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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by ed_uk on December 31, 2005, at 20:25:21
Well, what do you know? Some people like to snort Seroquel.
From the American Journal of Psychiatry.........
Intranasal Quetiapine (Seroquel) abuse
We would like to report on the widespread "abuse" of quetiapine among inmates in the Los Angeles County Jail—"the largest mental health institution in the world." Anecdotal reports from clinicians and staff estimate that as many as 30% of the inmates seen in psychiatric services report malingered psychotic symptoms (typically endorsing "hearing voices" or ill-defined "paranoia") in order to specifically obtain quetiapine. A history of substance dependence is common among those engaging in this practice. In addition to oral administration, the drug is also taken intranasally by snorting pulverized tablets. Such abusive self-administration seems to be driven by quetiapine’s sedative and anxiolytic effects (to help with sleep or to "calm down") rather than by its antipsychotic properties. Accordingly, the drug has a "street value" (it is sold to other inmates for money) and is sometimes referred to simply as "quell."
Although the prevalence of this behavior beyond this narrow forensic population is unknown, the possibility of such an abuse potential is both curious and clinically pertinent. For example, it suggests that quetiapine is indeed associated with a better subjective response than its conventional antipsychotic counterparts (1). It also appears to give lie to the clinical myth that only psychotic patients will ask for and take antipsychotic medications. In our collective clinical experience, many patients (in particular, those with substance dependence) complain of "hearing voices" in order to procure hospital admission, disability income, or psychotropic medications (2). The "voices" are usually vague, highly suggestive of malingering (3), and occur in the absence of other symptoms (such as clear-cut delusions or thought disorganization) that would warrant a diagnosis of schizophrenia. While antipsychotic medications are not typically recognized as drugs with abuse potential, the use of intranasal quetiapine suggests otherwise and underscores the importance of recognizing malingered psychosis in clinical settings. This phenomenon is reminiscent of the era before the widespread use of atypical antipsychotic compounds, when a select group of patients would inappropriately seek and self-administer not only anticholinergics, such as trihexyphenidyl (4), but also low-potency antipsychotics, such as thioridazine or chlorpromazine. Finally, since the monosymptomatic "voices" endorsed by patients are often assumed to represent psychosis and therefore lead to reflexive prescription of antipsychotic medications, further investigative efforts aimed at distinguishing this clinical presentation from schizophrenia would be useful. If these entities could be reliably disentangled, it would help to reduce the diagnostic heterogeneity of schizophrenia and the unnecessary exposure of patients to the potentially harmful side effects of antipsychotic medications.
Intravenous Quetiapine abuse
There are recent reports in the literature describing the intranasal abuse of quetiapine among jail inmates, who may obtain it by reporting malingering psychotic symptoms and who refer to it as "quell" (1).
Ms. A was a 34-year-old woman with a history of polysubstance dependence (alcohol, cannabis, and cocaine), depressive episodes associated with multiple suicide attempts, and borderline personality disorder who was incarcerated after conviction on charges of physical assault and possession of controlled substances. She had a history of incarceration on multiple occasions for similar charges. She complained of difficulty sleeping, poor impulse control, irritability, and depressed mood. For these symptoms, she was given oral quetiapine, 600 mg at bedtime. On one occasion, she took the pills provided to her but did not ingest them. Instead, she crushed the two 300-mg tablets, dissolved them in water, boiled them, drew the solution through a cotton swab, and while lying in bed, covered by blankets, intravenously injected the solution.
Twelve hours later, she was awoken by facility guards who found the syringe she used still in place on her arm. She informed the guards that she had intravenously injected herself with quetiapine the previous evening and became rapidly sedated, falling asleep before she could remove the syringe. She additionally admitted to previous intranasal abuse of crushed quetiapine tablets. Apart from "the best sleep I ever had," she described no dysphoric, euphoric, or other effects.
