Talk:Propofol/Archive 1

Archive 1

Milk of Amnesia

not everybody understands the pun "milk of amnesia". i suggest adding "(a wordplay on the term Milk of Magnesia)". —Preceding unsigned comment added by 93.172.26.199 (talk) 20:21, 2 September 2009 (UTC)

Advantages

Advantages of propofol include rapid, clear headed recovery within 5-10 minutes, even after prolonged use, and a reduced incidence of postoperative nausea and vomiting.

{{sofixit}} JFW | T@lk 22:26, 24 July 2005 (UTC)

Half-life

Is the half-life 30--60 min or 2--24 hr?

30-60 min is the elimination phase halflife, as per product information. Initial (re-distribution) phase halflife = 2-4 min. Ld99 11:35, 11 December 2006 (UTC)

Benzyl alcohol

Isn't benzyl alcohol toxic? (Or are they only neurotoxic?) Why would it be used as preservatives? I can't say I've seen such formulations yet. Ld99 11:39, 11 December 2006 (UTC)

Yes I currently use only propofol preserved with benzyl alcohol. Benzyl alcohol toxic? Not really. If you eat a peach and wash it down with a cup of tea you're also getting benzyl alcohol. Perhaps more. (talk • contribs) 03:08, 8 September 2008 (UTC)

Link with Alzheimer's disease

This section is totally absurd. This is the kind of preliminary results that make everyday science, it has not been commented (to my knowledge) and hasn't been extensively scrutinized. It can be then considered as not mainstream knowledge. In a scientific review on propofol, this study will take at most one line, if any. Of note, the journal of publication, Neurochemical Research, is absolutely not notorious. I will therefore remove this section. ^talk 02:14, 2 January 2007 (UTC)

Pain on injection

I hestitate to edit such things, but as a nonprofessional I'm going on what the drugs.com website says, who cites the information provided by the drug manufacturer. I presume they know what they're talking about. --Robert Merkel 02:34, 2 January 2007 (UTC)

Ph-data removal

I have removed the cited pH range for Diprivan as it was incorrect. In fact there are substantial differences between the pH and properties of Diprivan and some of the propofol generics; to explain these would probably fall outside the scope of the article and get into some detailed wrangling over product claims and intellectual property, which is probably not particularly central to the article.

Astrazenece Scientist, 5/1/07 --—Preceding unsigned comment added by 71.207.34.46 (talk • contribs)

Amnesia Effect

I'm a little surprised to find that the amnesia effect of propofol isn't mentioned in this article. http://www.anesthesia-analgesia.org/cgi/content/full/91/5/1056?ck=nck and http://bja.oxfordjournals.org/cgi/content/full/89/3/376 and even in Time Magazine, of all places (http://www.time.com/time/health/article/0,8599,1671492,00.html) (Rabagley 16:15, 18 October 2007 (UTC))

The amnestic effect is as great as that from midazolam. Reference added. This article doesn't need to get into the differences between explicit and implicit memory. Essentially propofol when given for sedation also prevents memory storage. The rest is beyond the scope of this article. Mfbabcock (talk) 04:16, 31 March 2008 (UTC)

Picture

Why does the picture look as though the Propofol is pink? 86.132.164.7 (talk) 10:36, 22 January 2008 (UTC)

Is this perhaps one of the veterinary formulations? All human formulas I've seen are white. Mfbabcock (talk) 03:43, 31 March 2008 (UTC)

Milk of amnesia

Milk of amnesia redirects to this article but the term is not mentioned here at all. ~ R.T.G 11:53, 28 December 2008 (UTC)

It's under the "Chemisty" Section!! "It resembles milk, and is jocularly called "milk of amnesia" by medical professionals." --FJBMinor (talk) 16:11, 1 July 2009 (UTC)

Moved to introduction; bolded it. Tdinatale (talk) 13:32, 11 August 2009 (UTC)

Michael Jackson

Premature speculation at this point 6-30-09 This does not belong in an encyclopedia article without more information and evidence

It's not premature to state that it's mentioned in connection with MJ. Probably will be the largest exposure in public for this drug forever. So, some mention is acceptable, since the Death of Michael Jackson has raised the profile of the drug. Perhaps an in popular culture section could be built. 76.66.193.20 (talk) 23:37, 1 July 2009 (UTC)

Yes it is. At least wait for official results of the investigation. This is an encyclopedia, not a gossip newspaper. —Preceding unsigned comment added by Mfbabcock (talk • contribs) 02:55, 2 July 2009 (UTC)

I agree with Mfbabcock, It's true that a nurse that he talked to mention that he wanted to get a hold of the drug in order to help him sleep and was warned by her not to use it for that purpose, however it's speculation that it was the drug Propofol that the actual a cause or major contributor of death, we won't know until the toxicology test are finished and release 4 to 6 weeks from now, although it very well may be it would be embarrassing is it was written in Wikipedia that this was the cause of death only for the test results to show another cause. I do understand 76.66.193.20 point though about in popular culture, where someone might read a section that read that this drug gained worldwide attention when it was speculated by many in the major press on weather or not this drug had anything to do with his death based on a report that a nurse of of his mention that he had earlier requested it, however I think if it is mention in this manner it should be done after the results, where at that time it would read either it was then later confirmed to be the leading contributing factor or it would read, however it was determined that it was actually the drug xxx that was the cause. —Preceding unsigned comment added by 24.176.132.87 (talk) 05:19, 2 July 2009 (UTC)

The drug was found in his home by police, as reported by the Associated Press. Its inclusion is certainly appropriate now even if it doesn't end up to be a primary cause of death. -- Dougie WII (talk) 02:08, 4 July 2009 (UTC)

     And who is your source for this?  The AP isn't saying.
     Unnamed sources are not appropriate
     for encyclopedia articles.   Anesthesiologist EtherDoc (talk) 01:13, 6 July 2009 (UTC) 

Agreed. Dougie WII's edit has added the relevant information that can be reliably sourced now. ReverendWayne (talk) 04:38, 4 July 2009 (UTC)

But it's information about Michael Jackson, not about the drug. It doesn't belong *here*, it belongs in Michael Jackson's article. - Nunh-huh 09:08, 4 July 2009 (UTC)

The Jackson story has brought this drug to public attention; nearly half the ghits for propofol also refer to Jackson. Articles such as Oxycodone and Erotic asphyxiation also mention individual abusers. Earlier versions of the MJ material in this article gave undue weight to the current news story, but a single sentence of well-sourced information about an incident which has brought attention to this drug is entirely appropriate. ReverendWayne (talk) 18:20, 4 July 2009 (UTC)

That's pretty much what we call "recentism" here at Wikipedia, which is an encyclopedia rather than a gossip rag that speculates about causes of death. If people come here for information about propofol because they've heard about it from Jackson, then they don't need us to tell them about Jackson, then, do they? We don't mention Elvis in our article on morphine, and we shouldn't note Jackson here, either; the info belongs in Jackson's article. If (and only if) propofol is actually determined to be the cause of Jackson's death, should we consider making reference to it here; certainly we shouldn't make notations in the article in every drug found in his residence that it was "found at Michael Jackson's house". - Nunh-huh 22:59, 4 July 2009 (UTC)

I would also note in response to this particular comment that finding Diprivan (generally used only in hospitals) in a private home is extremely unusual (therefore notable) in comparison to other drugs such as narcotic and benzodiazepine drugs that are commonly prescribed and could cause death. -- Dougie WII (talk) 23:50, 4 July 2009 (UTC)

The consensus shown here is that a mention about the drug's possible role in Michael Jackson's death is now appropriate here since it's been reported in numerous reliable sources. You seem to be the only editor who feels otherwise, and are showing WP:OWN tendencies about this issue. Please try to build a consensus in accordance with your opinion before reverting again. -- Dougie WII (talk) 23:04, 4 July 2009 (UTC)

Well, if you insist on crapifying the article, I'll just tag it until common sense - and the general distaste for popular culture cruft - prevails. You are showing WP:RECENTISM tendencies about this article, which is unfortunate. - Nunh-huh 23:08, 4 July 2009 (UTC)

I don't think anyone wants to "crapify" the article, you should learn to WP:AGF. If this drug caused Michael Jackson's death, it'll be the biggest news about propofol ever, and even if it didn't, he obviously abused it with the help of his doctors which still makes it notable. -- Dougie WII (talk) 23:37, 4 July 2009 (UTC)

That's a big "if", and I've already said "if" it killed Jackson, it might merit a brief mention. However, it has not yet been determined to be the cause of death, so you're insisting on including "crystal ball" predictions in the article, simply because they're in the news. That is not the stuff of which an encyclopedia is made: it's crapifying the article, whether you choose to acknowledge that or not. As to notability: if it's notable, it's notable in his article, not this one. - Nunh-huh 00:53, 5 July 2009 (UTC)

"Allegations of recentism should prompt consideration of proportion, balance, and due weight." Including one sentence about a current event does not disturb the article's proportion or balance, and does not give undue weight to that event. WP:RECENTISM does not apply here. ReverendWayne (talk) 06:35, 5 July 2009 (UTC)

Including one sentence about a possible relation to a current event certainly evokes consideration of undue weight. Don't remove tags while discussion is ongoing. - Nunh-huh 06:38, 5 July 2009 (UTC)

Apologies for removing the tag, which I see was not the right thing to do. ReverendWayne (talk) 07:43, 5 July 2009 (UTC)

I agree with this being a place of educational education, not speculation and gossip. I politely request that out of respect for Mr. Jackson the editors remove any mention of him in this article. It is an article about the drug, not about him or any other famous person. These comments belong on a blog where people like to gossip and insult others. This is not my understanding of what Wiki is trying to be. I find it interesting that this has been aloud to stay...

