Skip to main content
SpringerLink
Log in

Lebensbedrohliche Fentanyl- und Propofolabhängigkeit

Interview mit einer Überlebenden

Life-threatening fentanyl and propofol addiction

Interview with a survivor

  • Allgemeinanästhesie
  • Published:
Der Anaesthesist Aims and scope Submit manuscript

Zusammenfassung

Das erhöhte Risiko von Anästhesisten für einen Substanzmissbrauch u. a. von Opioiden und Propofol ist bekannt. Es gibt jedoch nur wenige Selbstbeschreibungen suchtkranker Ärzte mit i.v.-Analgetika- und Anästhetikamissbrauch, speziell auch von Propofol, die aber dazu betragen könnten, die Dynamik in der Entwicklung der Abhängigkeit besser zu verstehen. Der hier vorgestellte Fallbericht enthält ein Interview mit einer ehemals suchtkranken Anästhesistin, die nach langjährigem Tilidin- und Naloxonmissbrauch zu i.v.-Fentanyl- und später auch Propofolinjektionen wechselte. Hierunter kam es zu mehreren lebensbedrohlichen Zwischenfällen. Erst nach stationärer Behandlung und nach einigen Rückschlägen gelang die berufliche Rehabilitation außerhalb der Anästhesie. Exemplarisch zeigt dieser Fall in Übereinstimmung mit dem aktuellen Schrifttum, dass einerseits Warnsymptome bei abhängigen Ärzten in Kliniken leicht missachtet werden, aber auch dass eine professionelle Therapie unter laufender Überwachung die Möglichkeit zur Rehabilitation eröffnet. Der Fall unterstreicht zudem die Notwendigkeit, die Abgabe von Propofol zu kontrollieren, um dieses lebensbedrohliche „Berufsrisiko“ von Anästhesisten zu reduzieren.

Abstract

Anesthesiologists have a well-known increased risk of substance abuse including the intravenous administration of opioids and propofol. However, katamnestic reports from the point of view of propofol-addicted anesthesiologists themselves are missing which would aid a better understanding of the dynamics and progress of addiction. This article presents an interview with a formerly addicted female anesthesiologist who after long-term abuse with oral tilidine combined with naloxone switched to intravenous administration of fentanyl and later on propofol. Several life-threatening incidents occurred but after some severe setbacks occupational rehabilitation outside the field of anesthesiology was successful following inpatient treatment. This case shows exemplarily in accordance with the current literature that warning signs in addicted physicians are often ignored by colleagues and supervisors and rehabilitation is possible under professional therapy and continuous surveillance. Additionally, this case emphasizes the necessity of controlling the distribution of propofol to reduce the life-threatening professional risk to anesthesiologists.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Beaujouan L, Czernichow S, Pourriat JL, Bonnet F (2005) Prevalence and risk factors for substance abuse and dependence among anaesthetists: a national survey. Ann Fr Anesth Reanim 24:471–479

    Article  PubMed  CAS  Google Scholar 

  2. Boening JA (2001) Neurobiology of an addiction memory. J Neural Transm 108:755–765

    Article  PubMed  CAS  Google Scholar 

  3. Böger RH, Schmid G (2011) Analgetika. In: Schwabe U, Paffrath D (Hrsg). Arzneiverordnungs-Report 2011: Aktuelle Daten, Kosten, Trends und Kommentare. Springer, Berlin Heidelberg New York, Tokio, S 254–269

  4. Bonnet U (2011) Einschätzung des Abhängigkeitsrisikos von Propofol. Fortschr Neurol Psychiatr 79:442–452

    Article  PubMed  CAS  Google Scholar 

  5. Boyd JW, Knight JR (2008) Substance use disorders among physicians. In: Galanter M, Kleber HD (Hrsg) Textbook of substance abuse treatment. 4 Aufl. American Psychiatric Publishing, Washington, S 609–621

  6. Brennscheidt U, Brunnmüller U, Proppe D et al (2007) Pharmacokinetics of tilidine and naloxone in patients with severe hepatic impairment. Arzneimittelforschung 57:106–111

