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.

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

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soundoff (126 Responses)
  1. Anonymous

    As a nurse, I have utilized propofol in the care of my patients frequently. I don't think that making this drug a "controlled substance" will make any difference. With narcotics (controlled substances) we have checks in place to prevent people, including staff, from abusing them. The truth of the matter is, is someone decides that they are going to abuse a drug, it doesn't matter if you have changed the classification or locked it up. They will find a way to get their hands on it.
    "Wischmeyer advocates that it should be a controlled substance because of how lethal it is," using this theory there are hundreds probably thousands of drugs that she have increased classifications. IV potassium can be extremely lethal if injected to quickly (this is what they use with lethal injection, and it's also given routinely in the hospital for simple electrolyte replacement.)
    I believe that this would be a waste of time and resources. My hospital, after an incident where someone abused propofol, voluntarily locked it up- without the government telling them to. Although this will deter some, just like those who divert narcotics: Where there's a will, there is a way.

    July 6, 2009 at 16:02 | Report abuse | Reply
  2. kathy blair

    i was investigating the medical licensure of Dr. Conrad Murray, Michael Jackson's physician who was onsite in LA. I found out he has medical licensure in NV, CA and TX. In TX, he is associated with the Armstrong Medical Clinic. Dr. Davill Armstrong has had a lot of dealings with the TX Medical Board regarding prescription fraud! Apparently, Dr. Armstrong allowed his wife, to prescribe medications without a physician approving it.

    I find that physicians who have a shady past find each other.

    Money does not always buy you quality medical care!

    July 6, 2009 at 18:39 | Report abuse | Reply
  3. kathy blair

    According to the literature, patients should be monitored for early signs of significant hypotension and/or cardiovascular depression, which may be profound. These effects are responsive to discontinuation of DIPRIVAN Injectable Emulsion, IV fluid administration, and/or vasopressor therapy. In the elderly, debilitated, or ASA-PS III or IV patients, rapid (single or repeated) bolus administration should not be used during sedation in order to minimize undesirable cardiorespiratory depression, including hypotension, apnea, airway obstruction, and oxygen desaturation.

    As with other sedative medications, there is wide interpatient variability in DIPRIVAN Injectable Emulsion dosage requirements, and these requirements may change with time. Failure to reduce the infusion rate in patients receiving DIPRIVAN Injectable Emulsion for extended periods may result in excessively high blood concentrations of the drug. Thus, titration to clinical response and daily evaluation of sedation levels are important during use of DIPRIVAN Injectable Emulsion infusion for ICU sedation, especially when it is used for long durations.

    July 6, 2009 at 18:54 | Report abuse | Reply
  4. A

    Diprivan should not be a controlled substance. There is too much control of most everything these days. The media seeks to blame everyone they can think of when someone dies and drugs are involved but the person responsible is the victim themself. Where is personal accountability? If someone wants to take drugs, let them as long as they are not hurting others. It seems the only people who have access to drugs anyways are celebrities. My doctor wouldn't prescribe painkillers after surgery! I would have to kidnap her kids to get a lortab! People choose to take drugs knowing the side effects and consequences could be bad or fatal, lets not take away that freedom. What moron doesn't know that drugs, cigarettes, fast food, caffeiene are all bad for you? I think we need LESS CONTROL.

    July 6, 2009 at 21:12 | Report abuse | Reply
  5. susan

    Controlled Substances are so classified due to risk for abuse – not pharmacologic addiction or tolerance, as we see that with even acetaminophen or ibuprofen in headache sufferers and certain with a few crucial drugs such a beta blockers.

    Controlled Substances are so designated due to risk for abuse and psychological addiction as opiates – or those that work on opiate receptors (such as tramadol) – as well as various stimulants, hypnotics (aka "sleepers").

    The big concern is "diversion." This is why this entire issue is under the aegis of the Department of Justice and not the Food and Drug Administration.

    If you've ever had to deal with someone who is addicted, they will find a way to get what they want/"need". This is why illegal drugs are so expensive. (compare beer during and after prohibition. When was it better controlled? I believe a similar argument was undertaken during the AC360 week on Marijuana (which is a Class I CS, including THC I believe, the active chemical compound.)

    The bizarro aspect is who in their right mind would even Want to use Diprivan for insomnia. If someone has problems with Insomnia, then talk to a doctor who knows something about insominia, e.g. an internist, or a sleep specialist – (yes, there is a separate subspecialty board) who is usually also trained in either neurology or pulmonology. Anesthesiologists are not trained in sleep. They put people in comas. Comas do not have the restorative aspects of Sleep (viz, Slow Wave or Delta Sleep).

    So if the concern is insomnia (a very common complaint), why not talk with some sleep specialists instead of these common misconceptions. Be aware of the effects of sleep deprivation – REM v Non REM – psychologically, physiologically. And that first and foremost for treatment is Sleep Hygiene (just like we tell you to work on the Lifestyle Modification, aka diet and physical activity for certain other physiologic (and psychologic) maladies. And, there is great data about the effectivenes of that sleep hygiene.

    July 6, 2009 at 21:19 | Report abuse | Reply
  6. sultana bell

    I don't know what to belive I just wish mj was still here! I hope they can get to the bottom of all this drug stuff soon,so we all can starting celebrating who mj really was, & how he changed so many lives!!

    July 7, 2009 at 01:56 | Report abuse | Reply
  7. courser01

    I'm familiar with Propofol in a veterinary setting. While it's an expensive alternative to more traditional anesthetics, it was a safer alternative for elderly or sensitive dogs. It was my understanding (I was a veterinary technician, not a veterinarian) that it's not metabolized in the liver, making it a safer choice for animals that could have reduced liver function.

