/ 7 August 2009

The seven-minute coma

Michael Jackson’s death was every bit as strange as his progressively more eccentric life. He died in a swelteringly hot room because he always felt cold, surrounded by the paraphernalia of addiction — oxygen tanks, an intravenous drip, empty drug canisters.

As the details of his final hours emerged, attention came to settle on the drug propofol, which he appears to have been given intravenously by his personal doctor in the early hours of June 25, the day he died, as an insomnia remedy.

Should toxicology reports confirm propofol as the primary cause of death, that would place Jackson in a rare category: there are only two other deaths recorded of lay people addicted to it.

Propofol abuse is largely confined to the medical profession, specifically anaesthetists and nurses who are constantly in the presence of the drug. Outside the medical world, their plight is relatively little known.

Interviews with recovering users, self-help groups and experts in the United States paint a picture of desperate cravings, yearnings for oblivion, escape from childhood abuse and the slow, stuttering road to recovery.

They reveal, too, a drug that is almost entirely unregulated, kept freely available to medical staff at the behest of drug companies and health providers, yet powerfully addictive and potentially lethal. A tiny excess dose can stop the heart or suppress breathing and send the user into a coma from which he or she never comes back.

Propofol is a white, milky substance that was introduced in 1986. Its popularity as an anaesthetic has steadily grown until it is now the most widely used intravenous drug for putting patients to sleep. Doctors like it because it is quick to act and leaves a minimal hangover.

But it became known early on that it was addictive. In tests, rats and primates became hooked on it. In 1992 the first human dependency was recorded — an anaesthetist who began injecting himself to cope with stress. His secret was uncovered when he was found unconscious one night in the toilets at work.

Concern has grown over the dangers. Alarm bells started ringing for Paul Wischmeyer, an anaesthetist from Colorado, when a medical-school friend was found at home with a syringe stuck in his arm. Wischmeyer began making informal inquiries and was shocked by what he discovered.

“People would reach into the needle­discard boxes full of used syringes and pull out old vials of propofol, not knowing what patient it had been used on or whether it was spoiled. That’s pretty extreme,” he said.

In another case, an addict fell asleep at his desk so frequently that his lolling forehead bore a perpetual bruise.

As propofol can only be injected in small doses, because its effects last no more than seven minutes, users have been known to inject more than 100 times a day.

In 2006 Wischmeyer contacted 126 anaesthesia departments across the US. He found that almost one in five of them had experienced propofol addiction among staff. Though numbers remained small compared with opiate addiction, he calculated a fivefold increase in propofol abuse over 10 years.

Those findings matched the experiences of Paul Earley of the Talbott Recovery Campus, a treatment centre for troubled medical professionals. He saw eight cases of propofol abuse in 2006, 12 in 2007 and 27 last year.

Earley began to notice a striking factor shared by many propofol addicts: sexual or physical abuse in their past. “I started seeing a fair number of our patients who are victims of abuse as children,” he said. “When I mentioned that to a colleague he said: ‘Yeah, I’ve noticed that in my patients, too.'”

Omar Manejwala, an expert in addiction treatment at the William Farley Centre in Virginia, has observed an alarming rate of post-traumatic stress disorder among his patients. Post-traumatic stress disorder is not uncommon among addicts, presenting in maybe 30% or even 50% of cases; but with propofol he sees it in 70% or 80%.

What draws these people to propofol, he believes, is that the drug has the ability to induce a sense of oblivion.

“Most propofol patients are not looking for euphoria or for a high — they just want to go into a coma. They want to disappear.”

Thayne Flora, a nurse from Virginia, wanted to do just that. She fell into addiction to opiates when she was working in anaesthesiology and suffering from chronic headaches. She abused sedatives, on and off, for years.

Towards the end of her addiction she developed severe insomnia and was desperately sleep-deprived. That’s when she turned, much as Michael Jackson did, to propofol. “I was in such bad shape, I was looking not only to sleep, but to escape. Escape from life,” she said.

By then her addictive self had driven away friends and family and she was socially isolated. “I just felt so lost, so completely alone. I thought I needed to end my life — and propofol did that for me. It just allowed me to go away for a while.”

Flora was lucky. On March 16 1993 an intervention was organised for her and she was put into treatment. She has been clean since that day.

Others are not so lucky. The drug is potent and can kill without constant observation and respiratory help. Astonishingly, medical professionals in anaesthesia know that, but still take the risk. In particular danger are young doctors just starting out who are not fully trained. The Colorado study found that almost 40% of first-year doctors who abused propofol ended up dead.

Propofol is not a controlled substance and stocks of the drug do not have to be registered or accounted for.

Art Zwerling, who runs an online forum for about 180 recovering medical addicts, believes the case for regulation is even stronger now. He believes there’s a risk that the media circus surrounding Jackson’s death has brought propofol to the attention of a wider field of potential abusers. —