    PubMed  CAS  Google Scholar 

  7. Bryson EO, Frost EA (2011) Propofol abuse. Int Anesthesiol Clin 49:173–180

    Article  PubMed  Google Scholar 

  8. Canaday BR (1993) Propofol abuse. Clin Pharm 12:449–451

    PubMed  CAS  Google Scholar 

  9. Cicero TJ, Inciardi JA, Surratt H (2007) Trends in the use and abuse of branded and generic extended release oxycodone and fentanyl products in the United States. Drug Alcohol Depend 91:115–120

    Article  PubMed  Google Scholar 

  10. Cicero TJ, Lynskey M, Todorov A et al (2008) Co-morbid pain and psychopathology in males and females admitted to treatment for opioid analgesic abuse. Pain 139:127–135

    Article  PubMed  Google Scholar 

  11. Collins GB, McAllister MS, Jensen M, Gooden TA (2005) Chemical dependency treatment outcomes of residents in anesthesiology: results of a survey. Anesth Analg 101:1457–1462

    Article  PubMed  Google Scholar 

  12. Daunderer M (1977) Klinischer Entzug bei Tilidin- (Valoron@-) Abhängigkeit und Nachweis seines Morphiattyps. Dtsch Apoth Z 117:1439

    Google Scholar 

  13. Di Chiara G (1995) The role of dopamine in drug abuse viewed from the perspective of its role in motivation. Drug Alcohol Depend 38:95–137

    Article  Google Scholar 

  14. Dieckhöfer K, Wolf R, Scholl R (1977) Tilidine (Valoron R) abuse and delirium in chronic neurologic pain syndromes. A case report from the neurologic-psychiatric viewpoint. Munch Med Wochenschr 119:1431–1432

    Google Scholar 

  15. Gatch MB, Forster MJ (2011) Behavioral and toxicological effects of propofol. Behav Pharmacol 22:718–722

    Article  PubMed  CAS  Google Scholar 

  16. Goldstein RZ, Volkow ND (2002) Drug addiction and its underlying neurobiological basis: neuroimaging evidence for the involvement of the frontal cortex. Am J Psychiatry 159:1642–1652

    Article  PubMed  Google Scholar 

  17. Guendel H, Kuhs H (1992) Kasuistische Mitteilung über neuntägigen Propofol-Missbrauch. Anaesthesiol Intensivmed Notfallmed Schmerzther 21:181–182

    Article  Google Scholar 

  18. Heinzow B, Lüllmann H (1979) Pharmakokinetische Grundlage eines möglichen Mißbrauchs von Valoron® N. Dtsch Arztebl 15:1003–1006

    Google Scholar 

  19. http://www.aana.com/resources2/professionalpractice/Documents/PPM%20PS%20Joint%20AANA-ASA%20Propofol.pdf. Zugegriffen Dezember 2011

  20. http://www.bfarm.de/DE/Bundesopiumstelle/BtM/sachverst/Protokolle/Ergebnisse_38.html. Zugegriffen 05. Dezember 2011

  21. http://www.land-der-traeume.de/trip_lesen.php?id = 10172. Zugegriffen 01. Dezember 2011

  22. Hyman SE (2005) Addiction: a disease of learning and memory. Am J Psychiatry 162:1414–1422

    Article  PubMed  Google Scholar 

  23. ICD 10 www.dimdi.de/static/de/klassi/diagnosen/icd10/

  24. Iwersen-Bergmann S, Rosner P, Kuhnau HC et al (2001) Death after excessive propofol abuse. Int J Legal Med 114:248–251

    Article  PubMed  CAS  Google Scholar 

  25. Jasinski DR, Preston KL (1986) Evaluation of tilidine for morphine-like subjective effects and euphoria. Drug Alcohol Depend 18:273–292

    Article  PubMed  CAS  Google Scholar 

  26. Kintz P, Villain M, Dumestre V, Cirimele V (2005) Evidence and addiction by anesthesiologists documented by hair analysis. Forensic Sci Int 153:81–84

    Article  PubMed  CAS  Google Scholar 

  27. Kirby RR, James M, Colaw JM, Douglas M (2009) Death from propofol: accident, suicide, or murder? Anesth Analg 108:1182–1184

    Article  PubMed  Google Scholar 

  28. Kranioti EF, Mavroforou A, Mylonakis P, Michalodimitrakis M (2007) Lethal self administration of propofol (Diprivan). A case report and review of the literature. Forensic Sci Int 167:56–58

