Takeaways from AP’s investigation into fatal police encounters involving injections of sedatives
The practice of giving sedatives to people in police custody has quietly spread across the country over the past 15 years, based on dubious science and supported by police experts, according to a study led by The Associated Press.
At least 94 people died after being given sedatives and restrained by police between 2012 and 2021, according to findings by the AP in collaboration with FRONTLINE (PBS) and the Howard Centers for Investigative Journalism. That’s almost 10% of the more than 1,000 deaths identified during the investigation into people subdued by police in ways that should not be fatal.
Advocates say sedatives allow rapid treatment of drug-related behavioral emergencies and psychotic episodes, protect frontline responders from violence and are safely administered thousands of times a year to get people with life-threatening conditions into hospitals. Critics say forced sedation should be strictly limited or banned, arguing that the drugs, given without consent, are too risky to be administered during police encounters.
The injections stretched across the country, from an Arizona desert to a St. Louis street to a Florida home. They took place in big cities like Dallas, suburbs like Lithonia, Georgia, and rural areas like Dale, Indiana. They took place in homes, in parking lots, in ambulances and sometimes in hospitals where police clashes came to a head.
It was impossible to determine what role tranquilizers played in each of the 94 deaths, which often involved the use of other potentially dangerous violence against people who had taken drugs or drunk alcohol. Medical experts told the AP that their impact could be negligible in people who were already dying; the last straw that caused cardiac or respiratory failure in medically needy people; or the leading cause of death when given in the wrong circumstances or used incorrectly.
While tranquilizers were cited as a cause or contributing factor in a dozen official death sentences, authorities often did not even investigate whether injections were appropriate. Medical officials have traditionally viewed them as mostly benign treatments. Now some say they may play a bigger role than previously thought and deserve more study.
Here are the conclusions from AP’s research:
The study found that about half of those who died after injections were black.
Behind the racial disparity lies a controversial medical condition called excited delirium, which has fueled the rise of sedation outside hospitals. Critics say the alleged symptoms, which include “superhuman strength” and high pain tolerance, play into racist stereotypes about black people and lead to biased decisions about who needs anesthesia.
Guidelines require paramedics to make rapid, subjective assessments of the potential dangers posed by the people they treat. Only those considered at high risk of harming themselves or others are considered eligible for shots.
But the study found that some whose behavior did not meet the requirements – who had already largely calmed down or in rare cases even fainted – were given injections. In some cases, paramedics cited fears that people would become violent on the way to hospitals.
The death of Elijah McClain in Aurora, Colorado in 2019 put a spotlight on the practice. A paramedic convicted of giving McClain an overdose of ketamine was sentenced last month to five years in prison, and a second paramedic will be sentenced Friday.
Time and again, the AP found agitated people held face down by police, often handcuffed and with officers pushing on their backs, struggling to breathe and trying to get free. Citing belligerence, paramedics administered sedatives, which further slowed their breathing. Cardiac and respiratory arrest often occurred within minutes.
Paramedics have drugged people who posed no threat to themselves or others, violating treatment guidelines. Medics often didn’t know if there were other drugs or alcohol in people’s systems, although some combinations cause serious side effects.
Police officers sometimes suggested that paramedics give shots to suspects they were holding, a potential abuse of their power.
The majority of those killed were bound face down in handcuffs, which can restrict breathing.
Experts say giving sedatives to someone who is already having trouble breathing can put them at risk of death because the drugs slow breathing. If they can’t get enough oxygen and blow off enough carbon dioxide, their heart may stop or stop breathing.
The use of sedatives by medical workers outside hospitals has spread rapidly over the past two decades based on a now discredited theory. Law enforcement leaders in the 2000s were concerned about the number of people who died after being shocked by police Tasers and forcibly restrained.
They began promoting a new strategy, calling officers calling encounters with severely agitated people, including those experiencing psychotic episodes or high on drugs, as medical emergencies. Instead of using force to gain compliance, officers were encouraged to call emergency medical services to sedate people and transport them to hospitals.
Proponents of this approach promoted a term to describe behavior that they said put combative people at risk of sudden death: excited delirium.
The strategy got a boost in 2009 when the American College of Emergency Physicians recognized excited delirium and urged the prompt use of ketamine, midazolam and other medications to treat it.
Emergency services quickly adopted protocols for excited delirium, although drugs like ketamine had not yet been thoroughly studied in the field. The paramedics who injected McClain with ketamine said they followed such a policy.
Critics have argued that the concept of excited delirium shifts blame from police in the deaths. The National Association of Medical Examiners and the American College of Emergency Physicians distanced themselves from the concept in 2023.
Police-involved deaths often result in news headlines and criminal investigations focusing on officers’ use of force. But the AP investigation found that medical staff giving sedatives were often largely ignored.
The use of sedatives in nearly half of deaths has not previously been reported by the news media. There are many reasons that explain this lack of attention.
Police stories omit sedative use due to medical privacy concerns. EMS treatment data is not subject to public records laws. Medical researchers consider tranquilizers as treatments and rarely mention them as contributing factors to deaths. Researchers have no knowledge of the role tranquilizers play and are not interested in delving into the complicated details.
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Associated Press researcher Rhonda Shafner contributed from New York.
___ The Associated Press receives support from the Public Welfare Foundation for criminal justice-focused reporting. This story was also supported by Columbia University’s Ira A. Lipman Center for Journalism and Civil and Human Rights in partnership with Arnold Ventures. The AP Health and Science Department also receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
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Contact AP’s global investigative team at Investigative@ap.org or https://www.ap.org/tips/
___ This story is part of an ongoing investigation led by The Associated Press in collaboration with the Howard Center for Investigative Journalism programs and FRONTLINE (PBS). The research includes the interactive story Lethal Restraint, the database and the documentary ‘Documenting Police Use Of Force’, premiering April 30 on PBS.