Propofol Addiction

Propofol Addiction

Propofol Addiction

Propofol AddictionThe death of superstar Michael Jackson, like his strange life, captivated his public. According to his doctor, the singer’s bizarre last words were, “Please give me my milk. I need my milk to sleep. It is the only thing that will work.”

As it turned out, Jackson was pleading for an injection of a general anesthesia called Propofol, nicknamed “milk of amnesia.” Propofol does look like milk, except shinier and oilier, and apparently, Jackson was using it to get to sleep. Since he traveled in the 1990s with an anesthesiologist on his staff, celebrity watchers speculated that the superstar may have been addicted to Propofol for some time. But how could it be possible to be addicted to a general anesthesia used for surgeries?

Michael Jackson died on July 25, 2009. Two years later his doctor, Dr. Conrad Murray, was convicted of involuntary manslaughter for administering Propofol to his famous patient. Ever since these events propelled Propofol into public awareness, more people than ever are experimenting with it, even as scientists and the U.S. government are still trying to determine if it is truly an addictive substance.

What Is Propofol?

Propofol is a general anesthesia used to put people into semi-comas during surgeries. It is quick-acting in that it can render a person unconscious within 40 seconds, but the person will wake up within four or five minutes unless the drug is continued intravenously. Propofol probably works on the GABA receptors in the brain, but no one is exactly sure how or why. It is not a sleeping pill or painkiller, and not classified by the U.S. government as a controlled substance.

When it was first introduced in 1977 by Imperial Chemicals, it was hard to manufacture until chemists figured out how to stabilize it using egg emulsifiers and to keep it from bacterial contamination due to its high fat content. It is now being made by Teva, Hospira, and AstraZeneca, but it is currently in short supply because of issues of tainted vials. Teva will stop making Propofol in 2012, after paying out more than $250 million in lawsuit settlements that claimed people developed hepatitis from contaminated Propofol.

Propofol is known by the trade-name “Diprivan,” which comes from the phrase di-isopropyl intravenous anesthetic. It comes as a milky white solution that reflects light because of its high fat content. The solution contains 1% Propofol, 10% soybean oil, 1.2% purified egg emulsifier, and 2.25% glycerol. The chemical name is 2,6‑di-isopropylphenol.

By 1990 or so, Propofol had replaced nearly all other anesthesia, particularly sodium pentothal, for surgical procedures because it is faster-acting, wears off more quickly, and is less likely to cause vomiting or grogginess. It is now used in 50 countries and in over 75% of all surgeries.

How Is Propofol Used Medically?

Propofol is used only as an anesthesia during surgeries. Its other legal use is for lethal injections during criminal executions.

What Are The Side Effects And Drug Interactions With Propofol?

Most people only experience minor side effects from Propofol, but a few have allergic reactions that might include difficulty in breathing or slowed breathing, fast or irregular heart rate, low blood pressure, fainting, numbness or tingling in feet or skin, muscle spasm, cough, itching, swollen face, hives, tightness in chest, wheezing, pain, and seizures. “Propofol Infusion Syndrome” can occur rarely and cause death, and its symptoms are breakdown of heart muscle, kidney failure, and ceased breathing. It should not be used on people who have irregular heartbeat, blood vessel diseases, heart disease, high cholesterol, seizures, pancreatitis, head injuries, or who are pregnant.

Propofol reacts with 226 drugs, including alcohol, barbiturates, St. John’s Wort, sleeping medicines, cold and weight loss medications, medications for mental illnesses, and pain killers.

Why Do People Abuse Propofol?

Propofol injected in therapeutic amounts causes people to become unconscious and then wake up in a euphoric state. What little research has been done about Propofol addiction indicates that it has a “huge correlation” with a history of trauma, as Dr. Omar Manejwala, an addiction specialist in Virginia, has said.

“I don’t know of any other drug where the incidence of trauma, particularly sexual trauma, is so high,” he noted. Propofol abusers are not seeking a drug high, but instead they want to “block out the entire world” by falling asleep. According to professionals who have treated Propofol addicts, many of them inject it 50 to 100 times a day to achieve those brief vacations from reality. Just like post-operative patients, they wake up elated, talkative, and euphoric.Most begin their addiction because of insomnia, which is often related to a history of trauma or post-traumatic stress syndrome or prescription drug abuse.

