TOPLINE:

Intramuscular (IM) chemical sedation was used in 11.7% of ED visits involving mental health consultations, with higher odds among Black patients and patients arriving via emergency medical services (EMS) or law enforcement, under physical restraint, or on involuntary holds, a retrospective study found.

METHODOLOGY:

• Researchers conducted a retrospective cross-sectional study of 94,204 ED visits among 56,154 adults (median age, 34 years; 49.8% men; 46.1% White individuals) who received mental health consultation in EDs in California between 2017 and 2021.
• Data on whether patients received an initial IM dose of sedating or antipsychotic medications during the ED visit as well as patient demographic, clinical, and visit characteristics were obtained from electronic health records.
• Researchers assessed the frequency of IM chemical sedation and characteristics associated with its administration in patients; they also assessed adverse events, including supplemental oxygen use, noninvasive ventilation, intubation, ICU admission, and death, during the ED visit.

TAKEAWAY:

• Overall, 11.7% of ED visits involved patients receiving IM chemical sedation.
• Black individuals were more likely to receive IM chemical sedation than White individuals (adjusted odds ratio [aOR], 1.38; 95% CI, 1.27-1.50). Patients insured with Medicare/Medicaid were more likely to receive IM chemical sedation than those insured privately (aOR, 1.38; 95% CI, 1.29-1.48).
• Use of physical restraint (aOR, 33.05; 95% CI, 30.28-36.08), arrival via EMS or law enforcement (aOR, 1.51; 95% CI, 1.43-1.60), and involuntary mental health hold placement (aOR, 1.66; 95% CI, 1.56-1.77) were associated with higher odds of receiving IM chemical sedation.
• Supplemental oxygen administration was the most common adverse event (3.6% of ED visits with IM chemical sedation vs 2.5% without), whereas intubation, ICU admission, and death were extremely rare.

IN PRACTICE:

"Among ED patients with mental health consultation, IM chemical sedation was associated with EMS/law enforcement arrival, Black race, and involuntary mental health hold," the authors wrote.

"Further work is needed to understand how comorbid mental health conditions, implicit bias, and unmeasured confounders may impact the use of IM chemical sedation," they added.

SOURCE:

The study was led by Suzanne C. Lippert, MD, MS, The Permanente Medical Group Inc, Pleasanton, California. It was published online on March 18, 2026, in the Annals of Emergency Medicine.

LIMITATIONS:

Limitations included a retrospective cross-sectional design, which relied on available electronic health records and limited the assessment of psychosocial factors, agitation severity, comorbidities, and prior mental health history. The cohort was restricted to patients requiring mental health consultation, potentially overrepresenting more severe illness and limiting generalizability. Sedation exposure may have been misclassified, and the indication for IM medications could not be definitively confirmed. The lack of stratification by medication type or dose limited the evaluation of treatment-specific outcomes, and some severe adverse events may have been undercaptured.

DISCLOSURES:

The study was funded by Kaiser Permanente Northern California Community Health. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.