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July 6th, 2009
10:54 AM ET

Should Diprivan (propofol) be a controlled substance?

By Elizabeth Landau
CNN.com Health Writer/Producer

The general anesthetic Diprivan (propofol) has been making headlines as questions about Michael Jackson's death abound. A nurse who had worked for the singer told CNN that Jackson requested the drug because he had trouble sleeping, and The Associated Press reported that it had been found in his home. Diprivan is not approved as a sleep aid by the Food and Drug Administration. Read more about propofol.

It turns out that propofol, used routinely for surgeries and procedures such as colonoscopies, has been a point of concern among some anesthesiologists because of the potential for abuse by health care workers. A 2007 study published by the International Anesthesia Research Society found that about 18 percent of the 126 academic anesthesia programs in the United States had at least one reported instance of propofol abuse within the previous 10 years.

Researchers also found that six out of 16 residents (about 38 percent) who abused propofol died from it. While these are small numbers, lead author Dr. Paul Wischmeyer, professor of anesthesiology at the University of Colorado, believes this is indicative of a larger problem.

People who abuse propofol tend to have had trauma earlier in life, and take the drug to escape it, Wischmeyer said. These people also tend to be impulsive and risk-taking, he said.

Wischmeyer became passionate about the issue because one of his classmates in residency died from using the drug.

"I know physicians that have reached their hands into sharps boxes, where all of the needles are disposed of, to pull out old, used syringes of this stuff that have been used in other patients, and then use it on themselves," he said.

The drug affects two important brain receptors, one of which is associated with marijuana, and the other is targeted by anti-anxiety drugs such as Valium, he said.

"Once someone has tried this drug in a way that they remember it, they very much always choose to try it again," he said.

Some people may die from propofol abuse because the drug itself becomes contaminated when it sits out for too long, like "spoiled milk," he said. There is also a risk of overdose.

"The difference between being high and being dead is a cc or two," Wischmeyer said.

If propofol is the direct cause of death, it should show up in an autopsy in urine, blood, and possibly hair, he said. But it does depend on how long before death the drug was injected.

Should propofol be considered a controlled substance that needs to be "scheduled," with tight distribution and strict accounting of its use? Anesthesiologists are still debating this.

On the down side, stricter pharmacy control of Diprivan would involve increased costs and administrative oversight, the study authors noted. Although there have been documented cases of propofol abuse, it is still much less frequent than abuse of opioids and benzodiazepines, which are governed by strict federal laws and local pharmacy control, they wrote.

But Wischmeyer advocates that it should be a controlled substance because of how lethal it is. He argues that having an extra layer of accounting, as there is with many painkillers and sedatives in hospitals, would not delay the supply of drug for the patients who need them. It was only with Wischmeyer's group's study that the anesthesiology community became more aware of the growing abuse problem, he said.

Most anesthesia programs do not keep track or control of propofol stocks, the authors wrote.

The drug does not produce a "high" per se, but does give the person who takes it a euphoric feeling upon waking up, said Dr. Hector Vila, chairman of the Ambulatory Surgery Committee for the American Society of Anesthesiologists.

For more information about the propofol issue among anesthesiologists, read the study and check out Anesthesiology News.

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