Securing Propofol Position Statement The American Association of Nurse Anesthesiology (AANA) supports the well-being and safety of Certified Registered Nurse Anesthetists (CRNAs) and student registered nurse anesthetists (SRNAs). The AANA recognizes that anesthesia professionals have an increased occupational risk of substance use disorder (SUD), as well as experience professional and personal consequences of SUD.1-6 Since the introduction of propofol, the incidence of healthcare professionals’ abuse of propofol continues to increase.5,7 Propofol is among the most commonly abused drugs by anesthesia professionals.8 Propofol accounts for 41% of reported substance abuse cases among anesthesia providers.9 Research has shown that at least 1 incident of propofol abuse or diversion occurred in 18% of anesthesia departments affiliated with an academic program in the United States.4,10,11 The 10-year incidence of propofol abuse was 0.1% (10 per 10,000 anesthesia providers), which is higher than previous reports indicating a propofol abuse incidence of 0.02%.4,10,11 Incidence of death among anesthesia professionals abusing propofol was 28%.4,10,11 This abuse is primarily due to ease of access, rapid onset of action, short duration of action, and feelings of elation and euphoria. 2,5,6,12-24 Access to highly addictive drugs, including propofol, is a significant risk factor for SUD among anesthesia and other healthcare professionals.2,3,5,6,11,15-20,25,26 Research also suggests that exposure to propofol aerosolized in the operating room may sensitize personnel to later abuse.5,27-29 Unfortunately, the first sign of propofol abuse or addiction is often death.6,11,17,18,21-23 A lack of controls (e.g., pharmacy accounting, stricter dispensing control) is associated with an increased incidence of abuse.4,18,24,30 Propofol storage, dispensing, return, and disposal is not standardized across facilities.24 Because healthcare professionals who divert drugs, such as propofol, pose a risk to their patients, employers, coworkers, and themselves, the AANA takes a strong position on the need to secure propofol within facilities. 5,24,31
Position Recommendation for Classification by Federal Drug Enforcement Administration •
Since 2010, it has been the AANA’s position that, due to the risk of abuse, propofol warrants, at a minimum, Schedule IV controlled substance classification. 12,17,25,32,33
Recommendations for Facilities •
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AANA supports the development of facility policies, procedures, and clinician education that address signs and symptoms of diversion and SUD, prevention, reporting, and safe intervention. If propofol is controlled in a manner consistent with a scheduled drug, the incidence of propofol abuse and accidental fatal overdoses is decreased.9,18 The AANA strongly recommends that facilities with propofol on formulary develop and implement methods to reduce the likelihood of propofol diversion, such as placing propofol in a secure environment only accessible by those professionals identified in a medication management policy. Controlled substance diversion prevention programs that build in
1 of 4 American Association of Nurse Anesthesiology 10275 West Higgins Road, Suite 500 | Rosemont, IL 60018 Professional Practice Division l 847-655-8870 l practice@aana.com