Assessment of the Addictive Risk of Propofol

In a survey of American and German medical personnel, the injectable hypnotic propofol was identified as one of the most frequently abused anaesthetics. With the help of MEDLINE, EMBASE, Scopus, Cochrane and internet search, data were sought that permit an assessment of propofol's risk of addiction. The clinical evaluation for hypnotics can usually be made with the scale of Griffith and Johnson. Thereafter, the relative risk of addiction (dependence potential/toxicity) of propofol is rather moderate if compared to phenobarbital. Its addictive potential is somewhat lower than that of lorazepam and cannabis (non-hypnotic reference) approximately in the range of that of triazolam or zopiclon. The few published clinical case reports (n = 8) are mainly from Germany and describe distinct psychological (craving, loss of control, focusing of behaviour on the use and procurement of the substance) and low levels of physical features of addiction (withdrawal symptoms, tolerance). On average, in the case reports 4.25 of 6 criteria of dependence (ICD-10) were met. The consumption of propofol is mainly limited to medical or medical-related occupations. Propofol has yet not arrived on the local black markets. An oral consumption appears not to occur or to be unattractive. The incentive of propofol's "high" (euphoria/relaxation) via the intravenous route is probably underestimated. This is supported by a high mortality rate (46.2%) in the 78 reports on the consumption of propofol up to date. Forensic analyses consider mainly accidental respiratory arrests to be responsible for the deaths. In summary, propofol is considered to be a primary mental addictive substance that is characteristically intravenously consumed by persons within the medical profession. Because of its apparently narrow safety margin between pleasure and death, propofol is an extraordinary hazard which, unfortunately, is only reflected insufficiently in the scale of Griffith and Johnson.