Few people understand substance abuse better than Dr Naham "Jack" Warhaft. In the past he'd struggled with his own substance abuse issues and now Dr Warhaft is an addiction specialist. He understands addiction is a persistent danger for some people, especially doctors and anaesthetists.
In the last few years, Dr Warhaft says narcotic abuse among healthcare professionals has declined on the whole. At the same time though there's been growing abuse of one powerful anaesthetic: propofol.
While the drug, commonly promoted as "Diprivan," is far more powerful than similar anaesthetics such as opioids and benzodiazepines. They merely reduce the perception of pain during surgery. Propofol causes total unconsciousness and memory loss. In less than an hour, a dose of just 100-200 mg will put a patient to sleep for up to 15 minutes.
Propofol is also extremely deadly. If a patient is given a slightly higher dose, their blood pressure drops immediately and respiratory arrest follows. The results can easily be fatal. While its name may not have the same bite as heroin or morphine, Dr Warhaft says propofol abuse is also "extremely dangerous." Not least because, as he explains, "anaesthetists have extraordinary access to dangerous drugs."
In the inner sanctums of hospitals, the drug is also casually referred to as the "Jacko Drug" or simply "Jacko." This is because it was the sleeping agent haphazardly prescribed to Michael Jackson, which resulted in the King of Pop's untimely death in 2009.
"We see doctors who come to us [all the time] for help," says Kym Jenkins, medical director of the Victorian Doctors' Health Program. "It's really only in the past couple of years that I've seen people coming to help for propofol."
Jenkins believes these people are desperate to "self-medicate," and it's not just anaesthetists. Propofol is also being abused by a number of exhausted health care professionals.
Jenkins says propofol is not as highly regulated, nor is its monitoring as "rigorous," as other anaesthetic agents. Similar drugs, such as morphine and fentanyl (which both belong to the opioid family) are classified as Schedule 8 drugs in Australia. This means they can only be approved for use by specific permitted healthcare professionals. Propofol is only Schedule 4, so it doesn't have the same strict rules.
Chloe Durukan, who works as an anaesthetic nurse and is currently studying to become a doctor has also noticed increased misuse of propofol in the "last year or so." She attributes this to the drug's accessibility. "We don't hear about the other stuff [fentanyl, morphine] a lot because they're tightly controlled," she says. "So it's not surprising people use propofol."
Despite the number of recorded cases of propofol abuse in Australia being comparatively small, Durukan still believes the problem is not receiving enough attention. Given propofol's potency, cases of abuse by healthcare professionals are too often being ignored.
"It's definitely kept on the hush hush," she says. "When we see someone being given propofol they literally stop breathing. It's really potent."
The misuse of propofol by healthcare professionals is by no means a recent phenomenon, nor is it merely exclusive to the Australian healthcare industry. A study conducted by the American Journal of Addiction Medicine in 2013 found that the number of healthcare professionals treated for propofol abuse from 1990-2010 rose steadily. The study also found that many of those treated for abuse were doctors and nurses working in anaesthetic departments, who thus had ready access to the drug.
While no official studies on propofol abuse have been conducted in Australia, a questionnaire sent out to 185 anaesthetic colleges across Australia and New Zealand yielded some unexpected results. The study, published in the Anaesthetic and Intensive Care Journal , found that while on the whole opioid abuse had decreased, propofol abuse had risen steadily. It also found propofol abuse had a particularly high mortality rate of around 45 percent.
Anaesthetists have to be able to constantly adjust propofol levels during surgery. Image via
Despite these recent numbers, Dr Linda Stephenson* who has been an anaesthetic surgeon for 15 years says substance abuse in the profession has "always been a problem." Anecdotally, she has not noticed any increase in the misuse of propofol in her years as a doctor.
Dr Stephenson also believes that tightening restrictions on propofol would have an adverse effect, making it harder for anaesthetists to do their job, and limiting their ability to make a call about giving a patient more of the drug during crucial moments of surgery.
"Say you have an anaesthetised patient and they start waking up during an operation. You need to give them more propofol," she says. "If it's locked away in a cupboard, like fentanyl and other Schedule 8 drugs, then you can see how ridiculous that is."
Dr Stephenson is not the only doctor sceptical of changing the sleeping agent's classification. Dr Warhaft also agrees that tighter restrictions would be "impractical." "This has been tried around various parts of the world," he says. "But determined addicts would find ways around it anyhow."
Nevertheless, Kym Jenkins remains vigilant to the dangers of propofol abuse. Despite the lack of solid data recorded in Australia, Jenkins understands that trends in America may have resounding effects. "[Propofol] is recognised as a problem in the US and now we're on high alert that it could become a problem here," she says. "We have to be very alert to the possibilities."
So while cases of Australia doctors abusing propofol aren't widespread, there's enough of an issue to cause concern. These people are practising what is widely recognised as the most trusted profession in the world, yet they are hazardly self-medicating to deal with their stressful jobs .
"There's not an anaesthetist born who doesn't know drugs are dangerous," Dr Warhaft says. "But addiction is such a powerful driving force that all the knowledge in the world is not going to stop an addict from getting and using the drugs."
If you need help:
Victorian Doctors' Health Program (03) 9495 6011
Australasian Doctors' Health Network (02) 9437 6552
Nursing and Midwifery Health Program (03) 9415 7551
*Name changed on request
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