This description lends support to findings by other investigators of an increased risk of abuse of prescription medication in individuals who have a history of substance abuse or dependence (2). It is conceivable that such a progression from the use of quetiapine to its abuse either intranasally or intravenously is more prevalent than is currently assumed. This may be particularly apt in settings in which the prescription of sedative agents, such as benzodiazepines, barbiturates, and stimulants, is decreasing secondary to concerns of abuse and resale, e.g., prison settings and substance abuse treatment programs and among school-age children. The calming and sedating effects of quetiapine, which make it useful in clinical practice, also make it a substance of abuse and confer "street value" on it by the same token.Quetiapine treatment has been demonstrated to be associated with prolonging abstinence and decreasing the number of hospitalizations in patients with alcohol dependence and posttraumatic stress disorder (3). This is hypothesized to be related to the impact of quetiapine on improving disturbed sleep but may also be related to a direct action of quetiapine in reducing the use of alcohol. The awareness of the "extra-antipsychotic" effects of quetiapine provides potential areas for further clinical research for understanding the treatment of substance abuse and anxiety disorders.
Ed
Posted by Phillipa on December 31, 2005, at 20:32:29
In reply to Seroquel 'abuse', posted by ed_uk on December 31, 2005, at 20:25:21
Ed where did a prisoner get a syringe? I know inmates sell their meds to others as I worked parttime in a jail. But a syringe? Fondly, Phillipa
Posted by yxibow on January 1, 2006, at 0:24:22
In reply to Re: Seroquel 'abuse' » ed_uk, posted by Phillipa on December 31, 2005, at 20:32:29
> Ed where did a prisoner get a syringe? I know inmates sell their meds to others as I worked parttime in a jail. But a syringe? Fondly, Phillipa
Veterinary syringes require no prescription for non veterinary use -- I know, I've used them for fungicidal injection in sick plants. They could have been obtained that way somehow although packages are screened so I doubt it. Or someone inside the jail hospital could have been payed off for regular syringes.
Seroquel abuse -- that's the strangest thing I've heard, I guess considering I take it because I have to, not because I get any pleasure. In fact its stupifying at night. But that she fell asleep is no surprise.. it probably just boosted the blood level of it, I know its heavily sedating at the 900mg I take.
Posted by UgottaHaveHope on January 1, 2006, at 1:01:49
In reply to Re: Seroquel 'abuse' » Phillipa, posted by yxibow on January 1, 2006, at 0:24:22
Seroquel is no different from any other prescrption or over the counter drug.
Posted by James K on January 1, 2006, at 12:09:17
In reply to Seroquel 'abuse', posted by ed_uk on December 31, 2005, at 20:25:21
I was in the hopital this summer, and I used to sit looking out my window and listen to the guys next door crush up and snort their tablets on their windowsill. Some of the people in this hospital were the kind of unfortunates who have a life of disability, drifting, and hospitalizations. I'm not the one to say what their true motivations or circumstances are, but it was a tense and violent hospitalization for me (I came in with an attitude). This psych ward uses seroquel as an all purpose sleeping pill for almost everyone anyway, so I think the abuse started with the administration.
As for malingering, we had people check themselves out for the weekend, come back on Monday claiming suicidal, with a bag full of pills to sell. I still found some recovery, but it was hard to be in chemical dependency groups while I knew this was going on.
Posted by linkadge on January 1, 2006, at 12:15:56
In reply to I've run across this » ed_uk, posted by James K on January 1, 2006, at 12:09:17
I wouldn't have seen that one coming.
I can see abuse of anticholinergics though.
Strange, I took Seroquel, and would have to say that it there are many other drugs I would abuse before it. (although I don't abuse drugs)
Are stimulant drugs ever prescribed in prision ?
Linkadge
Posted by ed_uk on January 1, 2006, at 13:11:29
In reply to I've run across this » ed_uk, posted by James K on January 1, 2006, at 12:09:17
Hi James
Thank you for posting.
So it was Seroquel they were crushing?
