America's New Drug Addiction
The anesthetic Propofol, suspected in Michael Jackson’s death, has experienced a surge in abusers. Gerald Posner reports on a highly potent drug that’s largely unregulated.
Editor's Note: In an earlier version of this article, several quotations and passages were copied from an Anesthesiology News report without attribution. The Daily Beast has attributed the sentences and regrets the error.
Talking heads on TV universally express shock, in the aftermath of Michael Jackson's death, that anyone would abuse the powerful anesthetic Propofol outside of a hospital surgical setting. Subsequent to Jackson’s apparent overdose, only two instances have emerged of lay people addicted to Propofol. A 21-year-old American bought it on eBay and killed himself while administering it through an IV drip. A 25-year-old German became addicted through a supply he obtained from a local veterinarian clinic.
There is some evidence that Propofol is so strong that just the fumes from the patient’s mouth lead to a secondhand exposure.
But the largely untold story of Propofol addiction is that of the steadily increasing numbers of abusers among medical professionals, primarily anesthesiologists and the nurses who work with it. The Talbott Recovery Campus, in Atlanta, is the world’s largest and oldest treatment center for addicted medical professionals. In 2006, the center had 8 cases of Propofol abuse, 12 in 2007, and 27 in 2008. The numbers are small compared to problems with other prescription pills, especially with anesthesiologists who historically have one of the highest addiction rates among doctors. But the trend is moving in a worrisome direction for those who study it.
“In 2006, it was a phenomenon,” Dr. Paul Earley told Anesthesiology News in 2007. “but now it’s grown to the point where a year ago we instituted on our regular questionnaire whether there had ever been any Propofol abuse.”
Michael Jackson traveled with an anesthesiologist during his mid-1990s tour. It’s not yet known if he was then being administered the white milky substance that had been introduced in 1986. It was only in 1992 that the first human addiction case was recorded, a 31-year-old anesthesiologist who had begun injecting himself up to 100 times daily “to reduce his feelings of boredom, inner tension, and depression.” His addiction was only uncovered when he was found unconscious on the hospital’s bathroom floor one evening.
“There is a very narrow window between getting high, going unconscious, and dying, when it comes to Propofol,” Dr. Earley told Anesthesiology News. “Only a few cc's more than what's required to put a person to sleep can trigger fatal respiratory arrest. We see impaired professionals who have contusions on their face or body. That’s because they fell unconscious at a desk and hit their face, or literally fell out of a chair. And as you develop a tolerance to the drug, you need more to get high, and that brings someone close to the lethal level.”
Paul Wischmeyer, a University of Colorado anesthesiologist and one of the leading experts on Propofol addiction, became interested in the problem in when he learned that some colleagues were giving themselves minute injections of Propofol, producing a mellow, somewhat spacey high, that lasts only a few minutes. But even that high makes it impossible to function. “It’s not a subtle drug,” says Dr. Earley. "It's not like opiate narcotics, where you can be slightly inebriated on the drug and show up for work. Most of the time on propofol, you inject it and pass out.”
Three years ago, Wischmeyer began the first formal study of Propofol addiction in the medical community, “A Survey of Propofol Abuse in Academic Anesthesia Programs.” One hundred and twenty-six anesthesia departments across the U.S. participated, according to Anesthesiology News. Twenty percent admitted having encountered an addiction problem among staff. Although the numbers were small—25 abusers—Wischmeyer calculated a fivefold increase in Propofol abuse over the past decade. Nearly 40 percent of residents who abused Propofol ended up dead. Others, when confronted, left the medical field instead of staying in a line of work that put them in regular contact with such a powerful addictive substance.
There is some evidence that Propofol is so strong that just the fumes from concentrations around the patient’s mouth during a surgical procedure, where anesthesiologists spend many hours, lead to a secondhand exposure to “aerosolized Propofol,” which can create an increased risk of full-time abuse in susceptible persons. Another part of the problem, Wischmeyer told Anesthesiology News, is that despite the evidence of its strong addictive potential, Propofol remains mostly unregulated. The FDA does not consider it a controlled substance, and surprisingly, there are no laws requiring the drug to be registered or accounted for at hospitals or medical clinics. Traditional pharmacy rules do not apply to it. Wischmeyer discovered that 71 percent of the medical facilities he polled did nothing to regulate Propofol. As opposed to the more heavily regulated opiates, it’s easier for an addict to take a supply of Propofol from a medical stockroom and not to have the missing stock noticed.
Dr. Earley told Anesthesiology News that has seen firsthand evidence of the power of Propofol’s addictive ability. A family physician he treated was "so desperate for a fix that he started hunting through hospital sharps bins for discarded needles that might have a trace of the drug so he could inject himself." And among those who have sought help at the Talbott Recovery Campus, Earley has found two common threads: almost every Propofol addict started injecting to overcome insomnia, and many had endured abusive childhoods. Two factors that could well have played a role with Michael Jackson, from the abuse dished out from his father, to his own two decade problem with sleeping.
Wischmeyer and others who have studied the drug believe that Jackson’s death might be the final wake-up call for the federal government to institute some strict controls for Propofol. That is especially true since Michael Jackson’s death likely brought Propofol to the attention of a wide field of risk takers and drug abusers who might now want to experiment with the drug that probably killed the King of Pop. As Wischmeyer concluded in his study, “With the increasing availability and ease of obtaining Propofol along with its difficulty of detection, its abuse will probably continue to grow.”
“We’re just now learning how to best treat these patients,” says Dr. Earley.
Gerald Posner is The Daily Beast's chief investigative reporter. He's the award-winning author of 10 investigative nonfiction bestsellers, ranging from political assassinations, to Nazi war criminals, to 9/11, to terrorism. He lives in Miami Beach with his wife, the author Trisha Posner.