    In the proper setting propofol is a very safe drug. I don't want people to be afraid of it if their doctor is going to use it for a procedure.

    July 7, 2009 at 08:15 | Report abuse | Reply
  8. Jane

    Don't make it a scheduled drug. I work an ICU and we use it all the time. If someone wants to abuse a drug they will find a way. More paperwork won't stop people from being abusers.

    July 7, 2009 at 11:04 | Report abuse | Reply
  9. acj

    As an anesthesiologist, I use propofol (on patients) every day. Although propofol abuse is a real problem, I think that making it a controlled substance would cause more harm than good. There are times during an anesthetic when propofol is needed immediately, to deepen the anesthetic , control blood pressure etc. Sometimes a patient requires more narcotic than initially signed out. However, the patient can usually wait for the time it takes to sign out more medication. This is often not true of propofol. By the time the propofol is obtained, the patient may have developed recall of the procedure, may have developed a stroke from too high blood pressure, may have bucked leading to disruption of the surgeon's repair, etc. Any means of preventing propofol diversion shold not come at
    the expense of patient care.

    July 7, 2009 at 13:41 | Report abuse | Reply
  10. Adrian

    I'm a critical care nurse. A few years back a coworker of mine took propofol home and purposefully committed suicide with it. After that our hospital made some changes in how it it is retrieved. Like other controlled substances a two-nurse check could be implemented when the drug is wasted. But again, people will abuse drugs. It is not a drug that makes one high. I would think abuse of this drug is a rarity. It's sometimes used during intubation (airway placement) and often used to maintain a patient's sleep state while on a ventilator. To control it or not is a good debate. Ask yourself this," Should acetaminophen be controlled since it's abused and injures and kills people every year?" I don't think controlling propofol will matter one bit.

    July 7, 2009 at 15:15 | Report abuse | Reply
  11. Bob

    I thought it was "controlled" in the sense that nobody has any business using it outside of a hospital setting?

    July 7, 2009 at 16:20 | Report abuse | Reply
  12. C

    We use propofol to anesthetize our baboons in the medical research setting. It's fantastic: they go down fast, stay down and it dissapates super fast (which is bad if your IV anesthetic line slips out during a procedure!). I can't even imagine using propofol on myself- whatever for? It would knock me into a coma. It would, however, be a fabulous method for suicide as it would be painless and is so very easy to fatally overdose. The trick would be in being able to push it all in before losing consiousness.... Don't "try" propofol as a recreational drug- you'll win a Darwin award and the world will be a better place.

    July 7, 2009 at 16:39 | Report abuse | Reply
  13. Austin

    I have been given Propofol during surgery and it works very well, when used properly and in trained hands. However, it appears that it is prone to abuse, not to mention the risks involved...namely death, if proper precautions are not taken.

    I would be in favor of a rule forbidding the use or dispensing of Propofol outside of a medical setting, defined as:

    1. A hospital or other licensed health facility, equipped with devices necessary to assist in breathing and/or otherwise reverse or mitigate harmful effects of the drug.

    2. A licensed veterinary clinic or animal hospital, subject to conditions similar to (1) above, and also to the condition that in this case the drug only be administered to animals.

    Dispensing, or use, in other settings, such as at home, would be banned.

    July 7, 2009 at 17:57 | Report abuse | Reply
  14. Brian

    Actually, anesthesiologists are indeed one of the four specialties which are eligible for subspecialty training in sleep medicine. There's no evidence, however, that an anesthesiologist was anywhere near MJ when he died. If there were, he would still be alive.

    Drug diversion is a problem, no doubt. As has been said before, classifying it as a controlled substance will not really make much difference in terms of its abuse. The biggest concern I have over the publicity associated with propofol is that now people are going to fear it irrationally.

    Think of it as a tool which is extremely safe for those who use it correctly, and clearly deadly in those who do not. This is why physicians go through years of training before most hospitals will allow them to use it in patient care.

    The fact that MJ had propofol is truly sad. It has no business for use in insomnia; it induces coma, not sleep. He probably didn't realize how dangerous it was, but the fact that he had it says that somebody (probably medical) used tremendously bad judgement in giving it to him. Find that person, and let the courts decide what to do with him/her.

    July 7, 2009 at 18:34 | Report abuse | Reply
  15. Scott Christner

    I thought that taking that stuff has no use outside a Hospital.This means MJ was a doper. That is sad ,very sad!!!!!

    July 8, 2009 at 17:06 | Report abuse | Reply
  16. Quattrone

    I had a colonscopy and I can only assume they used propofol on me. I'll tell you what, that was AWESOME. I had a mild apprehension about the procedure but when they popped that drug in and the room started spinning and I came back afterwards not having remembered anything, all I can say is I'm so grateful cool drugs like that exist.

    July 8, 2009 at 17:46 | Report abuse | Reply
  17. Tina

    Absolutely...with the news out that Michael Jackson may have used it to battle insommnia, you can bet that there is someone out there who will think,"Well, it may have killed Michael Jackson, but I'll be more careful."

    July 8, 2009 at 18:05 | Report abuse | Reply
  18. Allen

    Anyone who abuses Propofol might as well be playing Russian Roulette with 5 rounds in a 6-chamber revolver. This particular medication has absolutely no recreational value. Access to Propofol is only in a hospital setting; this is neither a street drug nor medication that one can obtain at a neighborhood pharmacy. Patients administered Propofol must have their vital signs continuously monitored and maintained by an anesthesiologist. It's unconscionable that any ethical medical doctor would prescribe Propofol for any off-label purpose, or otherwise make this drug available to a patient in a residential setting. There is absolutely no clinically appropriate reason for Propofol to be situated in MJ's private residence.

