The qualities that make propofol a popular sedative also make it a recreational drug for some in the medical profession. It doesn't show up in standard drug tests in the urine, and with a half-life of only five minutes, it doesn't leave the user groggy or affect behavior in a way that signals a substance-abuse problem.
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The study cited seven deaths. Dr. Wischmeyer and others in the field say that they know of other cases and estimate that the total number of deaths is at least several dozen in recent years.
"If you try to count backward from 100 after it's injected, you don't get to 97," says Dr. Wischmeyer. He and others say the drug is safe for hospital patients as long as a medical worker monitors "airway management" and provides oxygen as needed to ensure breathing doesn't stop.
Anesthetists and users say propofol can bring a brief but captivating high as the sedation wears off. Some call the habit, "dancing with a white rabbit," referring to the drug's color and hallucinogens of the 1960s. Others call it "pronapping," because the drug induces a short rest for medical personnel between long shifts.
Paul Earley, medical director of Talbott Recovery Campus in Atlanta, which treats many medical professionals for substance abuse, said addictions to opiates and other drugs obscured the growing use of propofol.
"I was injecting it 50 times a day when I was in my worst period," says an anesthesiologist in the Midwest, who recently completed a stint in rehabilitation to kick the propofol habit. He said he began "pronapping" a couple of years ago while under stress from his job, family and finances. He hid the signs of shooting up by putting a port for a syringe on his leg, where it wasn't visible.
At night, he would inject the drug into the port in the bathroom, where his wife assumed he was brushing his teeth. "Sometimes it acted so fast, I couldn't get back to bed in time," said the anesthesiologist. He would pass out on the floor, terrifying his wife, and he said that on occasion he broke his nose or cheekbone or sprained a wrist.
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Propofol is so potent that a tiny amount -- 20 milligrams -- can be the difference between rest and death. "It enters your bloodstream fast, and even highly trained anesthesiologists can't control it, and die. They don't even have seconds to pull out the needle," said Art Zwerling, a registered nurse anesthetist and counselor with the Association of Nurse Anesthetists, a 39,000-member group.
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Clarence Ward, a California anesthesiologist, wrote in a 2008 article in the California Society of Anesthesiologists bulletin, that too many doctors don't acknowledge abuse. In an interview, he said people die "not necessarily from intent, but from an inability to control a drug that causes abrupt loss of consciousness."