Propofol abuse by health care professionals

Abuse of common anesthetic has ‘rapid downhill course’, reports Journal of Addiction Medicine.  Abuse of the anaesthesia drug propofol is a “rapidly progressive form of substance dependence” that is being more commonly seen among health care professionals, reports a study in the April Journal of Addiction Medicine.

“Propofol addiction is a virulent and debilitating form of substance dependence” with a “rapid downhill course,” write Drs Paul Earley and Torin Finver of Georgia Health Professionals Program, Inc, Atlanta. Their study identifies some emerging characteristics and consequences of propofol abuse among health care professionals.

Propofol abuse: rates and risk factors

Data from an addiction centre specializing in substance abuse problems among health care professionals identified 22 patients treated for propofol abuse from 1990 to 2010. Propofol is a drug widely used to induce anaesthesia for surgery and sedation for other procedures. It is commonly used because it has a rapid onset and quick recovery time, with fewer side effects than other anaesthetics.

The number of health care professionals treated for propofol abuse increased steadily during the period studied, although increased recognition by addiction centre staff may have played a role. The patients were thirteen physicians, eight nurses, and one dentist. Most of the physicians and all of the nurses were anaesthesia providers, who had ready access to propofol.

Patients using propofol were more likely to be women, compared to health care professionals abusing alcohol or other drugs. Most propofol abusers had depression, along with a history of childhood sexual or physical abuse. In addition, most of the propofol-abusing health care professionals reported a family history of substance abuse, and a higher than expected number had family members with schizophrenia.

The patients generally started using propofol to get to sleep. However, they quickly developed characteristics of addiction, with propofol becoming a preferred drug of abuse. Most patients came for addiction treatment within a few months after starting to use propofol. Five patients came to treatment after a single propofol binge.

Side effects of Propofol abuse ‘begin almost immediately’

“When humans abuse propofol, unintended side effects begin almost immediately,” Drs Earley and Finver write. About half of propofol abusers entered addiction treatment after dramatic events such as car crashes or other injuries. Some sustained facial injuries when they passed out immediately after injecting propofol.

Five patients were admitted into treatment when they were discovered unconscious. These characteristics reflect the “narrow window between desired effect and unconsciousness” and the rapid loss of control over propofol use, according to the authors.

“Propofol dependence is a rapidly progressive form of substance dependence seen in 1.6 percent of all health care addiction cases reporting to treatment,” Drs Earley and Finver conclude. Within the limitations of the data, the study suggests that propofol abuse by health care professionals is increasing—particularly among physician and nurse anaesthesia providers with ready access to anaesthetics.

Some characteristics of the patients studied—including their history of depression and childhood trauma and patterns of physical injury—have important implications for identification and treatment of propofol abuse by health care professionals. Drs Earley and Finver add, “Outcome studies…are needed to help solve the difficult decisions of when and if a propofol-abusing health care professional should return to their high-risk work environment.”