"Diprivan was found by law enforcement officers in the home of Michael Jackson following his June 25, 2009 death, bolstering claims that the medication might have played a role.[21]"

As when I did editing on a page last year, many of my research based editions where removed with a statement that they where "personal" ideology not research related by Zepher. (Despite findings where from a research project and published in several professional & university sites.) How is the above relevant to what Diprivan is and its benefits and ill effects? Please clarify why this is not being removed. —Preceding unsigned comment added by Tparris (talk • contribs) 16:10, 5 July 2009 (UTC)

An unnamed source report by AP does not constitute reliable information for an encyclopedia. A reference to the death of MJ might eventually be appropriate for this article, IF it is ever shown that propofol was involved in his death. That has not yet occurred. EtherDoc (talk) 00:27, 6 July 2009 (UTC) (anesthesiologist)

I do not think Mr. Jackson should be included in NON-MEDICAL use - insinuating that he took it for euphoric reasons described. Mr. Jackson had insomnia. Doctor Murray said he was treating his insomnia. —Preceding unsigned comment added by 78.144.159.73 (talk) 14:46, 2 February 2010 (UTC)

Propofol Addiction

An article first posted in the Journal of Psychoactive Drugs in June 2008 - http://www.journalofpsychoactivedrugs.com/Articles/Propofoleditorial.html —Preceding unsigned comment added by Zimmerme (talk • contribs) 03:13, 4 July 2009 (UTC)

Dangers of Diprivan as Anesthesia In a Controlled Intravenous Setting

Even in a controlled setting intravenous administration of Diprivan by an anestheseologist can have dangers. Upon administration through the active IV, the patient becomes unconscious. Oxygen is monitored with a finger monitor by the physician and anesthesiologist. Respiratory arrest may occur. The patient may stop breathing. When this happens, the doctor and attending anesthesiologist stop the administration of the Diprivan, and are forced to end the procedure, such as colonoscopy. The patient is pulled out of the anesthesia and returned to consciousness. A physician may suggest after the life-threatening reaction that the patient be tested for sleep apnea, and return with their CPAP mask. However, some patients have no sleep apnea and have stopped breathing under Diprivan anesthesia. For a patient to deal with a life-threatening reaction to Diprivan as anesthesia, a course of action is to find another physician who uses a different anesthesia and inform the physician of the patient's life-threatening reaction to Diprivan.Judith Briggs (talk) 05:25, 4 July 2009 (UTC)

The above summary is not written by an anesthesiologist and contains some obvious errors. First, anesthesiologists are physicians. Second, propofol is an anesthetic (although can be used as a sedative). Anesthetic induction ALWAYS produces apnea. When I give propofol I want the patient to stop breathing. That is the goal. Once anesthesia is induced we ventilate the patient and typically insert some type of airway. Artificial respiration continues often till the end of the surgery or until the patient is allowed to return to spontaneous ventilation. When given for sedation, the goal is to keep the patient breathing on his own. We don't stop procedures because the patient isn't breathing. We breath for them. The main anesthetic risk of propofol is hypotension. This reverses quickly and occurs mainly in dehydrated patients. EtherDoc (talk) 00:39, 6 July 2009 (UTC)

Thanks for this info, EtherDoc. I'm getting a colonoscopy this week, and the dr. is using a propofol and fentanyl cocktail. Since I'm prone to dehydration, I'll make sure I drink up the day before surgery.

Simplemines (talk) 13:56, 7 July 2009 (UTC)

If you don't want propofol don't bother having an anaesthetic! Life threatening reaction (in the idiosyncratic sense of the word) are almost unheard of with propofol. Even with people who are allegedly allergic to eggs can have it quite safely. —Preceding unsigned comment added by 124.190.50.27 (talk) 06:29, 15 September 2009 (UTC)

Propofol does not always produce apnoea - it depends entirely how much you administer and how quickly you do it. It is quite possible to give a spont vent GA via an LMA with a TIVA technique. However it is obviously quite a fine line and most colonoscopy sedations could be described as a GA with a hudson mask. However, propofol is quite safe for patients with sleep apnoea as it wears off quickly, thus it does not linger so the patient's sleep apnoea is not exacerbated. —Preceding unsigned comment added by Alantse (talk • contribs) 09:17, 27 August 2009 (UTC)

RfC: Should Michael Jackson be mentioned?

Should the current investigation into the death of Michael Jackson be mentioned at all in this article? ReverendWayne (talk) 07:47, 5 July 2009 (UTC)

No, we need to respect others need for privacy, famous or otherwise here in Wiki.

This is an article on a drug, not a venue for speculation and bias remarks that are certainly not conclusive. We would not tolerate some one putting up information about an unfounded truth on other pages - why would we allow it here?. —Preceding unsigned comment added by Tparris (talk • contribs) 16:14, 5 July 2009 (UTC)

I still stand by my original statement above of 6-30-09. No results from the investigation have been released. Wait until there is some official and reliable information from a reliable named source. As of 7-06-09 there is still none. NONE. Others seem content to add MJ comments to the Propofol article since the AP is reporting on it with unnamed sources. This is crazy. The fact that this is not a paper encyclopedia does not lower its standards. Any current speculation about MJ should be in his article, not one about a pharmaceutical. (an anesthesiologist)EtherDoc (talk) 00:13, 6 July 2009 (UTC)

I agree that reference to medication found at Michael Jackson's home is not particularly relevant to this article (at this point). If it ever turns out that there is some official determination that it played a role in his death, then I can see this article having a sentence or two about it. -- Ed (Edgar181) 00:16, 6 July 2009 (UTC)

It should be mentioned because it is almost certainly going to be the biggest media exposure ever for this drug, and thus therefore a notable event in the history of the drug. 70.29.208.69 (talk) 07:25, 6 July 2009 (UTC)

That's a very nice prediction, 70.29, but we don't include items because of what wikipedian's predict about them. That Michael Jackson used this drug would [1] tell us nothing about the drug, and [2] tell us something about Michael Jackson. Therefore, once some actual facts are established, they belong in Michael Jackson's article, not here. And before they are established, they belong nowhere in Wikipedia. - Nunh-huh 10:56, 6 July 2009 (UTC)

Let's recognize that we're dealing with a question of a temporary nature. I'm confident that if propofol turns out to be the cause of Jackson's death, there will be consensus for including that information in the article, as has been done with Oxycodone for example. The value of mentioning it now is that readers will have confirmation that the drug in question is indeed the one that's in the media spotlight. Readers will expect to see a reference here, and if it's not present they'll assume that Wikipedia is not being kept up to date. Remember that Wikipedia serves a general readership, and most people who see this article are neither medical professionals nor Wikipedia editors.

As for the source, we really do have much more than speculation at this point. The LA Times has been told by police that "numerous bottles" of the drug were found at Jackson's home. That's not merely speculation. It's information from a source that the Times considers reliable, but who is (understandably, in the circumstances) unwilling to go on the record now. ReverendWayne (talk) 13:04, 6 July 2009 (UTC)

Anyone looking for confirmation that this is Jackson's drug will be looking in Jackson's article, not here. Readers who don't find it here won't conclude that "wikipedia isn't up to date"; they'll conclude that we don't crap up articles on serious subjects with crufty popular references of the moment - or, of course, at the moment, that we do. - Nunh-huh 13:24, 6 July 2009 (UTC)

OK, most likely MJ has/had taken propofol at some point, and it may be involved with his death. But unnamed sources are unnamed sources regardless of who quotes them. As long as the information is presented with the caveat that it is merely a report from an unnamed source at least we are being accurate. EtherDoc (talk) 14:28, 6 July 2009 (UTC)

Here's the text from the LA Times: Investigators are focusing on at least five doctors who prescribed drugs to Michael Jackson as they try to unravel the circumstances surrounding the pop star's death, according to law enforcement sources. The names on some of the prescriptions were Jackson pseudonyms, and in some cases, the drugs had no prescription labels on them at all, the sources told The Times. The source, who spoke on the condition of anonymity because it is an ongoing investigation, said some of the bottles were full and others were empty. Hey I like the LA Times too, but they are not revealing their sources. EtherDoc (talk) 14:37, 6 July 2009 (UTC)

I'm not sure why there's a dichotomy here between unnamed and named sources. Of course the sources are not going to be named until some sort of police report surfaces because it's an ongoing law enforcement investigation. It's certainly not on the same level, but if Wikipedia existed in the 1970s would it have included Deep Throat's allegations in its article? I believe so, even though DT was clearly an unnamed source. The main issue, instead, should be that the most famous person in the world has died, his death is being linked to drug which is the subject of this particular article by multiple news organizations, and people will be coming to this article to see what it says. It certainly should not become the focus of this article but it is definitely important enough to be included.--Gloriamarie (talk) 20:33, 6 July 2009 (UTC)

If people come to this article, it will be to find information about the drug. If they want information about Michael Jackson's use of the drug, they need to consult his article. Speculation that it may have killed Jackson doesn't belong here. The dichotomy between named and unnamed sources is well-established: the former are harder to fake, and therefore more reliable. It's not just something Wikipedia made up. - Nunh-huh 20:41, 6 July 2009 (UTC)

Nunh-huh, just to clarify your position, in the event that Michael Jackson's death is attributed to propofol, should this article include that information? Thanks. ReverendWayne (talk) 21:40, 6 July 2009 (UTC)

Sorry, I don't feel answering hypotheticals is any more appropriate than adding guesswork to articles. Let's try something reasonable, like actually waiting until the facts are established. - Nunh-huh 21:46, 6 July 2009 (UTC)

With the time you've saved, perhaps you could review WP:CIVIL. ReverendWayne (talk) 23:00, 6 July 2009 (UTC)

Thanks, but your implication that I've been uncivil is a personal attack. Review that, then. - Nunh-huh 05:19, 8 July 2009 (UTC)

I have come around to agree MJ should be mentioned (article looks good as is). I just wanted to make clear the reliability (or lack thereof) of the current information. Once the official toxicology reports are published this can be added. Ultimately the subject only deserves a couple of sentences in the propofol article and can be covered in depth in the Death of MJ article.EtherDoc (talk) 12:36, 7 July 2009 (UTC)

Agreed. Noting that the information comes from an unnamed source is valuable to the reader. ReverendWayne (talk) 15:34, 7 July 2009 (UTC)

• No, the death of an American entertainer, however tragic to those who knew him personally, has little wider significance and doesn't need to be included in articles about pharmaceuticals. Tim Vickers (talk) 18:16, 8 July 2009 (UTC)

• No, way too early. There will be time enough to gauge this when and if (1) reliable information confirms that the cause of Jackson's death is in some way relevant to this drug, and (2) the relevancy of the drug in connection with his death is somehow strong enough to provide useful information to others about its use in the face of clinical studies and widespread positive use. As for (2), the fact that medications are sometimes abused is of little note without reliable information indicating that such potential for abuse somehow affects decisions as to whether the drug is manufactured or prescribed; a scenario in which one specific individual's abuse of medication leading to death has that effect (even MJ) is difficult to imagine. In that light, assuming Propofol is relevant to MJ's death, it's hard to see how MJ's death is relevant to the nature, existence and use of Propofol. I could see where Jackson's article might link here at some point, but it's awfully hard to see this article linking to Jackson without some truly significant future events. Steveozone (talk) 02:42, 9 July 2009 (UTC)

• Comment I have removed the Michael Jackson reference and the recentism tag. This edit should satisfy the two positions in the discussion that between them appear to be consensus: the view that including this information was premature, and the view that Jackson should not be mentioned here even if Propofol is implicated in his death. For the record, I don't think we have reached a consensus that supports the second view, but that's an argument for another day, if events dictate. If no one has reverted me in the next day or two, I will remove the RfC tag as nominator. ReverendWayne (talk) 17:17, 9 July 2009 (UTC)

• Yes I strongly believe that if the drug is officially implicated as a contributing factor in his death, it warrants a single sentence mention. He is an extraordinarily well-known figure, as an anon mentioned above, "It should be mentioned because it is almost certainly going to be the biggest media exposure ever for this drug, and thus therefore a notable event in the history of the drug." Certainly there is precedent on other pharmaceutical wiki pages like Oxycodone for individual abusers, and I think you would be hard pressed to deny his well-known status. To the issue of whether it is premature, google.com shows 791,000 hits for "Propofol Michael Jackson" and 487,000 hits for "Diprivan Michael Jackson". I note that many of the recent editors are either medical or scientific professionals (as described on their talk pages) or at least primarily edit medical and scientific pages - I assume that you are trying to keep the crap that seeps into many articles out of your areas of interest, a noble goal. However, precedent has already been set and it seems to be a reasonable encyclopedic addition, if minimal and proportional. As for unnamed vs. named sources, there is a named source - Cherilyn Lee who is a licensed medical professional - is a named source by ABC news http://abcnews.go.com/Health/MichaelJackson/story?id=7980996&page=1. So, there is a named source, with a credible citation, and precedent on other pages. Short of a corner report, what more would be needed to be reasonable?Bevinbell (talk) 03:43, 10 July 2009 (UTC)

