The high that killed the king of pop

Michael Jackson asked for propofol to help him sleep. It is not a sleeping aid and has potential for recreational use, reports Sharon Begley.

HIS doctor said it helped Michael Jackson sleep, but propofol is far more powerful.

When the 2009 autopsy report on Michael Jackson listed the cause of death as “acute propofol intoxication”, his fans were not the only ones who wondered why he was being given this powerful intravenous anaesthetic to sleep, as his physician — Conrad Murray — said.

The trail heard that Jackson’s anxiety over his comeback concerts was partially responsible for the insomnia that pushed him toward propofol for relief.

Nurse/nutritionist Cherilyn Lee told the court that in April, about the time that production for the concerts began, Jackson complained to her of insomnia. She offered a variety of natural treatments, which Jackson told her were ineffective.

Jackson, Lee said, told her that he needed something to “knock him out,” and asked her about procuring propofol for him.

After researching the drug, Lee recommended against it, and warned Jackson of the powerful anaesthetic’s side effects. Jackson countered that it would be safe, if he were to take the drug under supervision.

“I will be okay, I only need someone to monitor me with the equipment while I sleep,” Lee recalled the singer saying.

To Jackson’s ultimate detriment, he found that someone in Conrad Murray.

Though evidence suggests that Jackson was no stranger to propofol — he at least knew enough to ask for it by name before employing Murray’s services as a physician — he was certainly taking a lot of it under Murray’s care.

Two days after Jackson’s death, Murray told police that he administered propofol to the singer nearly every night in the two months that he treated him. Propofol expert Dr Steven Shafer testified that Murray had ordered just over four gallons of the drug — “an extraordinary amount to administer to one individual” — in the two months that he treated Jackson.

However, Propofol is not a sleeping aid, but it has another property that experts are only beginning to focus on: it has a significant potential for recreational use and abuse.

“It’s not a narcotic like heroin, and doesn’t get you high,’ says anaesthesiologist Ethan Bryson of Mount Sinai Medical Center in New York. “But it does provide the feeling of oblivion or being spaced out ... And there is an association between having a history of sexual abuse and seeking the escape that propofol provides.”

Jackson, who was acquitted of charges that he sexually abused a child, had said his father abused him physically and emotionally. “If you wanted to draw any inferences regarding Jackson’s use of propofol and sexual abuse, it would be abuse that he suffered as a child and not perpetrated on another as an adult,” says Bryson.

As a general anaesthetic, propofol acts on the brain’s GABA receptors, which cause inhibitory neurons — those that quiet other circuits — to fire; that’s how it induces unconsciousness. Propofol also increases levels of the feel-good neurotransmitter dopamine, triggering a sense of reward not unlike sex or cocaine.

Some patients experience euphoria, sexual disinhibition, and even hallucinations, followed by a feeling of calm and an upbeat mood. Since propofol is so widely used — it revolutionised ambulatory anaesthesia, allowing a physician to knock someone out in seconds to perform, say, a colonoscopy, and have them up and about after only 10 minutes — scientists have had no shortage of subjects able to describe the experience. About one-third don’t remember a thing, and another third say they dreamed, but don’t recall specifics. The rest experience “vivid, strange dreams, sometimes of a sexual nature”, says Bryson.

Once propofol wears off, some patients report feeling well rested, energetic, and happy. Murray said he gave Jackson propofol because the singer wanted to feel energised for rehearsals, but propofol does not provide a restorative sleep; anyone using it regularly could become dependent on the drug to function.

Soon after the drug was introduced in 1989, reports of abuse surfaced — all among medical professionals. Reports of such cases appeared as far back as 1992, when an anaesthesiologist was found to be self-injecting 10 to 15 times a day. Abuse has since spread. A 2007 survey of academic anaesthesiology departments found that 18% reported propofol abuse by physicians or nurses — a 500% increase from 10 years earlier.

Physicians are also reporting more cases of laypeople becoming addicted. One man, who was given propofol for headaches liked it so much he managed to obtain it from vets; he was found unconscious after an overdose.

In Jackson’s case, propofol caused cardiac arrest. Unlike other anaesthetics, it has no reversing agent, and there is no straightforward way to rescue someone who takes too much. That helps explain why, in a study of 25 people abusing propofol, seven died.

Last year, the American Society of Anaesthesiologists formally endorsed a proposal by the Drug Enforcement Administration to classify it as a controlled substance. No action has been taken.

(c) 2011, Newsweek/Daily Beast Company LLC.