A chemical restraint is a form of medical restraint in which a drug is used to restrict the freedom or movement of a patient or in some cases to sedate the patient. Chemical restraint is used in emergency, acute, and psychiatric settings to perform surgery or to reduce agitation, aggression or violent behaviours;[a] it may also be used to control or punish unruly behaviours.[2] A drug used for chemical restraint may also be referred to as a "psychopharmacologic agent", "psychotropic drug" or "therapeutic restraint" in certain legal writing.[3][4]
In the UK, NICE 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.[b]
The Human Rights Watch 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.[2] The FDA estimates 15,000 elderly individuals in nursing homes die each year due to the unnecessary use of anti-psychotics.[7] According to the Nursing Home Reform Act, 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.[8]
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;[9] it can cause more confusion in patients, slowing their recovery;[10] 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.[d]
^"Chemical restraint, also known as rapid tranquilisation, is the use of psychotropic medication to control severe agitation, or violent behaviours."[1]
^"Sedation (rapid tranquilisation) will be required to facilitate rapid intervention and institution of potentially lifesaving treatments if an individual displaying [acute behaviour disturbance] ABD fails to respond to de-escalation techniques. The rapid control and calming of an individual displaying the extreme physical exertion associated with ABD is essential to prevent further worsening of their metabolic status. Ideally sedation should be administered via the intravenous route; however, this route is unlikely to be immediately available." "Guidelines for the Management of Excited Delirium / Acute Behavioural Disturbance (ABD)"(PDF). Archived from the original(PDF) on 2020-11-01. Retrieved 2020-08-29.
^"While there is a sizeable, good quality body of RCT [randomized controlled trial] evidence regarding chemical restraint practices from around the world, the interventions, outcome measures, and findings are heterogenous and preclude more than simple description. On the current evidence base from RCTs, front-line clinicians could be advised to use haloperidol (alone or in combination with lorazepam or midazolam) delivered via IV, oral, or IM methods, to safely, speedily, and effectively control agitated, aggressive, and violent behaviours."[1]
^"Chemical restraint can furthermore be experienced as a violation of integrity and cause psychological discomfort";[1] "Further, the individual experience of any form of restraint is well recognized as traumatizing and anti-therapeutic".[1]: 15
^ abcdMuir‐Cochrane, Eimear; Oster, Candice; Gerace, Adam; Dawson, Suzanne; Damarell, Raechel; Grimmer, Karen (2019-09-09). "The effectiveness of chemical restraint in managing acute agitation and aggression: A systematic review of randomized controlled trials". International Journal of Mental Health Nursing. 29 (2). Wiley: 110–126. doi:10.1111/inm.12654. ISSN1445-8330. PMID31498960. S2CID202406529.