    July 8, 2009 at 19:26 | Report abuse | Reply
  19. Chris Shaffer

    I don't understand why this is even a question. As an RN in North Dakota, it is out of my scope of practice to administer propofol. It is LOCKED in the medstation, and needs to be dispensed under a patient's name. The medication can only be given by an MDA or CRNA, the ICU staff my titrate it on a pump (like a PCA), but there are tight controls. This whole thing with Michael Jackson is causing an issue with my patients, because I administer moderate sedation in an endoscopy department, and our patients are all coming in asking if we're going to give them "the medication that killed Michael Jackson". I understand any medication can be abused by healthcare providers, but what kind of healthcare settings are leaving this stuff laying around?

    July 8, 2009 at 21:39 | Report abuse | Reply
  20. peggy chiu-wong

    As a hospital pharmacist, I work with diprivan in the intensive care unit setting where it is used with our sedation protocol as well as in our surgery units. Diprivan should never be available for use outside of these specific settings. To make it a controlled substance would require the FDA to make all pharmaceuticals controlled substances and that alone would be an incredibly tedious if not futile task. The issue here is whether physicians can prescribe and obtain medications outside their scope of practice. In this case, a cardiologist has no business ordering propofol for any reason whatsoever much less as a treatment for insomnia. I am just speechless that this should even be an issue.

    July 8, 2009 at 23:07 | Report abuse | Reply
  21. laverne reynolds


    July 9, 2009 at 03:17 | Report abuse | Reply

    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 9, 2009 at 05:57 | Report abuse | Reply
  23. Sandra Reed

    Apparently, Michael Jackson, after trying many others found a drug for his insomnia that actually worked. Most marketed for sleep and prescribed by doctors simply don't do it.

    July 10, 2009 at 21:38 | Report abuse | Reply
  24. SH

    I see a few issues here.

    One point has been touched over and over and is very true. The fact that if there is a will there is a way. I have personally been there. Being a Surgical Technologist, many years ago I battled an addiction to IV Fentanyl. The second highest controlled substance. When working in the OR I never had a shortage of Fentanyl.

    Regulate all they want- Its not going to matter. Fentanyl has been scheduled for quite sometime, but still remains a drug that is abused commonly by medical professionals.

    Also, in order for controlling a substance to combat diversion, protocol must be followed.

    Now, in no way do I blame anyone else for my addiction, I can attest to Vials of Fentanyl, Morphine, Versed, Ect being left in unsupervised rooms, out in the open on Anes carts after being checked out... Half full syringes of controlled drugs just thrown in a sharps box instead of being wasted... Im not saying this is the norm, but there is a lot of complacency.

    July 18, 2009 at 05:10 | Report abuse | Reply
  25. Ellen

    With all of the endless coverage of Michael Jackson's life and death, little has been said that gives insight to his addictions and other strange behavior. Michael, I believe, was not truthful about his drug use (typical) and other matters, like plastic surgery. I was astounded when I saw images of his head aflame and his lack of reaction to it! It is absolutely astonishing – third degree burns are incredibly painful and, yet, he didn't seem to be aware! It is typical to blame addiction on some event, but his claim that the burns and resulting treatment with pain meds is doubtful. It seems much more likely that he was already under the influence of strong drugs, which would explain his lack of sensitivity to pain. It is also likely that he began using drugs much earlier, as is often the case with young people and especially those with a history of abuse or other problems in childhood. Discussing the path of addictions, and the disruptions they caused in his life, would be one positive outcome of the tragic end to his life. Too many people die of their addictions, and they are very often intelligent, gifted and decent people who fall into the same trap. His addiction and heavy drug use would also explain his difficulty in sleeping at night. With all of the attention being paid to him, discussion in an honest fashion would help the young people who feel his loss most heavily to learn, and would help parents to see how drug and alcohol abuse trap young people. Please give the matter more clear and informative details.

    July 19, 2009 at 08:23 | Report abuse | Reply
  26. ED Pharmacist

    This propofol concern pertaining to provider abuse potential and scheduling the medication as a controlled substance is unfounded. Controlled medications and scheduling pertain to the ability or perceived ability of a drug to not only have addictive properties, but to also induce a physiological withdrawal symptom.

    Also, increased costs of administration because pharmacy would be controlling the medication? Wake up, hospital pharmacies already are controlling the medication. Where at any "local pharmacy" are you going to find ANY propofol for outpatient use? The only people diverting this drug are health care professionals.

    July 20, 2009 at 11:54 | Report abuse | Reply
  27. Walter Grant

    As a former California resident, NOW living in Canada, it is appalling to hear Representatives in the U.S. Congress
    trashing Canada's National Health Care System using the negative stories of a very few Canadians to support their case.

    Please use your considerable knowledge and common sense to tell the World that Canadians are Proud of THEIR (OUR) SYSTEM- and Americans will be well advised to emulate it!

    In November, 2008 my Gallbladder was removed within 24 hours of my 2nd attack. At NO COST to me!

    Walter Grant

    July 22, 2009 at 10:43 | Report abuse | Reply
  28. EtherDoc

    It's an anesthetic. Anesthesia is a coma. That's what we do everyday.

    Used by a trained anesthesia provider it is quite safe. Used by anyone else (including non-anesthesia providers) it can easily result in respiratory arrest that the provider cannot handle.

    All drugs are classified. This drug is currently not schedule 2, but perhaps should be.

