To the Editor:—
My 25-yr personal experience considering the choice of drugs for self-administration by physicians, excepting the standbys alcohol, opioids, and stimulants, has usually generated fairly predictable questions. One common query is “why in the world would anyone abuse that” at some time during the evaluation. In fact, the first published report1of propofol abuse more than 10 yr ago generated exactly this question. Often, even after time in an established recovery, a satisfactory response to this query is not forthcoming.
The recent paper by Tung et al. 2may represent a unique clear insight into the reinforcing properties of propofol self-administration that helps answer the “why in the world” question, at least for this drug. Chronic fatigue from repetitive extended workdays and longer evenings/nights is an inescapable part of a busy practice. Sleep deprivation resulting from inadequate duration or poor quality of sleep represents a major impetus for research into pharmacologic sleep augmentation for those living with recurring daytime exhaustion.
The editorial3accompanying the paper by Tung et al. proposed that perhaps someday patients might emerge from prolonged sedation feeling refreshed and rested. Might I suggest that there are some historical hints in the form of case, and sometimes coroner, reports, that uncontrolled research on this subject has been underway for more than a decade? If indeed propofol immediately induces sleep that mimics the best properties of non–drug-assisted rest, including deprivation recovery, then the attraction can become, for a few, overwhelming, despite constant personal danger. For someone with a long-standing concern with physician well being and chemical dependency, the response to the titles alone, of the paper and editorial, prompted the response “so that’s it.”
Anesthesia Service Medical Group, San Diego, California. cward2@san.rr.com
