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SOMERSWORTH — As soon as reports surfaced that pop icon Michael Jackson may have overdosed on the anesthetic drug Propofol, Dr. Michael O'Connell saw more patients make a troubling association.
"Am I going to have the Michael Jackson cocktail today?" O'Connell said some of his patients have quipped before receiving the drug, which is used to induce sleep and shield them from any pain before they receive spinal cord injections or surgical implants.
O'Connell said ever since Jackson died on June 25 he and the staff at PainCare in Somersworth and other physicians that regularly prescribe Propofol have wanted to educate the public and cure their concerns.
"We want to put the word out that it is a very safe drug in skilled hands," O'Connell said Tuesday afternoon.
He said he was perplexed after learning that Jackson and his physician, Dr. Conrad Murray, were using Propofol, commonly known as Diprivan, to help the pop star sleep.
"The use of it for insomnia is not even published in the literature," he said.
Propofol, which looks like milk, is intravenously given to a patient to induce sleep, O'Connell said. He said it is a hypnotic agent that leads to a trancelike state and unconsciousness and it can take as little as 30 seconds to work.
O'Connell said patients at the clinic in Somersworth usually receive about 4 ccs of Propofol, which allows them to be in a sleepy state for up to 10 minutes while they receive spinal cord or surgical treatment. He said some patients may receive the anesthetic once a month when they come in for regular treatments. Four ccs is the equivalent of one or two drops less than a medical teaspoon.
He said he has not seen any cases at the clinic where any patients have demonstrated any withdrawal symptoms after receiving Propofol or cases where a patient develops a tolerance to it and requires a higher dose than 4 ccs to receive treatment.
If a patient needs to remain unconscious for longer than 10 minutes, he said staff at the clinic would administer a general anesthetic to keep them under.
According to Associated Press reports, police say Jackson regularly received Propofol and relied on it like an alarm clock. A doctor would administer it when Jackson went to sleep, then stop the IV drip when the singer wanted to wake up.
On June 25, the day Jackson died, Murray gave him the drug through an IV some time after midnight, an official is quoted as saying by the AP. Murray's lawyer, Edward Chernoff, has said the doctor "didn't prescribe or administer anything that should have killed Michael Jackson."
Toxicology reports are still pending, but investigators are working under the theory that Propofol caused Jackson's heart to stop, the official said. Jackson is believed to have been using the drug for about two years and investigators are trying to determine how many other doctors administered it, the official told AP.
O'Connell said when Propofol is administered by trained medical staff who are certified registered anesthetists it is safe. He said all of the staff at the Somersworth clinic are licensed in the state of New Hampshire and have passed an Advanced Cardiac Life Support class taught by the American Heart Association for critical care health care personnel.
The Somersworth clinic employs 115 people and has two operating rooms, O'Connell said. According to PainCare's Website, the staff also has equipment on hand to monitor patients and reverse the effects of the drug, if necessary.
When the drug is not used properly, he said a patient can fall so heavily asleep they can't breathe properly. He surmised that if Jackson received too much of the drug it likely slowed his breathing and he went into cardiac arrest, which authorities listed as the official cause of death.
O'Connell said it is possible Jackson may have tried many over-the-counter sleep aids to ease his insomnia and possibly other drugs before he turned to Propofol. He said if anyone takes a given drug long enough their bodies build up a tolerance to it and they have to take a higher dosage or seek a more potent drug.
O'Connell also believes the federal Food and Drug Administration and medical community may push for Propofol to more regulated. Right now, he said any physician who wants to use it can get access to the drug very easily and that needs to change. O'Connell is concerned some people may believe they can get a good high from Propofol and seek to get it in hospital settings.
"I think it is undeniable that it will be more heavily regulated in the future," O'Connell said.
O'Connell said the use of Propofol is very important for clinics. At the Somersworth clinic, O'Connell said they see 100 patients per day and 30 to 40 of those patients receive a surgical or spinal cord-related treatment.
He said 90 percent of their patients suffer from chronic pain and the other 10 percent of their patients suffer from acute pain that comes from things such as a recent amputation, back injury or accident. The patients range in age from as young as 16 to those who are 60 and older, he said.
Nationwide, O'Connell said 70 million people suffer from chronic pain, which is defined as pain lasting longer than six months. The constant flow of patients who go to the Somersworth clinic alone shows how widespread the pain is for some, he said.
"We feel we are only touching the tip of the iceberg," O'Connell said.