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Acute Propofol Intoxication: Its Connection to the Death of Michael Jackson

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Propofol is the active agent of an intravenous anesthetic formula used to induce and maintain anesthesia. Over the past few decades, it’s become the more popular drug for anesthesia over sodium thiopental because of its effectiveness in causing almost immediate relaxation and sleepiness, with a predictable onset and duration and low organ toxicity. It is most commonly used during surgery and other medical procedures. In lower doses, it can also be used for conscious sedation of patients who are undergoing outpatient procedures. But it can be a dangerous drug if not carefully administered under proper medical attention, and acute propofol intoxication was a big part of the death of singer Michael Jackson in 2009.

During surgery, a larger dose is first given to cause the patient to go unconscious, with smaller doses, which are measured by the minute, continuously given to keep them under using a computer-controlled pump. It is compatible with fentanyl, and the two drugs are often used together during medical procedures. In some cases, propofol is also used as a form of sedation for people in intensive care in the hospital receiving mechanical ventilation.

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Understanding Propofol

Because of its milky white, oily appearance and need for refrigeration before use, propofol is also referred to as the “milk of anesthesia.” The ingredients in a propofol solution include soybean oil, fats from egg yolks, and glycerol. Because it can be painful to inject, doctors will usually numb the area first with a local anesthetic like lidocaine. 

Some brand names for propofol are Diprivan, Anesthesia S/I-40, and Anesthesia S/1-60. It’s not something you can buy at a drugstore and is exclusively meant for use in hospitals and other medical care centers. It can slow breathing and lower your blood pressure, especially if too much has been given, causing acute propofol intoxication, so continuous monitoring should be done while you’re under its effects. You should also have someone able to supply supplemental oxygen, artificial ventilation, and cardiovascular resuscitation in case of emergency. Recreational use is not ever recommended because of the high risk of acute propofol intoxication and death. 

The Risks of Propofol Use and Misuse

Propofol is not meant to be a recreational drug, and its misuse comes with many risks. In fact, in Canada, a lethal dose is used for medical assistance in dying. It’s a very potent drug, and you also need to be monitored closely to ensure your safety while under its effects. While you may experience short-term euphoria and lowered inhibitions, it simply isn’t worth gambling with your life. 

Along with the risk of death, some other dangers related to propofol use and misuse are:

  • Lowered blood pressure, with drops up to 30% or more.
  • Apnea due to respiratory depression.
  • Cerebrovascular issues, with decreased blood flow to the brain.
  • Decreased myocardial blood flow and oxygen consumption.
  • Uncontrollable muscle contractions.
  • Worsened sleep quality due to suppressed REM cycles.
  • Allergic reaction to the egg ingredients or soy.
  • Bronchospasm in individuals who have asthma.

Rarer side effects include anxiety, delirium, hallucinations, priapism, dry eyes and mouth, difficulty urinating, coughing up blood, and cloudy or green urine. The severity of these issues depends on the dose administered and the rate of administration. 

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Acute Propofol Intoxication: Definition and Symptoms

Acute propofol intoxication is what it’s called when propofol reaches a toxic level in the body. When this happens, chemical changes occur at a cellular level that can lead to heart arrhythmias and an imbalance of the body’s energy supply, leading to organ dysfunction throughout the body. This can cause slurred speech, confusion, sedation, slowed heart rate, heart attacks, unconsciousness, slowed breathing, poor muscle control, shock, and organ failure. 

The Case of Michael Jackson

Michael Jackson unfortunately passed away in 2009 from what was deemed to be acute propofol intoxication, although other drugs were also found in his system. He had been having trouble sleeping and struggling with fatigue and insomnia, and his doctor, Dr. Murray, administered propofol after the pop star had already taken benzodiazepines like lorazepam (Ativan), midazolam (Versed) and diazepam (Valium). These drugs are known to slow a person’s breathing and heart rate. In Michael Jackson’s case, the combination turned out to be deadly. Like other musicians lost to drug overdose, the loss was felt across the world.

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Legal and Ethical Implications

Using propofol in a non-medical setting is never legal, and in Michael Jackson’s case, an appropriate standard of care wasn’t met by Dr. Murray. He was convicted of involuntary manslaughter. Administering propofol in this manner was illegal, and according to prosecutors, he lacked adequate expertise, equipment, and justification for providing this drug to his patient. Using an anesthetic as a sleeping aid is extremely dangerous, and unfortunately for the King of Pop, it can kill the patient without extremely specific precautions in place. When using propofol, it’s recommended to have:

  • Appropriately trained anesthesia personnel present for the entire period under anesthesia.
  • Two sources of oxygen.
  • Laryngoscopes, laryngeal mask airways, endotracheal tubes, and a bag valve mask.
  • A crash cart with ACLS medications and a defibrillator.
  • Monitoring devices for blood oxygenation, circulation, ventilation, and temperature.

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Preventing Propofol Misuse and Intoxication

Because propofol is not a controlled substance, it seems that one of the best ways to prevent its abuse would be to restrict access even more so than it already is. Many people working in the medical or veterinary field can freely access this drug, which makes it a temptation for anybody looking for a new way to get high. 

Educating medical staff and the public in general about the serious dangers and intensely risky effects of this drug will also prevent people from trying this drug recreationally. Knowing what could happen will make it seem like a less appealing option. 

Treatment for Propofol Intoxication and Addiction

If somebody needs treatment for acute propofol intoxication, they must go to the hospital immediately. Call 911 and make sure the medical team knows they’ve taken an anesthetic. This will help them administer appropriate care. 

If you know somebody addicted to sedative drugs like propofol, or if you’ve been abusing sedatives and are ready to quit for good, you can call Resurgence Behavioral Health today for addiction treatment. We’re non-judgmental; whether you’ve been misusing medical drugs or need drug addiction treatment, we can help you stop safely. 

Our treatment plans are customized so you can get the treatments and therapies that will best help you on your unique recovery journey. We offer medication-assisted detox programs, dual diagnosis plans for people with co-occurring mental health conditions, psychotherapy, behavioral therapy, EMDR, group therapy, family therapy, and more. 

All care is delivered in a trauma-informed holistic treatment plan, meaning we see you as a person, not as an addiction. Through comprehensive programming, you can overcome addiction, heal emotional pain, gain a new understanding of yourself and why you do the things you do, and start working toward some short- and long-term goals. 

Resurgence Behavioral Health Can Help

The longer you abuse sedative drugs, the more likely you are to develop a substance use disorder. Resurgence Behavioral Health can help. We provide all clients an uplifting, welcoming experience, offering 24-hour inpatient addiction treatment and customizable outpatient options. With our help, you can make lasting changes that will help you stay sober long-term as you heal the root of addiction through intensive therapy sessions and gain a new sober community in the process. To learn more, please call Resurgence Behavioral Health today at 855-458-0050, or contact us online. We are here to help.

Josh Chandler
Josh Chandler
After growing up in Chicago and North Carolina, Josh chose to get help with substance use disorder and mental health in California because of the state's reputation for top-tier treatment. There, he found the treatment he needed to achieve more than five years of recovery. He's been in the drug and alcohol addiction rehab industry for four years and now serves as the Director of Admissions for Resurgence Behavioral Health. Josh remains passionate about the field because he understands that one phone call can alter the course of a person's life.


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