Anesthesia abuse
Anesthesia abuse refers to the intentional use of anesthetic agents, such as nitrous oxide and propofol, for nonmedical and recreational purposes. While predominantly seen among healthcare providers, including nurse anesthetists and anesthesiologists, anyone can misuse these potent substances. The root causes of anesthesia abuse often lie in a combination of biological predispositions and environmental factors, particularly among individuals with existing substance use disorders. This form of abuse poses significant health risks, including the potential for life-threatening conditions like respiratory failure or cardiac arrest, as evidenced by high-profile cases such as the death of Michael Jackson.
Symptoms of anesthesia abuse can include impaired functioning, mood changes, and an array of behavioral shifts, which may be crucial for others to recognize in order to provide necessary support. Identifying anesthesia abuse typically involves urine drug screenings, though many anesthetic drugs may evade standard tests due to their short half-lives. Treatment often includes inpatient programs and peer support groups, which emphasize recovery and accountability. Preventative measures, such as drug screening and regulatory oversight, remain essential to mitigate the risk of abuse within the medical community. Understanding the complexities of anesthesia abuse is vital for fostering a supportive environment for those affected and promoting safe practices in healthcare settings.
Anesthesia abuse
DEFINITION: Anesthesia abuse is the intentional use of anesthetic agents for recreational and nonmedical purposes. Anesthetic agents are potent medications with mind-altering effects and include inhaled gases such as nitrous oxide, intravenous medications such as propofol, and local anesthetics such as cocaine.
Causes
As with any addiction, biological and environmental factors contribute to anesthesia abuse. Individuals with substance abuse disorder have a genetic predisposition and a chronic, compulsive need for the substance of choice. For the anesthesia abuser, these substances include a variety of potentially addictive agents. Generally, insatiable cravings compel chronic use (abuse) of a particular drug, which results in damage to internal organs. However, because many anesthesia drugs have the potential to cause apnea or paralysis within seconds, abuse of anesthetic agents can lead to death.
Risk Factors
Although laypersons abuse anesthesia drugs, the most frequently cited anesthesia abusers are anesthesia providers such as certified registered nurse anesthetists, medical residents, and anesthesiologists. Easy access to anesthetic medications enables anesthesia providers to experiment with controlled substances such as fentanyl and other opioids, which are highly addictive.
Anesthesia providers often work long and irregular hours under stressful conditions with access to anesthetic agents. Propofol abuse is increasingly popular because the substance has a short half-life and is quickly eliminated from the body. Nitrous oxide, commonly known as laughing gas, is an inhaled anesthetic that also is abused. The primary risk of inhaled nitrous oxide is hypoxia, which results from inadequate oxygen supply to the body’s tissues, particularly the brain. The death of music legend Michael Jackson in 2009 brought increased media attention to propofol abuse, as the singer died from cardiac arrest due to a lethal combination of sedatives and propofol, which the artist had been abusing for months to deal with chronic insomnia.
Symptoms
A variety of symptoms occur from using common anesthetic medications. These symptoms (and their symptom-producing medications) include amnesia and anxiolysis (midazolam), pain relief (opioids), and sedation and apnea (opioids and propofol). Abusers experience impaired functioning because of these drugs. The dose associated with abuse is often less than that required for general anesthesia. However, the effects of anesthetic medications are dose-dependent and may also lead to dysphoria and mood changes. Therefore, abusers may exhibit behavioral changes; appear fatigued, irritable, euphoric, dysphoric, drowsy, or depressed; or may simply appear out of character. Recognition of these signs is imperative to protect the abuser and to aid healthcare providers who have a legal responsibility to report colleagues known or suspected of chemical dependency. This not only protects the abusers but also the patients under their care.
Screening and Diagnosis
The screening test commonly used to confirm drug use is typically a urine drug screen. However, many anesthetic medications (such as fentanyl, propofol, naltrexone, and ketamine) are not included in standard drug screens and must be specifically requested. Because of the short half-lives of these anesthesia drugs, many are quickly eliminated from the body and, therefore, are difficult to detect. In some cases, the metabolites of these drugs can be detected in urine samples, while hair samples fulfill other testing needs. Although more expensive than urine testing, hair-sample testing can detect chronic exposure to certain drugs; urine drug screens are limited to detecting drug use only within hours or days of use.
Treatment and Therapy
The American Association of Nurse Anesthetists and the American Society of Anesthesiologists are two national organizations that govern the practice of anesthesia providers. These organizations and many others not affiliated with medical and nursing personnel recommend inpatient treatment for persons with chemical dependency.
Short- and long-term therapy combined with support-group attendance and abstinence monitoring offers the highest success rates. Various peer assistance groups are available to monitor and assist those undergoing treatment. Narcotics Anonymous offers a twelve-step program that protects anonymity and offers the person with substance abuse disorder a structured plan for recovery that includes admitting loss of control over the compulsion (the repeated use of anesthetics) and the aid of a sponsor to evaluate mistakes made by the individual. In return, once the individual has entered recovery, they offer help to others who have the same type of addiction.
Prevention
The United States (US) Drug Enforcement Administration (DEA) establishes standards and substance schedules and enforces these standards to prevent and control drug abuse. Although the DEA once had plans to treat propofol as a Schedule IV controlled substance to institute more accountability and address the overwhelming availability of the drug to anesthesia providers, this initiative was not pursued, and the drug remains a prescription medication. Random drug screening following the US Substance Abuse Mental Health Services Administration’s guidelines and employing the proper chain of custody are two methods that various organizations use to deter and detect drug abusers, including anesthesia abusers.
Bibliography
ABC News. "Michael Jackson's Death Ruled a Homicide, Caused By Lethal Drug Cocktail." ABC News, 28 Aug. 2009, abcnews.go.com/Entertainment/MichaelJackson/story?id=8433380. Accessed 22 Aug. 2024.
Bryson, Ethan O., and Jeffrey H. Silverstein. "Addiction and Substance Abuse in Anesthesiology." Anesthesiology, vol. 109.5, 2008, pp. 905–17.
DeFord, Stephanie, et al. "A Review of Literature on Substance Abuse among Anaesthesia Providers." Journal of Research in Nursing: JRN, vol. 24, no. 8, 2019, pp. 587-600, doi.org/10.1177/1744987119827353. Accessed 22 Aug. 2024.
Sinha, Ashish C. "The Drug-Impaired Anesthesia Provider." Audio-Digest Anesthesiology, vol. 50, no. 7, 2007.