Singer’s Death Sheds Light on Dangers of Propofol/Diprivan Abuse

By Hugh C. McBride

In the aftermath of the death of pop music icon Michael Jackson, news reports were filled with discussions about a number of health-related topics, including eating disorders, mental health issues and substance abuse (especially the abuse of prescription medications). As more information about the superstar’s drug use made its way into the public forum, one relatively unknown word began to take on increasing significance: propofol.

Almost every news service that covered Jackson’s death and the ensuing inquiries into his last days noted that officials were looking closely at the singer’s use of propofol, a strong sedative that is marketed under the trade name Diprivan. For example, a July 24 report by CBS News correspondent Ben Tracy said that preliminary autopsy reports indicated that Jackson’s death pointed to his use of propofol, a medication that Tracy referred to as “a powerful drug Jackson never should have had access to.”

Though many people continue to speculate wildly about the nature of Michael Jackson’s life and the cause of his death, there appears to be near unanimity on at least one aspect of his story: Propofol is a highly dangerous drug that should never be used without the close supervision of a qualified physician.

What Is Propofol?

Nicknamed “milk of amnesia” due to its appearance and effects, propofol is most commonly used to sedate patients before certain invasive medical procedures.

The U.S. Food and Drug Administration (FDA) describes propofol as “an intravenous sedative-hypnotic agent for use in the induction and maintenance of anesthesia or sedation.” In more consumer-friendly terminology, the medical reference website Drugs.com offers the following description:

Propofol is a drug that reduces anxiety and tension, and promotes relaxation and sleep or loss of consciousness. Propofol provides loss of awareness for short diagnostic tests and surgical procedures, sleep at the beginning of surgery, and supplements other types of general anesthetics.

Tracy’s CBS report notes that the drug can induce unconsciousness within 30 seconds, but is very short-lasting. Individuals who take a single dose of the drug will awaken within about five minutes. In order to maintain sedation during medical procedures, propofol is often applied in a continuous, controlled manner via IV drip.

In an interview with Kate Dailey and Rebecca Shabad for a July 29 Newsweek article, Dr. David Kloth, president of the Connecticut Pain Society, said that although propofol is used to induce states of unconsciousness, the drug is highly addictive:

“It actually lights up in the addiction center in the same place that alcohol and morphine and even nicotine [do],” says Kloth. However, he adds that the benefit to addicts are few. “People abuse drugs to get high on them, [but] you don’t even enjoy the high. You wake up and say, ‘Oh, shoot I missed it.’” 

What Dangerous Side Effects Are Associated with Propofol?

According to Drugs.com, the following side effects are associated with using propofol or Diprivan:

• Breathing problems
• Swelling of the throat
• Rapid heartbeat and heart palpitations
• Lightheadedness or fainting spells
• Numbness or tingling in the hands or feet
• Convulsions or uncontrollable muscle spasms
• Rash, itching and skin redness

As dangerous as propofol can be, the medication is not on the U.S. Drug Enforcement Agency’s list of controlled substances, meaning that any licensed physician can access and use the drug.

However, in October 2005, the American Society of Anesthesiologists (ASA) encouraged members to request that the FDA retain the warning label indication that propofol should be administered only by clinicians who are “trained in the administration of general anesthesia and not involved in the conduct of the surgical/diagnostic procedure.”

According to the ASA website, the following points were of primary concern:

  • Even if the clinician administering propofol intends to produce a state of deep sedation, general anesthesia is often the result. Patients vary, with little predictability, in their reactions to propofol.
  • Physicians administering propofol must be thoroughly trained to identify and treat immediately patients who lose an airway or who experience cardiovascular difficulties, as well as in the pharmacodynamics of propofol.
  • Because of the potential for life-threatening emergencies, the physician who is administering propofol must not simultaneously be performing the endoscopy – there must be a dedicated, trained, independent clinician observing the patient continuously.

Though the ASA continues to hold this position, propofol remains available to all doctors.

Is Propofol Abuse a Common Problem?

At first glance, it would appear that a very short-lasting drug that does not produce a euphoric or hallucinogenic effect would be unlikely to be abused recreationally. However, as Thane Flora (a former nurse anesthetist who became dependent upon Diprivan) told CBS, common sense does not always factor into the decisions made by a drug-dependent individual.

“What makes sense to an active addict makes no sense to someone that’s not an active addict,” Flora said.

Supporting Flora’s observation, several sources have noted that Diprivan-dependent individuals (most of whom began using the drug in order to combat insomnia or get to sleep quickly) may inject themselves dozens of times a day in order to “benefit” from the drug.

“That’s the drive to use this drug. It’s amazing,” Paul Wischmeyer, MD, an anesthesiologist at the University of Colorado Health Sciences Center in Denver, said in the May 2007 issue of Anesthesiology News. “People who have abused propofol say it’s pretty much their first-choice drug every time.”

The article that included Dr. Wischmeyer’s quote also contained the following facts about propofol abuse:

  • One in five academic anesthesiology training programs reported at least one case of abuse by physicians or other healthcare workers over the past decade.
  • The incidence of propofol abuse has risen fivefold over the last 10 years.
  • Access to the drug is not a problem, as propofol is among the most widely used anesthetic agents in both hospitals and, increasingly, office settings.
  • A survey conducted by researchers with the Colorado Health Sciences Center in Denver found that 71 percent of programs studied had no formal system in place for monitoring propofol, as is required for opioid drugs and other controlled substances.

Getting Help

Though no demographic group is immune from the risk of propofol abuse, studies indicate that the behavior is most likely to occur among medical professionals – individuals who have easy access to the drug, and who may be enticed by its ability to offer rapid access to sleep in the midst of a hectic and stressful work environment. The Anesthesiology News article also indicated that previous exposure to trauma increases the likelihood that a person will abuse propofol.

If you or someone you know is abusing propofol or any other drug (prescription, over the counter or illicit street drug), know that help is available and recovery is possible. Because propofol abuse appears to most commonly impact members of the medical profession, an executive residential rehabilitation program may be best prepared to meet your needs or those of your loved one.

While providing exceptional medical and therapeutic care, executive rehab programs offer the utmost in security, privacy and discretion. From gourmet meals to exquisite locations to luxurious accommodations, executive rehab programs are conducted in an environment of serenity and comfort – the ideal atmosphere in which professionals can receive the world-class care that will allow them to resume their pursuit of their greatest potential.

Abusing propofol is a dangerous behavior, with death a very real possibility with each illicit use. But with effective professional intervention, dependence upon propofol can be beaten, and any underlying or co-occurring emotional issues can be identified, addressed and resolved as well.