The Misuse and Abuse of Propofol

Abstract

Media attention on the misuse of propofol increased significantly when the drug was implicated in the death of pop music superstar Michael Jackson in 2010. The misuse and abuse of propofol among healthcare providers has been reported worldwide, with some misuse resulting in death. Propofol policies guiding healthcare worker re-entry into the workplace after misusing propofol have received rare attention in the research literature. The paucity of information regarding propofol-specific re-entry policies suggests that little research has addressed this problem and the lack of research and policy guidance can contribute to unsafe re-entry and even death. This paper focuses on healthcare providers because they have an easy access to propofol and therefore are vulnerable to misusing or abusing the drug. To accomplish this, the pharmacology and misuse/abuse potential of propofol and the influence of the 12-step recovery paradigm in the re-entry literature are reviewed. In conclusion, existing research and policy are drawn upon to suggest employment re-entry guidelines for healthcare workers.

RÉSUMÉ

Mots clés: dépendance au propofol; mauvaise utilisation du propofol; abus du propofol; réinsertion professionnelle après abus de propofol; règles de réinsertion liées au propofol; professionnels de santé œuvrant dans le domaine de la toxicomanie et/or readaptation

L'attention médiatique portée à la mauvaise utilisation du propofol a augmenté de manière significative lorsque ce médicament a été mis en cause lors du décès en 2010 de la superstar de pop musique Michael Jackson. La mauvaise utilisation et l'abus du propofol parmi les professionnels de santé ont aussi été constatés à l’échelle mondiale, avec des conséquences telle que la mort. Les règles de conduite encadrant la réinsertion dans le milieu de travail d'un employé ayant un problème d'abus du propofol a jusqu'ici reçu peu d'attentions. La pénurie d'informations concernant les règles spécifiques de réinsertion de professionnels suggère que peu d’études ont examiné ce problème et ce manque de données et de directions peuvent contribuer à une réinsertion dangereuse pouvant même entrainer la mort. Cette étude se concentre sur les professionnels de santé parce qu'ils ont facilement accès au propofol et par conséquent peuvent être davantage tentés de mal l'utiliser ou même d'en abuser. Pour se faire, la pharmacologie, la mauvaise utilisation/l'abus potentiel du propofol et les résultats d'un programme de reprise en 12 étapes dans le domaine de recherche sur la réinsertion professionelle, sont en cours d'examen. En conclusion, la recherche existante et ses avancées sont utilisées pour encourager la mise en place de règles régulant la réinsertion au travail pour ces employés dans le domaine médical.

RESUMEN

Palabras claves: adicción al propofol; mal uso del propofol; abuso del propofol; restablecimiento en el trabajo posterior al abuso de propofol; reglas de reentrada vinculadas al propofol; proveedores de cuidados de salud en estado de recuperación

Ha habido una reciente atención en los medios de comunicación sobre el abuso del propofol. Su aumento se produjo cuando la droga fue vinculada con la muerte en 2009, del artista y superestrella de música pop, Michael Jackson. La malversación y abuso del propofol entre los profesionales de la salud se ha diseminado por todo el mundo, además de causar la muerte como resultado del abuso. Las reglas sobre el propofol que guían la reinserción del personal al empleo, una vez que han abusado la droga, han recibido escasa atención en la literatura de investigación. La falta de información sobre la reentrada específica al propofol sugiere que un mínimo de investigación se ha concentrado en este problema, y la carencia de investigación, puede contribuir a un mal restablecimiento, el cual hasta puede resultar en fatalidades. Este informe se enfoca en los proveedores de servicios de la salud, debido a su acceso fácil al propofol, y de acuerdo a su vulnerabilidad para la malversación o abuso de la droga. Para lograr lo dicho, se consideran la farmacología y posibilidad de abuso y mal uso, y la paradigmática del programa de rehabilitación de 12 pasos en la literatura de reentrada. En suma, se examinan aquí la investigación sobre el abuso y las reglas actuales para sugerir protocolos que guíen la reentrada de proveedores de servicios de la salud.

