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Concerns mount over misuse of anaesthetic propofol among US health professionals

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3673 (Published 08 September 2009) Cite this as: BMJ 2009;339:b3673
  1. Fred Charatan
  1. 1Florida

    Pressure is mounting in the United States for tighter curbs on access to the anaesthetic propofol, amid fears that a growing number of healthcare professionals are becoming addicted to it.

    The drug has been implicated in the death of singer Michael Jackson, who died in June, after the Los Angeles coroner’s office said that “lethal levels” had been found in the singer’s body. Propofol, which has been licensed for use since 1986, is given intravenously to induce brief anaesthesia and is not generally available outside hospitals and clinics.

    In July the American Association of Nurse Anesthetists warned that “abuse of the drug is becoming more common among anesthesia professionals and other health care providers who have easy access to it” (www.aana.com/News.aspx?ucNavMenu_TSMenuTargetID=62&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=22278). The association recommends that healthcare facilities keep propofol in a secure environment to reduce the risk of its diversion and misuse by providers.

    A survey carried out by the University of Colorado in 2007 of 126 academic anaesthesiology programmes in the United States showed that almost one in four (18%) reported one or more incidents of propofol misuse or inappropriate distribution over the past 10 years (Anesthesia and Analgesia 2007:105;1066-71, doi:10.1213/01.ane.0000270215.86253.30). The observed incidence of propofol misuse was 10 per 10 000 anaesthesia providers, a fivefold increase on the findings from previous surveys of propofol misuse.

    Seven deaths have also been reported, six of them in residents. Seven in 10 anaesthesiology programmes said they had no established system to control or monitor propofol, as is the case with opioids.

    Paul Earley, medical director of Talbott Recovery Campus, a drug misuse treatment facility in Atlanta, Georgia, said, “It is hard to tell the reason for propofol becoming the drug of choice among professionals,” but he added that people with a childhood history of violence seemed to be more vulnerable.

    He added, “When it is abused it leads to a mild dissociative condition, with euphoria after the abuser wakens to a well rested state—for example, in a resident [anaesthetist] who has had a tough schedule then later feels like they’ve had a full night’s sleep.”

    Two years ago a citizens’ petition was filed at the Drug Enforcement Administration of the US Justice Department requesting that propofol be designated a schedule IV controlled substance (the fourth of five grades of controlled substance, schedule I being the most strictly controlled). Barbara Wetherell, a spokeswoman for the administration, said that the Department of Health and Human Services referred the petition to the Food and Drug Administration, which would pass on its recommendations to the administration when it had completed its study of propofol. A decision is expected in the next few months.

    Asked why no restrictions were imposed on propofol originally, Dr Earley replied, “Who would have thought that anyone would try and abuse a drug with such a narrow therapeutic window?” He recalled that in July the Drug Enforcement Administration proposed placing fospropofol (propofol is its active metabolite) on schedule IV. He said, “Eventually propofol itself will follow.”

    Notes

    Cite this as: BMJ 2009;339:b3673

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