Regards
Ed
Posted by James K on January 1, 2006, at 15:22:56
In reply to Re: I've run across this » James K, posted by ed_uk on January 1, 2006, at 13:11:29
I can't 100% say that it was seroquel I heard being snorted, but I know seroquels were saved under the tongue for "later", and I'd see guys "drunk" as heck "later".
The truth is I didn't get close enough to this bunch to totally know what they were up to - just speaking terms. I think I posted with a little more certainty than I should have.
The first time I took seroquel, a year or so earlier, I felt like I had slammed a six-pack. I was shocked that they would give me a med so intoxicating when I was rehabbing from alchohol abuse. They claimed the effect would go away, but I didn't take it long enough to find out.
On the other hand, I knew meth addicts on 8 times the dose I was on function normally in the day time.
A high is a high I guess, but I sure wouldn't choose that one.
James K
Posted by Phillipa on January 1, 2006, at 16:37:17
In reply to Re: Seroquel 'abuse' » Phillipa, posted by yxibow on January 1, 2006, at 0:24:22
Believe it or not at the jail I worked we had to count the number of syringes daily just like narcotics. Maybe a guard was getting in in. In return for some of the drugs. That happens often. Fondly, Phillipa
Posted by Phillipa on January 1, 2006, at 16:42:38
In reply to I've run across this » ed_uk, posted by James K on January 1, 2006, at 12:09:17
I've seen this too. Didn't they do room and body checks on return to the hospital? Heck at one time on a chemical dependency unit we had marijuana, coke, bongs, etc we had to get rid of that we found on the pts when they returned. I remember on girl was alchoholic and had the nerve to spike her coke with alchohol and was drinking it on the unit til she appeared so drunk someone found out about it and got rid of it. Fondly, Phillipa
Posted by ed_uk on January 1, 2006, at 22:55:19
In reply to Re: I've run across this » ed_uk, posted by James K on January 1, 2006, at 15:22:56
Hi James
>I was shocked that they would give me a med so intoxicating when I was rehabbing from alchohol abuse.
You found it like alcohol? I've never thought Seroquel would be anything like alcohol.
Regards
Ed
Posted by Chairman_MAO on January 2, 2006, at 12:22:04
In reply to Re: I've run across this » James K, posted by ed_uk on January 1, 2006, at 22:55:19
People will abuse anything that is sedating and anxiolytic when imprisoned; just look at the lab rats that self-administer cocaine until they die. Think this is a result of the drug? Think again:
http://en.wikipedia.org/wiki/Rat_Park
People abuse drugs because of the experiences they provide, not the biochemical profiles. The latter is an inappropriate level of explanation because it ignores the ecology of the situation.
Posted by ed_uk on January 2, 2006, at 12:38:57
In reply to Re: I've run across this » ed_uk, posted by Chairman_MAO on January 2, 2006, at 12:22:04
Hi Chairman
Thanks for the interesting link.
Seroquel is not a euphoric drug. Whatever the prisoners were taking it for I am sure they weren't getting 'high'!
Ed
Posted by Larry Hoover on January 2, 2006, at 13:39:07
In reply to Re: I've run across this » ed_uk, posted by Chairman_MAO on January 2, 2006, at 12:22:04
> People will abuse anything that is sedating and anxiolytic when imprisoned; just look at the lab rats that self-administer cocaine until they die. Think this is a result of the drug? Think again:
>
> http://en.wikipedia.org/wiki/Rat_Park
>
> People abuse drugs because of the experiences they provide, not the biochemical profiles. The latter is an inappropriate level of explanation because it ignores the ecology of the situation.Thank you very much for this link.
Lar
Posted by med_empowered on January 2, 2006, at 14:56:17
In reply to Re: I've run across this » Chairman_MAO, posted by Larry Hoover on January 2, 2006, at 13:39:07
I think chairman_MAO made an interesting and valid point. The person writing this paper seems strangely pleased--like "finally, we have an antipsychotic so tolerable, some people will abuse it!". But really I think prison life will drive people to find a means of escape--any means of escape.
