Addressing Acute Propofol and Benzodiazepine Intoxication

Propofol is a highly effective anesthetic that is on the World Health Organization’s List of Essential Medicines. When this drug is used appropriately, it can be extremely effective. But when it is misused, either alone or in combination with other substances, its effects can be devastating. One of the many potential dangers is known as acute Propofol and benzodiazepine intoxication.   

Meaning of Acute Propofol Intoxication

Propofol is an intravenous anesthetic, which means that it is administered via injection. Both medical doctors and veterinarians use Propofol to relax and sedate patients before surgery or certain other medical procedures. In the United States, it is sold under the brand name Diprivan, though a generic version is also available.

When administered by a qualified anesthesiologist in a medical setting, Propofol can safely elicit a sense of relaxation, then sedation. Since the drug also lowers patients’ blood pressure and slows their respiration, it is important that a trained professional monitors their vital signs at all times while they are under the effects of Propofol.

The improper or illegitimate use of Propofol can lead to catastrophic outcomes, including death. 

One such dangerous outcome is acute Propofol intoxication, which may also be referred to as Propofol toxicity or Propofol infusion syndrome (PFIS). 

Studies have found that excessive Propofol can affect a person’s body at the cellular level. Among these effects is a disruption of the body’s ability to safely metabolize fatty acids, which can lead to abnormal heart rate and diminished energy. 

Other possible effects of acute Propofol intoxication include:

• Confusion
• Slurred speech
• Limited muscle control
• Hyperkalemia (elevated potassium levels in the blood)
• Shock
• Loss of consciousness
• Organ failure

As we will discuss in the next section, the dangers associated with Propofol use can be magnified when other drugs are involved.

The Infamous Acute Propofol and Benzodiazepine Intoxication Case

One of the most infamous cases of acute Propofol and benzodiazepine intoxication involved the death of entertainment superstar Michael Jackson in June 2009.

Jackson, who was in the midst of rehearsals for a 50-concert residency at London’s O2 Arena, had been complaining of fatigue and insomnia. According to several news reports from the time, he had been receiving regular injections of Propofol and other drugs, including benzodiazepines, from his personal physician, Dr. Conrad Murray.

The Los Angeles County Coroner ruled that Jackson’s cause of death was “acute Propofol intoxication.”  

The coroner’s report also identified lorazepam, which is a benzodiazepine, as a contributor to Jackson’s death. Other substances in his system when he died included midazolam and diazepam (both of which are also benzos), lidocaine (a local anesthetic), and ephedrine (a stimulant).

The LA County coroner defined Jackson’s death as a homicide. In November 2011, Dr. Murray was found guilty of involuntary manslaughter and sentenced to four years in prison. He served almost two years before being released on parole in 2013.

Is Propofol Addictive?

Yes, Propofol can be addictive.

The U.S. Food and Drug Administration (FDA) initially approved Propofol for use in the United States in 1989. At the time, most researchers did not consider the drug to have a high risk of either abuse or addiction. However, through the years, this viewpoint has changed.

As reported by a team of experts from Rutgers University, reports of Propofol abuse began to circulate in the early 1990s. According to the Rutgers team, recreational Propofol use, which involves sub-anesthetic doses, can produce the following effects:

• Feeling drunk, elated, or high
• Euphoric rush
• Decreased sensation of being in control of their mind and body
• Easing of anxiety symptoms
• Improved ability to get to sleep

The Rutgers experts also referred to several studies that document the risk of Propofol addiction. 

“With growing evidence that Propofol poses an increased risk of addiction and abuse, hospitals and regulation agencies should consider certifying Propofol as a controlled substance to minimize incidences of morbidity and mortality from its abuse,” they wrote.

In 2010, the U.S. Drug Enforcement Agency (DEA) proposed classifying Propofol as a Schedule IV controlled substance, but this change was never enacted. However, as the Rutgers team recommended, some organizations have unilaterally opted to treat it as a controlled substance.  

What Should You Do if You Believe Someone You Know is Addicted to Either Propofol or Benzos?

Given the extreme damage that addictions to Propofol and/or benzodiazepines can cause, it is understandable to be concerned if you believe that someone you care about has become dependent on either of these substances. While you can’t cure a loved one’s addictions, you can play a key role in connecting them with the help they need.

Here are a few ways that you can help:

• Educate yourself about the disease of addiction and the effects of these drugs. This can help you better understand what your loved one is going through.
• Research treatment options and identify providers in your area that seem to offer the types of services your loved one may need.
• Talk to your loved one. Express your concern, emphasize your support, and share what you’ve learned. Encourage them to schedule an assessment with their primary physician or an addiction professional.
• Listen to their response. Be prepared for pushback, denial, or even anger. It may take several conversations until your friend or family member is ready to get help.
• If your loved one refuses to seek help, talk to the centers you’ve been researching to get advice on how to support someone who is currently not willing to enroll in treatment.
• Get a small group of trusted friends or family members to help you with your research and assist in keeping your loved one safe until they get help.
• Consider seeking therapy for yourself. Depending on your relationship with your loved one, you may be negatively affected by their substance abuse struggles.
• Plan to be a source of ongoing support for your loved one during and after their time in treatment. Recovery is a lifelong effort, and effective interpersonal support can make a world of difference.

To learn more about treatment for propofol or benzos in Southern California, or to schedule a free assessment, please visit our Contact page or call us today.