Keywords :

• propofol addiction
• propofol misuse
• propofol abuse
• re-entry to work after propofol abuse
• propofol re-entry policies
• recovering health care providers

THE AUTHORS

Dr. Todd Monroe, Ph.D., is a Research Associate and Postdoctoral Fellow at the Vanderbilt University School of Nursing (VUSN). His fellowship is jointly supervised between the VUSN and the Vanderbilt University Institute of Imaging Science. Dr. Monroe received a BSN degree with honors from the University of Southern Mississippi, an MSN degree from the University of Alabama, and his Ph.D. in Nursing from the University of Tennessee Health Science Center. For more than a decade, Dr. Monroe has worked clinically in both acute and long-term care. Dr. Monroe has spent past several years in researching substance misuse and abuse among healthcare providers and students with an emphasis on policy development. Dr. Monroe's current research is focused on the neurobiology of pain and using functional magnetic resonance imaging to study pain in older adults with cognitive impairments.

Heather Hamza, CRNA, is a Faculty Anesthetist/Clinical Instructor at Los Angeles County Medical Center at the University of Southern California. She received her Master of Science in Nurse Anesthesia from the University of Buffalo. Mrs. Hamza has been interested in healthcare provider substance abuse and re-entry to work policy for several years. She is a national Peer Assistance Advisor with the AANA. Because of her expertise, Mrs. Hamza frequently speaks to healthcare audiences about substance abuse issues among healthcare providers. Mrs. Hamza is also a third-year Ph.D. student at UCLA, where her dissertation research will involve CRNA re-entry, specifically focusing on cue reactivity.

Greg Stocks, J.D., has practiced as a Nurse Anesthetist over the last 21 years in major academic institutions and private practice. He is a former Peer Assistance Advisor for the AANA and holds an Executive Juris Doctor in Health Law. Currently, he provides medical legal consulting services through Law Med Consulting, LLC, a company that he owns in Baltimore, Maryland.

Paula Davies Scimeca, RN, MS, obtained her baccalaureate degree in Nursing from Adelphi University and her master's degree in Psychiatric/Mental Health Nursing from the State University of New York at Stony Brook. Her career has spanned over three decades, with the first 10 years spent in medical, surgical, and critical care nursing. With over 20 years’ experience in addiction and psychiatric nursing, her focus has centered on addiction and recovery in nurses since 2003. The author of “Unbecoming A Nurse” and “From Unbecoming A Nurse to Overcoming Addiction,” she is an adjunct professor at Wagner College School of Nursing in Staten Island, New York.

Dr. Ronald Cowan, Ph.D., M.D., is an Associate Professor of Psychiatry, and an Assistant Professor of Radiology and Radiological Sciences at Vanderbilt University School of Medicine. He is an Assistant Professor of Psychology at Vanderbilt University. He also serves as the Director of Vanderbilt's Psychiatric Neuroimaging Program and as the Scientific Director of the Vanderbilt Addiction Center. Dr. Cowan received his Ph.D. in Neuroscience from the University of Tennessee Health Science Center and an MD from Weill Cornell University Medical College. Dr. Cowan completed an internship in internal medicine at the Massachusetts General Hospital/Harvard Medical School and a residency in psychiatry at the McLean Hospital/Harvard Medical School. Dr. Cowan directs a research program on addiction, with a focus on the neurobiology of motivated behavior. Clinical areas of interest include addiction, depression, and obesity.

Notes

1 The journal's style utilizes the category Substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be abused. Editor's note.

2 The reader is reminded that the medicalizing and associated diagnosis of types of psychoactive substance use and selected users is relatively recent and is a consensus-based taxonomy, which is not empirically informed. Editor's note. American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (4th ed.). Washington, DC: Author.