    Boston Anesthesiologist

    July 24, 2009 at 10:21 | Report abuse | Reply
  29. MQ

    Fact of the matter is, propofol has NO ANALGESIC properties whatsoever. It is a sedative-hypnotic used in anesthesia for general anesthetics or procedures that require a "twilight" type state. The duration of action of propofol is approximately 5-10 minutes. Therefore, unless MJ received an induction dose (2mg/kg) of propofol, enough to render him apneic within that time frame before his death, propofol couldn't have killed him. It would be nice if the media researched their topic thoroughly before publication. Unfortunately this kind of misinformation is leading to a lot of bad rap for a drug that has revolutionized anesthesia.

    July 27, 2009 at 22:18 | Report abuse | Reply
  30. Jessica

    Propofol is, in many ways, a controlled substance. A patient cannot walk into a pharmacy with a prescription for Propofol and fill it. My husband and I are both physicians working at different teaching hospitals in Boston and neither of us are allowed to administer propofol to our patients without an anesthesiologist present. The reason is that there is no "reversal agent," or drug that can reverse the sedative and respiratory depressive effects of Propofol. Most other drugs in its class have reversal agents and they are therefore considered more safe. We have had many discussions over dinner about how we feel that Propofol is overly-controlled in the hospital setting.

    July 27, 2009 at 22:22 | Report abuse | Reply
  31. KD

    I am a RN; I used this drug before when a Patient is on a ventilator!
    These Doctors that it to Michealt are all murders and ruthless and
    in the Medical Profession for Just the Money;Good Riddens
    I hope they all lose their Physician Liscences (that they Did not Deserve in the first place);Off with thier heads as I heard a Reknown and respected Foresenic Physicians said, Personally I am sick of the some people that come into this country who are Doctors and want there children to be Doctors for the Greed and love of Money not the love for Humans, I seen to much of in over 3 decades of working in hospitals. Oh I have a Physician in my family to Woopidue!
    I wonder Liz Taylor has to say about this mess?
    RIP MJ

    July 27, 2009 at 22:34 | Report abuse | Reply
  32. SML

    Propofal is used daily for surgeries by my repo vet. It is considered one of the safest anthesthia there is for the animals. They go down quick and come back fast after surgery.
    As other sedation meds – only a specialist should be administering this form of drug to a patient (human or animal). I am still shocked to hear time after time how money can buy the power to go over the system and law – most times resulting in addiction or death.
    What a shame such a brilliant and talented artist had to resort to this type of usage. Shame on the Dr's that enabled him as well.
    Ultimately, we all are responsible for our actions.

    July 27, 2009 at 22:49 | Report abuse | Reply
  33. FloridaRN

    I doubt that making propofol a schedule 2 is going to change a situation like Michael Jacksons. If abuse is the goal, controls only slow down the aquisition, they don't prevent it. What this whole situation illustrates to me is the need to police those handful of Docs that can't or won't tell an addicted patient "no". As an RN I cannot imagine an ethical medical professional that would give the man propofol for home use. It just makes absolutely no sense to me. I think there needs to be greater incentive to refer patients to treatments programs for chemical dependency. If a red flag goes up, the docs need to recognize it as an illness, just like any other. You wouldn't give a diabetic with a blood sugar of 400 a snickers bar....

    July 27, 2009 at 23:19 | Report abuse | Reply
  34. LUCY

    Doctors have a responsibility to heal – not to money... Unfortunately doctors are human and fall to temptation so how can laws (existing or new) ever be enforced if their responsibilities are not self imposed and respected first. Evil flourishes when good men do nothing. Doctors who have known of such a practice that prescription drugs are being abused to those rich enough to obtain them are as guilty as those who write the script in the first place. Shame Shame Shame....

    July 27, 2009 at 23:30 | Report abuse | Reply
  35. Stec

    No, I don't think propofol should be a controlled substance. Why, because as it's been mentioned if you have a shaddy doctor (which there are quite more than society knows) than they can kill you directly or indirectly. Like for example the one who gave my mother Norco (a controlled substance) knowing that she was a prescription drug addict because I had told him. But low and behold, she's dead six months after my converstation with him and his name is on the bottle of Norco she overdosed on. Because I didn't have the money of the Jacksons and my mother wasn't Michael Jackson I couldn't do a damn thing about it. So we can try and control drugs as much as we want but as long as their are addicts and legalized drug dealers (MD's) then any and all drugs can be lethal. Go after the doctors, not the medications. Doctors take an oath that they choose to ignore and so many of them think they are above the law and can't be touched unless an obvious error is made but the truth is whether you are rich or poor or in between, doctors give and prescribe drugs freely because they can. Yes, maybe Dr. Murray may get charged with manslaughter, but there are so many more Dr's that need to go down with him. I'm a nurse and I do know what doctors can and will continue to do this because they can. With everyday people it's all about keeping the MD's schedule full and if that includes keeping addicts as regulars than that's what they do. Pharmacists and MD's need to be held accountable for leading people to think that just because a doctors prescribes it and a pharmacist dispenses it that it can't hurt me. That's total BS. I hope they fry one of these doctors involved in this case so that maybe other doctors will know that they to can be held accountable for their negligence, poor ethics and bad practices.

    July 27, 2009 at 23:35 | Report abuse | Reply
  36. Rita

    I think the drug should be considered a controlled substance especially considering how addictive it is.

    July 27, 2009 at 23:41 | Report abuse | Reply
  37. desertrose

    Diprovan is a very powerful drug that usually is used on ventilated patients and for anesthesia. I do know that when person is not monitored the risk of injury is more. I do know that diprovan has some lot numbers that have been recalled for endotoxins which can cause several problems. I don't want to pass any judgement here but MJ was aware of the dangers of letting someone put him down. Any MD with any knowledge of diprovan would of refused this type of treatment to a patient. Really if this is true and he adminsitered this to Mr. Jackson I am sure he will never practice medicine again and rightly so.

