A chemical restraint is a form of

medical restraint Medical restraints are physical restraints used during certain medical procedures to restrain patients with (supposedly) the minimum of discomfort and pain and to prevent them from injuring themselves or others. Rationale There are many kinds of m ...

in which a

drug A drug is any chemical substance that causes a change in an organism's physiology or psychology when consumed. Drugs are typically distinguished from food and substances that provide nutritional support. Consumption of drugs can be via insuffla ...

is used to restrict the freedom or movement of a patient or in some cases to

sedate Sedation is the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure. Examples of drugs which can be used for sedation include isoflurane, diethyl ether, ...

the patient. Chemical restraint is used in

emergency An emergency is an urgent, unexpected, and usually dangerous situation that poses an immediate risk to health, life, property, or environment and requires immediate action. Most emergencies require urgent intervention to prevent a worsening ...

acute Acute may refer to: Science and technology * Acute angle ** Acute triangle ** Acute, a leaf shape in the glossary of leaf morphology * Acute (medicine), a disease that it is of short duration and of recent onset. ** Acute toxicity, the adverse eff ...

, and

psychiatric Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related to mood, behaviour, cognition, and perceptions. See glossary of psychiatry. Initial psy ...

settings to perform

surgery Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

or to reduce agitation, aggression or violent behaviours; it may also be used to control or punish unruly behaviours. Chemical restraint is also referred to as a " Psychopharmacologic Agent", "

Psychotropic Drug A psychoactive drug, psychopharmaceutical, psychoactive agent or psychotropic drug is a chemical substance, that changes functions of the nervous system, and results in alterations in perception, mood, consciousness, cognition or behavior. Th ...

" or "Therapeutic Restraints" in certain legal writing. In the UK,

NICE Nice ( , ; Niçard: , classical norm, or , nonstandard, ; it, Nizza ; lij, Nissa; grc, Νίκαια; la, Nicaea) is the prefecture of the Alpes-Maritimes department in France. The Nice agglomeration extends far beyond the administrative c ...

recommends the use of chemical restraint for acute behaviour disturbances (ABD), but only after verbal calming and de-escalation techniques have been attempted. It is viewed as superior to physical restraint, with physical restraints only being recommended for the administration of a chemical restraint. In the

United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territorie ...

, no drugs are presently approved by the

U.S. Food and Drug Administration The United States Food and Drug Administration (FDA or US FDA) is a federal agency of the Department of Health and Human Services. The FDA is responsible for protecting and promoting public health through the control and supervision of food ...

(FDA) for use as chemical restraints. Drugs that are often used as chemical restraints include

antipsychotics Antipsychotics, also known as neuroleptics, are a class of Psychiatric medication, psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizophrenia but ...

, benzodiazepines, and

dissociative anesthetic Dissociatives, colloquially dissos, are a subclass of hallucinogens which distort perception of sight and sound and produce feelings of detachment – dissociation – from the environment and/or self. Although many kinds of drugs are capable of ...

s such as

ketamine Ketamine is a dissociative anesthetic used medically for induction and maintenance of anesthesia. It is also used as a recreational drug. It is one of the safest anesthetics, as, in contrast with opiates, ether, and propofol, it suppresses ne ...

. A systematic review in 2019 advised the use of intravenous

haloperidol Haloperidol, sold under the brand name Haldol among others, is a typical antipsychotic medication. Haloperidol is used in the treatment of schizophrenia, tics in Tourette syndrome, mania in bipolar disorder, delirium, agitation, acute psychosi ...

(a short half-life, first-generation antipsychotic) alone or in conjunction with

lorazepam Lorazepam, sold under the brand name Ativan among others, is a benzodiazepine medication. It is used to treat anxiety disorders, trouble sleeping, severe agitation, active seizures including status epilepticus, alcohol withdrawal, and c ...

midazolam Midazolam, sold under the brand name Versed among others, is a benzodiazepine medication used for anesthesia and procedural sedation, and to treat severe agitation. It works by inducing sleepiness, decreasing anxiety, and causing a loss of ...

(short half-life benzodiazepines), but said more research was needed. The

Human Rights Watch Human Rights Watch (HRW) is an international non-governmental organization, headquartered in New York City, that conducts research and advocacy on human rights. The group pressures governments, policy makers, companies, and individual human r ...

wrote a report on the use of chemical restraints amongst the elderly in the US. It concluded that antipsychotic drugs are sometimes used almost by default to control difficult-to-manage residents. The FDA estimates 15,000 elderly individuals in nursing homes die each year due to the unnecessary use of anti-psychotics. According to the

Nursing Home Reform Act The Nursing Home Reform Act is a part of the Omnibus Budget Reconciliation Act of 1987 which gives guidelines to regulate nursing home care in the United States. The act was intended to advance nursing home residents' rights. Background A 1986 stud ...

, individuals have the right to be free from physical or chemical restraints imposed for purposes of discipline or convenience and not required to treat the resident's medical symptoms. The use of chemical restraint has been criticized. It is sometimes misused by health care workers for the convenience of the staff rather than the benefit of the patient, with workers using them to prevent patients from resisting care, rather than improving the health of the patient; it can cause more confusion in patients, slowing their recovery; and it can be unclear whether drugs used for chemical restraint are necessary to treat an underlying mental health condition or whether they are being used to sedate the patient. Patients can view chemical restraint as a violation of integrity and find the experience traumatic.

Notes

References

{{DEFAULTSORT:Chemical Restraint Physical restraint