Addiction to Propofol: A Study of 22 Treatment Cases

Objective: To review and report the history and clinical presentation of a cohort of health care professionals (HCPs) who have abused the drug propofol. Methods: The authors queried a clinical database (the HCP Database) that contained information about HCPs treated at a large addiction center between 1990 and 2010. Patients who reported propofol use were removed from the HCP Database and placed in a second database referred to herein as the Propofol Database. The medical records of each of the cases in the Propofol Database were pulled and carefully reviewed; a clinical case history of each case was prepared. The Propofol Database was expanded by this chart review, adding demographics, drugs used, course of substance use, other clinical history, presenting signs, diagnoses, and comorbid conditions. At this point, the case histories and databases and were anonymized. When variables were present in both data sets, significance was tested between the HCP Database and the Propofol Database. When comparable data were not present in the HCP Database, the authors reported simple percentages within the Propofol Database. This study focused on gender, medical education and specialty, drugs used, course of illness, and comorbid conditions. Results: Compared with the composite treatment population of HCPs during the same time, records showed that the propofol group was more likely to work in the operating theater, be female, and have training as an anesthesiologist or certified registered nurse anesthetist. Presentation into treatment from the propofol cohort more commonly occurred soon after beginning propofol use, often presenting in a dramatic fashion such as motor vehicle accidents or other physical injuries. When such injuries occurred, it was a direct result of acute propofol intoxication. The number of cases arriving in treatment increased over the duration of the study. The propofol group frequently suffered with a depressive illness and had a history of earlier life trauma. They had a high frequency of biological relatives with substance dependence. The most common subjective response as to why they began using propofol was to induce sleep. Most of these patients identified propofol as one of their preferred drugs of abuse. Conclusions: This study suggests the incidence and/or detection rate of propofol abuse in HCPs is increasing. Women and anesthesia personnel were overrepresented in the propofol cohort. Propofol-dependent patients commonly have a history of depression and earlier life trauma. A rapid downhill course and physical injury are common adverse effects of propofol abuse. The time from initial use to treatment entry is often contracted when compared with other drugs of abuse making the diagnosis of a true dependence disorder and disposition after treatment more difficult.