    July 28, 2009 at 01:11 | Report abuse | Reply
  38. J.J. Jatson

    Dear all,

    What a great loss!

    Is year 2008 to 2009 a year for rapture? If it is why am I still here then? Why is God still keeping me here?

    Since I was born I have NEVER experienced this type of years full of bad news. However, bad news will not be our portion in Jesus name. May the gentle soul of Michael Jackson rest in peace – Amen

    Life on earth is vanity. I have experienced heaven when I was 11 years old and now I am 54 years. I tell you this world is nothing but hell and we live in that bottomless pit of burning fire that is stated in the Bible. The breathing in and out that people breathe here on earth is enough punishment for mankind and animals alike. The eating we eat and drinking water is another big punishment for man. When I was in a comma I saw myself in heaven. I did not feel my body while there; I did not eat nor drink, I did not breathe the air because there was simply no air up there. I did not walk but just flying and there was no sun and darkness in heaven. All was bright and there are simply no suitable adjectives to describe the beauty of heaven when I was there and I wish I had not returned to this world. The grave that was prepared for me was later covered empty without that my small body wrapped in old clothes because my parents had no money to buy a white cloth to wrap my body then. I bounced back to life mysteriously and unexpectedly. While my mother was happy I was back to life, I was angry and crying and wishing to be taken back to that same place. He who feels it knows it better and that which you have not experienced you don't know it.

    There is nothing in this world that is worth admiring or crying for. This world is vanity – Absolute vanity. I am so eager to see that place once again. Those who have died if they go to the same place that I went at age 11, I tell you non of them will wanna come back here in this crazy world full of evil and inhumanity to mankind and animals. Though when one dies we the relations and friends cry, but I tell you if that person is told to come back here he will cry more than you that is crying that he is dead. He will fight you for asking him to come back here in this HELL call world. I tell you if Late Michael Jackson is asked to come back here he will not agree and he will do every thing that it takes to remain with God.

    I know how His Father and Mother are feeling and both with his borthers, sisters and all his fans and me inclusive, but if God can make us see where Michael Jackson is living presently we will all wish we are there. I pray to the Almighty God, the author of the Universe, Alfa and Omega, the Governor of the entire world and the incomprehensible give his mother and father, brothers and sisters the fortitude to bear this great loss in Jesus name – Amen.

    Peace be unto you all and remain blessed.
    J.J. Jatson

    July 28, 2009 at 02:49 | Report abuse | Reply
  39. letta

    After reading some of these comments, I needed to put my two cents in. Sometimes it is the medical/surgery doctors faults. When you tell them that you are in pain, the first thing they do is write you a prescription. In my case, I can take nothing that has codiene in it, so when I get a prescription they have to have an special lience number for it to get fill. Now, I not taking up for Michael, but I too suffer with sleeping. My doctor has given me serveral different types of sedatives to sleep, because for one thing after you take it for so long your body gets use to it and don't work. Then I have this pill call Zolpdem Tartrate that I suppose to take every night. Which I don't because once I take this one pill, it knocks me out before I realize I am sleep. Since, the dealings of Micheal death and how he was under different IV drips to sleep, I am very scare about taking a sleeping pill. I do not want to become addicted to something this powerful.

    Again, I look at the doctors, I also have problems with my legs, the are always in pain, due to some problem in my back. The doctors prescribe me two different type of pain pills that I am suppose to take one bottle of two pillkillers in the morning and the other type of painkillers at night, and on top of that they gave me more pain killers so that makes three types that I suppose to take of total of six pills a day. Now, this is were you become use to painkillers, some of us are weak, to it and when to fell better, I know I do, but since all this has come too light, I starting to stay in pain more because I won't take the painkillers at this time.

    Something else that got to me I was in the hospital for an operation that require that I use the Morphine drip when the pain because for bad. Well, I Hit the button the first time and when I woke up they next morning I have the telephone laiding on the pillow of my bed, I don't remember even taking to anyone, so when the doctor came in that morning to see how things where going, I told him that I did not want the morphine drip anymore, because I did not like it when I did not have any ontrol, HE had the nerve to tell me I was the first patient he ever had that refuse this drug. But, he would not removed the drip, stating it was in my best interest. So, I refuse to hit the button, and since I was hook up to a monitor the nurses stations could tell that I was in pain and they would hit the button on the drip. So, by sharing my dealing with these Doctors, sometimes they really don't give a care about if you become addicted. What really should happen is that these Drug enforcements really should check the guidelines on how often a doctor writes painkillers to their patients and how often.

    Micheal became addicted to painkillers after his accident at pepsi commericals. Now, his doctors back them should had been paying my attention to how MJ was becoming more and more dependant on painkillers, but accourse they did not because the saw more Money in their pockets. Even, after Michael went into recovery from painkillers, he started using again may when all the charge for abusing young boys came out, and this was his way of dealing with the situations at hand. I also blame the doctors, for not seeing this and denying him access to painkillers or Diprivan. They was not thinking about what it could or would be doing to Michael. They saw money instead of a person that may needed some help other them prescribing him license medication. It is easy to become addicted through medically prescription drugs because they figure that it is safer them maybe street drugs.

    There has got to be a way to truley monitor what is prescribe and how often it is being use. Maybe Doctors need a refresh course on prescribibg medication. Someone made a comment that Michael knew what he was doing, maybe or maybe not. If this is the case he may had thought that with a personal physician there he would be okay, since in the past he did not have problem with the other anthesiologist whom was on payroll when he done his last concerts. But the problem is that Dr C. Murray, was not license to administrator this type of drug, this was out of his lead, and as a medical physician he took a oath to save lives, instead he took a life. So, I just do not put the blame at Mihael because he wanted some sleep, because I know how that feels, I am up to 6 in the morning everyday, and when I do go to sleep I may sleep two to three hours tops and back up. They Doctor there knew or should had knew that if he was willing to take this step with giving him Diprivan that he needed to be montoring Michael every second, then I feel Michael would be alive today, but something went wrong and Dr Murray, is not man enought to he honest about exactly what happen.

