Posted by halcyondaze on January 6, 2007, at 19:50:25
What do you all think? I have taken (and abused) many drugs in my life, and Seroquel is not one that (in my opinion) has ANY reinforcing properties whatsoever. And this is coming from someone who exhibits drug-seeking behavior and dose increases without psychiatrist approval on Ambien and Parnate. I personally find this line of research laughable, as well as the conclusion of the second letter that "clinicians should be extremely cautious when prescribing this medication for nonserious mental disorders and for individuals with histories of substance abuse." I have NEVER known anyone to abuse Seroquel and cannot see why ANYONE would want to, and I've known many an addict who would take virtually anything to get high. Everyone has the same opinion of Seroquel in the drug circles I know: not worth paying for.
Two letters to the editor from the most recent edition of "The American Journal of Psychiatry":
1) Intravenous Quetiapine-Cocaine Use ("Q-Ball")
BRIAN M. WATERS, M.D. and KAUSTUBH G. JOSHI, M.D.
San Antonio, Tex.
To the Editor: We have noted recent reports of quetiapine diversion and misuse among inmates in correctional settings where it is also called "quell" or "baby heroin" (1, 2). It is used orally, intranasally, and intravenously for its potent sedative and anxiolytic properties (1, 2). Inmates obtain quetiapine for illegitimate use by malingering of psychotic symptoms or obtaining it from other inmates. The high prevalence of substance use disorders in corrections and the secondary gain of serving out "easy time" with pharmacological assistance contribute to an underground economy of diverted psychoactive medications (3). Anecdotal reports from colleagues—as well as online testimonials—support the existence of quetiapine diversion and misuse in noncorrectional settings as well (4). The following case is an example of prescription medication diversion with concomitant illicit substance use seen in the local county hospital emergency room.
A 33-year-old married Caucasian male with a history of polysubstance dependence (cocaine, heroin, alcohol, benzodiazepines) reported to the local county hospital emergency room requesting assistance with drug detoxification and rehabilitation. The patient endorsed daily use of intravenous cocaine mixed with 400 mg–800 mg of quetiapine. Quetiapine was surreptitiously diverted from his wife’s prescription. He reported crushing the quetiapine tablets and mixing the resulting powder with cocaine and water. He subsequently heated the mixture and drew the supernatant through a cotton swab into a syringe to administer intravenously. When asked why he engaged in this drug mixture, he stated that it achieved desired "hallucinogenic" effects.Combining prescription medications and/or illicit drugs is a common practice to synergistically heighten the intoxication from the substances while potentially reducing undesirable side effects. The combination of intravenous heroin and cocaine (also known as "speedball") is a well-known strategy to both maximize the cocaine "rush," while mitigating its "crash" (5). It may be hypothesized that quetiapine was substituted for heroin in our case (to form a "Q-ball") because the sedative/anxiolytic effects of quetiapine may mitigate the dysphoria associated with cocaine withdrawal and to possibly provide a "hallucinogenic" effect.
The case presented highlights the unknown effects (such as a "hallucinogenic" experience) of combining substances with different pharmacological properties and subsequently circumventing first-pass metabolism through intravenous administration. Individuals who use oral medications intravenously have the potential to develop significant pulmonary complications secondary to the deposition of medication binders in lung parenchyma. Furthermore, the cardiovascular and arrhythmogenic properties of cocaine may be amplified in combination with quetiapine (which has a risk of QTc prolongation). Physicians should remain cognizant of potential medication diversion and misuse in noncorrectional settings.
FootnotesThe authors report no competing interests.
