Abuse of Propofol by Anesthesia Providers: The Case for Re-Classification as a Controlled Substance

Propofol was first reported as a drug of abuse in 1992 after a New York anesthesiologist became addicted to the then recently approved medication. Abuse of propofol, primarily among anesthesia providers, has since been reported around the world. As an uncontrolled substance, propofol is seldom kept in locked storage, nor is it inventoried or accounted for similar to other potential drugs of abuse found in most operating rooms. Rarely identified as a preferred drug of choice for abuse, ease of access appears to be a primary factor in propofol abuse, as well as its use as a drug of substitution for unavailable controlled drugs. Rather than contributing to the rate of substance abuse in anesthesia providers, most concerning is the high rate of accidental fatal overdose in individuals who abuse propofol. When propofol is controlled in a manner similar to more familiar drugs of abuse, specifically Scheduled drugs found in the operating room, the incidence of propofol abuse falls dramatically along with corresponding fatal outcomes. This dramatic decrease in abuse due to control is an attribute unique to propofol. As this journal goes to press the DEA has published a Proposed Rule for Placement of Propofol Into Schedule IV of the U.S. Controlled Substance Act. Control of propofol will not decrease the overall incidence of substance abuse among health professionals, but it will prevent many accidental deaths.