Abuse Potential of Propofol After Procedural Sedation

Abstract

Objective: In this study, we examined the euphoric effect of propofol and its high satisfaction ratio regarding its liability to be abused, particularly in painless procedures, such as colonoscopy. Methods: Fifty subjects aged between 18 and 65 years who fulfilled the criteria for ASA 1-2 and were prepared for colonoscopy were enrolled into this study. For intravenous sedation induction, 2 mg/kg propofol was used, and additional injections were administered according to BIS values. After colonoscopy, the subjects were taken to a recovery room and observed for 30 minutes. Patients were interviewed with the modified Brice questionnare regarding the incidence and the content of dreams. A 5-point Likert scale was used to classify their dreams, and the content of the dreams was also recorded. To assess the subjective effects of propofol, the patients were asked to use the Hall and Van der Castle emotion scale; their biological states were also assessed. The patients’ feelings regarding propofol were each rated as absent or present. We used the Morphine-Benzedrine Group scale to measure the euphoric effects of propofol. At the end of the study, subjects scored their satisfaction on a five-point scale. Results: There were no statistically significant differences in sex age, weight, propofol dose, or satisfaction ratio (p>0.05) in the groups, although male patients received a higher dose of propofol and had higher satisfaction ratio. Patients reported no residual after-effects. The incidence of dreaming was 42%. There was no statistically significant difference in dreaming between the sexes, but male patients had a higher dreaming ratio. Dreamers received higher propofol doses and had a higher satisfaction ratio (p>0.05). All dreamers reported happy dreams regarding daily life, and their mean MBG score was 10.5. There was no correlation between MBG scores and propofol doses (r= -0.044, p= 0.761). Conclusions: We conclude that propofol functions as a reward; that patients enjoy its acute effects; and that no residual after-effects should arise. We suggest that propofol may carry potential for abuse, and further abuse liability testing is indicated.

Factors associated with euphoria in a large subset of cases using propofol sedation during gastrointestinal endoscopy

“…Propofol may also trigger dreams or hallucinations related to sex, which are usually pleasant and vivid ( 24 ). The reported cases of dreaming showed more obvious euphoria than those without dreaming, which may be related to the decrease in sexual desire inhibition mediated by propofol ( 3 , 25 , 26 ). Therefore, the addiction to propofol may be related to its hallucinogenic effects.…”

“…Propofol is recommended for sedation during gastrointestinal endoscopy, but evidence of its addictive potential has increased ( 3 , 16 – 18 ). Additionally, after painful postoperative conditions, patients may have unpleasant emotions that affect their evaluation of their feelings toward propofol ( 19 , 20 ).…”

“…However, propofol dependence and abuse have gradually attracted extensive attention after pop star Michael Jackson died in 2009 due to propofol intoxication ( 2 ). Tezcan et al reported that the euphoric effect score (Morphine–Benzedrine Group, MBG)of propofol reach about 9.8, which was quite high ( 3 ). The first use produces pleasure, relaxation, and euphoria, making it difficult to stop ( 4 ).…”

“…Clinically, propofol-induced euphoria is more common in patients undergoing short or painless surgeries, such as gastric or gastrointestinal endoscopy ( 3 , 10 – 12 ). However, to the best of our knowledge, limited clinical trials have investigated the euphoria and abuse potential for propofol after endoscopic procedures.…”

Neurons in the Locus Coeruleus Modulate the Hedonic Effects of Sub-Anesthetic Dose of Propofol

“…In addition to being commonly used for the maintenance of anesthesia in patients undergoing long-term surgery, propofol is also used for short procedures such as painless gastrointestinal endoscopy due to its short-acting characteristics. Propofol has no obvious respiratory and circulatory side effects, but various hedonic effects such as feelings of wellbeing, sexual hallucinations, and euphoria have been reported ( Tezcan et al, 2014 ). Clinical study observed and evaluated the postoperative experience of 82 patients undergoing gastroenteroscopy under propofol anesthesia and found that 43.9% of the patients experience obvious euphoria during the period of anesthesia recovery ( Brechmann et al, 2018 ).…”