Homicides Using Anesthesia Medications Increase

A study published in the March issue of Anesthesiology examines several homicides involving anesthetic drugs and calls on anesthesiologists to assist in the investigation and prosecution of criminals who divert and kill with these drugs.

In recent years, homicides have been committed using hypnotics, inhalational general anesthetics, opioids, and muscle relaxants, according to information provided in the article. An analysis of 523 homicidal poisonings occurring between 1999 and 2005 found that the rate of these poisonings was increasing and that 65% involved medicines.

The 2009 death of singer Michael Jackson from propofol, a widely used anesthetic, along with the ruling that the death was a homicide, heightened the profile of this issue, according to the article, which outlines the experiences of anesthesiologists in several investigations and prosecutions.

“The role of anesthesiologist is that of a healer and defender of life” said Robert E. Johnstone, MD, of West Virginia University, Morgantown, WV, in a press release. “Seeing the harm done to victims in these cases, several anesthesiologists have offered their expertise to help solve these crimes and bring the perpetrators to justice.”

Johnstone calls on anesthesiologists to continue to work with health care providers and administrators to stop drug diversion and support criminal investigations by doing the following:

• Recommending to prosecutors specific anesthetic drugs, muscle relaxants and metabolites for tissue and blood analysis.
• Explaining the meaning and limitations of drug tests.
• Explaining how muscle relaxants and anesthetic drugs can cause death.
• Describing probable routes for drug administration.
• Explaining drug dosages and effect timing.
• Explaining anesthetic drug storage and access issues in institutions.
• Explaining the probability of various natural causes of death.
• Describing the anesthesiologist’s expert qualifications.

In the study, lead investigator Johnstone and colleagues reported on four homicides and one attempted homicide involving medications typically used during anesthesia such as rocuronium, succinylcholine, fentanyl, and pancuronium. These are cases where anesthesiologists provided insight into the investigation and prosecutions.

“The person on trial in cases involving murder by muscle relaxants or anesthetic drugs is often a health care worker, occasionally a physician,” said Johnstone. “The drugs used in four of the cases reported in this article came from hospitals. Drug diversion from operating rooms is a recognized problem, especially with the storage of such medications throughout hospitals, possibly making their diversion easier.”

The Drug Enforcement Agency has not classified muscle relaxants or propofol as controlled substances, so they are not individually tracked in most hospitals.

Therefore, it is critical that anesthesiologists who use powerful drugs to anesthetize patients and facilitate surgery “recognize that criminals can use these same drugs to depress breathing and commit murder,” the authors wrote.