Propofol: dangerous 'milk of anesthesia'

Public attention has been recently focused on the abuse of propofol, an anesthetic drug, after police said they were looking into allegations that Lee Boojin, Hotel Shilla CEO and daughter of Samsung Group Chairman Lee Kunhee, was given the drug regularly at a plastic surgery clinic in southern Seoul.

Gangnam Police Station and district health authorities inspected the clinic late last month, to find out whether Lee, 48, received propofol without a "proper" prescription.

Propofol is a sleep inducer used to start and maintain anesthesia, and is largely used for conscious sedation endoscopy or cosmetic surgery. It was classified as a psychoactive drug here in 2011 and it is illegal to use it for anything other than surgical procedures.

Michael Jackson's death in 2009 gave momentum to public awareness of the drug in Korea. It is widely known as "milk" here because of its white color ― its key ingredient is not dissolved in water but in soybean oil that gives it a milk-like color.

In 2013, Korean actresses Park Siyeon, Jang Miinae and Lee Seungyeon were indicted over abusing the drug for recreational purposes. Although they strongly denied the allegations at that time, speculation was rampant that more celebrities were engaged in abusing the drug.

Propofol is the most common sleep inducer and is easy to use because people can recover quickly from the anesthesia state. However, it is stronger than some other drugs and can lower blood pressure and hamper breathing. In Michael Jackson's case, the doctor who gave the drug had left him unattended, which ended up killing him.


Why is it dangerous?


Questions about the drug include "how dangerous is it?" and "why does it cause addiction?"

A plastic surgeon who has run a clinic in southern Seoul for nine years said some people have misconceptions about the mechanism behind drug abuse and addiction.

"Some media outlets reported people who use the drug for recreational purpose get addicted to the good feeling they have when they wake up. But when you fall asleep after injection just like when you have a conscious-sedation endoscopy, you don't have to worry about addiction at all," said the doctor who asked not to be named.

He said when the drug is injected, brain function is suppressed and it signals sleep by raising the level of gamma-aminobutyric acid in the brain. At that time, dopamine levels, associated with feelings of euphoria, also increase, but people don't usually feel the euphoria as they are asleep.

"However, when having only a small dose which is less than that required to put a person to completely asleep, they can feel euphoria caused by the dopamine, and end up becoming addicted," the doctor said.

The danger in using the drug is that it can cause a decrease in blood pressure and difficulty in breathing, or can halt respiration, so a patient should never be left alone.

The Ministry of Food and Drug Safety has warned of the fatal consequences from using propofol.

"Habitual use of the drug causes addiction and serious side effects such as insomnia, depression, impulsive aggression, auditory and visual hallucinations and accidental death," said an official of the ministry's drug safety division.

The ministry revised regulations on psychotropic drugs last May. Under the revised rules, pharmaceutical companies, wholesalers, clinics, pharmacies and others that handle psychotropic drugs must record any use of the drugs into an integrated management system. The ministry expects this will prevent illegal use of the drugs by monitoring the entire process from import to use.

However, critics say clinics can easily misrepresent the actual use of some of the drugs such as propofol and fentanyl, because they are not covered by state medical insurance.

The Korea Association of Pharmacists is calling on the government to strengthen regulations on drugs that are not covered in order to prevent drug abuse.

"In the case of propofol, for example, how much of the drug was administered and how much was discarded is recorded in the management system of psychotropic drugs. But with less detailed regulation in prescription than drugs covered by insurance, it can't be tracked whether the doctor used a specific dose of propofol for a patient as recorded in the system or used it for another person," said Song Haejin, secretary general of the association.