Lee says Jackson was asking for the drug, but she doesn't claim he got it or used it. Otherwise I agree with your comment. ReverendWayne (talk) 15:14, 10 July 2009 (UTC)

• IMHO, Michael Jackson should not be mentioned until the results of the investigation are made public (and I'm not talking about "anonymous law enforcement sources") and should be mentioned if the results prove he received propofol before his death and/or directly implicate propofol in his death. Simple as that. Should we mention that MJ seems to have procured the drug, regardless of whether it contributed to his death, as suggested above? I'm not sure. Fvasconcellos (t·c) 03:52, 10 July 2009 (UTC)

• Of course it should be mentioned, regardless of whether or not it actually killed Jackson. Either way, Jackson's death is what brought propofol into public awareness and debate. In other words, Jackson's death has played a role in the social history of the drug, and "History" is a standard section of WP:MEDMOS drug articles. And, even if Jackson didn't die from propofol, he is noted to have requested it off-label--and off-label use is included in "Legal status", another standard MEDMOS section. The official results of the investigation could determine how much weight this article should give to the incident, as well as whether or not it ought to name the administering physician. But the unofficial result is that the drug has entered public consciousness (no pun intended). Perhaps the problem is that it's hard to tell just where Michael Jackson would fit into an anaesthesiology article. If so, then the MEDMOS offers a solution (again, no pun intended). Cosmic Latte (talk) 01:21, 29 July 2009 (UTC)

• Notability criteria reached, even if Propofol is not substantiated to be the cause of Jackson's death, the claim that it was will now remain the most notable fact about this drug to the average reader given the cultural importance of Jackson's death and theories about this mystery. Encyclopedia content about a chemical is neutral in regard to kind of associated information. Normally this information will be scientific but myths and widely held false beliefs need also to be mentioned (with their status i.e. believed, myth, proved wrong) if they have a high level of notability. One criteria for inclusion is the question "would someone come to this page about this information" if so it should be mentioned in an appropriated way i.e. "Michael Jackson's death was attributed to Propofol with early criminal investigation of his doctor centered upon its inappropriate administration. However this was ... --LittleHow (talk) 05:30, 29 July 2009 (UTC)

"Abuse" is POV

I renamed the section "recreational use", because "abuse" implies that something is wrong, or immoral, that definitley qualifies as POV.--Metalhead94 (talk) 23:14, 17 July 2009 (UTC)

No, it implies it is outside the prescribed use, which it is, so I've restored it. It's also stupid, as recent events demonstrate. - Nunh-huh 23:23, 17 July 2009 (UTC)

I stand by my previous statement, "abuse" is POV and you saying "It's also stupid" just reinforces my point. We could at least use the term "Misuse" to avoid the stigma the term "abuse" has.--Metalhead94 (talk) 23:26, 17 July 2009 (UTC)

Feel free to issue a request for comment. And you not realizing it's also stupid just reinforces my point. - Nunh-huh 23:35, 17 July 2009 (UTC)

Of course you could call overdosing on it stupid, however, those people aren't using propofol "properly" recreationaly or medically if there ending up in the hospital.--Metalhead94 (talk) 23:49, 17 July 2009 (UTC)

And "properly" is just another POV word. - Nunh-huh 00:09, 18 July 2009 (UTC)

Keep Abuse - does this really merit a discussion? Are you on 9/11 and editing out the word terrorist too?Bevinbell (talk) 00:15, 18 July 2009 (UTC)

I see no problem with using the word abuse here. Recreational use is not quite the same thing. For example, using propofol for insomnia, as the tabloids claim may have happened in a recent high-profile case, is abuse but not really recreational use. ReverendWayne (talk) 02:04, 18 July 2009 (UTC)

"Recreation" describes why the patient/user was using (not good here based on sources to date and reflects poorly on certain living persons). "Abuse" seems to imply enabling and complicity by prescribing or administering (and living) healthcare professionals. How about "Anesthesia" to describe "apparent" or "alleged" "misuse" of a medication that multiple sources indicate is not conventionally prescribed or used outside of a hospital? This all will settle down in a few weeks; in the meantime, I suspect most readers understand the meaning of "anesthesia" in this particular context, and that will serve well to describe the controversy, at least until the autopsy report is actually released. Steveozone (talk) 05:44, 18 July 2009 (UTC)

Oh, IMHO "anesthesia" might accurately be referred to as "requested" with good sources (if there are any) Steveozone (talk) 05:56, 18 July 2009 (UTC).

Abuse of a drug, in my opinion, is meant to mean use outside of the generally accepted medical prescribing guidelines. In the case of Diprivan, any use outside of a hospital or other medical setting (such as a highly equipped doctor's office) is not recommended, therefore use in a private home lacking resuscitation equipment and medical staff would therefore be a clear abuse of the drug. -- Dougie WII (talk) 06:46, 18 July 2009 (UTC)

There's quite a few assumptions (possible but not established) lurking in that proposition. "Would therefore be" is a big hurdle at the moment, particularly in an article about the drug itself. "Misuse" will better generally describe a phenomenon in general, that might later be shown to include a certain specific current event involving specific conditions and conduct that might at some point fairly be called "abuse." Steveozone (talk) 23:19, 19 July 2009 (UTC)

The main problem with "abuse", as I see it, is it seems POV, it has a stigma around it, as I have already stated, and, besides that, its not a very clear term anyway, the Drug abuse page itself states that it has a huge range of definitions, mainly depending on who is telling the story. "Misuse" seems a better term in that it has less stigma around it and it clearly describes using a drug outside of its accepted medical use.--Metalhead94 (talk) 14:43, 19 July 2009 (UTC)

"The references use the term "abuse" (Nunh-huh)

Good point. I found a reputable reference that describes safe use of this drug for the purposes of non-long-term recreation, so I trust you will honour this revision. InternetMeme (talk) —Preceding undated comment added 14:15, 23 July 2009 (UTC).

No, what I asked you is to achieve consensus before making unilateral changes, so it's back to "abuse" until that's done. The reference you chose actually refers to "recreational purpose", not recreational use: but the point was not for you to find a reference to support the term you'd rather be used, but to use the term used by most reliable sources. We don't head the section "Lethal Self Administration" just because we can find a reference for that, either. And the heading you've chosen ("Short-term recreational use") seems to have no basis in the reference: the point of the authors is not that "recreational purpose" is safe, but that it's unusual. I might add that it might be useful for you to consider the fact that "use at home to induce sleep in an insomniac" is abuse, not recreation. - Nunh-huh 14:46, 23 July 2009 (UTC)

Firstly, according to "Thesauraus.com", "use" is a synonym for "purpose" ([1]), so your initial point serves no use, or purpose. Your insistence of making a distinction between these terms might therefore be described as splitting hairs. Secondly, it's a matter of opinion as to what the purpose of the previously referred article is. That article (a) Clearly states the term "recreational purpose" (which—as mentioned—is a synonym for "recreational use"), and (b) that "deaths due to recreational purpose are unusual", which somewhat serves to mitigate the notion that recreational use is neccessarily hazardous (and thus abusive).

In conclusion, my point remains: This section separately and distinctly covers both the recreational use and abuse of propofol, and therefore the heading of this section should reflect that fact.

Also of note is the fact that the section heading Recreational use is common in most psychoactive drug articles. If the articles on Wikipedia are to remain consistent, then a consistency of headings should be applied. InternetMeme (talk)

Addendum: Also, in reference to your sentence

"the point was not for you to find a reference to support the term you'd rather be used"

I'm not trying to substitute a term that I'd rather be used instead of your term. I'm trying to present a term that is widely accepted on Wikipedia in addition to your preferred term. InternetMeme (talk)

Again, you've misread the abstract if you think it supports the notion that "recreational use" is not hazardous. "Recreational use" may be common in psychoactive drug articles, because those specific drugs are commonly used recreationally. Propofol is not. As for consistency, I refer you to Emerson. This would be a clear instance of a false consistency. - Nunh-huh 02:10, 24 July 2009 (UTC)

Okay, I think I misunderstood your argument slightly. So you're not trying to say that recreational use of propofil is impossible, you're saying that it's uncommon. That's fair enough.

Well, the main thing I'm trying to say is that the only time that propofil is abused is as a result of excessive recreational use. So, without the recreational use of propofil, there wouldn't be any abuse of propofol. Hence the idea of amending the heading to "Recreational use & abuse"; you can't have abuse without first having recreational use. InternetMeme (talk)

Yes, I know that's what you're trying to say, and it's still wrong. Consider for argument's sake that propofol is indeed the drug that killed Michael Jackson, and that he was using it as a sleeping aid. That's not a recreational use: it's an abuse of a drug, without any "recreational" purpose. - Nunh-huh 11:02, 25 July 2009 (UTC)

So, are you saying that (accidentally) overdosing on a drug (irrespective of the intended effect of the drug) is abuse, or are you saying that using a drug as a sleeping aid is abuse? The second explanation doesn't make sense to me. InternetMeme (talk)

Using the drug as a sleeping aid is an abuse; using it at home is an abuse; using it without proper monitoring is an abuse. Overdosing is a mistake. But using a drug for a medical condition it was not approved to treat (i.e., using the wrong drug) is not recreation. - Nunh-huh 23:20, 25 July 2009 (UTC)

Isn't there still a problem then, in the definition of "proper monitoring" (proper how?) and that this idea excludes any possibility that proper monitoring for a potential off-label use might be achieved in a "home" or other setting outside an established hospital (where the "home" is staffed and equipped in a manner unlike most one would ever encounter)? Is that "abuse" without further consideration of additional facts? I'm not looking to expand acceptable uses here, but whatever language is used, this header is soon likely to be under huge scrutiny. Depending on the specific wording, the header (and this section) could potentially cause very ugly BLP problems for a certain doctor if a certain recent news event plays out the way that it seems to be headed. Steveozone (talk) 00:49, 27 July 2009 (UTC)

The only problem is if Wikipedians start deciding what is abuse and what is not, or what monitoring is proper. The FDA has approved propofol for the following: initiation and maintenance of monitored anesthesia care sedation, combined sedation and regional anesthesia, induction and maintenance of general anesthesia, and intensive care unit sedation of intubated mechanically ventilated patients. The label includes a warning that it should be administered only by persons trained in the administration of general anesthesia, and that sedated patients should be "continuously monitored", with "facilities for maintenance of a patent airway, providing artificial ventilation, administering supplemental oxygen, and instituting cardiovascular resuscitation" immediately available. The monitoring required is "for early signs of hypotension, apnea, airway obstruction, and/or oxygen desaturation": in short, blood pressure monitoring, respiratory monitoring, and blood oxygen content measurement. Use outside a facility equipped to do this is clearly abuse. If someone runs into problems because he participated in such an activity, that a problem, but it's not a BLP problem as long as we present documented facts rather than indulging in apologetics. - Nunh-huh 02:39, 27 July 2009 (UTC)

