Published in The Health Journal
In the wake of the Los Angeles coroner’s confirmation that pop star Michael Jackson died from a lethal dose of the surgical anesthetic Diprivan (propofol), Dr. Omar Manejwala, addictions expert at The William J. Farley Center/Williamsburg Place and one of few U.S. physicians specializing in Diprivan abuse and addiction, shares some details about this potent narcotic.
Q. What is Diprivan (propofol)?
A. Propofol (sold by AstraZeneca as Diprivan) is an intravenous sedative medication that is used both for medical procedures (such as surgeries or colonoscopies) and for non-procedural sedation (for example, calming a patient who is extremely agitated when admitted to a hospital’s intensive care unit, or ICU).
Often described as “milk of amnesia” or “milk of the ICU,” propofol has been around since the 1980s. Many practitioners prefer to use it because of its rapid onset; they also find it easy to carefully titrate doses and find that patients recover quickly from the medication’s sedative effect. Propofol has a history of being safe and effective when used appropriately.
Q. What is Diprivan abuse/addiction?
A. When Diprivan was first being used in hospitals, practitioners generally did not think people would be able to abuse it. In fact, it isn’t really controlled or regulated like other powerful intravenous (IV) narcotics such as fentanyl and sufentanil. That’s not to say that anyone can access the drug, but the strict monitoring seen with most IV narcotics is not generally applied to Diprivan.
Often when I discuss Diprivan abuse with colleagues, their first reaction is usually, “Are you kidding me?”
—Dr. Omar Manejwala
Research confirms, however, that people can abuse Diprivan, and people can develop an addiction to it. Animal research shows that Diprivan increases brain concentrations of the neurotransmitter dopamine in the nucleus accumbens (a cluster of neurons and a key player in the brain’s reward circuit)—a finding present in all other addictions.
Q. How does Diprivan produce a “high” if it lasts such a short time and causes amnesia?
A. Often when I discuss Diprivan abuse with colleagues, their first reaction is usually, “Are you kidding me…Diprivan? Why would anyone want to do that?” With addiction, people more frequently are trying to avoid a feeling than to achieve one. Many addicts describe their own compulsive use as “just trying to feel normal.” Patients using Diprivan often describe a short-lived sense of relief that is so rewarding that, when it wears off, they try again and again to re-achieve that state.
Q. Who tends to abuse/develop an addiction to Diprivan?
A.Diprivan abuse is extremely rare. In my clinical experience, most individuals who abuse Diprivan are health care practitioners—often anesthesiologists, nurse anesthetists and operating room technicians. Most commonly, they use it initially to treat persistent insomnia that other medications don’t ease. The insomnia can be due to any number of causes including depression, post-traumatic stress disorder (PTSD), alcoholism or addiction to other agents, or just primary insomnia. Some of our patients were health care practitioners who developed the brain disease of addiction to alcohol or to opiate medications, and then developed addiction-induced insomnia. Patients I’ve treated who have a history of Diprivan abuse often self-administered the medication dozens of times in a single day. And most, not all, with Diprivan addiction (usage beyond recreational abuse) had a history of significant trauma, usually (but not always) sexual trauma or molestation.
Some have suggested that if Diprivan was controlled or regulated more strictly, there would be less of a problem with abuse and addiction. But even the most strictly regulated intoxicants are abused. One thing is absolutely clear: regulation alone will not solve the problem. Education and raising awareness to promote prevention, and advocacy and treatment for those who abuse Diprivan or develop an addiction, must be the mainstays of eliminating these disorders.
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