Monday, July 27, 2009

Murder by propofol

The outlook for propofol just became more tenuous. Today the news agencies are saying that Michael Jackson's personal physician, Dr. Conrad Murray, is being investigated for possibly injecting the propofol that killed the singer, manslaughter by propofol. Propofol was found in the closet of the doctor's bedroom in the house, along with IV supplies. MJ had needle tracks in his arm and even in his neck (which partially explains why he was always covered up, even in broad daylight). And the toxicology studies reportedly show propofol in his system.

In the April 2009 issue of Anesthesia & Analgesia, there is an article about possibly the first murder by propofol ever recorded (here is the abstract). It details how an SICU nurse in Florida took propofol from the hospital and gave a lethal injection to his female friend. He not so carefully took the empty bottles of propofol out to the garbage then flew overseas. The coroners found the needle stick in the antecubital fossa and the police traced the propofol bottles to the hospital where this nurse worked. At this hospital the propofol had to be checked out, which is how the police tracked down the nurse as the culprit. He is eventually extradited and sentenced to life without parole.

At this rate, the DEA will soon be making propofol a controlled substance, just like narcotics, benzos and the new fospropofol that was just approved. In the case of the Florida murder, controlling the dispensation of propofol proved the link between the killer and the murder. At the end of that article, it lists several case reports of nurses and physicians dying from overdosing on propofol. They also cite a study saying 18% of anesthesiology residencies in the United States have found evidence of propofol abuse. In a ten year stretch, 25 abusers were reported and seven died (28%). In all these cases, the dispensing of propofol was not controlled. Even with this, the authors still insist locking up propofol will be detrimental to the practice of anesthesia. While I agree with them that making propofol a controlled substance will substantially hinder our practice, I think the DEA will be under enormous pressure to make propofol less accessible. And as always, anesthesiologists will just have to be creative and work with the new rules as best as we can. Remember pentathol was a controlled substance too.

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