are very common with ketamine (insomnia). Infusions were deemed too dangerous as were oral tablets of it, despite it being the only thing that helped my pain go from “my bones are broken” to a “not bothersome at all”. Not even morphine does that and hydrocodone takes it to about a “my bones are broken, but I can deal” for roughly 2 hours as long as I’m not terribly active during those two hours… strenuous activity makes it last even less time.
Now, I learn if I were to get drunk and combative with police in some states they can request EMS give me a ketamine injection. What the F*ck!? I can’t use it for legitimate medical reasons because of the dangers, but it can be used to subdue drunk and disorderlies? Oh and at 500 times the dose I would use it at? I mean oral tablets are 1-2mgs and they inject these people with 500mgs. Again, I ask “What the F*ck!?”
It is almost never used in surgery without a specific reason anymore because it is such a dangerous sedative. We had to schedule out the anesthesiologist 2 weeks early for my gallbladder surgery and then when he couldn’t be there, I was given two options; reschedule or allow the surgeon to do the ketamine because the replacement anesthesiologist refused. The surgeon had some experience with CRPS patients and as a result ketamine, so I felt comfortable enough to proceed. I was given just 10mgs for my surgery… A fifth of what I would have gotten if the anesthesiologist had done it.
The justification is a condition called “excited delirium” and if you remember the 1970s/1980s you might be familiar with the term. It became a bit of a buzz term in those decades because it was used to describe the effects of PCP on some users. However, these days PCP is less common and it is used to describe a heightened physical and mental state not recognized by the American Medical Association, but it’s the reason sometimes little old ladies lift cars off their grandchildren. However, true “excited delirium” is incredibly rare. Interestingly, I have come across the term several times in my research on psychopaths and excited delirium does figure into the fictional D&R world I have created… But D&R is fiction and while I try to keep the books “fact based” it is my prerogative to change what needs to be changed to make them work. In the real world, entering a heightened physical state in which adrenaline and rapid fire nerve synapsis allows one to pick up a car or physically exert yourself to the point of bodily system failure almost never happens. Which is why I find it mind-boggling that this happens…
Plus, let’s be realistic; if a trained anesthesiologist (can and) will refuse to give it to a patient in a highly monitored and controlled environment for the purpose of preventing spread of a serious neurological disease, is it safe for EMS to use it in a less controlled and monitored environment? Furthermore, ketamine is considered far more dangerous than any opiate except fentanyl. Most pain management doctors won’t even consider it for CRPS patients (like mine), even as a last resort, despite knowing it is the only drug proven to help. I take opiates nearly every day because the only other drug that helps is more dangerous. I mean ketamine is dangerous enough that in my pre-surgical appointment for my gallbladder removal we had to discuss whether I wanted a ventilator or not, because ending up on a ventilator or in a coma is a common side effect of ketamine even in small doses in a surgical setting. I knowingly accepted the risks of ketamine during surgery because the possibility of spreading this disease to the nerves in or near my liver was the greater evil.
Think about that; I gave informed consent to be dosed with ketamine… I knew it could put me in a coma, stop my ability to breathe, and increased the risk of death related to the surgery. I was sober. I was given packets of information. I was told to go home, read them, come back, and give them my decision, and even after all of that a doctor trained in anesthesiology said it was too dangerous after I was in the operating room and I was given the option to go home and not have the surgery done (in the operating room). But a paramedic can give someone ketamine without their informed consent because they “might be experiencing the incredibly rare condition of excited delirium”.
How is that justifiable? I don’t think it is… Which is why I borrowed a line from Ray Bradbury for the title of this post. Unfortunately, ketamine is a very quick and effective sedative and because it works so well, it will become more common despite the risks to the person being injected with it. My research on this turned up a handful of cases that made news for the practice, none of those being subdued were raging psychopathic serial killers or rapists. They weren’t even a majority drunk and disorderly, they seemed to be just disorderly because they were being detained for no reason (which I can sympathize with… I was very pissed the day the Missouri Highway Patrol stopped me for going 4 miles over the speed limit and decided to search my car). The patrolman popped open panels on my car I didn’t even know existed and dumped out an entire box of tampons on my passenger’s seat after dumping my purse and backpack into the back seats. When he was done he told me he’d “catch me next time” and didn’t even issue me a written warning for the speeding, so I get being detained is infuriating and might make someone belligerent and uncooperative even if they have nothing to hide. It definitely doesn’t warrant dosing someone with ketamine.