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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
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
Posted by linkadge on January 6, 2007, at 20:11:23
In reply to Seroquel addiction [absurd, if you ask me]:, posted by halcyondaze on January 6, 2007, at 19:50:25
I really don't understand it. I tend to agree that (mis)use of seroquel would probably stem from comorbid disorders among substance users.
It does have sedating and anxiolitic properties, but I would not think it is reinforcing at all.
Does it have street value, or just a street name?
Maybe I am different, but seroquel causes
imediate dysphoria in me.Linkadge
Posted by halcyondaze on January 6, 2007, at 20:30:32
In reply to Re: Seroquel addiction [absurd, if you ask me]:, posted by linkadge on January 6, 2007, at 20:11:23
It's funny because I am exactly the type of "target population" who would abuse this drug if abusable (depressive, borderline, polysubstance dependence) and my doctor jokes that I am like a litmus test for drugs: if it's possible to abuse it, I will do it. I have found ZERO recreational potential in Seroquel.
I have also run in many drug circles in many states and have only known one person who bought Seroquel on the street more than once [a lot of people, not knowing what it is, want to try it to see if it has recreational value] and he was a crystal meth addict who needed something to help him sleep.
I have never known anyone who sold Seroquel or bought Seroquel and can name you prices for amphetamines, barbiturates, and benzos off the top of my head, but Seroquel? It just isn't on the market.
However, the articles made it seem like it does have street value. I mean, if I were in prison, I might want to sleep my way through jail, too, but that doesn't mean that it would make me euphoric. Like you, I get dysphoric from it.
> I really don't understand it. I tend to agree that (mis)use of seroquel would probably stem from comorbid disorders among substance users.
>
> It does have sedating and anxiolitic properties, but I would not think it is reinforcing at all.
>
> Does it have street value, or just a street name?
>
> Maybe I am different, but seroquel causes
> imediate dysphoria in me.
>
> Linkadge
>
>
Posted by blueberry1 on January 6, 2007, at 21:00:02
In reply to Seroquel addiction [absurd, if you ask me]:, posted by halcyondaze on January 6, 2007, at 19:50:25
Maybe they're just looking for that immediate heavy sedation or getting zoned out. Some abusers don't necessarily look for a high as they look for just zoning out in veggie land. I can't imagine anyone experiencing anything euphoric from it though. I can't imagine anyone having drug-seeking behavior with seroquel either. Weird.
Maybe some of them have underlying anxiety or depression problems and the seroquel provides rapid relief for some of them? It made me feel kind of crappy, but obviously somebody else likes it. I don't understand it.
Posted by Phillipa on January 6, 2007, at 23:05:48
In reply to Re: Seroquel addiction [absurd, if you ask me]:, posted by blueberry1 on January 6, 2007, at 21:00:02
Tried it at 25mg and hated it. Made me feel wierder than usual the next day. Love Phillipa
Posted by yxibow on January 6, 2007, at 23:29:42
In reply to Re: Seroquel addiction [absurd, if you ask me]:, posted by Phillipa on January 6, 2007, at 23:05:48
Cocaine-Seroquel. That's the wierdest thing I've heard about. I mean, I have a need to take Seroquel and I wouldn't wish it upon anyone. A potential heart-attack inducing agent mixed with a low-blood pressure inducing agent. I suppose that cancels something out? I must admit I wish they made a Seroquel without the HUGE H1. Annoyingly, I can't take Zyprexa which is much much less sedating. Anyhow, a side story.
Of course the Erowid vault is filled with the most bizarre combinations of drug "trials" and "descriptions." I never understand the value of tripping on multiple medications and then writing it up. Who could possibly say what each one is actually doing, if you believe in the whole site, which does have some curious stuff, but humph...
-- tidings
Posted by cgd092 on January 6, 2007, at 23:53:46
In reply to Re: Seroquel addiction [absurd, if you ask me]: » Phillipa, posted by yxibow on January 6, 2007, at 23:29:42
You wrote, "I must admit I wish they made a Seroquel without the HUGE H1. Annoyingly, I can't take Zyprexa which is much much less sedating."
I take about 100mg/day Seroquel. I usually divide the dose into 25mg. bits, and use it sort of an anxiolytic. But I know that it's really just the H1 (histamine, right?) agonist that's making me sleepy and hence, slightly less anxious. I honestly can't feel it doing anything else but make me feel like I just took a Benadryl. Whatever else it is supposed to do (augment my Celexa?) I don't really feel it.My pdoc said, "Hopefully, when we get you up to speed on the Lamictal, you can reduce your Seroquel." I said really, why would you do that? She said, "Don't worry, I won't take away your Seroquel yet." I laughed because I was just curious; I have no dependency on Seroquel that I know of. But perhaps she's read about the few guys in a correctional facility somewhere that think it's da bomb and thought I was gonna be all, "I need my Seroquel, man!"
