With the wisdom of hindsight, Deepak Chopra recalls a conversation he had with Michael Jackson a few years ago. "He said there's something you can take that takes you to the valley of death and then takes you back," the best-selling author and physician tells TIME. "I hadn't the vaguest idea of what he was talking about. And then he quickly changed the subject." Now, says Chopra, "I see he was talking about propofol."
The role of propofol in Jackson's final days looms large even as the coroner's report remains under official seal. On Aug. 24, the Los Angeles Times reported that the L.A. County Coroner's Office found fatal amounts of the powerful anesthetic (also known as Diprivan) in Jackson's body. The information was contained in a search warrant for the office of Jackson's personal physician Dr. Conrad Murray that was unsealed in Houston, where Murray has an office. According to the Times, Murray told police that he had been administering 50 milligrams of propofol to Jackson intravenously every night for six weeks to treat insomnia. But according to the report, Murray said he was afraid Jackson was forming an addiction to the drug and switched medications two days before the musician died.
On Aug. 24, the Associated Press also reported that the coroner's office had ruled Jackson's death a homicide, raising the likelihood that one or more of Jackson's doctors may face charges. Murray is reportedly the subject of an LAPD manslaughter investigation.
Jackson's death on June 25 has brought the subject of propofol abuse from obscure medical research papers to the celebrity-laden Web pages of TMZ. Until Jackson's death, there was little talk about it in celebrity circles. "I didn't know much about it," says Chopra. Dr. Drew Pinsky, host of Celebrity Rehab, says he had never seen the drug abused by his hard-living Hollywood clientele. Home use of Diprivan "is something I had never heard of," Pinsky tells TIME. "I'd have an easier time believing that Martians had set down outside this building."
Researchers who are familiar with the drug were just as stunned. "No one would ever take this to sleep. No one would ever take this drug for insomnia," says Paul E. Wischmeyer, professor of anesthesiology at the University of Colorado, who co-authored a major 2007 study on propofol abuse. "Never, ever. It would be like using a shotgun to kill a small mouse."
The abuse of Diprivan, which is mainly used in the operating room, was originally limited mostly to medical professionals. But it is not a controlled substance. "Anyone can throw on a pair of scrubs if they know what they are looking for, walk into an operating room, and walk away with this stuff, and it's unlikely to be noticed," says Wischmeyer. With one self-administered dose lasting for a five-minute high, the drug offers a quick escape, then a quick disappearance from the bloodstream. "For professionals, it's easy to get and difficult to detect," says Wischmeyer. "You can use this drug and be back at work and no one will even know you were using it."
Wischmeyer says the potent drug has benefits in the operating room but poses major risks for abusers. "In the right hands, the drug is the most effective, safest anesthetic that many of us use," says Wischmeyer. "In the wrong hands, it's a very lethal drug."
Wischmeyer saw this firsthand as a medical resident in 1999, when a fellow student was found dead from a propofol overdose, the syringe still stuck in his arm. Since then he's followed cases of professionals, and a handful of non-professionals, who have abused the drug. Even the professionals he has studied have high mortality rates with the drug, with a third of the abusers dying from it. The small pool of non-professionals fare worse. "I've never found a non-medical person abusing this drug that has ever lived," says Wischmeyer. Propofol's potency leaves very little margin for mistakes. "The terrifying thing about this drug is that it might take your stress away, but if you take one or two cc's more, you stop breathing," says Wischmeyer. "This is not like Vicodin take too much and you get a little high. With propofol, you might not survive it."
Dr. Paul H. Earley, medical director at Atlanta's Talbott Recovery Campus, equates abusing the drug to playing Russian roulette. "There is a very narrow window to go from feeling euphoric to be being unconscious to being unconscious and not breathing," says Earley. In a closely monitored operating theater, doctors can make quick adjustments to avoid problems. Abusers have no such recourse for a drug that acts so quickly that they often injure themselves immediately by falling. Earley says that a center that specializes in drug abuse among medical professionals started to see early signs of propofol abuse five years ago. "Now it's part of the screening for all physicians who come here. Do you use intravenous propofol?" says Earley. "I wouldn't have believed this if you had asked me that five years ago."
Propofol was approved by the Food and Drug Administration in 1989 with little thought of abuse potential. But even before the recent mainstream media coverage, the FDA was "hearing from health-care professionals about abuse by other professionals, long before Michael Jackson," says FDA spokeswoman Karen Riley. "[The Jackson news] just means I am answering a lot of propofol questions." DEA spokesman Rusty Payne says his agency was petitioned two years ago to "schedule" propofol which would make it a controlled substance. While the research process is under way, Payne would not give a timetable on the process.
Though the attention around the previously obscure drug has increased awareness of its dangers, there is also the chance it will raise curiosity among potential abusers. Dr. David Sack, chief executive officer of Promises rehabilitation facility in Malibu, Calif., says the drug presents inherent obstacles to mainstream appeal, including its lack of street availability and its need to be administered by a needle. While Hollywood's troubled abusers have yet to start showing up at his doors with propofol problems, he doesn't rule it out. "Whenever a drug gets attention like this in the media, people want to try it," says Sack. "It takes a while for things to break out. Sometimes they never do. But there are always people who abuse drugs who are looking for the next big thing."