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Comment by xkcd-sucks | Hacker News Reader

Setting aside the fact that this kind of thing happens at all: How is ketamine the drug of choice?! Although it has a very high active dose:fatal dose (alluded to in other comments), accepted practice for "chemical restraint" is Thorazine+Valium (or equivalent); ketamine is basically never used for behavioral "sedation" by any medical professional.

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The use of chemical restraint in a law enforcement setting is an appalling breach of human rights, but ketamine is by far the safest option in an out-of-hospital setting, especially when you don't have any sort of patient history. I'm sure that someone has been killed by a single clinical dose of ketamine, but I'm not sure how. Ketamine isn't a very good chemical cosh, but at least it's a safe one.

Anyone administering chlorpromazine and a benzodiazepine in this setting is criminally negligent - if the "patient" (and I very much hesitate to use that word in this context) has taken another CNS depressant, they're in deep trouble.

It’s a candidate for safest only if it’s being used where required by a trained administrator. And those two factors probably outweigh the choice of drug in their effect on lethality.

I would guess the problem is those already intoxicated on opiates, or even alcohol, as many arrestees are.

Adding a bento, like valium, to that mix is extremely dangerous because of the synergistic effect on respiratory depression.

Ketamine is also a CNS depressant and would have the same compounding effect when mixed with alcohol, it's a wholly inappropriate drug to administer to someone who was in a state of "alcohol-induced excited delirium"

If you're intoxicated on opioids, you are not going to be violently resisting arrest in the first place.

Not guaranteed

No, it's not guaranteed, it would depend on how intoxicated you were.

For the purposes of this discussion, I thought it was safe to assume we were talking about doses that could actually alter your behaviour; high doses of opioids do not make exactly for agresssive behaviour, while lower doses are unlikely to have an impact either way.

Our Ed takedown drug is midazolam. I can’t see benzos being safe being given by non-medics. The safety profile of ketamine is excellent (as I’m sure you know)

Having said that it blows my mind that it is considered necessary or appropriate to give someone ketamine to restrain them.

Also, aren't police claiming that they only use ketamine for people showing "excited delirium", where benzos are probably contraindicated?

Seems that hospitals love to give out Versed like candy.

The amount of opioids on the streets of the US (and elsewhere) is staggering. Many people are on a cocktail of different street drugs (meth + heroine where I live). You don't want to be adding a benzo like valium to someone who has opioids in their system due to respiratory depression.

It’s used “a lot” by the EMS. It’s doesn’t lower your blood pressure like Versed can, and ketamine has some pain relief properties.

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