Propofol Addiction Initiated by Anesthetic Use
Publication: American Journal of Psychiatry
To the Editor: Propofol is a safe anesthetic agent, acts rapidly, and allows a fast recovery from anesthesia. Despite its abuse potential by activation of the gamma-aminobutyric acid receptor type A (GABAA), only several cases of propofol dependency and abusive use for recreational intentions, mostly by medical professionals, have been reported since 1992 (1). We present the first case of propofol dependency initiated by repeated application of the drug within anesthetic use.
A 34-year-old female midwife was admitted to our hospital for propofol detoxification. The patient had no history of substance abuse or psychiatric disorders as well as no family history of substance use disorders. She suffered from a severe form of Crohn's disease, which resulted in her undergoing more than 28 necessary colonoscopies and surgeries between 1991 and 2008. Propofol was used for sedation and anesthesia in the majority of all her medical procedures. After her first surgeries, the patient described feeling “high and light-headed” and indicated that she “liked” the postanesthetic effect of propofol but had no craving for the drug between the surgeries.
In 2000, while faced with a variety of stressors and following renewed colonoscopies in which propofol was administered, the patient experienced a strong desire for the drug's euphoric and relaxing effects. She started self-medication with propofol, which she stole from her workplace. While keeping the dosage of each injection constant at 200 mg, she increased the frequency of the injections up to 5–7 times per day. For at least 1 year, the patient consumed propofol nearly everyday and was only limited by availability. During an inpatient treatment for Crohn's disease, she self-administered propofol twice through her central vein catheter and was found somnolent. However, she decided to visit our department for addiction treatment only after a colleague found the stolen propofol in her handbag (with the consequence being that she lost her job).
The present case indicates that propofol primarily used for anesthetic reasons has abuse potential even in patients without a history of drug abuse. Brazzalotto (2) found that 40% of 542 patients described feelings of pleasure after awaking from anesthesia with propofol, which is probably caused by a rapid activation of GABAA within mesocorticolimbic pathways.
It remains to be discussed why the vast majority of patients exposed to propofol apparently do not develop an addiction to the drug, contrary to our patient. One main contributing factor to the addiction seen in our patient might be the repeated exposure to the drug over several years. However, an important additional factor is that our patient (in contrast to the majority of anesthetized patients) was aware of propofol used for anesthesia, which caused the appreciated effect, and, moreover, was able to make the drug available for intentional use.
Based on the present report, vigilance should increase regarding the positively reinforcing effects of propofol, especially after repeated application in patients for whom propofol is available.
Footnote
accepted for publication in December 2010.
References
1.
Wilson C, Canning P, Caravati EM: The abuse potential of propofol. Clin Toxicol (Phila). 2010; 48:165–170
2.
Brazzalotto I: Propofol effects. Annales Francaises D Anesthesie et de Reanimation 1989; 8:388
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Accepted: December 2010
Published online: 1 February 2011
Published in print: February 2011
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The authors report no financial relationships with commercial interests.
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