Alert on M.D. Abuse Of Jackson Drug - WSJ.com

• AUGUST 6, 2009

Alert on M.D. Abuse Of Jackson Drug

Abuse of the sedative suspected in Michael Jackson's death is a growing problem among medical professionals, increasing pressure on the government to restrict it as a controlled substance.

Three days before the pop icon's death on June 25, the American Association of Nurse Anesthetists warned hospitals to restrict access to the potent drug propofol because some doctors and nurses are addicted to it.

Propofol, sold under the brand name Diprivan, is one of the most widely used hospital sedatives. Because it is quick-acting and rapidly leaves the system, it is convenient for routine procedures such as same-day knee and cosmetic surgery, colonoscopies and broken-bone repair.

The sedative propofol, thought to be a factor in Michael Jackson's death, can make a 10-minute nap feel like a good night's sleep. But there are signs that abuse of the drug is growing among members of the medical community, where the experience has been dubbed "dancing with the white rabbit."

The qualities that make propofol a popular sedative also make it a recreational drug for some in the medical profession. It doesn't show up in standard drug tests in the urine, and with a half-life of only five minutes, it doesn't leave the user groggy or affect behavior in a way that signals a substance-abuse problem.

The absolute number of people with a propofol problem is small, and there is little hard data tracking addictions or death. A 2007 study of 23,385 anesthesia providers published in the journal Anesthesia & Analgesia by Paul Wischmeyer, a University of Colorado anesthesiologist, found that propofol addiction increased fivefold from a decade ago, to 25 cases. The study cited seven deaths. Dr. Wischmeyer and others in the field say that they know of other cases and estimate that the total number of deaths is at least several dozen in the same time frame.

"If you try to count backward from 100 after it's injected, you don't get to 97," says Dr. Wischmeyer. He and others say the drug is safe for hospital patients as long as a medical worker monitors "airway management" and provides oxygen as needed to ensure breathing doesn't stop.

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Michael Jackson at a press conference on March 5, 2009 in London, England.

Anesthetists and users say propofol can bring a brief but captivating high as the sedation wears off. Some call the habit, "dancing with a white rabbit," referring to the drug's color and hallucinogens of the 1960s. Others call it "pronapping," because the drug induces a short rest for medical personnel between long shifts.

Most medical centers don't lock up propofol or closely monitor inventory as they would for addictive painkillers such as Oxycontin. Propofol is readily accessible in most hospital supply rooms along with Band-Aids and antibiotic ointments.

Paul Earley, medical director of Talbott Recovery Campus in Atlanta, which treats many medical professionals for substance abuse, said addictions to opiates and other drugs obscured the growing use of propofol, which only recently has come to be seen as an addiction issue in itself.

"I was injecting it 50 times a day when I was in my worst period," says an anesthesiologist in the Midwest, who recently completed a stint in rehabilitation to kick the propofol habit. He said he began "pronapping" a couple of years ago while under stress from his job, family and finances. He hid the signs of shooting up by putting a port for a syringe on his leg, where it wasn't visible.

At night, he would inject the drug into the port in the bathroom, where his wife assumed he was brushing his teeth. "Sometimes it acted so fast, I couldn't get back to bed in time," said the anesthesiologist. He would pass out on the floor, terrifying his wife, and he said that on occasion he broke his nose or cheekbone or sprained a wrist.

After Mr. Jackson's death, police found both propofol and oxygen tanks in his house, according to the Associated Press. Mr. Jackson's case would be rare, however. Almost all of the victims of propofol addiction and overdose are medical professionals, particularly anesthesia providers, experts say. The drug isn't generally available outside hospitals and clinics.

Propofol is so potent that a tiny amount -- 20 milligrams -- can mean the difference between a refreshing rest and death. "It enters your bloodsteam fast, and even highly trained anesthesiologists can't control it, and die. They don't even have seconds to pull out the needle," said Art Zwerling, a certified nurse anesthetist and counselor with the Association of Nurse Anesthetists. A 39,000-member group.

Teva Pharmaceuticals Ltd., which makes generic propofol, and APP Pharmaceuticals Inc., which sells the drug under the Diprivan name, said separately that the drug is very safe when used as directed in proper settings. They declined to discuss the addiction problem.

Propofol was never classified as a controlled substance by narcotics regulators such as the Drug Enforcement Administration when it was first approved 20 years ago, nor was it recommended for that status by the Food and Drug Administration. Two years ago, a citizen petition was filed at the DEA, asking the agency to designate propofol as a controlled substance, which requires an FDA recommendation. Representatives of both agencies said they have been reviewing the matter. One official said a decision could come in the next few months.

An FDA spokeswoman said since Mr. Jackson's death, the agency has received many questions from doctors and the public about when and whether it will decide to classify propofol.

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Making propofol a controlled substance under DEA rules would require hospitals to track inventory, account for all vials, list users, and lock it up with narcotics. That is not popular with many anesthesiology providers, and a poll by Anesthesiology News taken after Mr. Jackson's death found that 61% of them oppose it.

Several say that because propofol is an important drug for use in emergencies, it must be handy. In some cases, a surgeon may suddenly need more propofol to keep a patient sedated, and a few seconds delay makes a difference. They said hospitals should take voluntary steps to control inventory, as some already do.

Another concern about tighter regulation is that it might impede doctors and nurses from seeking help for addiction, because abusing a DEA-controlled drug is more likely to cost them their license and lead to criminal charges.

Clarence Ward, a California anesthesiologist, wrote in a 2008 article titled "Dancing With a White Rabbit" in the California Society of Anesthesiologists bulletin, that too many doctors refuse to acknowledge the propofol abuse. In an interview, he said: "People die dancing with this 'white rabbit' not necessarily from intent, but from an inability to control a drug that causes abrupt loss of consciousness."

Write to Alicia Mundy at alicia.mundy@wsj.com