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The capacity to become physically addicted to propofol has not been firmly established by any literature. Propofol is not structurally or pharmacologically related in any way to other common anesthetics such as opioids (narcotic pain killers), barbiturates (such as phenobarbital) or benzodiazepines. Propofol has no attraction to receptors that the above drugs commonly interact within the brain--meaning that potential for abuse and/or addiction should be limited. It is actually chemically similar to vitamin E and aspirin.
A case report titled Lethal Self-Administration of Propofol (Diprivan): A Case Report and Review of the Literature states, regarding dependency "there is no evidence of tolerance", which refers to the need to increase the amount of drug to maintain a given response. An article authored by Zacny, et al. discusses the possibility that propofol might be psychologically addictive at sub-therapeutic levels in healthy volunteers. However, Dr. J. Robert Sneyd blasted this study for its use of volunteers with a history of alcohol, soft and hard drug use. Sneyd also discussed the biased reporting of the statistics. Furthermore, Jackson was well into therapeutic range and was not using sub-therapeutic doses for recreational use. Jackson was also not self-administering propofol.
Valium (diazepam) is a long-acting benzodiazepine. Ativan (lorazepam) is an intermediate-acting benzodiazepine. Versed (midazolam) is a short-acting benzodiazepine. All the benzodiazepines administered to Jackson are acceptable for the treatment of insomnia. However, other kinds benzodiazepines are typically used for insomnia, such as Restoril (temazepam) which was found among Jackson's medications though this particular medication was not taken June 25th. Concerning insomnia, even though benzodiazepines may be used, IV benzodiazepines should not have been used to treat Jackson since he could take oral medications. There was no need for IV benzodiazepines for Jackson.
There have been rumors that Jackson had an addiction to various benzodiazepines. Rumors are simply that--rumors--and there is no current proof of such an addiction thus far. Jackson had one oral benzodiazepine prescribed to him by Dr. Metzger for insomnia. Jackson had three oral benzodiazepines prescribed to him by Murray, two for insomnia and one, written days before his death, was prescribed to take throughout the day. Information from Table 3A in the autopsy report shows that Jackson did not appear to be a compliant patient--he rarely finished or took his medications as prescribed, including antibiotics which should be finished in most situations. He underutilized almost every medication he had in his possession. For those medication bottles found empty, based on the date the medications were filled at the pharmacy, it is appropriate to have found them completely used. The amount of benzodiazepines remaining and the length of time since being filled/written do not correlate with an addiction. However, Murray's benzodiazepine-prescribing was more encouraging of establishing a tolerance in his patient (with no apparent tolerance) rather than trying to prevent one from occurring.
Even though benzodiazepines do pose a physical risk of tolerance and dependence, it is not common. An excellent article to read is "Benzodiazepine Use, Abuse and Dependence" by Charles P. O'Brien M.D. Ph.D. A link to this article can be found here:
This article highlights the differences between tolerance, dependence and abuse. This article states that benzodiazepines are rarely a primary drug of abuse and that the actual percentage of people who abuse these drugs is very low. There is a major different between someone who intentionally chooses to abuse a drug and someone who accidentally becomes tolerant or dependent from regular use. Jackson did not appear to suffer from tolerance or dependence when he died though Murray was writing prescriptions which could have easily led to a tolerance or dependence to benzodiazepines. Physicians should be at the forefront of preventing tolerance and/or dependence from occurring. Physicians should be monitoring their patients regularly for signs or symptoms of tolerance or overuse and limiting the amount of medications they prescribe to their patients. Also, Murray never mentioned a fear of Jackson becoming addicted to benzodiazepines--Murray said he feared an addiction to propofol only. Jackson reportedly slept the entire night with the use of midazolam and lorazepam and without propofol on June 23rd. This notion could also indicate Jackson had no tolerance or addiction to benzodiazepines (nor a dependence on propofol as previously discussed).
Jackson did not have any organ damage that would indicate long-term drug abuse. For example, hearing loss from chronic narcotic analgesic (ex. Oxycontin) abuse is common. Liver damage is also a common find among drug abusers since the liver is responsible for metabolizing almost all medications. It appears that chronic propofol abusers (abuse over years) may develop hepatic steatosis or a "fatty liver", possibly from the triglyceride content of propofol. Valvular heart damage from bacterial infections and/or certain kinds of skin damage/demarcations may be seen if someone injects medications regularly with needles. Jackson had none of these theoretical or common signs of abuse. It is known that Jackson used narcotic pain relievers at times. Narcotic analgesics are known to cause accidental dependence and tolerance in many patients. Even if Jackson had a tolerance issue in the past, it is important to remember that no narcotic pain relievers were found in the residence or in Jackson's body. Every medication found in Jackson's system were administered to him by Murray, under his own admittance. Even if some dependency issues arose from the treatment of pain, as Jackson admitted to a pain medication dependency in 1993, this dependency seems to have been treated appropriately as all of his organ systems were in excellent condition other than some lung issues that were minimal and not due to any form of drug abuse. Jackson was determined to have had bronchiolitis and chronic interstitial pneumonitis along with scarring in his lungs. These were likely from autoimmunity issues.
Please realize that all of the information above concludes that Jackson was not the "drug addict" the media has painted him out to be--he ended up being a victim of someone else's actions, not from personal misuse of medications. Everyone in their lifetime has at some point misused a medication, perhaps shared a medication they should not, taken a medication that may not have been necessary for an ailment, etc. That does not mean someone is an addict. In fact, Jackson was at intermittent times on very high doses of prednisone, presumably to treat his discoid lupus. This steroid critical in the treatment of immune diseases could have caused him to have appeared unusually euphoric or "high" at times. Individuals without a substantial medical background may not be aware of such effects with a medication like prednisone. Many people do not understand the basis behind drug addiction, what may lead to it, how the physical components of a drug may actually induce addiction/tolerance/dependence or how many find themselves relying on a medication just to have some sort of livelihood. By far, many who take medications in excess usually do so either from accidental tolerance/dependence formation or from inappropriate self-medication of an ailment. Perhaps they are depressed or suffering from an ailment such as fibromyalgia which then is treated with inappropriate medications or substances. Many people who find themselves using drugs and/or alcohol do so from something a physician cannot see--emotional pain. People in general should be more sympathetic to others who may or may not have a drug problem instead of seeing them as below one's self. Jackson may or may not have had some issues in the past, but it is important to remember he, too, was human. He does not appear to have any long-term damage from any sort of abuse of medications and certainly did not have any issues when he died--other than Murray being in his life.