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. Propofol is not usually considered a drug with abuse potential, yet it may be, and it may be a deadly drug to abuse.

"These data appear to be the first report of this significant and widespread problem," Paul E. Wischmeyer, MD, stated at the 2006 annual meeting of the International Anesthesia Research Society. Dr. Wischmeyer is Associate Professor of Anesthesiology, University of Colorado School of Medicine, Denver.

Poster viewers questioned the appeal of propofol as a drug of abuse. Session moderator M. Sherif Afifi, MD, admitted puzzlement as well. "But it does happen," he said. There have also been instances of death from abuse of inhalation agents, noted Dr. Afifi, who is Associate Professor of Anesthesiology and Director of Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago.

The Denver investigators sent surveys to all academic anesthesia departments in the United States. The response rate was 59% (71/120). 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. "Of those discovered abusing propofol, one-half were discovered when they were found dead from an overdose," noted Dr. Wischmeyer. Four of the nine (44%) died of propofol overdose.

The five residents confirmed to have abused propofol tended be older and were pursuing anesthesia as a second career. They also tended to be known risk takers based on previous high-risk professions, stated Dr. Wischmeyer. The three attendings tended to have a history of drug abuse with opiates or other controlled substances, and had relapsed.

The researchers also collected reports of a family practice resident, an orthopedic surgery resident and an operating room nurse who had been known to actively abuse propofol.

Perhaps because its abuse potential is unappreciated, the majority of departments (48/71, or 68%) did not secure and/or actively account for propofol. Only 25% of departments had pharmacy accounting of this agent.

These figures on propofol abuse in academic anesthesia departments do not account for those who may be abusing it without detection, noted Dr. Wischmeyer. Abuse may be more widespread, since propofol is not tested for in drug screening of anesthesia providers suspected of substance abuse.

—Elizabeth Douglas

Based on a poster (Abstract S-96) at the 2006 annual meeting of the International Anesthesia Research Society.