Back when they were still doing lobotomy and psychosurgical experiemnts, I read a couple case studies where prisoners agreed to be operated on, were paroled/released, and then promptly changed their minds and decided not to be operated on. They had just wanted an escape from prison life--nothing more. Plus, although Thorazine abuse wasn't widespread, it did happen..if you read Andy Warhol's diaries, for instance, you'll see a couple cases of people popping Thorazine in low-ish doses. I think that among some groups of drug users (particularly those who are miserable and/or depressed, for whatever reason), the drug of misuse becomes less important than using a drug to escape--pretty much any drug will do.
Plus..if you were in today's harsh, under-funded, under-staffed, highly violent prisons, wouldn't you want to be as apathetic and calmed down as possible?
Posted by Larry Hoover on January 2, 2006, at 15:25:24
In reply to context of drug abuse, posted by med_empowered on January 2, 2006, at 14:56:17
> Plus..if you were in today's harsh, under-funded, under-staffed, highly violent prisons, wouldn't you want to be as apathetic and calmed down as possible?
Absolutely. Next time you look at the calendar, you leaped forward, because a chunk of time is missing/minimized.
Lar
Posted by James K on January 2, 2006, at 17:20:58
In reply to Re: context of drug abuse » med_empowered, posted by Larry Hoover on January 2, 2006, at 15:25:24
Looking back over this thread, there is a lot of fascinating stuff here. Some of my thoughts are -
Yeah seroquel felt like alcohol to me. I think maybe at that point, I'd lost euphoria when I drank. So perhaps any impairment felt like alcohol. I've also always reacted strongly and sometimes oppositely to chemicals prescribed and otherwise. such as getting energy from cns depressants and opiates, and calming from stimulants. Feeling ssri's the first day I took them - not as anti-depressant but as something off. Benydryl drives me nuts etc...I agree with the concepts in the chairman's link. I think some societal proof of the concept is the huge number of people who stop or slow down drinking and drugs after college. or those who voluntarily enter rehab, or just quit on their own just because they want to, not from fear or ruination.
As to Larry's and others ideas of the context of drug abuse, I also agree. I've never been in prison, so this is slightly different, but I remember what the first psychiatrist I ever saw pointed out to me. I was spending all work day and week looking at the clock till I could leave, and all time off obliterating time until I had to go back. I wasn't in prison, but I was so unhappy and uncomfortable in my own skin, that I was rarely just "there" in the moment. It was also a time and place of poverty and violence, where the only social options seemed to involve intoxicants.
Summing up what I think about the inital subject which was "recreational" abuse of seroquel, in my personal experience, substance abuse can be for both fun and euphoria, and for complete escape, and anything will work for the escape. - psych meds, glue, listerene, self injury, nutmeg, masturbation - i don't know, whatever works.
Thanks for the info and for listening,
James K
Posted by Phillipa on January 2, 2006, at 17:47:26
In reply to Re: context of drug abuse, posted by James K on January 2, 2006, at 17:20:58
All I know is my brief experience with seroquel left me feeling very drunk. Fondly, Phillipa
Posted by stillaventfound on January 3, 2006, at 18:53:33
In reply to Re: context of drug abuse, posted by Phillipa on January 2, 2006, at 17:47:26
Ironically was reading a report on the net last nite of a man treated for schizophrenia...numerous hospitalizations, non compliant with haldol,etc.Was treated with increasing doses of seroquell was released from hospital, but complaints started to come in to his social worker of, i believe public masterbation.when re-admitted he complained of spontaneous ejaculations periodicaly, and a strong feeling of sexual arousal amenable to frequent masturbation.Main point is that it was a)dose dependant, and b) hypothesized it had to do with seroquel acting at a different d2 sub receptor (along with clozaril and one other atypical)as opposed to most other old or new anti-psychotics.It seems instead of decreasing sex drive, at the proper dose was robustly doing the opposite! I think this article was by S. Preskorn, not sure. Wouldn't take too much pondering to come up with a possible explanation for this prison phenomenom!
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