I am 10000% with Nunh-huh on this one, its clearly off-label abuse, if not down-right malpractice if the press reports prove true. I don't know how you can argue use for insomnia is anything but abuse. Certainly not recreation. Misuse seems too light of a treatment.Bevinbell (talk) 02:43, 27 July 2009 (UTC)

Oh, I very much agree that Wikipedians should not be deciding for themselves whether a given set of facts constitutes "Abuse." That is the problem. I've commented on that aspect of things above. The point is, whatever label is used for this section, there are likely to be some furious new additions to this section in coming days, none of which will tell us much about the drug itself, but many of which will mention a certain doctor, by name, and without any sort of systematic and logical collection of sourced facts that would justify a term that implies/requires such a collection of facts. Nunh-huh, I think we are much closer in concept here than you may realize. My very specific point is, it is very likely that "all hell will break loose" in this section of this article, well before anyone attempts to collect sourced facts establishing everything itemized in your immediately above post which thoughtfully describes an appropriate distinction between use and abuse. It would be very unfortunate if that sort of incomplete information is furiously posted under a heading which says..."Abuse." Steveozone (talk) 03:02, 27 July 2009 (UTC)

Improper or inadequately cited additions will be dealt with by removal. It doesn't matter where on the page they're posted; they just have to be eliminated. If there is too much to deal with, the article can be partially or completely protected. I wouldn't oppose preemptive protection, but that's really not an option. - Nunh-huh 03:07, 27 July 2009 (UTC)

Fair enough; and I also hope and expect that. But, what will happen when a specific name is introduced in the next paragraph of this section, where that person is deceased, and propofol is implicated according to a reliable source? Assume also that there are living people who are known to have been present in the same place where said decedent is discovered in cardiac arrest, without any information beyond hype that would indicate involvement of any specific such living person in the implicated use of propofol (imagine that the use of the substance will be "confirmed" by RS before there is any real information beyond hype as to involvement of any such persons). Now what? Steveozone (talk) 03:40, 27 July 2009 (UTC)

If a sentence is in the wrong place, it should be moved. But the statement you describe doesn't sound like it belongs in this article at all. A sentence that might be placed here would, if the facts support it, be something like "Because the coronor of Los Angeles found that the death of X was caused by propofol, the FDA placed the drug on its schedule of controlled substances." Any further detail would belong elsewhere, because it wouldn't be about the drug per se. - Nunh-huh 03:45, 27 July 2009 (UTC)

I think I agree with that (we'll see when something along that lines happens way down the road) but, putting it another way, shall we agree that there is a big difference between (1) describing the characteristics, clinical experience, and social history of a drug based on the broad population of use, and (2) news reporting of any specific individual outcome that might be related to the use of that drug? Steveozone (talk) 04:27, 27 July 2009 (UTC)

I would like to think that would be self-evident. Experience suggests otherwise :) - Nunh-huh 04:54, 27 July 2009 (UTC)

[removing indent]

How about the term "Non-FDA approved uses" for the heading? I think that covers most of our various perspectives.

Incidentally, all the FDA approved uses involve high doses commensurate with some level of general anaesthesia. One would expect that medical monitoring would be neccessary at these doses, as it would be for high doses of alcohol, codeine, or one of many other drugs.

Taken at proportionally low doses, then, is there any reson to assume that propofol is any more hazardous than alcohol, codeine, etc? InternetMeme (talk)

If you have a reliable source that says low doses are safe, produce it. If you have a reliable source that says monitoring is unnecessary, produce it. If you have a reliable source that says propofol is as safe as alcohol, produce it. Otherwise, please don't waste our time with this sort of nonsense. The fact that you'd like it to be a safe drug doesn't make it one. - Nunh-huh 13:07, 27 July 2009 (UTC)

To put your proposition another way: Do you have any reliable source to suggest that—at low doses—propofil is un-safe? I've already provided a reliable source that suggests that propofil can be used safely without medical supervision (Brugada-like EKG pattern and myocardial effects in a chronic propofol abuser)

Out of curiosity, other than the usual suspects (alcohol, caffeine, paracetamol, etc) What drugs do you regard as "safe"? InternetMeme (talk) 16:13, 27 July 2009 (UTC)

The source you cite suggests no such thing. Please don't misrepresent sources. And since the low-dose distinction is something that you simply made up (you apparently mean lower-doses-than-what-the-FDA-calls-low-dose, since they consider that low dose propofol requires monitoring), it's up to you to supply a source that supports the point you seem to want to make. - Nunh-huh 16:23, 27 July 2009 (UTC)

Really? Well, as I asked before, other than the usual suspects (alcohol, caffeine, paracetamol, etc) What drugs do you regard as "safe"? InternetMeme (talk) 16:29, 27 July 2009 (UTC)

I'm not in the business of making that judgment; that's FDA territory. The risks of propofol are many times that of most other scheduled drugs, which is why there are so many warnings in the FDA required labeling; I see no particular reason to endeavor to list the many drugs that are safer than propofol, and it would be as unenlightening for me to do so as it would be for you to list the drugs you consider more dangerous than propofol. - Nunh-huh 16:35, 27 July 2009 (UTC)

Well then, would you consider any non-FDA approved use of a drug to be abuse? InternetMeme (talk) 16:49, 27 July 2009 (UTC)

No, clearly there are drugs which are used off-label both safely and efficaciously. Use which specifically violates FDA warnings, however, and use which would leave a physician open to disciplinary or legal action, seems to fall quite squarely into the category "abuse". - Nunh-huh 17:11, 27 July 2009 (UTC)

I strongly agree that the term "abuse" is inherently non-neutral that has no objective definition. Therefore it violates the Wikipedia:Neutral point of view policy and is inherently non-encyclopedic. Therefore, is a long-established consensus on Wikipedia to avoid the term "abuse" in drug-related articles and to use more exact terminology depending on the context, such as non-medical use, recreational use, illegal use, off-label use, use... Cacycle (talk) 02:51, 28 July 2009 (UTC)

Excuse me. Just a country anesthesiologist here. The term "abuse" is a medically accepted term for the non-medical use of pharmaceuticals in ways the manufacturer has not indented. Clearly if anyone takes propofol "recreationally" this is abuse. Furthermore it is not safe. The reference listed as showing "a reliable source that suggests that propofil (sic) can be used safely without medical supervision" doesn't show that at all. You can be quite assured the authors of that article do not consider any non-medical use of propofol safe. This has nothing to do with use of other recreational drugs. Getting anesthetized is not the same as getting high. Propofol needs to be given IV and often causes apnea. One can recreationally use marijuana or cocaine but not so easily propofol. Similarly one cannot easily use succinylcholine or pancuronium (look it up) recreationally, but one can abuse these drugs and die in the process. Apparently MJ was so tolerant of narcotics and hypnotics that he assumed he needed an anesthetic to "sleep". Propofol doesn't cause sleep, it causes anesthesia which is quite different. This is abuse not recreation. Very sad. No physician should have aided this descent.EtherDoc 04:22, 28 July 2009 (UTC)

Well, how about the headings "Off-label use" or "Non-medical use"? Although the term "abuse" is no doubt commonly used in medical literature (which obviously has a bias in favour of the exclusive medical use of drugs), Wikipedia is not a medical journal. Encyclopedias tend to use more general terms. Btw, I believe there are forms of propofol that can be administered orally.

The article I linked states that "Cases of death are reported due to medical use of propofol, whereas deaths due to recreational purpose are unusual". It then goes on to detail a (presumably unusual) death due to long-term recreational use. I think most drugs are hazardous when taken long-term. InternetMeme (talk) 12:38, 28 July 2009 (UTC)

EtherDoc: I totally agree that non-medical use of propofol is not a safe thing, but that is not the point. Wikipedia is an encyclopedia and as such has a much broader perspective and therefore requires a different, in this case more exact, terminology. "Abuse" in the medical literature and language always means "use that we as doctors do not like". Wikipedia is not (only) for doctors and it aims at an encyclopedic, neutral point of view, so we need a more exact and unbiased language here. I tend to prefer "non-medical use", "off-label use" often implies a legit medical use. Cacycle (talk) 12:58, 28 July 2009 (UTC)

Actually, NPOV requires that we use the most common term rather than make up our own terms to suit the agendas of wikipedians. That common term is "abuse", as demonstrated by its use in our references. - Nunh-huh 13:03, 28 July 2009 (UTC)

• "Abuse" is the wrong word for a few (in my estimation, glaring) reasons. First, what Cacycle just said. Second, of course it's POV. What three-fourths of Europe might call "moderation" would be (at least colloquially) deemed "teenage alcohol abuse" in America, where we also find such curious attractions as the Amish town of Intercourse and--around the corner and back to the point--the criminal offense of practicing oncology. It's elementary relativism--not so much, one might say, a matter of WP:WEIGHT being due or undue as it is a matter of weight being metric or customary. A third problem arises in the article's idea of "recreational abuse". Not to be confused with roid rage or with good, old-fashioned headbutts during soccer games, this looks like an amalgamation of recreational drug use and substance abuse--both of which have legitimate definitions on their own, but neither of which (for reasons I'll get to in a moment) seems entirely adequate here. Anyway, according to the article, "recreational abuse" means "mild euphoria, sexual hallucinations, and disinhibition". Really? The first and third of these are typical of baseball games and Southern Baptist Sunday services. So which is it, then--the "sexual" part or the "hallucinations" part of the second symptom--that ought to raise everyone's Abuse Antennae? According to the experts, it is neither. Rather, there must be "a maladaptive pattern of substance use leading to clinically significant impairment or distress". No huge pattern, no huge impairment, or no huge distress? Then no abuse. If nothing else, the term "abuse" is too narrow (it is, after all, a formal diagnosis, subject to doctor-patient confidentiality) for the information that's trying to get by it in the article. The concept of "recreational drug use" is more spacious, but by the time people are taking drugs primarily to ward off the painful or even fatal symptoms of withdrawal, they're probably not engaging in what one would precisely call "recreation". Or (in deference to the article's odd omission), if Michael Jackson really did take propofol to fight insomnia or pain, then as much as he might have met the official criteria for substance abuse, he probably was not having a whole bundle of fun. So, if "abuse" doesn't properly account for all of what the article is trying (or may try) to say, and if "recreational use" isn't a whole lot better, then what's the best alternative? I'd go with distinct mentions of socially deviant (i.e., illicit, off-label, or unlicensed) use and physically dangerous possibilities (especially contraindications, adverse effects, and overdose). And, as luck would have it, so would Wikipedia's medical community, which has written a prescription for precisely this arrangement. Cosmic Latte (talk) 08:57, 29 July 2009 (UTC)

Well, in light of this, I for one favour the term "Off-label use". InternetMeme (talk) 13:01, 29 July 2009 (UTC)

