On 25 July last year, the image of an Aboriginal boy strapped to a mechanical restraint chair with a white hood pulled over his head and fixed around his neck was shocking enough to resonate around the world. That incident and other forms of equally reprehensible treatment of children in detention in the Northern Territory highlighted by the ABC’s Four Corners program that night were rightfully condemned in the outrage that followed. An inquiry was ordered by the prime minister and recently the final report of that investigation was tabled. While numerous state-enabled abuses were documented within the report, there was one significant omission: the ongoing, routine practice of chemically induced compliance.

“Chemical restraint”, as it is otherwise known by health professionals, involves the use of psychotropic sedatives to subdue and control a patient or detainee. In the context of the protection and detention of children in the Northern Territory, children as young as eight years old – the majority of them First Nations kids – are being tranquilised by what the children themselves call “the settlement needle”.

Dr Peg LeVine, a clinical psychologist and trauma specialist, formerly working with royal commission-impacted clients in a contractual role within the Central Aboriginal Congress in Alice Springs, has described the application of chemical restraint in the context of young detainees as operating “like a drive-through”, where children recently detained in police custody could first be taken to a medical clinic and be administered a psychotropic sedative by needle in the back of a divisional van, before being shackled by wrist and ankle and admitted for a further course of settlement medication.

In a submission to the inquiry, LeVine provided insight into this “pattern of unsafe practices of developmental neglect and harm being implemented by public health and justice system personnel”.

Not contained in her submission, but subsequently obtained, is an account of the cocktail of drugs involved.

In the specific case described above, LeVine wrote a detailed court report for one young man taken to Alice Springs hospital after police arrested him for an alleged crime. After being pepper-sprayed at the scene, he was handcuffed and driven by police to the hospital emergency room. In order to “settle” the youth, medical staff entered the vehicle and injected him with five milligrams of an antipsychotic tranquiliser called Droperidol, followed by another five milligrams of the benzodiazepine sedative Midazolam, admitted him to the clinic and then put him on an intravenous bolus of more Midazolam. Later, police reports claimed the child was affected by methamphetamine when they arrested him. Methamphetamine combined with the known side-effects of Droperidol can severely restrict the patient’s breathing and potentially stop their heart, particularly above the recommended adult dose of 2.5 milligrams. Fortunately, the boy had nurses closely monitoring his “coma scale”, which included his respiration. Records obtained by LeVine show he took two hours to stabilise.

Outside of this specific incident, the primary set of psychoactive drugs used on many of the boys that became LeVine’s clients were the antipsychotic tranquiliser Risperidone (a minimum of 1mg per night), in combination with Methylphenidate hydrochloride, commonly known as Ritalin, (10mg three times a day most common). Long-term use is developmentally compromising and impacts cognitive and neurological functioning, which disadvantages these children all the more in social and educational engagement. According to LeVine’s own survey, male child detainees were started this combination beginning at age nine, without reviews on side effects or noted hormonal risks; she recounted a case of a pre-adolescent boy who had breast growth due to prolonged use of Risperidone.

The antidepressant Mirtazapine (15mg at night) was also common, a drug with known side-affects that include an increase in suicidal thoughts and actions, particularly when used in children and adolescents, with the risk spiking higher again within the first few months of its use.

The dangerous practice of state-enabled chemical-induced compliance is such that LeVine strongly believes that if examined by coroners, there may well be a pattern of chemical restraint in Aboriginal deaths in custody.

That mention of the settlement needle didn’t make it into the final report of the $54mn royal commission into the protection and detention of children in the Northern Territory is a glaring oversight. From the outset, Aboriginal people were asking what was the use of yet another royal commission into the welfare of our people held at the mercy of the state justice and prison systems, when almost all the recommendations of the last one continue to go unheeded and unimplemented. If acquiring a more forensic understanding of the depth of state-enabled abuse in the specific context of the young wards of the Northern Territory was the critical objective, then this commission has failed in its report and only emphasises the PM’s revealing recent admission that royal commissions are a typically ineffective mechanism for generating genuine structural reform.