    So yes they should have a Control Substances for these types of drugs that way they can montor who is prescribing it and for what.

    July 28, 2009 at 05:43 | Report abuse | Reply
  40. helena

    yes it should be a controlled substance. dont know much about it but from what i see and hear it should be used only in hospitals and under the right and professional doctors. look what happened now to MJ and probably many others. had it not been for this drug MJ would still be with us today...

    July 28, 2009 at 06:30 | Report abuse | Reply
  41. Henrik from Denmark

    Why is it that everytime somebody misuses something in an unintended manner, we rush to restrict or outlaw the compound.
    Last year my wife had a complex neurosurgical procedure and was sedated with Propofol (+ fentanyl and a host of other things, intubated and with all vitals monitored). Thank God for the availability of this, because it was the most easy wake-up after 4 hours with no nausea etc. Subsequently I had both a dental surgery and surgery on my knee, and in both cases I was sedated with Propofol, and it went really well, and I woke up with none of the traditional discomforts from sedativs.
    Earlier in my life I got a triple discusprolaps in the US Marine Corps, and I would have paid a fortune if they had been able to use that.

    As a Attention Deficit Disorder and Chronic Pain Suffere, I have access to relatively large quantities of Actiq (Fentanyl for breakthrough pain), Morfin base pain, and Adderall (two isomeric salts of methamphetamine), and I have been taking this and other supporting compounds for years, and I wouldn't dream of misusing it. It is highly restricted for a good reason. My doctor started giving me a weeks medication at a time, up'ed it to a month, and today I get the mailorder allowance – 3 months at a time. It is a matter of trust. And if you really need it, it would be foolish to misuse it, because you'd be cutting off your source of it.
    With Propofol I suggest that they do like here in Denmark where it only can be sold to anesthesiologists or other doctors with extensive training in the use of it. It is only "sold" through hospital pharmacies to anesthesiologists, specially trained ER doctors, Intensive care docs etc. where they have the equipment to maintain the airways with intubation or oral pherangyl (I think is the name), to prevent the patient to have his airways blocked by his own tongue, etc.

    I suspect Michael Jackson didn't have the benefit of these trained and equipped individuals. In fact, my guess is that he died because his tongue fell back and blocked his airway.

    But PLEASE don't let all of us patients who legitimately need for it have it restricted or prohibited, because some idiot pop idol misuses it.

    Thanks for your consideration,


    July 28, 2009 at 07:02 | Report abuse | Reply
  42. T Bailey

    I do not think blaming Dr's is a fair way to go. He wanted the drug's and got them however he could. That is what addicts do. He was warned and still took the drugs. If this is what killed him he only has himself to blame. I am suprised it did not happen sooner. 50 is a good age for an addict to reach.

    I speak from experience having a brother who s an addict. They lie, cheat and betray whoever necessary to get what they want. Just because he was famous it does not make him any different.

    Leave the Dr's alone, if he had not got it from one he would have got it from another .

    July 28, 2009 at 10:32 | Report abuse | Reply
  43. Glenda

    yes but that will not work. Money talks , bull sh____ walks. If you got enough money a doctor will give you anything. Right now if I went to any dr. and told them, I just got laid off, don't know what I am going to do, I can't sleep, I don't eat, I, I , I , guarantee, I would get wrote all kind of prescriptions and never tested the first time. That is why right now my daughter had an addiction problem. I tried doing something about , got no where, but now my daughter had a brain aneursym, and can not walk, has no short term memory and alot of other problems, was in hospital not expected to live almost a year, but that dr. still is prescribing anything and everything. And about got my other daughter in about as bad a problem. You got ins. they take advantage of you , you got money same thing. Any dr. will do this. I don't know a good dr. here lately, that is one of the reason I want the health care plan to go thru.

    July 28, 2009 at 12:47 | Report abuse | Reply
  44. TW

    Seriously? Is this a real question? Of course there should be clear, established contol on these medications. It's honestly, quite frightening and disturbing that there are not such restrictions place on it already.