"Off-label use" is in no way appropriate for this section; it implies legitimate and effective medical use which is simply not approved by a regulatory body, and is not in the "spectrum" of "socially deviant" drug use, as you put it. "Abuse" is an accepted and acceptable term, but it is controversial and poorly defined, so I don't support it either. Instead, I would recommend "Misuse", "Harmful use", or "Non-medical use"; whichever you folks choose, "Off-label use" has to go. Fvasconcellos (t·c) 12:57, 30 July 2009 (UTC)

break

Sorry Cosmic, I'd see "Abuse" as the most succinct and apt way of describing non-prescription use of propofol. Medical and psych textbooks use the term abuse (or misuse) all the time in when discussing recreational use. Usually only in a title or section heading, and then generally just use "use" through the text. Casliber (talk · contribs) 13:08, 30 July 2009 (UTC)

I don't see any good reason why one word is better than the other. I had a look through the Wikipedia:WikiProject Pharmacology FA and GA class articles. Among the FAs, "Anabolic steroid" and "Bupropion" refer to abuse. "Anabolic steroid" uses the term "Ergogenic use and abuse". "Bupropion" describes "Abuse liability". Of the GAs, "Alprazolam", "Benzodiazepine", "Benzylpiperazine", "Ethanol", and "Opium" are drugs of abuse. The terms used in these articles:-

1. Alprazolam: "Recreational use"
2. Benzodiazepine: "Drug misuse"
3. Benzylpiperazine: no term explicitly used (I think because this drug does not have therapeutic use)
4. Ethanol: no term explicitly used
5. Opium: "Recreational use"

I'm unconvinced that this is enough to set a precedent. However Wikipedia:WikiProject Pharmacology/Style guide recommends use of the title "Illicit use". To me, that guideline seems to be as good as any other proposed section title here. We should try to keep this article in line with the guideline and use the section title "Illicit use". Axl ¤ [Talk] 17:02, 30 July 2009 (UTC)

Although the term "Abuse" is commonly used in medical literature, the term is subjective, and therefore has no place in an encyclopedia.

"Illicit use" is an objective term, and is appropriately encyclopedic. InternetMeme (talk) 17:18, 30 July 2009 (UTC)

A couple people have noted that the word "abuse" appears in plenty of medical literature. I don't deny that it frequently pops up--particularly in textbooks, which by their nature have to make some compromises between semantic precision and efficient/intuitive communication. People have an intuitive sense of what "abuse" and "addiction" mean, and even physicians and clinicians can discern a family resemblance among "drug abusers" or "drug addicts". So it may be practical and convenient even for some well-grounded literature to use these words in ways that aren't too conceptually nitpicky. An encyclopedia, however, doesn't make such compromises; not entirely unlike a dictionary, it's necessarily hypersensitive to the terms it uses, given its capacity to devote article space to any of these terms. An encyclopedia would not, for example, define cocaine as a narcotic, even as some officials and professionals get away with doing so in other settings. And "abuse" just is not an exacting way to characterize any sort of deviant and/or dangerous drug use. For one thing, abuse is a DSM diagnosis that excludes any sort of use that isn't downright harmful. Secondly, the ICD is even more to-the-point; it doesn't even bother with "abuse", and leaves no doubt that only "harmful use" is clinically alarming. So, of all the medical sources that use the term "abuse", the one with the most WP:PROMINENCE (yes, ironically enough, that's a redirect to WP:DUE), the DSM, uses it to the exclusion of much "recreational use". Meanwhile, the DSM's equally authoritative counterpart, the ICD, excludes the word entirely. As this is by all accounts a medical article, medical precision is in order, and WP:MEDMOS is as relevant as ever. Probably all of what this article has called "abuse" fits properly under the MEDMOS heading of "legal status", in the subheading of "illicit use". Cosmic Latte (talk) 18:50, 30 July 2009 (UTC)

Actually, what was noted is that the word "abuse" is preferentially used in the medical literature. The reference are to journal articles, not textbooks! Medical literature is, despite your assertions to the contrary, generally more accurate than encyclopedias, and certainly more accurate than one anyone can edit. "Abuse" is not, as you claim, a "compromise"; rather the compromise is the alternative you prefer. The DSM is irrelevant, as no psychiatric diagnosis is being entertained or postulated, and the ICD is equally irrelevant. We're discussing a heading, not a diagnosis. As for "illicit use", that simply means "illegal", and fails to account for variations in laws and jurisdictions. "Abuse", on the otherhand, is abuse no matter what jurisdiction it occurs in. - Nunh-huh 19:13, 30 July 2009 (UTC)

Well, look at it this way for a moment: Ask the question "why do these uses constitute abuse?"

If it's because they are uniformly bad for you, then use the term Hazardous uses. If it's because they are uniformly illegal, then use the heading Illicit use. If it's because they don't fall within the uses prescribed by the medical community, then use the term Non-medical uses, etc. If it's a combination of these things that aren't covered in the main description of the drug, then use the term Other uses.

But you need to get one thing straight: abuse is a subjective term, and subjective terms have no place as headings in an encyclopedia. InternetMeme (talk) 20:12, 30 July 2009 (UTC)

[edit conflict] I'm not saying that "medical literature" is less "accurate" than "encyclopedias", but rather that medical writing of an encylopedic nature can't cut as many semantic corners as can medical discourse of other varieties (e.g., textbooks, one of which Wikipedia is not). And of course the DSM and ICD are relevant; they're the sources that stipulate what the medical community is (formally, i.e., preferentially) talking about in the first place. (So, even if a trillion sources used the word "abuse", they would be of little relevance here if they're meaning to invoke the DSM understanding of substance abuse as a maladaptive pattern of behaviour leading to significant impariment or distress.) Diagnosis is, you might say, a form of applied definition. And, speaking of definition, illicit is not just a synonym for illegal, but also encompasses deviance and social nonacceptance. Cosmic Latte (talk) 19:40, 30 July 2009 (UTC)

InternetMeme, the term abuse is not subjective: we'd just be copying the majority of sources. Yes: declaring a given activity to be abusive is inherently a statement of POV. But the important point here is that we are not making that statement: our sources are making that statement. Sources are allowed to have a point of view, and to have their view accurately represented in Wikipedia. If the majority of high-quality sources call it abuse, then so will Wikipedia. WhatamIdoing (talk) 19:48, 30 July 2009 (UTC)

Bingo. Fvasconcellos (t·c) 21:47, 30 July 2009 (UTC)

Please refer to 'Cosmic Latte's input above, the section starting with "A couple people have noted that the word "abuse" appears in plenty of medical literature. I don't deny that it frequently pops up--particularly in textbooks, which by their nature have to make some compromises between semantic precision and efficient/intuitive communication . . ." InternetMeme (talk) 20:12, 30 July 2009 (UTC)

I don't like "abuse" either, but we follow the sources. Fvasconcellos (t·c) 21:47, 30 July 2009 (UTC)

I would say that abuse is preferable to recreational use (a politically correct term in current use). Abuse is the term commonly used by authoritative sources, while recreational is more common in popular usage. Fuzbaby (talk) 22:47, 30 July 2009 (UTC)

Strongly believe abuse is the proper term. It's supported by various authoritative sources, including those cited in the actual article and is commonly understood vernacular. Clearly there is strong opinion and there is not a consensus either in this article, or among similar articles. In reviewing history, abuse has been used on the article for some time with no comment or debate. In addition, in reviewing edit history and discussion on the MEDMOS talk pages show that the topic has had little discussion or consensus Bevinbell (talk) 23:29, 30 July 2009 (UTC)

Abuse is a judgmental and biased term that always carries the connotation of disapproval of the non-medical use of a drug. It is also a ambiguous and imprecise term, making it essentially a catch phrase.

We are an encyclopedia, we care about the technical expertise found in the scientific literature but we are not simply parroting their lingo, especially if that would interfere with our fundamental policies (like the use of neutral language). Please also note that medical authorities, including DSM, ICD, and WHO [2] avoid the term for the stated reasons. Cacycle (talk) 14:05, 3 August 2009 (UTC)

Abuse: To beat a dead horse

I appreciate the preceding thoughtful, respectful & enlightening discussion. Sorry to beat a dead horse, but I feel like I should weigh in. Many dictionaries define "abuse" as nearly synonymous with "misuse":

• 1. To use wrongly or improperly; misuse: abuse alcohol; abuse a privilege.
• 2. Improper use or handling; misuse: abuse of authority; drug abuse.
• Definition of "abuse" in FreeDictionary.com

With respect to propofol, for the purposes of this discussion, I vote for the term "abuse". "Abuse" implies more than just misuse---rather it implies the intentional misuse of a drug. Any form of recreational use of propofol is abuse IMHO, because it is both intentional and it is also misuse. Furthermore, propofol is not like alcohol, marijuana, or even heroin, where there may arguably be a "safe" level of recreational use. The therapeutic window for propofol (e.g., the difference between the plasma level at which euphoria is produced and that at which apnea is produced) is extremely narrow. This renders propofol to be a drug which is practically impossible to use in a recreational capacity, unless one considers Russian roulette to be a form of recreation.

Misuse is not quite accurate, because one can misuse a drug unintentionally (example: you mistakenly took a Viagra pill, thinking it was aspirin).

Illicit use is also not quite accurate, because a drug can be used legally and still fall within the definition of "abuse". (example: a physician who lacks specific training in airway management, who administers propofol to a patient in a licensed facility to induce anesthesia for a liposuction procedure). In this case, the use is not illicit, but it is both "intentional" and "misuse", and therefore qualifies as "abuse".

Full disclosure: I am a practicing anesthesiologist with 20 years experience. I mention this only so that you can understand my bias, as well as my credentials with respect to this subject. The above is presented as opinion, and not as indisputable fact. I honestly hope my comments will clarify this matter, and not further cloud the issue. (Comments added by DiverDave)

Hey, that's great input. This dead horse just won't stay down, so the administration of some further beating is quite acceptable. I'll read over your points, and consider them carefully. In the mean time, I'd offer the following input:

Abuse Is again, not quite accurate. A person might legitimately and successfully use propofol to promote sleep, or for recreation, with no harmful side-effects. And, to direct a beating in the direction of another fatally wounded horse, I might add that—according to [dictionary.reference.com Dictionary.com]—"abusive" use is:

1. to use wrongly or improperly; misuse: to abuse one's authority.

2. to treat in a harmful, injurious, or offensive way: to abuse a horse; to abuse one's eyesight.

3. to speak insultingly, harshly, and unjustly to or about; revile; malign.

4. to commit sexual assault upon.

5. Obsolete. to deceive or mislead.

Now, as I said, a person might take propofol for the purpose of promoting sleep, or feeling sensations such as "mild euphoria, sexual hallucinations, and disinhibition". Firstly:

1. wrong and improper are subjective terms, and therefore can't be used in an encyclopedia.

2. The article I referenced previously states that "deaths due to recreational purpose are unusual". Is there any evidence that recreational use of propofol is uniformly harmful or injurious?

3. Use of propofol for any purpose is not insulting, harsh, or malignant to most people.

4. Use of propofol for any purpose does not generally constitute sexual assault.

5. Use of propofol for any purpose is not deceptive or misleading, unless it is acquired on the pretence of some other intended use.

