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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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soundoff (107 Responses)
  1. MA

    I feel so sorry for Dr. Murray. He was caught up with an addicted famous person, now everyone is blaming him. It's not fair. I am a MJ fan but the one who needed help/attention is dead. Now the blame falls on Dr. Murray. I can't wait until the reports come out about what was in MJ's system. I will be at peace but My heart still goes out to Dr. Murry.

    July 28, 2009 at 19:31 | Report abuse | Reply
  2. Peter Gozinya

    Every time something happens that makes the news. Idiots like this Dr. Paul Wischmeyer want to run to the DEA and have it scheduled as "controlled." Never mind that it is not available at your corner Walgreens. It's in HOSPITAL PHARMACIES AND ALREADY RIGIDLY CONTROLLED YOU FOOL.

    The University of Colorado should check this idiot. I would hate to think that someone he instructed might take me under some day.

    July 28, 2009 at 19:37 | Report abuse | Reply
    • Ed

      if Propofol is only "in HOSPITAL PHARMACIES AND ALREADY RIGIDLY CONTROLLED YOU FOOL", then HOW did Dr. Conrad Murry get over 550,000 ml of it in less than 2 months ?? and have it shipped to an APARTMENT in Los Angeles ???

      October 27, 2011 at 18:19 | Report abuse |
  3. sherri

    Everyone is forgetting MJ was a adult. No one held him down an made him take the stuff. MJ would have had any Doctor give him the drug or drugs? He had the money an most actors have their own physians so why act like its the Dr fault. MJ should be held accountable for his actions an his drug problem. Just wasting tax payers money an keeping MJ on the headlines. It was a sad end but its over. Quit blaming everyone except MJ for his drug problems.

    July 28, 2009 at 21:35 | Report abuse | Reply
  4. 26 yrs of nursing

    Is everyone forgetting that addiction is an illness. The person or people to blame are the MD's that prescribed these drugs and CERTAINLY "Dr. Idiot " that was adm. the Diprovan! It is disgusting and shameful that a DR. would sell his soul and take advantage of what was obviously a very sick man who should have had some phyce care. But I guess one hundred and fifty thousand a month made him seem very attractive even in a coma. I pray that we all get to see the responsible party behind bars. The world has lost a fantastic artist, his children have lost a great dad. I wish someone had cared enough to get him some help.! May he rest in peace, finally.

    July 28, 2009 at 23:43 | Report abuse | Reply
  5. Trish

    Joint Commission has made potassium a PINCH med, and although not "controlled" it is far better monitored and cautiously delivered to the units than just 10 years ago.
    Diprovan needs to be controlled, period. I have seen people walk around with it in their pockets, and whether they accidentally took it home, or did it with intention, it is getting out of the hospital setting quite easily. I already wrote to the Joint Commission regarding this concern last spring and they were not interested.
    I knew this day would come, but I cannot believe MJ, of all people, lost his life using this med. Hopefully, his death will not be in vain and things will now change.
    Trish Egenton RN BSN CEN CCRN
    Critical Care Clinician

    July 29, 2009 at 01:34 | Report abuse | Reply
  6. Trish

    And for those clinicians on here who don't think it should be controlled – the Pyxis or Omnicell does not lie. Track the stuff already, it's more lethal than Versed for Pete's sake! And immediately so!

    July 29, 2009 at 01:44 | Report abuse | Reply
  7. Connie

    Astounding! I read entire topic, all comments, & I concur with Paul Hamilton above who states:

    "People can intentially kill themselves with almost anything, tylenol, aspirin, shirts, lamp cords, light sockets i ti is possible that MJ intentionally killed himself with propofol. People can unintentionally kill themselves with tylenol, whiskey, cars. paint. They can unintentionally kill themselves with propofol it seems more reasonable to publicize widely that prpofol is an anesthetic, not a drug to treat insomnia, and allow medical professionals to use it in their settings where they can monitor it’s’ proper use. Do we have to regulate and control everything.?Can’t we allow our citizens to exercise some risk, and accept some responsiblity?:

    July 29, 2009 at 01:51 | Report abuse | Reply
  8. Henrik from Denmark

    I have heard several make reference to the addictive nature of Propofol, some compare it to Morphine/Fentanyl (which truly are addictive painkillers), but I have never heard any medical authorities state that Propofol has any addictive properties – such as needing more and more every time you take it, physical, or psychological dependencies.

    I can only imagine an addiction to the affect of Propofol – guarantied coma or state of unconsciousness, but please don’t confuse that with sleep or rest.

    As was pointed out earlier in this blog, there are so many substances in a hospital, that if used wrong, will lead to certain death – start with the compounds used to put criminals to death, I don’t believe they are scheduled, most substances on the heart revival cart would kill you if used in sufficient doses, like perhaps atropine, or your eye doctor, I believe frequently uses the poison originally used in the Amazon delta for poisonous arrows (curare), or get the blood pressure through the roof with a large dose of an explosive (nitroglycerin), and with some luck, you might cause a brain aneurism, or perhaps just a simple overdose of insulin. I’m sure there is a great deal of other examples, but I will leave those to authors of crime novels, or perhaps for a other episode of

    We have been blessed (according to my faith by God) with these compounds, to be used in competent hands of doctors, who take an oath to serve their fellow beings (I make the assumption here that they really take the oath with a continued intent to keep it). There will unfortunately always be a bad apple in the barrel, and then we need to identify it as soon as possible, hoping you get rid of it before it causes great damage. But leave it in the capable hands of the DEA to figure out truly needs restricted in a reasoned and scientific manner instead of running amok over a single drug, that when used appropriately is a blessing for those undergoing surgery, just because Michael Jackson makes the lethal unfortunate choice, assisted somehow by a doctor, who gave the drug to him, when he clearly shouldn’t have done so. Don’t mess with the medical professions toolbox in a rash reaction to an unfortunate incident.

