High-Risk Drug Is in Spotlight in Wake of High-Profile Death

By PAM BELLUCK As an anesthesiologist in a Nebraska hospital, he administered it to patients daily — propofol, a drug used to sedate millions of patients before surgery.

Then one day he heard his colleagues discussing a medical article about propofol abuse.

“I thought, How the heck can you abuse propofol?” said the doctor, who asked not to be identified. “Then, in the back of my mind, I thought, I wonder what that feels like?” Soon, the doctor was injecting himself at home to sleep, then to feel its mild euphoria, then because he could not stop. He would take home leftovers from his patients’ surgical procedures — easy to do because propofol is not a controlled substance.

Propofol is a high-risk drug that Michael Jackson was given before he died, according to sources close to his family, who also said the singer’s body showed signs of longtime drug use. The toxicology report concerning Mr. Jackson’s death has been delayed as investigations expand.

While Mr. Jackson’s apparent method of using the drug was unusual — with a private doctor in his home — researchers and addiction experts say propofol abuse is growing, particularly among those with medical access like the Nebraska doctor.

One afternoon, he recalled, his 9-year-old daughter came to wake him, saw an intravenous port in his leg and said, “Please tell me that isn’t an IV.” Last fall, after 15 injections in one night, the 38-year-old anesthesiologist dozed off while driving and hit a light pole, smashing his face on the windshield.

Some experts say propofol abuse is spreading because unlike many prescription drugs, it is not a federally controlled substance. A 2007 survey of the country’s 126 anesthesiology resident training programs found that 71 percent did not secure it in a pharmacy or track its dispensing.

Two years ago, a petition urged the Drug Enforcement Administration to restrict it as a controlled substance. A spokesman for the agency said it was still evaluating whether potential abuse outweighs the benefits of easy accessibility for doctors.

Propofol’s benefits have made it one of the most widely used anesthetics. It wears off quickly, leaves no grogginess or nausea and is not believed to be physically addictive. A white liquid doctors refer to as “milk of amnesia,” the drug is liked by abusers because it induces relaxation or sleep, can cause mild euphoria, sexual fantasies or sexual disinhibition upon waking and leaves the bloodstream so quickly it is difficult to detect.

But propofol can be extremely dangerous if not constantly monitored as it is in hospitals because it can slow breathing or lower blood pressure to the point of death. Its effects become compounded by other drugs in a person’s system. Abusers who inject it often pass out instantly, sometimes getting injured; the Nebraska doctor said he fell once and “cut my chin open.” He also started “talking gibberish” and “didn’t remember doing certain things.”

At Talbott Recovery Campus in Atlanta, an addiction treatment program, medical professionals who listed propofol among the drugs they were taking grew to 27 in 2008 from 8 in 2006, or 8 percent of those in the program, said Dr. Paul H. Earley, Talbott’s medical director.

“I think the number of deaths is well above what’s been reported,” said Dr. Robert R. Kirby, an emeritus professor of anesthesiology at the University of Florida College of Medicine, and a co-author of a recent journal article on propofol abuse.

The 2007 survey found 18 percent of the training programs reported cases of propofol abuse among employees or trainees, including seven deaths. While the numbers were small compared with other prescription drugs, the results were significantly higher than 10 years earlier.

Using propofol as a home sleep aid — as it might have been administered to Mr. Jackson — would be “kind of like me using chemotherapy so I don’t have to shave my head,” said Dr. John F. Dombrowski, director of the Washington Pain Center and a board member of the American Society of Anesthesiologists.. “You’d never do that.”

AstraZeneca, which makes branded propofol called Diprivan, says on its packaging that self-administration has rarely resulted in death and suggests restricted access.

Some cases of nonmedical abuse have been recorded, including one man who reportedly bought propofol on eBay. And the Nebraska doctor saw people dripping it from an IV a decade ago at a rave party. Others use a syringe for quick bursts of relaxation or instant naps between long, stressful hospital shifts.

“Someone can go to a bathroom, inject a small amount and recover five minutes later,” Dr. Kirby said. One doctor-in-training at an East Coast hospital injected himself up to 100 times a day to relieve “his stress, his loneliness, boredom,” said Dr. Paul E. Wischmeyer, a professor of anesthesiology at the University of Colorado, Denver, School of Medicine, who conducted the 2007 survey.

When he could not find it on hospital carts, he would reach into boxes of needles discarded during surgery with “remaining propofol in it and stick himself with those,” Dr. Wischmeyer said, adding that the man risked contamination with patients’ infections.

Dr. Earley said people drawn to propofol seem to have histories of “physical or sexual trauma,” which, he said, “makes sense because the drug really produces this dissociative state — you’re disconnected from yourself.” Dr. Omar S. Manejwala, associate medical director of the Farley Center, an addiction treatment program in Virginia where propofol cases are increasing, said addiction is possible and “more complex to treat because there are other co-occurring conditions like post-traumatic stress disorder.”

Even in hospitals with controls, abuse can occur. Last year, a nurse in Gainesville, Fla., was convicted of killing a 24-year-old college student in 2005 with propofol injections.

Introduced about 20 years ago, propofol quickly “revolutionized” medicine, Dr. Dombrowski said, replacing sodium pentathol, whose side effects included nausea. Propofol is used for colonoscopies, surgery on hips and broken bones and plastic surgery, where Mr. Jackson might have been given it.

Dr. Ken Elmassian, an anesthesiologists’ society board member and a physician at Ingham Regional Medical Center in Lansing, Mich., said patients had begun paying attention to the anesthetic they were getting, saying, “ ‘Oh, you mean the drug that Michael Jackson got?’ ”

Ultimately, without proper training, it is virtually impossible to gauge the right amount to use.

“You can be a little floaty and high, followed by being asleep, followed by stopping breathing, and the window between those stages is a very small quantity of the drug, and it’s not predictable,” Dr. Earley said. “Using it by yourself is Russian roulette.”

After his car crash, the Nebraska anesthesiologist, a father of four, spent 90 days at the Talbott addiction center and was disciplined by his state medical board. He was allowed to return to administering propofol in the operating room two months ago. He is monitored by counselors and takes daily drug tests, although propofol, experts point out, leaves the system too quickly for detection.

“I have these big thoughts that pop up — ‘Oh, that would feel relaxing’ — but never a craving like I want to go home and use that,” he said.

Still, he sees its use among other doctors. Just a week after returning from rehab, he attended the funeral of a colleague “I never would have dreamed was using it,” the doctor said. “He had overdosed on propofol.”

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