    For those that have prejudgements they are chosing to voice, I respect their right for opinion, however, I'd challenge all of you to educate yourself, take a stroll back through his life, and especially within the last 15-20 years, all that's ever been reported about him is the scandal and controversary, all sensationalized by the demented media at all cost. While I recognize that Jackson himself certainly had a hand in taking the medications, he too, was empowered by a ring of doctors that had a medical, ethical obligation to treat him, care for him, and they chose to bandaid his pain, rather than providing him with the help he sought all these years. Those are the people that failed him in the end.
    It is even more distressing to dig back through the past many years, reliving those times in his life that went unnoticed, unrecognized, as he spent most of his life, starving for the simple things that all of us take for granted on a daily basis. The "adults" and "grown ups" (and peers) let him down, time and again. His kindness was used against him, and often seen as a weakness. The numbers of people that betrayed him, after he opened his home and his heart to them is truly appauling. There's only so much one person can take. With that it's no surprise that he remained loyal and devoted to animals and children. Not out of any distorted lifestyle, or other questionable motives, but rather because animals and children share many traits in common. They are loyal, innocent and untainted, and most importantly, they love completely, without condition. Shame on all of you that have participated in his destruction.
    Today, though we all are still grieving, and trying to come to terms with the magnitude and gravity of this loss, something has to change! Who is to be held accountable?
    For the countless medical personnel that treated Jackson through the years, how were these medications so easily available to them. Aren't doctors held to a "Code of Ethics?" Was that disgarded by the excitement of being so close to a superstar, that danger was completely overlooked in place of the dollar signs that flashed in front of them? Certainly he wouldn't have chosen to be put to sleep, knowing he would never wake up. What was Murray doing with such controlled medication anyway? Why was he suspended from his local hospital? Where was he in the hours that lead up to Michael's cardiac arrest? It's well reported, on a wide-scale, many times, throughout the nation, suggesting the dangers of administering a drug that is so powerful, and is only indicated for use in a controlled environment. Did Murray take him down the night of June 24, and simply walk away?
    This is a growing epidemic, and now even more commonly, an occurance within everyday society. Doctors write meds all the time, based on an initial visit where the patient complains of pain, and when they return to the office, the script is refilled, without treating the real problem, which is become the reliance on medicating just to make it through the day. If the script is denied, there the easy solution of going to another doctor that WILL fill the order.
    People today, are led to believe that because the narcotics are "prescribed" they are safe. Well, sadly, it's the complete opposite, and now it's gotten to the point that kids are seeking those scripted meds from their parents, and purchasing OTC meds, which all have become the new "drugs of choice", their easier to "score" and typically cheaper and more readily available with the traditional hard drugs like pot, cocaine, heroin and those toxins.
    After witnessing the horrific tradegy of Michael's death, and looking at both Heath Ledger, Anna Nicole and her son's death, clearly we have a problem.
    What are we going to do about it already! The DEA and FDA have the responsibility to the greater community to enforce restrictions on the distribution of these meds, and huge fines, penalties and other sanctions must be established to end this, out of control crisis!
    Doctors must be held accountable, for the preservation of so many people dealing with this same battle today. No more meds! Treat the person, there mind, and soul!

    July 28, 2009 at 13:42 | Report abuse | Reply
  45. Christianne

    First of all, who is the fool who even thought to ask the question? If I'm correct, this is an anasthetic. If an anasthetic is required, would a doctor not have a perfectly legitimate reason, say SURGERY, to admister this "medication" Oh and perhaps suggest a surgical team's presence? OK, I'm done with the sarcasm. I think that of course it should be a controlled substance. I suppose I expect that in the event that I would be in a state to request this medication, that health professionals would step up to the plate and 'DO THEIR JOB' ....(oops there's that sarcasm again).
    The addict cannot be held responsible for his or her actions, thought process or feelings when under the influence. We as a society must, and I say must open our eyes, ears and hearts. We are all aware of substance abuse, be it in our homes, our front walkways, our school yards, our parks. We all KNOW a substance abuser. Be he/she our parent, our sibling, our child, our neighbour, our teacher, our co-worker, our pastor, our doctor, our mayor. So what do we do, blame Dr.( I can't remember his name now, I'm so pissed, ) for giving Micheal Jackson what he asked for, or do we blame Michael for asking. In a sence, are we not all responsible, if we aren't doing anything about it individually? Awareness, equals accountability. Morality equals accountability. Don't be mad at the addict, the addict was born a child of God. Be mad at the monster (physical, emotional, psychological pain) he/she is being controlled by...the addict is. The addict needs to protect the monster, so yes, will lie, cheat and steal, to and from the ones they love the most, in order to protect them from that pain. The addict wants to fight that demon, but can't do it alone. Why not tell the addict you hate the monster and will fight it too, with the help of professionals. And believe me, the professionals around the world will become much more successul with your help. Yes, I suppose the doctor is responsible for prescribing, but we are also responsible for administering.
    So in conclusion, (and I apologize for rambling) yes, I believe Diprivan should be a controlled substance, and monitored by a medical team. But if we are AWARE that this drug or any other substance is being abused by someone we love, like or know, I believe that with love and kindness, we are ACCOUNTABLE to intervene. We are accountable to make others accountable too.

    July 28, 2009 at 14:00 | Report abuse | Reply
  46. sandy

    we all very well know, this drug is for hospital use only, was this doctor an out in out nut?, treating an addict on top of it?, comeon now, get to basic facts, and bring justice where justice is deserved, lock that nut up, and any others who enabled michael jackson, and maybe, the rest of the country will catch on, this happens every day in america, any enabler, should be brought too justice., we need to stop this epidemic in america, and where is our president on this one?, he gets involved in everything else, why is he not trying to stop the drugs in america?, why?, because it circulates money into the economy?,..what else can i think!

    July 28, 2009 at 14:50 | Report abuse | Reply
  47. jamie

    I think this is going to far, Its not the doctors fault that Michael Jackson killed himself. Think about it.....The doctor, I'm sure gave Michael advise that Michael didn't take.(like most of us do)
    It is Michael Jackson's fault that he couldn't control his own issues.
    That's what happens when you think you own the world with all your riches. Just hope he had faith in Jesus Christ.

    July 28, 2009 at 15:37 | Report abuse | Reply
  48. anon CRNA

    As one who provides anesthesia with propofol on a daily basis, I feel impelled to provide my opinion. Propofol is a VERY SAFE drug in the hands of anesthesia providers. Due to the pharmacologic properties that make it an outstanding anesthetic, it is a VERY DANGEROUS drug in the hands of those outside of the anesthesia and ICU areas. What was a nonboard certified cardiologist, who has a history of hospital suspension doing with this drug? It can cause apnea (no breathing) if give in certain doses (dosages that provide general anesthesia). If the provider cannot support an airway and breathing, the receiver of the drug will die. Shame on the person who provided this to MJ, who was an ill, addicted individual. The provider was a money hungry individual who wanted to be associated with a famous person.

