State health department announces plans to review the ketamine waiver program

Hide Featured Image

Contact:, 303-691-7870

REMOTE, Aug. 22: The Colorado Department of Public Health and Environment announced today plans to review the state’s ketamine waiver program. 

A review committee, facilitated by CDPHE’s chief medical officer, will consist of EMS provider(s), pharmacist(s), ER doctor(s), anesthesiologist(s), and others. The committee will be charged with examining the safety of ketamine administration in EMS settings. 

“Today I am calling for the immediate and thorough review of the state’s ketamine waiver program,” said Jill Hunsaker Ryan, executive director, CDPHE. “Our agency will work with medical experts to study the use of ketamine in the field-- as well as the state’s oversight mechanisms-- and produce a public report. Patient safety and program transparency are top priorities.” 

CDPHE regulates the scope of practice for Emergency Medical Service providers. Through a waiver process, EMS medical directors can obtain permission to expand the standard scope of practice and allow paramedics to administer ketamine outside of the hospital setting. CDPHE allows waivers for ketamine administration for excited delirium and/or extreme or profound agitation and pain management. EMS medical directors present waiver applications to the Emergency Medical Practice Advisory Council (EMPAC) for review. EMPAC reviews the training and oversight programs and makes recommendations for approval or denial to CDPHE. The department maintains a list of medical directors with waivers from the standard scope of practice. A condition of the ketamine waiver program requires medical directors to report to the department for every waivered ketamine administration. In the past 3 years, it has been used 902 times for excited delirium and/or extreme or profound agitation. 

The review will begin immediately and is expected to last a minimum of 12 weeks. To protect the integrity of the review, CDPHE will not provide additional information until the review is complete. At that point, CDPHE will release a final report. f


Update on Ketamine Investigatory Review Panel, April 15:

As CDPHE announced on August 22, 2020, we have empaneled a group of experts to examine if the department’s existing ketamine waiver process provides adequate oversight and training to ensure public health and safety. Since its formation, the panel has met several times and will continue its work over the next several months. As it does with all investigative reviews of this type, CDPHE is limiting the release of information about both the panel members and the process to protect the integrity of the work. While we are not disclosing the panel members’ identities during the investigative review, the members are medical professionals with relevant expertise to conduct this work.  The panel members’ expertise includes Anesthesiology, EMS Medical Direction, Emergency Medicine, Behavioral Health, Nursing, Toxicology, Public Health, and EMS practice, with several panel members having multiple certifications or areas of expertise. Additionally, subject matter experts from other professions are participating as needed. Once the panel’s work is complete, we will share the final report.