So, I think it's pretty clear that the term "abuse" is even less appropriate than the other terms available. What do you think of the term "Off-label use"?InternetMeme (talk) 14:22, 31 July 2009 (UTC)

no harmful side-effects I think is a point of contention. Fuzbaby (talk) 16:46, 31 July 2009 (UTC)

Well, if propofol uniformly had harmful side-effects, then surely anaesthetists wouldn't use it in hospitals, right? I mean, even peanuts have harmful side-effects for some people. Is peanut consumption "abuse"? InternetMeme (talk) 19:19, 31 July 2009 (UTC)

I'm sorry, but that is a completely, completely malformed analogy :) Some people are allergic to peanuts; peanuts don't produce "side effects" when consumed. All drugs, uniformly, are uniformly capable of producing adverse effects. For the love of God, paracetamol/acetaminophen can and will produce some of the most horribly unpleasant toxic effects possible when taken in excess!

Furthermore, we shouldn't be checking dictionaries for the definition of abuse and then weighing whether non-medical use of propofol is best described as such. In my opinion, that is some truly egregious original research. As I said above, the sources—both scientific and popular—call it "abuse". That's enough for Wikipedia to call it abuse. It is not "POV" in the Wikipedia sense of the word; on the contrary, it is accurate representation of the current way this use is characterized, by physicians, journalists, etc.

An aside: propofol doesn't really "promote sleep". The anesthesia/sedation induced by propofol are physiologically distinct from actual sleep. Fvasconcellos (t·c) 19:13, 31 July 2009 (UTC)

Heh, the peanut argument was a bit silly; I was just making a point about uncommon effects of the consumption of various materials. In regards to the idea of using terms verbatim from sources, please refer to Cosmic Latte's input above, the section starting with "A couple people have noted that the word "abuse" appears in plenty of medical literature. I don't deny that it frequently pops up--particularly in textbooks, which by their nature have to make some compromises between semantic precision and efficient/intuitive communication . . ." InternetMeme (talk) 19:24, 31 July 2009 (UTC)

Fvasconcellos, "adverse drug reactions" are usually used to describe harmful effects occurring with normal drug doses. Harmful effects arising from excessively high doses are usually described as "overdose". Of course there is some overlap between these sets of harmful effects. Also, you may be interested in these articles:-

• Overnight sedation with midazolam or propofol in the ICU: effects on sleep quality, anxiety and depression
• Changes in subjective sleepiness, subjective fatigue and nocturnal sleep after anaesthesia with propofol
• Recovery from sleep deprivation occurs during propofol anesthesia

Axl ¤ [Talk] 20:01, 31 July 2009 (UTC)

Ah. I didn't mean to imply that overdose = ADR (hence my use of "horribly unpleasant toxic effects"), sorry if it came out that way :) Maybe "adverse events" would have been a better collocation...

Those links are indeed very interesting—I wonder if the similarities between anesthesia and sleep have been studied more systematically. That would probably make for some cool reading. Fvasconcellos (t·c) 03:41, 1 August 2009 (UTC)

It bears noting that User:Bevinbell recently added the term "abuse" to the Wikipedia Manual of Style. I'm not sure that this is good practice in this situation. InternetMeme (talk) 19:38, 1 August 2009 (UTC)

why not? how about a discussion on your source doc? Seems like you have a single purpose account aimed at this topic, good faith? Not sure.Bevinbell (talk) 01:46, 2 August 2009 (UTC)

I realize I'm a little late here, but InternetMeme has every right to contest a policy/guideline change. And while Bevinbell has as much of a right as anyone else to suggest or to make such a change, he most certainly should not be reconfiguring a policy or guideline to his advantage in an ongoing content dispute, especially if he cannot back up the changes with some previous discussion. As per the policy policy, this is indeed not good practice at all, and may even be seen as downright bad practice. But it clearly is inappropriate to accuse InternetMeme of being a WP:SPA, when precisely three seconds of investigation (tick, tock, tick) show that this is not the case at all. Cosmic Latte (talk) 21:00, 10 August 2009 (UTC)

This is such a tedious and time consuming debate. Just pick a word and stick with it.

Ben (talk) 21:21, 1 August 2009 (UTC)

I agree. I'm happy with any term that is NPOV. "Other uses", "Non-FDA approved uses", "Illicit use", etc. There are many other fine terms: take your pick. "Abuse" is not neutral; at the other end of the non-neutral spectrum, that's like having the heading: "Safe and fun uses for propofol that are definitely a good idea". InternetMeme (talk) 06:18, 2 August 2009 (UTC)

Yea, I stand by my conclusion that "abuse" is POV, per above.--Metalhead94 (talk) 15:18, 2 August 2009 (UTC)

Appreciate the comments of DiverDave. I prefer the term abuse, but my feelings are not strong. Non-anesthesiologists however should understand that propofol is quite different from recreational drugs with which they may be familiar. You can't just take some propofol to feel good as you might with narcotics, barbiturates, etc. "Recreational use" of propofol is therefore like recreational use of dynamite. Small increases in the propofol dose (intravenous is the only method) lead very quickly to death if unattended by a skilled anesthesia provider. It is not a sleep medication, or a drug one might casually take to help with sleep. Anesthesia is not like sleep, and yes there has been tremendous amounts of research on this. Articles listed above refer to giving it to patients on ventilators to induce mild comas. So unless one is on a ventilator, any use of propofol needs to be constantly monitored by someone who is skilled in airway management. I can understand recreational use of many pharmaceuticals, but not propofol.EtherDoc (talk) 02:03, 3 August 2009 (UTC)

More dead horses. There seems to be some misunderstanding of the quote "deaths due to recreational purpose are unusual". I believe the authors were trying to say not many people have died from propofol. They were not I believe trying to say that most recreational use of propofol is unassociated with death. It's just that abuse of propofol has been relatively rare. Granted the statement was poorly written by the authors. I suggest reading the original article and not just the abstract. EtherDoc (talk) 03:05, 3 August 2009 (UTC)

Good input. Well, I'm not trying to railroad any term at all, the only thing I'm trying to say is that we must use a term that is in accordance with Wikipedia's NPOV policy, and that of encyclopedias in general. "Abuse" fails on that count, but there are many other terms available.

Just to recap why the term "abuse" is a term with an inherent POV:

Sentences such as "I abuse my pets", or "I abuse my privileges" or "I abuse my partner", all convey uniformly bad behaviour. In fact, any use of the word "abuse" conveys something bad. The word is inherently and invariably negative, and always denotes bad behaviour.

Also, Wikipedia doesn't necessarily use the same terms as used in source material. Cases in which the source material is presented without a NPOV are one such example.

As I said, I'm in no way trying to force a favoured term of my own to be used in the article. I'm only asking that we substitute the term "abuse" with any NPOV term of the community's choosing. If we can't agree on a single term, then probably the most general, encompassing and uncontestable term we could use would be "Other uses", which has no implications at all—negative or positive. InternetMeme (talk) 12:01, 4 August 2009 (UTC)

Well, It's been conclusively proven now that "Abuse" is an innately non-NPOV term, and therefore can't be used. I'll change the heading to the entirely neutral "Other uses" in the interim, until we come up with a more specific term. InternetMeme (talk) 12:10, 5 August 2009 (UTC)

You were blocked once for edit warring, and now you're persisting. There's no consensus for your change. Before you consider making such a change, discussion here should have led to a consensus of what that change should be. Your mere assertions about the word abuse are not enough to warrant a change from the word which reflects current use, and the use of the references we cite. You also misunderstand NPOV, which among other things means that the opinions of wikipedians alone mean nothing: if there is an actual, non-fringe group which thinks that abuse of propofol is not properly so described, we have yet to identify it, and therefore we should not treat your concerns as if they reflected some substantial group. Abuse of propofol is not an "other use", nor does the literature so describe it. - Nunh-huh 12:20, 5 August 2009 (UTC)

It's been conclusively proven that "abuse" is not an NPOV term. It is also clear that you will never agree to any term other than "abuse", therefore consensus is impossible. As I said, I'm not trying to insist on any term in particular, I'm just insisting that we uphold Wikipedia's policy of using neutral terms. If you like, bring the issue up with an admin, and state that you insist on using a non-NPOV term. Again "Other uses" has no connotations whatsoever, either positive or negative. Why do you have a problem with that term? InternetMeme (talk) 15:55, 5 August 2009 (UTC)

Also, what do you mean by "Abuse of propofol is not an 'other use'". It is definitively another use—a use outside of that use which the article previously described. InternetMeme (talk) 15:59, 5 August 2009 (UTC)

I have already stated that I don't really care whether abuse is the term used or not. Non-medical use sounds fine to me. But, I do find it silly to say "It's been conclusively proven that 'abuse' is not an NPOV term." Not sure that statement makes any epistemological sense.EtherDoc (talk) 21:16, 9 August 2009 (UTC)

I guess I used the wrong word. I was meaning that we'd demonstrated that the term "abuse" logically always has negative implications, in terms of the definition in Dictionary.com, and also in practice of its usage. So, I'll rephrase that as "It's been conclusively 'demonstrated' that 'abuse' is not an NPOV term." InternetMeme (talk) 06:57, 10 August 2009 (UTC)

We've demonstrated no such thing. You've demonstrate that you think 'abuse' is not an NPOV term, and others have disagreed. You've additionally demonstrated that you're very persistent in insisting that your understanding prevail, which is not quite the same as having achieved consensus. - Nunh-huh 07:01, 10 August 2009 (UTC)

It's a fact of linguistics. "Abuse" always connotes something bad, therefore the word is not neutral. It's that simple. InternetMeme (talk) 17:10, 10 August 2009 (UTC)

Yes, we know that's what you believe, but simply repeating it and calling it a fact doesn't make it so, and isn't convincing. - Nunh-huh 14:13, 18 August 2009 (UTC)

Abuse: Summary and call for edit war truce

This should definitely not end in an edit war. So let me summarize the discussion above: There were serious and strong concerns about the term "abuse" being inherently biased and violating our NPOV policy. The arguments against these NPOV concerns was that we should follow the terminology of our sources. This was responded to with that 1. the use of "abuse" in the medical literature is just sloppy and not supported by medical authorities, and 2. that we do not have to copy the lingo of our sources, especially if that would violate our NPOV policy. The second problem with the term "abuse" was that it is a very vague and imprecise term that lacks a common definition. Another important argument against changing the term "abuse" were concerns that other alternatives would downplay the danger associated with propofol.