    July 28, 2009 at 16:57 | Report abuse | Reply
  49. charmichael

    There's already too much "control" when it comes to psychotropic medications, so much so that often people who really need them can't get them because they're looked at as junkies when they show up at pharmacies with their prescriptions.

    The government, the FDA, no one can't take the place of a person's own judgment. Where there's free will, there's crime.

    There will always be people who abuse street and/or prescription drugs, just like there will always be people willing to break any law regardless of the potential punishment.

    It is what it is.


    July 28, 2009 at 17:38 | Report abuse | Reply
  50. M. Dye

    I am an outpatient pharmacist at a large teaching hospital (22 years of experience) and worked closely with cardiologists for two years when I worked in the "blood thinner" (warfarin) clinic.

    Part I, re: My opinion on controlled status for Diprivan and Dr. Murray's responsibility as Jackson's physician.

    Drugs are assigned controlled status based on their overall hazards, potential for physical dependence, and potential for abuse/addiction (see definition of "addiction" below).

    I remember hearing a few years ago that ketamine, an anesthetic used by veterinarians, was becoming a popular street drug. I thought, "What sort of drug experience would that yield that would be pleasurable?" having worked for a vet for a summer and seen some pretty unhappy cats on ketamine. Unfortunately, people seeking a drug experience can be quite creative

    Diprivan is much more dangerous than ketamine. My drug reference, Micromedex, clearly indicates that it should be administered only by physicians experienced with the drug (i.e anesthesiologists), in a supervised environment with resuscitation equipment readily available. It is available only in intravenous form. The risk of cardiac arrest with this drug is up to 10%!

    So yes, given the overall risk of harm and the fact that apparently this drug is being obtained and used outside a hospital environment for its powerful sedative effects, it should be controlled. True, there is not much data on physical dependence, which is the third part of the criteria for CS classification, yet the potential for harm is so significant that it alone tips the balance for giving this drug CS status.

    I wonder if Dr. Murray, the most likely person to have obtained and administered the drug, fully disclosed its risks to Jackson. He probably just said, "This will help you sleep". (I am all too familiar with doctors minimizing the disclosure of drug side effects and risks to patients). Moreover, as a cardiologist, (vs. a cardiac surgeon), he clearly had little or no experience with this drug. What I wonder is how did he obtain it without setting off some alarms, even if it wasn’t controlled? It's my understanding that he had no admitting privileges at hospitals in LA, and therefore no easy access to Diprivan.

    Part II:
    Re: comments above. I take offense at labeling Michael Jackson an "addict", at least as applied to the use of Diprivan. First of all, addiction is defined as "persistent compulsive use of a substance known by the user to be harmful". I doubt Michael Jackson knew just how harmful this drug was, as above, thus, he could not be labeled an "addict".

    More importantly, I believe his personal circumstances were complicated by significant mental illness, and his pre-existing issues with painkiilers stemmed from these mental health issues.

    He never had a childhood, and was physically and psychologically abused as a child. He had difficulty with friendships and relationships, and only felt truly comfortable onstage. I also believe reports from the mental health community that speculate that he had some pronounced psychiatric problems based on some significant symptoms he demonstrated starting in the early '90's. These disorders may have included generalized anxiety disorder (he occasionally had panic attacks onstage, and may have suffered more offstage), anorexia (note he was 120 pounds at 5'11" when he was booked for his criminal trial) , and a dysphoric disorder that causes the sufferer to be chronically repulsed by his/her appearance (multiple plastic surgeries, need I say more?).

    As far as I know, Jackson received psychiatric assessment only twice–during rehab in the early '90's, and during the criminal trial, when a court appointed psychiatrist examined him. His assessment was that he had the "emotional maturity of a ten year old boy", which makes sense, since he was touring and performing from the time he was five and likely missed many significant developmental milestones growing up.

    It is important to note that people with psychiatric disorders, (especially bipolar disorder), often "self-medicate" to ease their mental distress. Sometimes they are not aware that it is their mental disorder that drives them to seek out drugs to ease their pain, on other occasions, they try to handle their mental pain through more harmful avenues in the long term rather than facing the stigma (still) of psychiatric help.

    The other tragedy is even if Jackson sought help, can you imagine the field day the tabs would have had if he had received the care he needed? Remember Marilyn Monroe and Arthur Miller being mauled by the press after she left a psychiatric hospital for treatment of an undisclosed type of breakdown? In my opinion, not much has changed regarding the stigmatization of mental illness since then. Note he received the moniker "Wacko Jacko" in the early 1990's; wouldn't that label have given him pause if he actually tried to get help?

    These type of labels ("addict", "wacko"), the stigmatization of mental illness and drug dependence, and the willingness of many physicians to avoid addressing the more complicated issues patients often have by just saying "Take this pill” instead, are the main reasons why people with mental illness either cannot or will not seek the help they need. I believe that Michael Jackson is a case study of these circumstances converging to create the perfect storm that brought him down.

    I have my own experience, too, with mental illness and self medication. On July 31, 1969, the day after his 21st birthday, my older brother took his own iife. I strongly believe from the research I have done on mood disorders, the documented history of mental illness on my father's side of the family, and the accounts of my brother's behavior from my parents and remaining siblings, that he suffered from bipolar disorder (which has an unusually high suicide rate). I was 5 years old when he died.

    Please consider giving people who are suffering from mental illness your compassion, not your derision. If Michael Jackson had not been hounded constantly for personal information and subject to snap judgments by the press and the public, maybe he could have been appropriately treated and might still be alive today.

    I hope he is at peace now...

    July 28, 2009 at 19:29 | Report abuse | Reply
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