Lack of Monitoring, Treatment Raises Concerns Over Propofol Abuse

As the root cause of pop-star Michael Jackson’s death, the anesthetic propofol is now widely recognized as having abuse potential, particularly among healthcare practitioners such as surgeons, anesthesiologists, nurse anesthetists and operating room technicians. However, monitoring and treatment for propofol abuse are still missing from the majority of anesthesiology programs.

Propofol, also known as Diprivan^®, reduces anxiety and tension, promotes sleep or loss of consciousness and awareness for short diagnostic and surgical procedures and supplements other general anesthetics. Propofol’s abuse potential is relatively high, as it is not classified as a controlled substance and is readily available in hospital operating rooms, emergency rooms, doctors’ offices and emergency treatment vehicles.

In 2007, Wischmeyer, et al., surveyed 126 academic anesthesiology training programs in the United States. One or more instances of propofol abuse in the preceding 10 years were reported by 18 percent of the departments; the observed incidence of propofol abuse was 10 per 10,000 anesthesia providers per decade, a five-fold increase from previous surveys of propofol abuse. Of the reported propofol abusers, 28 percent died as a consequence of propofol abuse. Almost 86 percent of those who died were residents.

The biggest concern for healthcare practitioners is the lack of treatment for those abusing propofol. Wischmeyer reported 71 percent of the anesthesiology programs had no monitoring system for propofol.

Propofol’s time of action is very short, resulting in loss of consciousness within 40 seconds of injection. Its duration of action is also short, with a mean of three minutes to five minutes following a dose of 2 milligrams to 2.5 milligrams per kilogram of body weight. Patients injected with propofol are reported to wake up in an elated or euphoric state. Many propofol abusers have become addicted by using propofol to overcome persistent insomnia, often brought on by a history of psychological or physical trauma. Because of its short duration of action, propofol abusers may inject it as many as 50 times to 100 times in one sitting. Deaths occur among abusers due to the very narrow therapeutic window–even a small quantity of propofol over the standard dose can trigger fatal respiratory arrest.

Monitoring propofol levels in humans is very difficult due to rapid metabolism of the parent compound. However, testing urine for the propofol glucuronide metabolite is advantageous because the metabolite provides a longer detection window than its parent, propofol. Propofol is rapidly metabolized in the liver and is primarily excreted into the urine as propofol glucuronide. The window of detection of propofol glucuronide in urine is approximately five days to seven days following repeated dosing. USDTL offers a urine propofol glucuronide test that can be used as a stand-alone assay or as an addition to any of our Urine Drug Testing Panels. Contact Client Services at customer.service@usdtl.com or at (800) 235-2367 for further information.