Propofol Abuse Growing Problem for Anesthesiologists
- 4Jul 3, '09 by Anxious PatientNo formal system is in place (in hospital) for monitoring propofol, as there is for opioid drugs and other controlled substances.
The specialty (anesthesiology) is disproportionately treated for addiction.
The majority (of abusers) appear to be women.
Anesthesiologists may be unwittingly driven to substance abuse through chronic exposure to aerosolized fentanyl and propofol exhaled by patients in the OR.
At least one case of propofol abuse or diversion—theft of the drug or its use by someone other than a patient—was reported in 20% of the nation’s 126 academic training programs in the specialty.
Of the 29 cases reported to researchers, 16 involved residents and six were attending physicians; three were nurse anesthetists, and two were OR or anesthesia technicians, with two classified as “other.”
Unlike abusers of alcohol or most other substances, propofol addicts are unable to function on the job. This is not a drug that gets you high. Most of the time, you inject it and pass out.
Nearly every propofol addict started injecting to overcome persistent insomnia.
The article cited studies suggesting that “more than 400 drug-addicted anesthesiologists and residents may be working in operating rooms at this moment".
- 8Jul 3, '09 by CrufflerJJYup - it's an abused drug. I was surprised to see that unused Propofol was just pitched in the trash when I did my role transition in a Level 1 center's SICU last year. Not controlled like narcotics.
I actually emailed my preceptor about the issue, just for her info. Here are some other articles I found on the topic:
Propofol at a Subanesthetic Dose May Have Abuse Potential in Healthy Volunteers [Some people apparently get a "buzz" from low doses of it, while others don't like the feeling & choose not to try it again.]
Anesthesia Programs Report Incidence of Propofol Abuse
Survey Finds Reports of 24 Cases of Abuse, Seven Resulting in Death
San Francisco—A recent survey found that 21 (17.5%) of the 120 academic anesthesia programs in the United States had reported at least one instance of propofol abuse within the last five years.....They received reports of 24 cases of propofol abuse from 21 departments, with seven cases resulting in death.
Nine cases of propofol abuse confirmed by the investigators involved eight anesthesiologists and one operating room technician.
Death after excessive propofol abuse. [- male nurse in Hamburg, Germany found dead after abuse of propofol]
Lethal self administration of propofol (Diprivan). A case report and review of the literature. [death of female anesthesiologist in Greece]
http://www.ncbi.nlm.nih.gov/pubmed/16431058?ordinalpos=1&itool=EntrezSystem2.PEntrez. Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.P ubmed_Discovery_RA&linkpos=2&log$=relatedarticles& logdbfrom=pubmed
- 4Jul 3, '09 by nolabarkeep"Anesthesiologists may be unwittingly driven to substance abuse through chronic exposure to aerosolized fentanyl and propofol exhaled by patients in the OR."
Why is this exclusive to anesthesiologists? Shouldn't this also affect everyone else in the OR? Also, I would assume that a large percentage of Pt's in the OR are intubated. This would lessen direct contact with exhalation. I would like to see other studies on abused drugs by anesthesiologists. I would bet that propofol is on the lower end of the abuse scale.
- 4Jul 3, '09 by oramar GuideI guess the moral of the story is that, "if you invent a new drug for medical use with the best of intentions, you can bet that someone will figure out a way to abuse it" People need to keep human nature in mind when they invent anything. Take Oxycontin for instance, they could have designed it to deactivate when chewed from day one. They knew they could do it but chose not to(perhaps they thought it would cut into their profits). After many years of problems, giant personal cost to individuals, giant social cost to society, they decide to add this feature. I am saying "they" because I can't remember the pharmaceutical companies name at the moment. I should remember, Lord knows I passed out enough of those pills.
- 3Jul 3, '09 by azhiker96I've been told that anesthesiologists have a higher rate of abuse/addiction because they have access to the best drugs. Watch one get ready for a case. They hit the pyxsis like it's half price Saturday at the Goodwill store. Propofol, versed, fentanyl, and dilaudid all get pulled and drawn up into syringes. Oh, and succs too. Not a lot of abuse of that drug.
They sit at the head of the patient, unwatched, monitoring the patient, giving meds, adjusting the gases as needed. After the case they waste unused narcs with a witness, 2cc of clear colorless fluid purported to be fentanyl.
I do want to say I highly respect the anesthesiologists at work. They maintain a delicate balance in the patient. Deep enough so a surgeon can poke around inside the patient while maintaining oxygenation and perfusion.
- 1Jul 3, '09 by azhiker96BTW, I know of one anesthesiologist who had a narcotics abuse problem. He is currently in a 2 year long program that includes random testing, may not practice anesthesiology, no etoh or poppy seed consumption, no access to IV narcotics, 90 12-step meetings in 90 days, all personal healthcare through one PCP who's approved by the board, monthy reports to the medical board, and a few other odds and ends.
- 0Jul 3, '09 by SkeletorQuote from Anxious PatientSo you can still function on the job, as this article infers, if you abuse alcohol or other substances. Nice. . .I suppose I could start bringing my flask of Everclear to workhttp://www.anesthesiologynews.com/in...rticle_id=7579 Unlike abusers of alcohol or most other substances, propofol addicts are unable to function on the job. This is not a drug that gets you high. Most of the time, you inject it and pass out.
- 0Jul 3, '09 by DolceVitaQuote from azhiker96I always wondered about the poppy seed excuse....BTW, I know of one anesthesiologist who had a narcotics abuse problem. He is currently in a 2 year long program that includes random testing, may not practice anesthesiology, no etoh or poppy seed consumption, no access to IV narcotics, 90 12-step meetings in 90 days, all personal healthcare through one PCP who's approved by the board, monthy reports to the medical board, and a few other odds and ends.