Securing Propofol

Formerly Position Statement Number 2.14

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The American Association of Nurse Anesthetists (AANA) has a history of supporting the well-being and professional self-care of the Certified Registered Nurse Anesthetist (CRNA).  The AANA is aware of the occupational risks for substance misuse in anesthesia professionals and the professional implications  chemical dependency may have for the practitioner.1  The ease of access to propofol may contribute to the incidence of substance misuse and chemical dependency among anesthesia professionals and other healthcare providers.2-4  The purpose of this statement is to promote the securing of propofol in facilities as an effort to reduce propofol diversion and misuse.

Since the introduction of propofol into the healthcare market, its misuse through self-administration by anesthesia professionals and other healthcare providers has been documented.2, 3, 5, 6  Propofol produces dose-dependent sedation.  At sub-anesthetic doses feelings of elation and euphoria have been reported.7-10   Unfortunately, too often the first sign of propofol misuse or addiction is the healthcare provider’s death.2, 3, 5, 6

Fospropofol, the pro-drug to propofol, is classified under Schedule IV of the Controlled Substances Act.11  Propofol’s potential for misuse and chemical dependency also warrants Schedule IV classification.2, 4, 7, 11-13  The AANA recommends that facilities that maintain propofol on formulary develop and implement methods for  reducing the likelihood of propofol diversion and misuse, such as placing propofol in a secure environment.  However, simply securing propofol may not be enough to prevent substance diversion and misuse, therefore further investigation is needed to determine the most effective methods for preventing substance diversion and misuse in general.

References

  1. Position Statement 1.7 Substance Misuse and Chemical Dependency. Park Ridge, IL: American Association of Nurse Anesthetists; 2011.
  2. Welliver M, Bertrand A, Garza J, Baker K. Two new case reports of propofol abuse and a pattern analysis of the literature. International Journal of Advanced Nursing Studies. 2012;1(1):22-42. http://www.sciencepubco.com/index.php/IJANS/article/view/27/93. Accessed July 12, 2012.
  3. Wischmeyer PE, Johnson BR, Wilson JE, et al. A survey of propofol abuse in academic anesthesia programs. Anesth Analg. Oct 2007;105(4):1066-1071, table of contents.
  4. Welliver M. Propofol alert! Gastroenterol Nurs. Sep-Oct 2011;34(5):398-399.
  5. Kirby RR, Colaw JM, Douglas MM. Death from propofol: accident, suicide, or murder? Anesth Analg. Apr 2009;108(4):1182-1184.
  6. Riezzo I, Centini F, Neri M, et al. Brugada-like EKG pattern and myocardial effects in a chronic propofol abuser. Clin Toxicol (Phila). Apr 2009;47(4):358-363.
  7. Schedule of controlled substances: placement of propofol into schedule IV. Proposed rules. Fed Regist. 2010;75(207):66196-66199. http://www.gpo.gov/fdsys/search/pagedetails.action?granuleId=2010-27193&packageId=FR-2010-10-27&acCode=FR October 27, 2010. Accessed July 12, 2012.
  8. Koopmann A, von der Goltz C, Hermann D, Kiefer F. Propofol addiction initiated by anesthetic use. Am J Psychiatry. Feb 2011;168(2):211-212.
  9. Roussin A, Montastruc JL, Lapeyre-Mestre M. Pharmacological and clinical evidences on the potential for abuse and dependence of propofol: a review of the literature. Fundam Clin Pharmacol. Oct 2007;21(5):459-466.
  10. Zacny JP, Lichtor JL, Thompson W, Apfelbaum JL. Propofol at a subanesthetic dose may have abuse potential in healthy volunteers. Anesth Analg. Sep 1993;77(3):544-552.
  11. Schedule of controlled substances; placement of fospropofol into schedule IV. Final rule. Fed Regist. Oct 6 2009;74(192):51234-51236.
  12. U.S. Drug Enforcement Administration. Controlled Substances Act. 21 CFR 13§ 811 and § 812. http://www.deadiversion.usdoj.gov/21cfr/21usc/index.html  Accessed May 30, 2012.
  13. Kim DK. Propofol use for sedation or sedation for propofol use? J Anesth. Apr 2012;26(2):289-291.
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Adopted by AANA Board of Directors June 2009.
Revised by AANA Board of Directors September 2009.
Revised by AANA Board of Directors November 2012.