Law Med has suffered through a number of “experts” appearing on international broadcast media and in print who claim to know all about propofol, its administration, its abuse and addiction potential, while at the same time spouting misstated facts or downright nonsense regarding the drug.

First, to bring some perspective as to why Law Med’s opinions are worth a hill of beans, we must humbly state that Law Med is arguably a national expert on the abuse of propofol, and resultant fatal outcomes, as well as propofol addiction, including incidence, physiologic mechanisms and treatment. Law Med has 2 decades of experience administering anesthesia including propofol, peer assistance advisory experience with a national organization of anesthesia professionals, and has published two peer reviewed medical journal articles on the subject, and has been a national contact person for dozens of calls about individuals in crisis from propofol abuse, overdose and addiction. Law Med has read nearly every English language published article and research paper on the subject.

This is not boastful, but rather necessary background to make it clear that the information provided here is accurate, informed, and has been recognized as such by health care providers seeking their own education on the topic.

First, a few examples of bullshit exposed: 

To begin, we turn to the HIPAA violating Irish “cosmetic dermatologist” Dr. Patrick Treacy who, while being interviewed by the equally propofol clueless Dr. Drew Pinsky on CNN, makes the ridiculous claim that an individual cannot self administer propofol with the result being a fatal overdose. The good doctor postulates that due to the short duration of action of propofol, its effects will last only 4 minutes at a 200 mg dose, making it “almost physically impossible” for Michael Jackson to kill himself. Pinsky “wholeheartedly agrees”. While Law Med does not subscribe to the defense claim that Jackson self administered the propofol that killed him, it does not change the fact that this “expert” opinion is utter nonsense.

http://lawmedconsultant.com/pinsky.flv 

We will refrain from a discussion about the unethical actions of Dr. Treacy in discussing his dead patient’s medical care, not to mention his violation of HIPAA (if he has any sort of U.S. license which is doubtful). Suffice it to say that it is reprehensible and shameful.

Both Pinsky and Treacy are complete idiots when it comes to propofol and its potential to cause a fatal outcome when administered at doses even below 200 mg, when no respiratory support is given. How it is lost on the two physicians that 4 minutes (a very conservative duration of action for a 200 mg dose arrived upon from who knows where….certainly not from any clinical experience administering propofol) of respiratory insufficiency from airway obstruction followed by apnea can easily cause cardiac arrest and death if no action is taken to support respirations, is beyond belief. Actually, one would EXPECT to kill a patient if one administered 200 mg of propofol and then did nothing to support their airway and breathing. It would be the VERY rare patient indeed who survived such a scenario.

In point of fact, 10-15 minutes from injection to awakening is the correct profile for propofol, with that time frame being significantly lengthened when it is administered along with benzodiazepines like valium (Diazepam), lorazepam (Ativan) and midazolam (Versed). And Jackson had all three in his system. Dozens of fatal accidental overdoses of propofol during abuse, when the drug was self administered by ANESTHESIA professionals who were VERY knowledgable about the administration of propofol and its dangers, have been reported in the literature since 1992.

In short, it is VERY, VERY easy to die from a self administered dose of propofol, even when that dose is below that required for general anesthesia.

Next we turn to WebMD where in a featured article entitled “Propofol: Expert Q&A”, a Dr. John F. Dombrowski, an anesthesiologist at the Washington Pain Center in D.C., answers two of the seven questions he is asked with utterly false and uninformed statements:  

Can people get addicted to propofol? Is there any prolonged or repeated use of propofol? 

“There’s no data to support any addictive potential,” Dombrowski says. “As for repeated uses, only if you are getting multiple procedures done. But there’s no one out there saying, ‘Hey, I’m going to get another hernia repair’ just to get some propofol.

Are there any statistics on propofol abuse? 

“Abuse just doesn’t occur, and if there’s any abuse potential, it’s so small that it’s not enough to talk about,” Dombrowski says.”There’s no access to it, and there’s no reason someone would want it.” 

Propofol abuse and addiction are very real and known FACTS. Abuse most certainly does occur, almost exclusively among individuals working in hospitals or surgery centers, and with significant regularityy. Propofol has been shown to have the same addiction potential as other more commonly recognized drugs of abuse like cocaine, morphine, benzodiazepines and alcohol, in MULTIPLE studies involving human and animal subjects. Its effects on specific areas of the brain, and their chemical functions, common to most all addictive substances are identical. 

His answers to these two questions are utter nonsense, false, and completely uninformed. So much for “Expert Q&A”. 

Now, some propofol FACTS:

• Propofol is a sedative hypnotic and is the most common “induction agent” for general anesthesia in the U.S. In layman’s terms, propofol is used to induce general anesthesia initially, and then general anesthesia is maintained by administration of other medications, anesthetic gases, and/or a propofol infusion. 
• Propofol is a very safe drug when administered by specialy trained health care providers in the appropriate setting.
• In an anesthetizing dose, propofol induces general anesthesia in about 60 seconds.
• After a single anesthetizing dose of propofol, the patient can be expected to be awake in 10-15 minutes.
• Administration of other drugs like opiates (morphine, fentanyl) and benzodiazepines (midazolam and lorazepam) potentiate the effects of propofol meaning smaller doses have greater effect and duration of action is longer.
• When a patient is administered a general anesthesia dose of propofol, they stop breathing.
• Propofol is NEVER administered outside of a medical facility.
• Propofol is NEVER to be administered by untrained individuals. Training specific to propofol administration and emergency airway management and procedures is mandatory.
• Cardiologists, unless specifically trained, DO NOT have the requisite training to administer propofol. Training to administer propofol is uncommon for cardiologists.
• Propofol is NEVER administered to treat a sleep disorder.
• Propofol administration in someone’s home is ALWAYS negligence and below the standard of care.
• ONLY anesthesia professionals, Certified Registered Nurse Anesthetists and Anesthesiologists, administer propofol as a general anesthetic in an operating room.
• Emergency airway supplies and a crash cart must be present when propofol is administered. 
• All patients receiving propofol must be monitored using an EKG monitor, pulse oximeter, and blood pressure monitor. The patient must also be continuously observed.
• Propofol is given as a continuous infusion for sedation both in operating rooms and intensive care units. Frequently these patients have endotracheal tubes (breathing tubes) in place and are on mechanical ventilators, especially ICU patients.
• Administration of propofol at sedation doses can cause airway obstruction and apnea (breathing stops), requiring intervention to open the airway or assist with breathing.
• Propofol is an addictive substance.
• Propofol abuse is a well known occupational hazard among health care workers.
• Propofol has rarely been reported as a drug of abuse in laypersons and has been identified as a murder weapon in one case.
• No case of a physician ordering propofol for home use has ever been reported prior to the Jackson case.

Related Posts

1. Toxicology In The Michael Jackson Manslaughter Trial
2. Nurse Anesthetist Assoc. Warned Propofol Abuse Deadly 3 Days Before Jackson’s Death
3. Jackson Received More Propofol Than Anyone In Medical History
4. STUNNING Propofol Evidence In Jackson Physician Manslaughter Trial
5. Jackson Propofol Homicide Trial Begins September 26