So my suggestion for a solution that everybody could live with would be to change the term "abuse" into the more precise and unbiased term "non-medical use" (meaning an off-label use outside a medicinal context). This term is well established in the medical literature, it is much more precise, and it is unbiased. Any dangers associated with such use should be stated explicitly in the text. If we cannot agree on this solution, we might have to call for third opinions (see Wikipedia:Requests for comment or Wikipedia:Neutral_point_of_view/Noticeboard). Cacycle (talk) 17:52, 5 August 2009 (UTC)

Yep. "Non-medical use" is another great term. Let's go with that. InternetMeme (talk) 18:41, 5 August 2009 (UTC)

Thanks Cacycle for the concise summary of the above discussion. I very much prefer the term abuse, but I think your suggestion is perhaps some middle ground. Do you have some citations that could support your suggested language?Bevinbell (talk) 02:08, 6 August 2009 (UTC)

Please see the DSM, ICD, and WHO references provided above. Google test gives estimated 48000000 hits for non-medical drug use, mostly scientific (not only medicinal) and government publications and sites throughout the first checked pages. Cacycle (talk) 02:54, 6 August 2009 (UTC)

Similarly, there is "non-therapeutic use" [[3]] which would avoid the ambiguity that might be presented by the term "non-medical" as to situations in which medical providers are involved in the use. "Non-therapeutic" has been used in reference to the use of steroids or other substances to enhance athletic performance, as well as for medical procedures that are not warranted or required to address a health issue.Steveozone (talk) 04:36, 6 August 2009 (UTC)

I think personally I would prefer non-medical use as it a lay term that is readily understandable. There is this interesting new article today http://www.nytimes.com/2009/08/07/us/07propofol.html?hp on abuse of Propofol in the NYTimes, a pretty reliable source.Bevinbell (talk) 14:40, 7 August 2009 (UTC)

I don't strongly disagree with that; however, for that very reason it would be problematic to characterize certain (probably very infrequent) situations as "non-medical", such as in particular a situation in which a doctor controversially administered propofol to a "patient" under circumstances where some equipment and means for "appropriate" monitoring and recovery conditions were present, but the patient goes into cardiac arrest and dies. Such a doctor might well find himself in a position where he must medically justify his actions. Some would characterize the issue in that situation as a question of whether the administration of propofol was "medical," and others would point out that because a doctor was involved, the use could not be described as "non-medical." The doctor in question would be arguing that his conduct met the medical standard of care. It would be awkward to have the description of such a situation under a heading which calls such conduct "non-medical." Steveozone (talk) 01:26, 8 August 2009 (UTC)

Hi guys. I like all of these terms. Another term I like is "Off-label use", which is suggested in the manual of style, and even has a page of its own. However, user Fvasconcellos has suggested above that the term isn't appropriate. I'm pretty sure that the most all-encompassing term we could use would be "Other uses". That logically includes any use other than those which are previously stated in the article. InternetMeme (talk) 13:08, 9 August 2009 (UTC)

Yes, we know you "like" off-label use, but it has no application here. - Nunh-huh 14:13, 18 August 2009 (UTC)

Actually, "off-label" would be a valid descriptor here.   — C M B J   12:53, 16 October 2009 (UTC)

Oh, and sorry I kept editing the article before we reached some kind of consensus. I was just frustrated. InternetMeme (talk) 13:03, 11 August 2009 (UTC)

Well, I guess we have sort of consensus. I can live with the current heading. Bevinbell (talk) 00:36, 12 August 2009 (UTC)

Non-medical: implicit POV (round 4)

Firstly, "non-medical" is not an accurate description of this particular section. The "controversy" pertains to a licensed medical practitioner that administered a drug to a patient. By referring to this as "non-medical", we are not only defying logic, but we are also making a public ethical statement that could potentially influence the jury of a pending trial.

Additionally, because it is impossible to objectively differentiate "medical" from "non-medical" use, and because definitions vary depending on locale, the term itself is inherently biased. One doctor may believe that administration of %drug% is medically justifiable, while another doctor may not. One populace may believe that %herb% treats %condition%, but another populace may not. One regulatory agency may have approved %drug% for %purpose%, but another regulatory agency may have banned it entirely. We are not in the business of moralization.   — C M B J   13:33, 16 October 2009 (UTC)

Lets get some consensus - as you can see from the lengthy discussion above, consensus was reached with "non-Medical". I personally prefer abuse, but engaged in a dialogue. Please do not revert without getting consensus on whatever term you want to use. Bevinbell 15:38, 18 October 2009 (UTC)

AstraZeneca

AstraZeneca was founded in 1999 as a merger between Astra and Zeneca. So the sentence "This was re-launched in 1986 by AstraZeneca with the brand name Diprivan" seems a bit weird. PetterLundkvist (talk) 18:04, 28 July 2009 (UTC)

Propofol was still an ICI product at the time of its launch as Diprivan. I'll edit the article accordingly. Fvasconcellos (t·c) 21:40, 28 July 2009 (UTC)

All AstraZeneca web pages dealing with Diprivan seem to have disappeared. The AstraZeneca US website does not list Diprivan as one of the drugs they sell. What happened? --Westwind273 (talk) 22:41, 28 January 2010 (UTC)

Michael Jackson related hits on this article

The propofol article has shown a sudden increase in views recently. On the 28th it was 77,100, on the 29th 28,800. In the months before Jackson's death the figure was less than a thousand a day, averaging near 23,000 per month. It has been seen 437,827 times so far in this July.

This article risks failing the interest of these tens of thousands of people by not mentioning the limited information about Propofol and Jackson's death.--LittleHow (talk) 15:52, 30 July 2009 (UTC)

This doesn't bother me in the least. Propofol's ultimate importance to the world is not dependent upon the current media frenzy. I'd be sorry to see it re-written just to please fans of celebrity culture. WhatamIdoing (talk) 19:35, 30 July 2009 (UTC)

As I've said before, the article should mention any role of propofol in Michael Jackson's death, if and when it is clearly established and made public by named sources. Fvasconcellos (t·c) 21:48, 30 July 2009 (UTC)

Wikipedia is a general encyclopedia not a medical nor pharmacological one and so has content relevant to a topic that is of general interest even if that is of celebrity culture. Hemlock has a section on Socrates. There is already a long article Death of Michael Jackson and this has a section on Diprivan Death_of_Michael_Jackson#Diprivan that has a Main article link to this article. The status of propofol as the actual clinical cause or not of his death is not the relevant criteria for inclusion but the notability which the drug now has in regard to being or having been a possible cause of Jackson's death. There are presently appropriate sources for discussing its involvment--see Death_of_Michael_Jackson#Diprivan--LittleHow (talk) 14:37, 31 July 2009 (UTC)

I don't think the facts on the ground have changed sufficiently to upset the consensus we established in early July. Until we get something official that implicates propofol in Jackson's death, the issue is not yet ripe for discussion here. ReverendWayne (talk) 17:08, 31 July 2009 (UTC)

If tomorrow Jackson was identified as having died of another cause, his death because of who he was will have changed public discussions about propofol. For example this piece in the Guardian Abuse of drug used by Michael Jackson growing among medical professionals. Public awareness of propofol has become dramatically changed due to Jackson--whether the drug is confirmed or not in his death is beside the point--it is now part of the Propofol story--journalists are writing stories about Propofol addiction around Jackson's death. The facts linking Jackson and Propofol are very different now that early July.--LittleHow (talk) 19:20, 31 July 2009 (UTC)

Memory Loss

There is nothing in article about having no memory of events when used for sedation alone. When I had a procedure done the dr's and nurses kept saying 'you won't be under anaesthetic but a sedative however you won't remember anything.' It was this drug, and they were right, complete amnesia. Shouldnt' something be said about effects on memory when used for sedation alone? —Preceding unsigned comment added by 123.243.155.250 (talk) 08:03, 2 August 2009 (UTC)

Yes there is. I added it long ago. These characteristics of rapid onset and recovery along with its amnestic effects[14] have led to its widespread use for sedation and anesthesia. Amnestic means no memory.EtherDoc (talk) 02:04, 3 August 2009 (UTC)

"Misuse" is POV.

Hey guys. Most of the arguments presented in the "Abuse" is POV section apply to this term also.

According to dictionary.com, "misuse" uniformly denotes "bad" or "wrong" use.

As previously noted, these definitively non-neutral terms have no place in an encyclopedia. InternetMeme (talk) 14:00, 18 August 2009 (UTC)

You've previously, and repetitively, "noted" your belief that that is so, but the fact that you believe it doesn't make it a fact. - Nunh-huh 14:13, 18 August 2009 (UTC)

Well, my belief that the Earth is spherical doesn't make that a fact either. It's the evidence that makes it a fact. Check any dictionary for a definition of "abuse", and if that doesn't convince you, then take a course in linguistics and logic. InternetMeme (talk) 17:04, 18 August 2009 (UTC)

"Mis" implies, mistaken, misadventure pr as the dictionary implies "misaplication", improper use etc whereas abuse implies definite intentional harmful use to the user and society. We are talking here about a GENERAL ANESTHETIC!!! How can this be considered proper use and non-risky and non-harmful?--Literaturegeek | T@1k? 18:34, 18 August 2009 (UTC)

Well, "misuse" is not so inappropriate a word as "abuse", but it still doesn't provide enough scope for the heading of this section. This section covers recreational use of propofol, and potentially will cover use of propofol as a sleep aid, in addition to misuse of the drug ("misuse" meaning "the use of the drug with unintended results").

In reply to your question above, designating a particular use of any material as "proper use" falls outside the scope of an encyclopedia. We may however state whether or not a particular use of a material is legal, socially acceptable or medically approved. We can also point out instances in which the use of a material produces unintended results; "misuse". InternetMeme (talk) 19:29, 18 August 2009 (UTC)

IUPAC name

Can someone check it since it has been changed twice. Rich Farmbrough, 19:53, 20 August 2009 (UTC).

Reverted. The first edit introduced an error and a typo, and the second edit fixed the typo but not the error :) Fvasconcellos (t·c) 20:08, 20 August 2009 (UTC)

Michael Jackson Findings by Coroner

OK, looks like lots of interest in editing in the news of MJ's death by Propofol. There appears to be coupled with the verifiable sourced info on the death finding guesses as to why he was taking the drug - insomina, addiction, etc. The actual finding is homicide by Propofol. The edit to add reference to clinical levels of Propofol use seems out of place.Bevinbell (talk) 23:05, 24 August 2009 (UTC)

Many other drug articles (e.g. aspirin, hydrocodone, paracetamol) contain detailed explanations of the effects at different dosages. The dosage reference that I added was from a clinical trial of 10,662 adults that aimed to "evaluate the safety and effectiveness of nurse-administered low-dose propofol sedation for diagnostic esophagogastroduodenoscopy". Ideally, dosage information should be integrated in a more tasteful manner -- but that is no reason to omit it.   — C M B J   01:43, 25 August 2009 (UTC)

maybe it could live in a different section on dosages depending on the indication? I just don't see how a clinical study on dosage levels by medical professionals for medical procedures and monitoring relate to the abuse of the drug by Jackson for alleged insomnia (ok, a physician administered, but hardly was monitoring him according to press reports)Bevinbell (talk) 01:56, 25 August 2009 (UTC)

Yes, dosage information ultimately belongs in a different section. It is, however, relevant to to the MJ ordeal simply because the coroner's report specifies a "lethal dose" of 50 25 mg. This article elaborates on an individual which received 550 mg over 2 hours. Another article discusses the dangers of exceeding 5 mg/kg per hour; about 240 mg/hour for someone around Jackson's weight.   — C M B J   02:21, 25 August 2009 (UTC)

Where are you getting 50? I see 25 in the NY times article, admittedly a low dose, but he was not ventilated, not monitored, not on O2, just abandoned.Bevinbell (talk) 02:24, 25 August 2009 (UTC)

I'm not 100% certain of which article I saw earlier, but I may have mistaken the past from the present. This LA Times article states that his doctor had been giving him 50 mg of propofol intravenously in the weeks preceding his death.   — C M B J   02:39, 25 August 2009 (UTC)

WebMD has also published an article that includes the opinions of an expert anesthesiologist. It'd make an excellent reference.   — C M B J   02:58, 25 August 2009 (UTC)

That's pretty convincing. Is WebMD credible?Bevinbell (talk) 03:21, 25 August 2009 (UTC)

The opinions expressed in the article are largely from Hector Vila Jr., MD (chairman of the Ambulatory Surgery Committee for the American Society of Anesthesiologists), and the article was additionally reviewed by Louise Chang, MD.   — C M B J   04:11, 25 August 2009 (UTC)

(outdent) I have removed the text regarding MJ, with this edit. It said; "Attention to the risks of non-medical use of propofol recently increased due to the finding that Michael Jackson died from a lethal dose of the drug.(ref'd to this in NY Times). According to a search warrant issued by Los Angeles County on July 17, 2009, Jackson's personal physician administered 25 milligrams of propofol diluted with lidocaine shortly before his death."

