Diprivan controls may be tightened

Even before Michael Jackson’s death, federal regulators had become concerned about Diprivan, the anesthetic that police found at the pop star’s home. The attention Jackson’s death has attracted to the drug could lead to its becoming a controlled substance.

Also known by the generic name propofol, the drug is among the most widely used general anesthetics in the U.S. Its purpose is to quickly knock out patients or make them semi-conscious during uncomfortable procedures, such as colonoscopies.

The drug can be so dangerous that the U.S. Food and Drug Administration says only those trained in general anesthesia should administer it.

“Me administering this to you at home, I’m fairly likely to hurt you,” said Dr. Paul Wischmeyer, an anesthesiologist at the University of Colorado. “You’d need to have a surgery center at your house.”

Nearly all of the small but growing number of abuse cases involve doctors and other medical personnel. Because a dose lasts just a few minutes, it’s not uncommon for users to inject themselves 80 times a day as they search for a brief high or the sensation of slipping into unconsciousness, according to physicians who have studied Diprivan abuse.

“We’re used to administering what’s usually a lethal dose if we weren’t sitting there,” said Dr. Ethan Bryson, an assistant professor of anesthesiology at Mt. Sinai School of Medicine in New York. “But when you’re doing it to yourself and injecting it in the arm, you can make yourself stop breathing, and if there’s no one there to breathe for you, you’ll die.”

If Jackson was using Diprivan, he would have been one of the rare known cases of nonmedical personnel abusing it. In two such cases, the people using the drug died.

At many hospitals, Diprivan is given the same casual oversight as Tylenol, said Lisa Thiemann, senior director of professional practice for the American Assn. of Nurse Anesthetists. Three days before Jackson died, the group recommended the drug be placed in secure environments in medical facilities.

A 2007 survey by Wischmeyer found that 71% of the 126 anesthesiology departments he polled had no system to monitor Diprivan. Hospitals are required to monitor narcotics, including Demerol and morphine. Wischmeyer found that the anesthesiology programs whose doctors had died from Diprivan abuse were among those that did not keep track of the drug.

The FDA and the Drug Enforcement Administration said they were considering making it a controlled drug even before Jackson’s death. Now, that push has received renewed attention.

Local hospitals are also reviewing whether they should increase oversight, among them Ronald Reagan UCLA Medical Center. At Los Angeles County-USC Medical Center, where Diprivan is kept in locked anesthesia carts, officials are planning to track the drug as if it were a controlled narcotic, requiring it to be locked up and monitored.

Sources have told The Times that detectives found a large quantity of Diprivan in Jackson’s rented Holmby Hills mansion. Teva Pharmaceuticals, a maker of the drug, said the DEA contacted the firm about a lot number stamped on the drug’s packaging. The identification could help trace how the drug was obtained.

Dr. Arnold Klein, a Beverly Hills dermatologist who treated Jackson for 25 years, told CNN’s Larry King that the singer was using the drug with an anesthesiologist “to go to sleep at night” while touring Germany. The last time Jackson toured there was 1997.

Dr. Omar Manejwala, associate medical director at the William J. Farley Center at Williamsburg Place in Williamsburg, Va., an addiction treatment center that focuses on physicians, said nearly all Diprivan abusers started using the drug to overcome insomnia, even though injecting it would knock them out only for a few minutes.

“They describe a transient feeling of pleasure and a relief from the experience of sleep deprivation,” he said. They want to do “anything to avoid being awake.”

Doctors said that going under with Diprivan, even for several hours, is not the same as sleeping. “You never use propofol for insomnia treatment,” Wischmeyer said. “Never, ever.” Manejwala and others who have treated substance-abusing physicians also said that Diprivan users seem to have experienced abuse and trauma at a young age.Doctors said people taking Diprivan sometimes report hallucinations and sexual dreams. “They’ll inject the drug and get a tiny moment, 10 seconds of this euphoric floating, disconnected from the troubles of world, almost out of body, feel at peace, wonderfully floating, and then get unconscious, so they never have enormous periods of euphoria or wonderment,” said Dr. Paul Earley, medical director at Talbott Recovery Campus in Atlanta, which also specializes in treating drug and alcohol abusing doctors.

Other abusers, doctors said, simply find the world or their problems so difficult and overwhelming that they just want to escape, even if only briefly. “Most just want to go blotto,” Manejwala said.

Diprivan is not a drug people can buy on the street. Someone would have to take it from a hospital, surgery center or other medical facility or somehow obtain it from a distributor or manufacturer.

If Jackson did indeed use it, “there is no way he did it by himself,” said Dr. Zeev Kain, chairman of the anesthesiology department at UC Irvine Medical Center. “Somebody needed to steal or take it, and somebody needed to inject it in him.”

FDA spokeswoman Karen Riley said Diprivan was not controlled when it was introduced in 1989 because there was no evidence it could be abused. Even today, many doctors are surprised by reports of abuse.

“When I talk to colleagues who haven’t heard of Diprivan abuse, they will say, ‘You’re kidding? What’s the point?’ ” Manejwala said.

There is evidence the abuse is increasing. Wischmeyer said his research shows use among healthcare professionals was up five times from 1997 to 2007.

Earley said that in 2007, his center treated 12 people who had used Diprivan. A year later, the number nearly doubled, to 22. Although he didn’t have numbers, Manejwala said there is no question the number of cases his center has treated has increased.

Doctors like using Diprivan in medical procedures because it acts quickly -- it can sedate a person in less than a minute -- and puts anxious patients at ease during uncomfortable procedures.

Once the patient is anesthetized, doctors can continue using Diprivan intravenously to keep them sedated or substitute another anesthetic. Diprivan has fewer side effects after patients awaken, such as nausea, and leaves them more clear-headed.

“It’s a really good drug in the domain of anesthesia,” Kain said. “It’s very bad it’s gotten this bad rap right now.”

--

jeff.gottlieb@latimes.com

ron.lin@latimes.com