    I was very enlightened and grateful for the entry made by “Jessica MD from Boston” whose entry explained in a very logic fashion why the proper use of it is so restricted in a hospital environment – namely because of the lack of a “reversal agent”. It won’t keep me from letting trained well equipped doctors anesthetize me again with Propofol, but I will certainly ask him/her about his experience with using Propofol, a legitimate question to anybody who is about to assume responsibility for your life.

    Go fourth doctors and use Propofol in a responsible fashion, in the service of mankind, and let the law enforcement (DEA) review this and all other drugs, as I’m sure they routinely do. This is about an eccentric pop star who tragically got access to a prescription medication, possibly from a careless doctor (in fairness, that remains to be determined, the autopsy report and the criminal investigation isn’t done yet), and took the medication in a manner that appear to have lead to his death. Please de-emphasize this focus on Propofol, it could have been a dozen other agents he could have used, and that fact shouldn’t make us jump to the conclusion that we need to restrict or ban the drug.

    While mj never meant a great deal to me, it certainly seems to have inspired a lot of artists I like. To the fans of mj, I understand and appreciate your feeling of loss, but don’t lash out against a perfectly legitimate drug, which has done so much good for so many people. I’m not familiar with any trend related to the misuse of this medication. On the contrary, one of the MDs who submitted an entry to this blog, mentioned that it is in fact Fentanyl (a much used painkiller), that far and away is the most misused and addictive medication in OR, and I would assume in other areas of the hospital. And while it appropriately is highly controlled, it is frequently used by terminal cancer patients, and quite frankly, we should care too much if they get addicted or not, as long as it takes away their pain.

    I think I’ve approached this in several different ways, but I just don’t see how you can make the case for outlawing or further restricting the use of Propofol. Sure a few hospitals may review there fluid disposal after an operation, to make sure that Propofol, Fentanyl, and other such substances are appropriately removed and destroyed, but that review should be undertaken regardless of the mj case.

    Thank you for reading my entry.

    Henrik from Denmark

    July 29, 2009 at 07:43 | Report abuse | Reply
  9. Robin Brainard

    As a Paramedic/Nurse.....IF Dr. Murray administered Diprivan (propofol) to Michael Jackson, since (or IF) the doctor is not trained in field of anesthesia, could the doctor face charges for "operating outside the scope of his practice?"

    In Tennessee, where I am licensed this question often arises as new skills are added for Paramedics. Paramedics must get training (usually through CEUs) prior to being able to carry out that skill in the field?

    July 30, 2009 at 08:29 | Report abuse | Reply
  10. Severin

    As of the time of writing, publication of the official results of the 2nd autopsy has been postponed for a week.

    The whole world is talking about propofol being the cause of MJ's death, and the doctor administering it shortly before.

    We still don't KNOW. Nothing has been confirmed by the authorities.

    What surprises me in this case is that each and every rumour starts to lead its own life and people mistake it for hard fact. The media have their "sources"; up comes another fable. First it was demerol. Now it's propofol.
    Another example: Michael is/is not/cannot be the biological father of his three children. (O, but he has a fourth in Norway).
    This goes on.

    I wouldn't be surprised if there was no evidence found of poisoning by any external substance whatsoever. Not after the first, nor after the second autopsy. Huge problem, there is no story, no explanation....

    ...he just died, for God's sake.

    July 30, 2009 at 14:47 | Report abuse | Reply
  11. Art Zwerling

    All,

    There are a couple of very clear take away messages from this incident.

    1. Propofol is a substance of abuse- We have known this from the pre-marking animals studies that clearly and unequivically demonstrated that animals will self administer the drug because of it'spositive rewarding effects on midbrain reward pathways.
    2. This is a drug with an incredibly narrow therapeutic index meaning that the range between the effective hypnotic dose and a toxic dose that impairs breathing is extraordinarily narrow.
    3. This is clearly a drug that should ONLY be administered by qualified anesthesia providers such as CRNAs and anesthesiologists in settings where advanced airway management and full resucitative capabilities are immediately available!

    August 9, 2009 at 09:37 | Report abuse | Reply
  12. Lorraine Harrietha

    Dr. Murray is guilty,guilty, guilty of killing Michael Jackson. He had no business providing diprivan outside a medical facility. MJ was not even properly monitored. Murray was not qualified period. He is a murderer. I can't believe that he is being allowed to practice medicine.
    This would not happen in Canada. He would have been charged with murder and had his licence suspended definitely.

    December 1, 2009 at 22:50 | Report abuse | Reply
  13. Cole Powell

    i can say that i miss jacko so much coz i am one of his die hard fans*.,

    October 4, 2010 at 11:57 | Report abuse | Reply
  14. natalie

    I don't understand why anyone woud abuse propofol; I have had it for several procedures..it's an awful drug. It's like getting hit with a brick then beinf forced to lay there imobile unable to communicate. Anesthesiologists only should administer this drug..not nurses (and certianly not CRNA's)

    February 15, 2011 at 12:49 | Report abuse | Reply
  15. John

    Any professionals out there that can answer a question? How often should propofol be administered to a patient? What I mean is, if a patient has repeated procedures to be done, such as Lithrotripsy to bust up kidney stones, and they can't get them all with one treatment, is once a week too much? Twice a week? For how long?
    The reason I ask is because I am going thru that now, and my Daughter who works at a Vets claims that they won't put a dog or a cat under twice in a short amount of time. Kind of scary if it's not OK for an animal but it is "fine" for me.

    March 31, 2011 at 22:07 | Report abuse | Reply
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