References
Hussain MZ, Waheed W, Hussain S: Intravenous quetiapine abuse (letter). Am J Psychiatry 2005; 162:1755–1756[Free Full Text]
Del Paggio D: Psychotropic medication abuse in correctional facilities. The Bay Area Psychopharmacology Newsletter 2005; 8:1, 5
Della Volpe K: Intervention reduces abuse of psychotropic medications in correctional facility. Pharmacy Practice News, July 2005
The Vaults of Erowid. http://www.erowid.org/ (accessed April 2006)
Smith JE, Co C, Coller MD, Hemby SE, Martin TJ: Self-administered heroin and cocaine combinations in the rat: additive reinforcing effects-supra-additive effects on nucleus accumbens extracellular dopamine. Neuropsychopharmacol 2006; 31: 139-150
2) Quetiapine Addiction?
EMIL R. PINTA, M.D.
Columbus, Ohio and ROBERT E. TAYLOR, M.D.
Cambridge, Ohio
To the Editor: Quetiapine is not a controlled substance and is not considered addictive. Yet there are several reports describing abuse among inmates in jails and prisons (1, 2).The pharmaceutical formulary for the Ohio correctional system contains three second-generation antipsychotics, but quetiapine is not one of them. It may be prescribed with special authorization for patients with serious mental disorders who have not responded to formulary agents. However, inmates entering prison on quetiapine for other conditions, such as sleep and anxiety disorders, must have it tapered and discontinued.
The authors have treated a number of inmates who have engaged in drug-seeking and sometimes illegal behavior to obtain this medication. The following case is illustrative:
A 39-year-old incarcerated male with hepatitis C and a history of opiate abuse was treated for generalized anxiety disorder. When seen by the prison psychiatrist, he was receiving quetiapine 800 mg and clonidine 0.9 mg at bedtime.
The psychiatrist was concerned about the risks of prescribing an antipsychotic medication for a patient with hepatitis without a serious mental disorder. The patient refused to discuss other treatment alternatives stating, "I need my Seroquel." Efforts to enlist his cooperation for a quetiapine taper were unsuccessful. He abruptly left a treatment team meeting and informed staff that he would purchase quetiapine illegally from other inmates and had done this before.
We have treated other prisoners who have threatened legal action and even suicide when presented with discontinuation of quetiapine. We have not seen similar drug-seeking behavior with other second-generation antipsychotics of comparable efficacy. Emil R. Pinta, M.D. has worked as a prison consultant for 35 years and can only recall similar behavior to obtain controlled substances.Hussain et al. suggest that quetiapine abuse may be more prevalent among prisoners because commonly abused drugs are less readily available (2). Another reason may be that quetiapine treats anxiety and sleeplessness associated with substance use withdrawal—with prisoners having high rates for these disorders (3). However, an internet search yielded a number of self-reports by individuals who believe they have become addicted to this agent (4). There is a popular rap song in which "seroquel" is included in a long list of addictive substances (5). In street jargon, quetiapine is known as "quell" and "Susie-Q."
Our experience indicates the need for additional studies to explore the addiction-potential of quetiapine. Quetiapine is an effective medication for treatment of schizophrenia, bipolar disorder, and related illnesses. We believe clinicians should be extremely cautious when prescribing this medication for nonserious mental disorders and for individuals with histories of substance abuse.
FootnotesThe authors report no competing interests.
References
Pierre JM, Shnayder I, Wirshing DA, Wirshing WC: Intranasal quetiapine abuse (letter). Am J Psychiatry 2004; 161:1718[Free Full Text]
Hussain MZ, Waheed W, Hussain S: Intravenous quetiapine abuse (letter). Am J Psychiatry 2005; 162:1755–1756[Free Full Text]
Monnelly EP, Ciraulo DA, Knapp C, Locastro J, Sepulveda I: Quetiapine for treatment of alcohol dependence. J Clin Psychopharmacol 2004; 24:532–535[CrossRef][Medline]
Addiction to Seroquel. http://groups.msn.com/BipolarDisorderWeb Communnity/seroquel.msnw?action=get_message1
Lil’ Wyte lyrics-Oxy Cotton lyrics. http://www.seeklyrics.com/lyrics/Lil-Wyte/Oxy-Cotton.html
poster:halcyondaze
thread:719973
URL: http://www.dr-bob.org/babble/20070101/msgs/719973.html