Citing a dangerous trend of misuse and abuse, Alabama health authorities have reclassified the anesthetic propofol as a Schedule IV drug, a group which includes such controlled substances as the benzodiazepines Valium (diazepam), Xanax (alprazolam) and Klonopin (clonazepam).

"Propofol has an appropriate medical usage to sedate people quickly for surgeries, but its potential for misuse led to the scheduling of this fast-acting drug," the State Committee of Public Health said in a July 27 press release.

The ruling, which takes effect Aug. 27, will require the drug to be stored securely. "Only appropriate individuals should have access to propofol, which means storage to which there are a limited number of keys," explains Jim McVay, DPA, director of health promotion and chronic disease at the Alabama Department of Public Health in Montgomery. Providers will also be required to keep detailed records of access, administration and disposal of the drug, and will be subject to penalties under state law in the event of misuse or diversion.

While there was no specific incident that spurred authorities to reclassify propofol, Dr. McVey noted, "There has been a general concern among some healthcare providers about the potential abuse of the drug," particularly since the death of pop star Michael Jackson was linked to the drug's misuse.

"I'm surprised it took so long," remarks Jay Horowitz, CRNA, ARNP, president of Quality Anesthesia Care Corp. in Sarasota, Fla. He recalls the federal Drug Enforcement Administration's 2010 proposal to nationally schedule propofol, which hasn't yet come to pass. (Last summer, Georgia and North Dakota lawmakers moved to control propofol.) "Maybe this will motivate the DEA to do it all at once."

While Mr. Horowitz says he'd stand behind such an action — "Propofol is a dangerous drug [and] I think it should be controlled, because it's killing my colleagues," he says — he also expresses concern that the required security measures and recordkeeping policies and paperwork will unduly burden the smaller surgical facilities.

David Bernard