What drugs are doctors allowed to prescribe?

Michael Jackson may have received a dangerous anesthetic drug, propofol (Diprivan), prior to his death and toxicology reports that would prove this are still pending. Officials are now saying that propofol was found in his home and that Jackson may have been using the drug as a sleeping aid for up to two years. It has also been reported that the drug was administered by his physician, Dr. Conrad Murray, the day that Mr. Jackson died. There are no FDA indications for propofol as a sleeping aid. This raises the question of what drugs can be legally prescribed by doctors? It may surprise you to know that doctors can prescribe drugs for anything they see fit because the FDA does not regulate the practice of medicine. Individual states do this through their professional licensing laws and processes.

FDA refers to the U.S. Food and Drug Administration, the branch of the Department of Health and Human Services (DHHS) that approves drugs for marketing and sales. An FDA indication is the disease or condition for which a particular drug is approved to treat. Drug manufacturers are not allowed to market drugs for indications that are not FDA approved. However, once drugs are on the market, physicians may legally prescribe and administer FDA-approved drugs for any disease or condition and indeed such off label use is extremely common (see book links below). Off label use does not imply that a drug is either unsafe or ineffective for a non-approved use. It is up to the individual doctor to understand the latest medical information and their own qualifications and experience when giving any drug. Improper use is usually a retrospective judgment that is made in the context of medical ethics, malpractice laws or criminal laws.

So is it a good idea to use a drug like propofol (Diprivan) as a sleeping aid? Here are the actual FDA recommendations for indications, usage and warnings for propofol. An excerpt from this document follows:
“For general anesthesia or monitored anesthesia care (MAC) sedation, DIPRIVAN Injectable Emulsion [propofol] should be administered only by persons trained in the administration of general anesthesia and not involved in the conduct of the surgical/diagnostic procedure. Sedated patients should be continuously monitored, and facilities for maintenance of a patent [open] airway, providing artificial ventilation [breathing], administering supplemental oxygen, and instituting cardiovascular resuscitation must be immediately available. Patients should be continuously monitored…”



Mark Boguski, M.D., Ph.D. is on the faculty of Harvard Medical School and is a member of the Society for Participatory Medicine, "a movement in which networked patients shift from being mere passengers to responsible drivers of their health" and in which professional health care providers encourage "empowered patients" and value them as full partners in managing their health and wellness.

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