    Article  PubMed  Google Scholar 

  29. Maier C, Iwunna J, Bürkle H et al (2010) Empfehlung zum Umgang mit abhängigkeitserkrankten Mitarbeitern im Krankenhaus. Anaesth Intensivmed 51:20–29

    Google Scholar 

  30. Maier C, Iwunna J, Soukup J, Scherbaum N (2010) Abhängigkeitssyndrome bei Anästhesisten. Anasthesiol Intensivmed Notfallmed Schmerzther 45:648–654

    Article  PubMed  Google Scholar 

  31. Marshall EJ (2008) Doctors‘ health and fitness to practise: treating addicted doctors. Occup Med (Lond) 58:334–340

    Article  Google Scholar 

  32. Mäulen B (1996) Gute Therapieerfolge bei abhängigen Ärzten. Kassenarzt 36:48–52

    Google Scholar 

  33. Mäulen B (2010) Jedes Leben zählt. Suizid von Anästhesisten. Anaesthesist 59:395–400

    Article  PubMed  Google Scholar 

  34. Monroe T, Hamza H, Stocks G et al (2011) The misuse and abuse of propofol. Subst Use Misuse 46:1199–205

    Article  PubMed  Google Scholar 

  35. Nutt D, King LA, Saulsbury W, Blakemore C (2007) Development of a rational scale to assess the harm of drugs of potential misuse. Lancet 369:1047–1053

    Article  PubMed  Google Scholar 

  36. Pain L, Gobaille S, Schleef C et al (2002) In vivo dopamine measurements in the nucleus accumbens after nonanesthetic and anesthetic doses of propofol in rats. Anesth Analg 95:915–919

    PubMed  CAS  Google Scholar 

  37. Riezzo I, Centini F, Neri M et al (2009) Brugada-like EKG pattern and myocardial effects in a chronic propofol abuser. Clin Toxicol (Phila) 47:358–363

    Google Scholar 

  38. Robinson TE, Berridge KC (2008) The incentive sensitization theory of addiction: some current issues. Philos Trans R Soc Lond B Biol Sci 363:3137–3146

    Article  PubMed  Google Scholar 

  39. Robledo P (2010) Cannabinoids, opioids and MDMA: neuropsychological interactions related to addiction. Curr Drug Targets 11:429–439

    Article  PubMed  CAS  Google Scholar 

  40. Roussin A, Mirepoix M, Lassabe G et al (2006) Death related to a recreational abuse of propofol at therapeutic dose range. Br J Anaesth 97:268

    Article  PubMed  CAS  Google Scholar 

  41. Roussin A, Montastruc JL, Lapeyre-Mestre M (2007) Pharmacological and clinical evidences on the potential for abuse and dependence of propofol: a review of the literature. Fundam Clin Pharmacol 21:459–466

    Article  PubMed  CAS  Google Scholar 

  42. Schifano F, Corkery J, Oyefeso A et al (2008) Trapped in the „K-hole“: overview of deaths associated with ketamine misuse in the UK (1993–2006). J Clin Psychopharmacol 28:114–116

    Article  PubMed  Google Scholar 

  43. Schultz W (2010) Dopamine signals for reward value and risk: basic and recent data. Behav Brain Funct 6:24

    Article  PubMed  Google Scholar 

  44. Siegel RK (1978) Phencyclidine and ketamine intoxication: a study of four populations of recreational users. NIDA Res Monogr:119–147

    Google Scholar 

  45. Soyka M, Schuetz CG (1997) Propofol dependency. J Addict 92:1369–1370

    Article  CAS  Google Scholar 

  46. Talbott GD, Gallegos KV, Wilson PO, Porter TL (1987) The Medical Association of Georgia’s Impaired Physicians Program. Review of the first 1000 physicians: analysis of specialty. JAMA 257:2927–2930

    Article  PubMed  CAS  Google Scholar 

  47. Trinkoff AM, Storr CL (1994) Relationship of specialty and access to substance use among registered nurses: an exploratory analysis. Drug Alcohol Depend 36:215–219