People who inject tiny amounts of Propofol will feel something similar to the effect of alcohol: giddiness, loss of sexual inhibitions, and feeling spacey, mellow, and happy.

According to Dr. Beverly Phillip, a professor of anesthesia at Harvard University, “When Propofol first came out, it was very obvious it causes euphoria. It is not dissimilar to alcohol – people get giddy and it reduces inhibitions.”

The Drug Enforcement Agency estimates that 96% of Propofol abusers and addicts are healthcare professionals. Because Propofol is not on the list of the U.S. government’s regulated drugs, it is easy to steal because it is usually stored along with band-aids and other mundane supplies in hospitals. It is the only drug used in anesthesiology that is readily available to doctors and nurses, who can “divert” a vial meant for a patient for their own use by taking it or recording it as broken or tainted. It is also popular because it does not show up on urine tests or make you groggy, and its effects only last a few minutes.

There is some evidence that the number of people abusing Propofol is increasing. In a study of 126 training programs in anesthesiology, 18% of the administrators reported that they were aware of Propofol abuse among residents. A 2007 study of 23,385 anesthesiologists found 25 cases of Propofol addiction, but this rate is increasing. One survey found that 8% of healthcare professionals in rehabilitation for drug abuse were using Propofol. A spokesperson for the largest treatment center for healthcare professionals said that the number of patients in treatment for Propofol doubled between 2007 and 2008.

The reason Propofol concerns people in the field of addiction is that they have seen other drugs abused first within the medical community that gradually spread into the general population. For example, in the 1970s Ketamine was an anesthesia used almost exclusively by doctors, nurses and anesthesiologists to cause mild euphoria, dissociative reactions and other altered consciousness. Today Ketamine is known as “Special K” and widely abused as a club drug along with Ecstasy.

Recreational use of Propofol is sometimes called “dancing with the white rabbit” or “pronapping.”

Dangers Of Abusing Propofol

Propofol is an injected drug that should only be used in controlled settings where emergency equipment and trained professional help are available. The reason is that just a little too much can cause death — just four teaspoons or about one-half an ounce over recommended levels can be fatal. Michael Jackson’s doctor was sentenced to four years in prison partly because he used Propofol in a home setting and did not stay in the room to monitor Mr. Jackson’s reactions.

Unlike most other drugs, there is no antidote for Propofol which means if you overdose, there is no medicine to bring you back. One study of healthcare professionals who were abusing Propofol found they had a 33% death rate.

Another danger of Propofol abuse is that the drug works so quickly that people injure themselves in falls or by collapsing into their desks and so forth.

The damage that long-term use of Propofol may cause to the human body has not been determined.

Signs That You Are Addicted To Propofol

This questionnaire is based partly on a screening tool devised by addiction experts at Vanderbilt University. If you are using Propofol for non-medical reasons and answer yes to more than one of these questions, you may want to talk to your family doctor for advice about your drug problems.

  • Did you start using Propofol to get to sleep?
  • Are you using other drugs along with Propofol?
  • Do you have a history of severe childhood trauma, such as sexual or physical abuse by a parent, sibling or caretaker?
  • Do you like the idea that you can go into oblivion any time you want by using Propofol?
  • Have you tried unsuccessfully to quit using Propofol?
  • Have you injured yourself physically after using Propofol?
  • Do you feel that your use of all drugs, including Propofol, is beyond your control?
  • Do you get headaches or other withdrawal symptoms when you try to quit using Propofol?
  • Do you feel that your drug use is taking up too much time and interfering with your career or relationships?
  • Do you use Propofol more than once a day?
  • Do family members or friends complain about your drug use to you?
  • Are you worried about being fired or caught by authorities over your use of drugs?
  • Are you involved in illegal activity in order to obtain Propofol?

