J Korean Med Assoc.  2013 Apr;56(4):292-298. 10.5124/jkma.2013.56.4.292.

Drug abuse associated with procedural sedation

• Hong SH

• KMID: 2192930
• DOI: http://doi.org/10.5124/jkma.2013.56.4.292

Abstract

Procedural sedation is now becoming more popular in South Korea along with the increases in cosmetic procedures and surgery, gastrointestinal endoscopy, and minimally invasive surgery, which have been accompanied by a surge in propofol abuse. The mechanism of potential abuse of sedatives and hypnotics share the common feature of all addictive drugs, in that they increase dopamine concentrations in target structures in the mesolimbic dopamine system. The abuse of sedatives and hypnotics occupies a small proportion of all substance abuse; however, propofol abuse is sharply increasing and is closely associated with procedural sedation in South Korea. Previous case reports have indicated that the majority of propofol abusers were health-care providers; however, recreational use of propofol is spreading among the general public. Lay people become addicted to propofol through repetitive procedural sedation or wrongful use by clinicians who are enticed by the promise of monetary gain. Illicit distribution of propofol accelerates abuse by lay people. The extremely narrow safety margin of propofol may cause a large number of fatal cases. Therefore, nationwide establishment of a policy to prevent the spread of propofol abuse is urgently needed.

Keyword

Drug abuse; Hypnotic; Propofol; Sedation; Sedative

MeSH Terms

Cosmetics
Dopamine
Endoscopy, Gastrointestinal
Hypnotics and Sedatives
Propofol
Republic of Korea
Substance-Related Disorders
Cosmetics
Dopamine
Hypnotics and Sedatives
Propofol

Figure

• 

  Figure 1 Schematic diagram describing the circuit of the mesolimbic dopamine system. The reward system originates in the ventral tegmental area (VTA), which is composed of two major cell types, the dopamine neurons and the γ-aminobutyricacid (GABA) neurons. The dopamine neurons (blue) project to the ventral striatum, the nucleus accumbens (NAc), the prefrontal cortex (PFC) and the hippocampus. The VTA receives inhibitory projections (red) back from the NAc and from the pedunculopontine nucleus (PPT) and excitatory projections (green) from the PFC, the PPT, the amygdala, the lateral hypothalamus (LH), the laterodorsal tegmental nucleus (LDTg) and the bed nucleus of the stria terminalis (BNST). It also receives local inhibitory feedback from the GABA interneurons in the VTA (from Tan KR, et al. Trends Neurosci 2011;34:188-197, with permission from Elsevier) [8].

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