    Article  PubMed  CAS  Google Scholar 

  48. Trojan A, Beil HW (1978) Tilidine abuse and dependence. Drug Alcohol Depend 3:383–391

    Article  PubMed  CAS  Google Scholar 

  49. Wallace JE, Lemaire JB, Ghali WA (2009) Physician wellness: a missing quality indicator. Lancet 374:1714–1721

    Article  PubMed  Google Scholar 

  50. Ward CF (1992) Substance abuse. Now, and for some time to come. Anesthesiology 77:619–622

    Article  PubMed  CAS  Google Scholar 

  51. Wasan AD, Correll DJ, Kissin I et al (2006) Iatrogenic addiction in patients treated for acute or subacute pain: a systematic review. J Opioid Manag 2:16–22

    PubMed  Google Scholar 

  52. Weetman DB, Mascardo LA, Ross MB, Abramowitz PW (2004) Propofol as a drug of diversion. Am J Health Syst Pharm 61:1185–1186

    PubMed  Google Scholar 

  53. Wilson C, Canning P, Carvatia EM (2010) The abuse potential of propofol. Clin Toxicol (Phila) 48:165–170

    Google Scholar 

  54. Wilson JE, Kiselanova N, Stevens Q et al (2008) A survey of inhalational anaesthetic abuse in anaesthesia training programmes. Anaesthesia 63:616–620

    Article  PubMed  CAS  Google Scholar 

  55. Wischmeyer PE, Johnson BR, Wilson JE et al (2007) A survey of propofol abuse in academic anesthesia programs. Anesth Analg 105:1066–1071

    Article  PubMed  CAS  Google Scholar 

  56. Wise RA (2008) Dopamine and reward: the anhedonia hypothesis 30 years on. Neurotox Res 14:169–183

    Article  PubMed  Google Scholar 

  57. Wysowski DK, Pollock ML (2006) Reports of death with use of propofol (Diprivan) for nonprocedural (long-term) sedation and literature review. Anesthesiology 105:1047–1051

    Article  PubMed  Google Scholar 

  58. Xiong M, Li J, Ye JH, Zhang C (2011) Upregulation of DeltaFosB by propofol in rat nucleus accumbens. Anesth Analg 113:259–264

    Article  PubMed  CAS  Google Scholar 

  59. Yang B, Wang BF, Lai MJ et al (2011) Differential involvement of GABA(A) and GABA(B) receptors in propofol self-administration in rats. Acta Pharmacol Sin 32:1460–1465. DOI 10.1038/aps.2011.123

    Article  PubMed  CAS  Google Scholar 

  60. Yücel M, Lubman DI, Solowij N, Brewer WJ (2007) Understanding drug addiction: a neuropsychological perspective. Aust N Z J Psychiatry 41:957–968

    Article  PubMed  Google Scholar 

  61. Zacny JP, Lichtor JL, Thompson W, Apfelbaum JL (1993) Propofol at a subanesthetic dose may have abuse potential in healthy volunteers. Anesth Analg 77:544–552

    Article  PubMed  CAS  Google Scholar 

  62. Zernikow B, Hechler T (2008) Schmerztherapie bei Kindern und Jugendlichen. Dtsch Arztebl Int 105:511–521

    PubMed  Google Scholar 

Download references

Danksagung

Der erste Dank der Autoren gilt der hier interviewten Kollegin, deren Mut und Offenheit besonderen Respekt verdient. Die Autoren danken auch Herrn Rechtsanwalt Dr. jur. E. Biermann (Justiziar des BDA) für seine hilfreiche Beratung, Frau Nora Hansel und Frau cand. med. Stephanie Pohl für die Unterstützung bei der nichteinfachen Literaturbeschaffung und Internetrecherche sowie den Kollegen der Bochumer Schmerzklinik für die anregende kritische Diskussion des Manuskripts.

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seinen Koautor an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Abteilung für Schmerzmedizin, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-Universität, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland

    C. Maier

  2. Kontaktstelle für abhängigkeitskranke Ärzte, Ärztekammer Nordrhein, Nordrhein, Deutschland

    J. Leclerc-Springer

Authors
  1. C. Maier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Leclerc-Springer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Maier.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Maier, C., Leclerc-Springer, J. Lebensbedrohliche Fentanyl- und Propofolabhängigkeit. Anaesthesist 61, 601–607 (2012). https://doi.org/10.1007/s00101-012-2036-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-012-2036-y

Schlüsselwörter

Keywords

Search

Navigation