Withdrawal From Propofol Addiction

Whether Propofol is actually addictive has yet to be proven. Professor Ming Xiong of the University of Medicine of New Jersey conducted studies on laboratory animals exposed to Propofol, nicotine, alcohol or a salt solutions twice a day for a week, and found that Propofol produced changes in brain areas similar to those of the two addictive substances. Dr. Xiong concluded that “Propofol may induce addiction through dopamine D1 receptors/Delta FosB pathways.” Previous studies found that laboratory animals seek out Propofol, which indicates it is addictive.

According to the Drug Enforcement Agency, withdrawal symptoms for Propofol may include tremors, irregular or fast heartbeat, confusion, hallucinations, fever and agitation. The person can remain in a delusional state for up to seven days.

According to anecdotal evidence from addiction specialists, people in treatment for Propofol addictions may experience a withdrawal syndrome that is similar to benzodiazepine withdrawal, with symptoms that include hallucinations, food cravings, anxiety, sleep disturbances, sweating, tremors, and stomach cramps. Benzodiazepines depress the central nervous system and are prescribed for anxiety and sleep disorders, and withdrawal from benzodiazepines can be more difficult than withdrawal from heroin.

Treatment For Propofol Addiction

The vast majority of Propofol abusers are healthcare professionals, and entering into treatment programs is often extremely difficult for them. Dr. Paul Farnan, a Canadian doctor who monitors healthcare professionals with substance abuse disorders, said that it is hard for those in “pedestal professions” who command public trust to enter treatment.

“We’re the pedestal people,” he said. “We’re supposed to be bullet-proof.”

If a Propofol abuser finds the courage to enter rehabilitation, treatment will be similar for other drug addictions. The person will first go through detoxification, the process of chemical withdrawal from Propofol, and then undergo a program of counseling, education, and recreation to learn about why he became addicted and how to remain substance-free. The treatment program may include classes on drug addiction, nutrition, and relaxation techniques, as well as various therapies such as art, drama, and music. Counseling may be individual, group, family, couples, or a combination of these. If the person has a psychiatric issue separate from Propofol addiction such as a history of childhood trauma, depression or an anxiety disorder, this would be treated in a separate protocol.

Future Of Propofol

In December 2010, the Drug Enforcement Agency announced that it may classify Propofol as a Schedule IV Controlled Substance, after some authorities requested it be classified as a Schedule III Controlled Substance. Adding Propofol to the list of controlled substances would mean that doctors and veterinarians would have to register its use, keep closer records, and dispose of it under DEA rules. Reaction was immediate. Some people, such as Dr. Greg Takashima, president of the American Animal Hospital Association, thought the new classification may curtail a useful drug that would have to be “put under lock and key.” but others came out in favor of making the drug a controlled substance. The DEA has yet to make its decision on the status of Propofol.

The American Association of Nurse Anesthetists was among the first to call for the scheduling of Propofol. They called for restricting access to the drug on July 21, 2009 –ironically just three days before Michael Jackson’s death.

Sources:

“Michael Jackson’s Last Words Were For Milk,” The Telegraph, November 9, 2011.

Medina, Jennifer. “Jackson’s Doctor Sentenced,” The New York Times, November 29, 2011.

“Propofol,” Drugs.com, see http://www.drugs.com/propofol.html

“Propofol, Molecule of the Week,” the American Chemist Society, October 2011, see http://portal.acs.org/portal/acs/corg/content?_nfpb=true&_pageLabel=PP_ARTICLEMAIN&node_id=841&content_id=CNBP_028422&use_sec=true&sec_url_var=region1&__uuid=1a97d931-4bf0-411c-9f68-5cde7c14112f

Feeley, Jef. “Teva said to pay $250 to end Nevada Propofol Lawsuits,” Business Week, February 22, 2012.

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Gottlieb, Jeff. “Common Anesthetic Propofol in Spotlight,” The Chicago Tribune, July 21, 2009.

“Missouri To Use Jacko Drug Propofol For Executions,” The New York Post, May 24, 2012.

“Propofol Side Effects,” Drugs.com, see http://www.drugs.com/sfx/propofol-side-effects.html

“Propofol,”  Office of Diversion Control, U.S. Department of Justice, see http://www.deadiversion.usdoj.gov/drugs_concern/propofol.htm

“Propofol,” Drugs.com, see http://www.drugs.com/propofol.html

Ibid.

