The abuse potential of propofol.
BACKGROUND
Propofol is a sedative-hypnotic prescription medication that is widely used in anesthesia, long-term sedation, and conscious sedation. It is short acting, effective, and, when used appropriately, safe. It is not a controlled substance by the U.S. Drug Enforcement Administration, suggesting that it has little potential for abuse. The objective of this review was to evaluate the evidence for the abuse potential of propofol.


METHODS
A systematic review of the medical literature was performed using the search terms: propofol, Diprivan, abuse, addiction, tolerance, misuse, and withdrawal. Six online literature citation databases and relevant bibliographies were searched for articles.


RESULTS
Seventy-two articles were identified for review and 45 were relevant to the topic. These articles described propofol's biochemical and pharmacokinetic mechanisms of action that lend themselves to its abuse, propofol's physical and psychological effects that make it alluring as a recreational drug, the current evidence supporting the possibility of tolerance to and withdrawal from propofol, the risk involved in recreational propofol use, and the evidence supporting current abuse of this medication. We found evidence to support propofol's abuse potential from a pharmacological and experiential standpoint with multiple reports describing tolerance, dependence, withdrawal phenomena, abuse, and death from recreational use.


CONCLUSIONS
Propofol has alluring and addictive properties that lend itself to potential recreational abuse and dependence. We recommend that the U.S. Drug Enforcement Administration and other international agencies should consider regulating propofol as a controlled substance.
Wilson
Courtney
C
Division of Emergency Medicine, Utah Poison Control Center, University of Utah, Salt Lake City, UT 84108, USA.
Canning
Peter
P
Caravati
E Martin
EM
D018686:Anesthetics, Intravenous / Q000493:pharmacokinetics / Q000494:pharmacology / Q000633:toxicity*; D000818:Animals; D004361:Drug Tolerance; D004335:Drug and Narcotic Control; D006801:Humans; D015742:Propofol / Q000493:pharmacokinetics / Q000494:pharmacology / Q000633:toxicity*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D013375:Substance Withdrawal Syndrome / Q000503:physiopathology; D014481:United States
D018686:Anesthetics, Intravenous; D015742:Propofol