Dr. Julie Owen on Police, Sedatives and 'Excited Delirium'

Frederica Freyberg:
An investigation by the AP and PBS Frontline revealed police and medics using injected sedatives to deescalate people who have been deemed to have something called “excited delirium.”

Eric Jaeger:
We’ve now come to understand that “excited delirium” is a deeply flawed concept. In many cases, the definition of “excited delirium” was built on racial stereotypes, and probably more fundamentally, “excited delirium” was a concept that, in many of these cases, served to shift the focus from the actions of the first responders, restraint or chemical sedation by the police or by EMS to the individual for using methamphetamine, for engaging in criminal activity, for – in some cases – suffering from mental health emergencies.

Frederica Freyberg:
The use of medications is part of an “excited delirium” protocol in some departments to render the person compliant. This is often in combination with stun guns and pinning subjects face down, but the combination can be fatal. It happened to a man in Eau Claire County as described in the investigative reporting. “Excited delirium” purportedly marked by high pain tolerance and superhuman strength is a controversial and disputed diagnosis and should not be used to justify use of force and medication. That’s according to our next guest, psychiatrist Dr. Julie Owen from the Medical College of Wisconsin. Doctor, thanks for joining us.

Julie Owen:
Thank you for having me.

Frederica Freyberg:
Why do you say that “excited delirium” is a disputed diagnosis?

Julie Owen:
“Excited delirium” first came to be described in the 1980s, and that was in conjunction with a rise in cocaine use. There are very few professional medical organizations that actually recognize “excited delirium” as a diagnosis, and without that recognition and without that consensus of the medical community, there’s been a lack of true diagnostic criteria that folks agree on when using this term, which has called its use into dispute.

Frederica Freyberg:
So if it’s not “excited delirium,” what are police and first responders and medics responding to in the field that then have them using these injected sedatives?

Julie Owen:
So, oftentimes, an individual who might be described as displaying the features of what has been come to be known as “excited delirium,” they will look extremely agitated. They will potentially be behaving in a bizarre manner. The literature that has looked at this syndrome has described things like increased pain tolerance, the individual looking sweaty, the individual breathing rapidly, an individual who looks like they don’t really get tired despite a lot of physical exertion, and sometimes the literature also describes individuals who are not necessarily complying with law enforcement official orders, and/or being inappropriately clothed.

Frederica Freyberg:
In your research, what did you find about the outsized diagnosis of this “excited delirium” in Black or brown police subjects?

Julie Owen:
Usually, there’s a skewing of the use of this term with young men, young men of color, and young men of color who probably, at a later phase of examination, are found to be utilizing some sort of what we call sympathomimetic or a stimulant-like substance.

Frederica Freyberg:
The Frontline investigation narrowed in on the use of injected drugs like ketamine by police and medics. What’s your view of that use?

Julie Owen:
I work in the hospital setting. In the hospital setting, if an individual presents with agitation, typically the best accepted practice is as a physician to evaluate that person and try to determine what is the most likely cause of that person’s agitation and medications are used as a tool then to treat and relieve that person of that agitated state. So the use of medications in and of themselves is not necessarily problematic. It’s the use of a medication with oftentimes very incomplete data and with differing protocols and dosing and, again, sort of starting with that not truly a medical diagnostic term to sort of drive the intervention or the choice of the intervention that seems to be problematic in these cases.

Frederica Freyberg:
How troubling is it to you that “excited delirium” might be used as a justification for use of force or injections of ketamine?

Julie Owen:
It is troubling. And again, I think, you know, as a physician and as a physician who practices in solely emergent or acute settings, this sort of case is hard for somebody like myself to try to get to the bottom of, and when you have folks who don’t have the same amount of clinical training sort of throwing out terms that sound like diagnoses to then drive interventions with questionable safety involved, and, of course, when these interventions result in lethal outcomes when really that’s probably not necessary, that is disturbing.

Frederica Freyberg:
You say that it is imperative to find consensus among medical professionals around the diagnosis of “excited delirium.” Has that yet been found, that consensus?

Julie Owen:
No.

Frederica Freyberg:
And are more people like yourself talking about it?

Julie Owen:
I think so. We — you know, again, my practice clinically is working shoulder to shoulder with emergency medicine physicians and that sort of cross specialty collaboration and collaboration of expertise in this space. I think that’s what’s necessary to really find, again, consensus, but a real clear sense of what it is that we’re trying to accomplish with utilizing terms like this or trying to categorize clinical presentations like this.

Frederica Freyberg:
All right. We leave it there. Dr. Julie Owen, thanks very much.

Julie Owen:
Thank you.