I removed the first sentence because those specific facts are simply not stated by the source - it does not say anything about "non-medical use" (and this 'fact' is very controversial), nor is anyone stating that MJ specifically died of a lethal dose of this drug alone. It does say "lethal amounts of propofol in his blood", but that is not quite the same thing. I have no problem with the info on MJ being added to the article, if it can be done in a careful and correct manner.

I removed the second sentence because it lacked a citation to a reliable source; if a source is available, then of course it could be re-added.

I also think that we need to be careful adding this within the section "Non-medical use" (unless reliable sources assert that this was indeed 'non-medical use'. Perhaps we need a separate section to handle these unfolding events, although in this article, I hope that we can keep this story in perspective; the details re. MJ belong elsewhere.  Chzz  ►  03:29, 25 August 2009 (UTC)

Citation is now listed twice (both sentences from same source, and added source on increased attention to the drug for non-medical use. Instead of deletion, why not try to make it better. If you can find a source that calls treatment of insomnia with this drug as medically approved, by all means add itBevinbell (talk) 03:37, 25 August 2009 (UTC)

I also have added a new citation directly stating "Michael Jackson died in his rented mansion June 25 from a deadly dose of the powerful anesthetic drug propofol, according to an affidavit unsealed Monday." with named source.Bevinbell (talk) 03:42, 25 August 2009 (UTC)

See Talk:Pethidine and the accompanying article, bearing in mind that the connection with Propofol, unlike that of Pethidine, has been established professionally. I counseled to take it easy either way; the connection was eventually deemed too tenuous. It does not hurt to have facts in temporarily, but time will tell whether the connection is strong enough. Anarchangel (talk) 08:38, 25 August 2009 (UTC)

Two points are a little off. First, the court did not "issue" any affidavit; affidavit is a witness statement, and in the context of a warrant is submitted by the witness to the court to request the court to issue a warrant. Indicating that the court "issued" the affidavit strongly implies that the court has made an official pronouncement, rather than that a witness has asserted something, in an affidavit that has been released by the court together with the warrant (see for a cited source that handles this point better. Secondly, there has been no "finding" as such by the coroner, who has not issued a report, or any statement as to cause of death other than that the report is being withheld. A coroner's representative informing a detective as to preliminary conclusions, to assist the detective in applying for a warrant, is not the same thing as a "finding," a term which has a formal meaning, which is a formal statement announced in a formal coroner's report (which report here has not been issued, and might yet be revised before it is issued). The use of the term "finding" should be avoided in paraphrasing this point; indeed, two of the three sources don't use this term of art. Steveozone (talk) 04:44, 26 August 2009 (UTC)

I hear you, find a credible source that supports your opinion/original research and edit away.Bevinbell (talk) 04:47, 26 August 2009 (UTC)

There's no opinion or original research. The three sources are here already. The problem is in using the language of one rather than the other two. The NYTimes Artsbeat reporter is in particular using terms that are imprecise (this is a BLP for Jackson's doctor now, after all). Steveozone (talk) 04:53, 26 August 2009 (UTC)

Your change looks fine, I found the actual affidavit and added a link. I think the article is ok for BLP, its well sourced and avoids undue attention on the physician.Bevinbell (talk) 06:07, 26 August 2009 (UTC)

This should be an article about the anaesthetic, not gospel out of media.

For instance,

"Propofol is contraindicated by all respiratory depressants, including benzodiazepines such as lorazepam and midazolam."

Is simply nonsense because of several reasons. To start with, no medication is contraindicated by any other medication or substance for that matter. A medication (the administration or taking of a drug) is contraindicated, relatively or absolutely, by the drug label/drug SPC, a doctor/physician or a pharmacist, out of a reason, that being a health condition; the administration of propofol is relatively contraindicated in a patient intoxicated by benzodiazepines for example. That doesn't mean however, that an intoxicated individual cannot be given propofol, it means that the administration of propofol in an intoxicated patient is, if absolutely necessary (ultimate need for an emergency OP e.g.) to be undertaken by and only by the anaesthesiologist in charge under even more stringend vital function monitoring/support and even more carefully dosed, than in an non-intoxicated subject. After all, as all general anaesthetics, with some special exception, propofol is not intended to be administered otherwise than by an anesthesiologist or surgeon in a hospital or clinic under close vital function monitoring and/or vital function support. That is to say, to administer propofol "off-label" to a non-ventilated subject somewhere in his or her bedroom because of insomnia is recless in best case and potential manslaughter or murder in worst case. Another reason why the statement given in article is nonsense would be, that this relative contraindication does by far not mean that a patient in a proper environment (hospital OP preparation for example) cannot be given benzodiazepines followed by propofol; in contrary to that, this is quite a standard regimen for premedication (a dose of Ativan or Midazolam 30 - 60 minutes before the scheduled OP in order to calm the patient down and make him/her less stressed by procedures like inserting a transurethral catheter etc.), followed by a TIVA induction by propofol and other medications like opioids and curaremimetics right "on the table", immediately before the start of the surgery.
Since this article is locked and I truly am not into undertake corrections just to be reverted 5 times in 10 minutes following, I suggest that this particular article should stay under some sort of supervision by the WP Medicine and/or Pharmacology, possibly the best way being trusted Wikipedians who happen to be doctors or pharmacologists, at least until the most of this medial hype weans off. Any objections anyone? Ow, references, yes. What about reading carefully the full up-to-date valid FDA label for Diprivan and at least one more generic propofol preparation, plus possibly some other (non-US, governmental, UK, Australia, New Zealand etc.) labels and anaesthesiology references/guidelines for premedication and TIVA's? Cheers, --93.192.159.253 (talk) 01:26, 29 August 2009 (UTC)

Is the modified statement satisfactory?   — C M B J   07:25, 6 September 2009 (UTC)

Sure, 100^x % better. Thanks, --93.192.178.245 (talk) 12:10, 14 September 2009 (UTC)

Neither

about how MJ's doc is going to get 4 yrs prisonment etc. There should be simple mention about how medicine was found from Michael. All other issues are to be handled in MJ-article.--RicHard-59 (talk) 05:31, 8 November 2011 (UTC)

No need for capitalization

The name propofol is a generic name and need not be capitalized. Trade names such as Diprovan should be capitalized.

Indeed: not only need not propofol be capitalised; it should not be, save in particular circumstances, such as when it is at the beginning of a sentence (e.g., "Propofol is the usual drug used in this department for induction of general anæsthesia.") or when it is used as a proper noun (e.g., "This is my albino monitor lizard, Propofol."\

It seems to me that drug companies have been trying to make their trade names sound more "sciencey," and that this ends up making it harder to tell which is which if the drug is not a familiar one. Mia229 (talk) 13:01, 23 August 2014 (UTC)

Physical properties of Propofol

From the looks of the molecule, I might expect it to be s specialty fuel, or perhaps a flammable waxy or crystalline substance with an interesting smell. Anyhow, I would appreciate seeing some information about its physical properties if anyone can supply it. Puddik at (talk) 18:20, 23 May 2012 (UTC)

Celebrity deaths

Who'd have thought that propofol would be responsible for two celebrity deaths — that plastic-surgery addicted woman, and Joan Rivers.... - Nunh-huh 23:50, 11 November 2014 (UTC)

I have to admit, I'm a fan of MJ's and I chuckled a little at that. Evernut (talk) 13:25, 26 May 2017 (UTC)

Propofol for ECT

This is in reference to an assertion that "propofol and remifentanil" are used for ECT, which references item no. 7. This is a very odd study, as it compares anesthesia for ECT with propofol to sevoflurane. I have never seen this done in practice, nor have I seen remifentanil (or any other narcotics) used. Propofol is typically avoided for ECT since it raises the seizure threshold (as the article actually indicates!). ECT also typically occurs in psychiatric hospitals or otherwise outside the OR where ventilators and - especially - volatiles are not available. I won't remove the statement for now, but it is worth stating that propofol is not the anesthestic of choice for ECT, and I'll find an appropriate reference for that. — Preceding unsigned comment added by 47.55.210.194 (talk) 16:15, 8 September 2014 (UTC)

I think the claim is not sufficiently supported by the supplied reference, so I have removed it per WP:MEDRS. There needs to be something other than this weak primary source to indicate that this is anything more than a niche use. -- Ed (Edgar181) 19:20, 8 September 2014 (UTC)

Supply issue outdate

I don't believe Propofol is in short supply as indicated by the supply section on the article page. I know this from daily experience with it at a vet clinic. The sources are extremely old, so unless someone can cited some news I think this section is up for removal. --2605:E000:D804:DA00:60B1:C647:A55B:14FF (talk) 09:54, 21 January 2017 (UTC)

I'm not sure a temporary supply issue was all that relevant for an encyclopia article back in 2010 when it occured, but it's definitely not relevant now years later. I agree that the section should be removed; consequently, I've removed it. -- Ed (Edgar181) 12:25, 21 January 2017 (UTC)

CBS genetic defects

Citation needed, and even if referenced, wording should be changed from "people with this gene" to people with whatever variant of the gene is causative or associated with the side effect. --140.226.13.23 (talk) 17:37, 27 September 2017 (UTC)LKW

I removed the section because it was unclear was connection it had to the topic. NE Ent 22:58, 22 January 2019 (UTC)

Propofol should not be administered to patients under Extra Corporeal Membrane Oxygenation (ECMO)

Searching information about Extra Corporeal Membrane Oxygenation (ECMO), I found that Propofol should NOT be used in patients under ECMO, because it can produce a plasma leakage. Watch this training session for perfusionists, this part of the video shows an ECMO machine bubbling plasma. It is in youtube 4RccN0lL7LU?t=2706

youtu.be/4RccN0lL7LU?t=2706 — Preceding unsigned comment added by 201.124.247.212 (talk) 11:34, 3 April 2020 (UTC)

It happens because the "membrane" is made of lots of fibers that permeate oxygen. It is better explained in tha video.

I am not an expert, but a caution note should be included in the article, because ECMO is used along with artificial ventilation in the current COVID-19 pandemy. — Preceding unsigned comment added by 201.124.247.212 (talk) 11:32, 3 April 2020 (UTC)