Drug abuse associated with procedural sedation

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