Criminal Justice Health New York City

NYPD Instructs Officers to Tase, Pepper Spray People Experiencing Debunked Syndrome

Police training materials link the discredited “excited delirium syndrome” to synthetic marijuana use.

Chris Gelardi · December 12, 2023

New NYPD officers smile amid blue and white confetti at police academy graduation ceremony.

NYPD Police Academy Graduation Ceremony at Madison Square Garden in 2014. | Diana Robinson

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Synthetic marijuana is turning people into violent, super strong aggressors best subdued with stun guns and pepper spray, the New York City Police Department tells its new officers.

In training materials obtained by New York Focus, NYPD instructors are told to teach police recruits about “excited delirium syndrome,” “a state of extreme excitement and agitation” often associated with drug use. It’s a “medical emergency,” the materials say, characterized by symptoms including “elevated body temperatures, increased physical strength and lack of physical fatigue,” and it can lead to sudden death by cardiac arrest.

The problem: The medical establishment has disavowed the syndrome as vague and pseudoscientific.

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Chris Gelardi

Excited delirium became popular in the late 2000s, when tactical weapons manufacturing executives pushed law enforcement to embrace it as a way to explain deaths in police custody. Cops and city officials have cited it in some of the nation’s highest-profile police killings, including those of George Floyd, Elijah McClain, and Daniel Prude.

Some states have caught on. In October, California banned excited delirium as an official cause of death. This month, Colorado’s police standards board voted unanimously to strike mention of the syndrome from all of its training documents.

New York hasn’t taken those steps. The issue has so far escaped the attention of local and state lawmakers. In 2020, after Rochester police killed Daniel Prude by pinning him to the ground for several minutes with a knee on his back, an autopsy named excited delirium as a contributing factor in his death. Attorney General Letitia James unsuccessfully sought to indict the officers who killed Prude — and issued a report arguing that first responders “must be trained to recognize the symptoms of excited delirium syndrome and to respond to it as a serious medical emergency.”

The American Psychological Association denounced the syndrome in 2020, expressing concern that it’s “too non-specific” and that “there have been no rigorous studies validating excited delirium as a medical diagnosis.” In 2021, the American Medical Association decried it as “justification for excessive police force, disproportionately cited in cases where Black men die in law enforcement custody.”

New York Focus obtained the police training documents through a public records request, which the NYPD fulfilled 19 months after it was submitted. They include an instructor guide issued in January 2021 and a lesson plan last updated in April 2022, after the medical associations debunked the syndrome. The 2021 guide states that first responders should seek to restrain and then lower the heart rate of someone experiencing excited delirium.

“That could kill somebody, depending on the reason they’re experiencing delirium,” said Michele Heisler, medical director of Physicians for Human Rights and a professor at the University of Michigan School of Public Health. “If you don’t have enough oxygen, your heart rate is going to increase, so what you have to do is provide oxygen.”

A recent study found that between 2010 and 2020, Black people accounted for 43 percent of in-custody deaths that named excited delirium as a possible cause, despite making up 13 percent of the US population.

Treating any kind of delirium-causing condition, according to Heisler, “urgently requires a medical response and really focusing on identifying the physiological cause.”

The NYPD lesson plan offers another strategy: “If available the [conducted electrical weapons] should be utilized as a rapid method of control,” reads an underlined sentence, using a technical term for stun guns. The stun guns are “not only for pain compliance,” the document says, but “will also cause involuntary incapacitation (regardless of pain tolerance) making it an effective tool against [excited delirium] subjects.”

The NYPD did not respond to multiple requests for comment.

The term “excited delirium syndrome” dates back to the 1980s, when a doctor studying cocaine use concluded that the drug could result in a form of delirium that makes men “psychotic” and women die from a combination of “cocaine and sexual activities.” Police later found that the group of women the doctor studied — Black presumed sex workers in Miami — actually died at the hands of a serial killer.

As it’s used now, the term refers more to a list of common symptoms than a unique medical condition, according to Heisler. The main ones — like agitation, disorientation, and rapid breathing — are so vague they can apply to any number of medical crises.

“It is not a coherent diagnosis,” Heisler said. “They threw together different symptoms and signs, some of them racist tropes, like being impervious to pain and having superhuman strength.”

But the mythical syndrome lived on. In the mid-2000s, the company Axon — then known as TASER, the leading supplier of stun guns (including for the NYPD) — began distributing materials on excited delirium to medical examiner and police chief conferences. Meanwhile, a consultant and a top lawyer for the company held their own annual conferences on excited delirium deaths in police custody.

Those conferences resulted in a paper, published in 2009 by the American College of Emergency Physicians, outlining the basic features of excited delirium. Its co-authors included TASER’s medical director and three members of what The New York Times described as a “cadre” of paid experts “whose research and testimony is almost always used to absolve officers of blame for deaths.” A member of that network was the sole medical expert James’s office consulted for the attorney general’s report on Prude’s death.

The attorney general’s office did not comment on the record.

Several of the authors of the 2009 report teamed up with cops and medical examiners to publish a follow-up two years later. That report is the only literature on excited delirium directly cited in the NYPD training materials.

The lesson plan instructs cops to consider deploying velcro restraining straps and pepper spray, which “will cause the subject’s eyes to involuntarily close, even if they are insensitive to pain.”

When calling for medical assistance, it encourages police to request an advanced tier of paramedics able to administer sedative medicine, “a recommended practice for medical professionals who are treating [excited delirium syndrome] subjects.”

In 2019, paramedics in Colorado injected 23-year-old Elijah McClain with the sedative ketamine after diagnosing him with excited delirium, following their local training guidelines. The drug likely killed him, according to a coroner’s report.

In October, the American College of Emergency Physicians withdrew the 2009 paper and joined the other medical associations in officially disavowing excited delirium syndrome.

“We’ve turned a corner, and the NYPD is extremely behind the times,” said Joanna Naples-Mitchell, an international human rights lawyer and research advisor for Physicians for Human Rights. “This is quite embarrassing for them.”

The NYPD’s materials also take excited delirium beyond its dated conclusions. While the syndrome’s boosters have mostly attributed it to cocaine and other stimulant use, one of the lesson plan’s main objectives is to “identify its correlation” with consumption of synthetic marijuana.

The document cites 2015 “surges” in emergency room visits that highlight the “substantial public health threat” of synthetic cannabis. Without citation, it concludes that the drug has been associated with the controversial syndrome, and “therefore the rise in Synthetic Marijuana use has corresponded with a rise in [excited delirium] cases.”

“I’ve never seen [synthetic marijuana] associated with excited delirium,” said Naples-Mitchell, who, with Heisler, co-wrote a Physicians for Human Rights report on the history of the syndrome.

“I have no idea what this is,” echoed Heisler.