Pilkington, Ed. “Abuse Of Drug Used By Michael Jackson Growing Among Medical Professionals,” The UK Guardian, July 31, 2009.

“Propofol,”  Office of Diversion Control, U.S. Department of Justice, see http://www.deadiversion.usdoj.gov/drugs_concern/propofol.htm

Posner, Gerald.  “America’s New Drug Addiction: The anesthetic Propofol, suspected in Michael Jackson’s death, has experienced a surge in abusers.”  The Daily Beast, August 6, 2009.

Kaufman, Gil. “What Is Propofol And Why Was Michael Jackson Allegedly Using It?” MTV, July 1, 2009.

Posner, Gerald.  “America’s New Drug Addiction: The anesthetic Propofol, suspected in Michael Jackson’s death, has experienced a surge in abusers.”  The Daily Beast, August 6, 2009.

Harmon, Katherine. “What Is Propofol–and How Could It Have Killed Michael Jackson?” Scientific Americans, October 3, 2011.

“Proposal to schedule Propofol Draws Reactions,” The Journal of the American Veterinary Medical Association, March 16, 2011.

Campion, Michelle. “Molecular Basis of Propofol Addiction Identified – Drug Triggers Brain Activity Similar to Effects of Alcohol, Nicotine,” Pharmacology  Issue: May 2009, Volume: 35:5

Mundy, Alicia. “Alert on M.D. Abuse of Propofol,” The Wall Street Journal, August 6, 2009.

Wischmeyer, Paul et al. “A Survey of Propofol Abuse in Academic Anesthesia Programs Anesthesia and Analgesia,  October 2007 105:1066-1071.

Mundy, Alicia. “Alert on M.D. Abuse of Propofol,” The Wall Street Journal, August 6, 2009.

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Weil, Dr. Andrew. From Chocolate to Morphine. New York: Howard Mifflin, 1998, pg. 139-140.

“Ketamine: Fast Facts,” The United States Department of Justice, posted at http://www.justice.gov/ndic/pubs4/4769/index.htm

Mundy, Alicia. “Alert on M.D. Abuse of Propofol,” The Wall Street Journal, August 6, 2009.

Ibid.

Posner, Gerald.  “America’s New Drug Addiction: The anesthetic Propofol, suspected in Michael Jackson’s death, has experienced a surge in abusers.”  The Daily Beast, August 6, 2009.

Medina, Jennifer. “Jackson’s Doctor Sentenced,” The New York Times, November 29, 2011.

Kaufman, Gil. “What Is Propofol And Why Was Michael Jackson Allegedly Using It?” MTV, July 1, 2009.

Wischmeyer, Paul et al. “A Survey of Propofol Abuse in Academic Anesthesia Programs Anesthesia and Analgesia,  October 2007 105:1066-1071.

Herzog, Norbert and David Niesel. The case against Propofol.” The Galveston Daily News, May 8, 2012

Campion, Michelle. “Molecular Basis of Propofol Addiction Identified – Drug Triggers Brain Activity Similar to Effects of Alcohol, Nicotine,” Pharmacology  Issue: May 2009, Volume: 35:5

“Propofol, Proposed Rules Change, 2010,” Office of Diversion Control, U.S. Department of Justice, see http://www.deadiversion.usdoj.gov/fed_regs/rules/2010/fr1027.htm

“Propofol, Proposed Rules Change, 2010,” Office of Diversion Control, U.S. Department of Justice, see http://www.deadiversion.usdoj.gov/fed_regs/rules/2010/fr1027.htm

See websites of residential addiction treatment centers.

“Addicted in OR,” The Vancouver Sun, February 10, 2012.

“Propofol, Proposed Rules Change, 2010,” Office of Diversion Control, U.S. Department of Justice, see http://www.deadiversion.usdoj.gov/fed_regs/rules/2010/fr1027.htm

“Proposal to Schedule Propofol Draws Reactions,” The Journal of the American Veterinary Medical Association, March 16, 2011.

Mundy, Alicia. “Alert on M.D. Abuse of Propofol,” The Wall Street Journal, August 6, 2009.

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