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