-Katy
Posted by med_empowered on January 7, 2007, at 1:07:49
In reply to Re: Seroquel addiction [absurd, if you ask me]:, posted by cgd092 on January 6, 2007, at 23:53:46
Seroquel addiction? Lame. I think part of the problem is this people are incarcerated, so they're automatically suspect. They come in as deviant, and all their subsequent behaviors are viewed through that lens. So..my guess is mild sedation plus whatever else it is seroquel does for some people (anxiety relief, numbness, whatever) proves helpful for some inmates in coping with their situations. That's not euphoria, and that's not really abuse, either; its using a substance to cope with what I imagine to be a very, very harsh situation.
I think if prisoners want seroquel, they should have it. Lots of it. Since the gov't seems unwilling to improve prison life, the least the gov't can do is offer prisoners something to take the edge.Plus, I imagine it would reduce jail violence.
Posted by LlurpsieBlossom on January 7, 2007, at 6:47:10
In reply to Re: Seroquel addiction [absurd, if you ask me]:, posted by med_empowered on January 7, 2007, at 1:07:49
I can see how someone would grow dependent on the sedative qualities of seroquel. I take 300mg and I have gotten to the point where it will cause me to fall asleep in the evening, but have no grogginess in the daytime. I actually LIKE the antihistamine, because I havent had any problems with allergies or such this year. yay!!
another reason why seroquel might be abused is because it makes the little ruminative thoughts go away. I can easily imagine how someone who is incarcerated and socially isolated might develop an inner life of the mind that includes ruminative and intrusive thoughts. If one is in solitary confinement or ostracized for too long, one will likely show signs of mental illlness, including psychotic symptoms. Seroquel might be a way that such a person maintains a feeling of sanity in an insane world.
or maybe they just want to feel zoned out stoned out. mood stabilized?
Ll
Posted by linkadge on January 7, 2007, at 11:57:00
In reply to Re: Seroquel addiction [absurd, if you ask me]:, posted by cgd092 on January 6, 2007, at 23:53:46
>She said, "Don't worry, I won't take away your >Seroquel yet."
She might be more concerned with the fact that it might cause movmenet disorders in the long run. I know some doctors only want to use them short term to avoid such effects.
Linkadge
Posted by ed_uk on January 7, 2007, at 13:17:32
In reply to Re: Seroquel addiction [absurd, if you ask me]:, posted by LlurpsieBlossom on January 7, 2007, at 6:47:10
Hi L
>another reason why seroquel might be abused is because it makes the little ruminative thoughts go away
Not sure I'd call that 'abuse'. Sounds more like one of the therapeutic effects of Seroquel!
Ed
Posted by yxibow on January 8, 2007, at 3:30:43
In reply to Re: Seroquel addiction [absurd, if you ask me]:, posted by LlurpsieBlossom on January 7, 2007, at 6:47:10
> I can see how someone would grow dependent on the sedative qualities of seroquel. I take 300mg and I have gotten to the point where it will cause me to fall asleep in the evening, but have no grogginess in the daytime. I actually LIKE the antihistamine, because I havent had any problems with allergies or such this year. yay!!
>
> another reason why seroquel might be abused is because it makes the little ruminative thoughts go away. I can easily imagine how someone who is incarcerated and socially isolated might develop an inner life of the mind that includes ruminative and intrusive thoughts. If one is in solitary confinement or ostracized for too long, one will likely show signs of mental illlness, including psychotic symptoms. Seroquel might be a way that such a person maintains a feeling of sanity in an insane world.
>
> or maybe they just want to feel zoned out stoned out. mood stabilized?
>
> Ll
Curiously, the H1 effect of Seroquel does not too much for nasal congestion but everything and then some for grogginess -- not sleep, I still need things on top to remain asleep.Generic loratadine is sometimes necessary if I have some ear/sinus/whatever thing going on.
But I prefer saline anyhow, it does a good job of inducing sinus nasal flow and is basically not addictive. L-methamphetamine OTC Vicks for one day is allright. Its funny how they relabel it levmetamfetamine on the package -- maybe this is NIDA's way of saying oh, its not a rotated crystal meth that isn't terribly addictive and can't be converted without highly sophisticated organic chemistry manipulation if that is even possible.
I'm glad you like the effect, but it is not fun staggering upstairs with nearly 800mg of Seroquel just kicking in and having to use the loo and almost fainting. Trazodone does a similar thing. Orthostatic hypotension.
Posted by LlurpsieBlossom on January 8, 2007, at 11:57:55
In reply to Re: Seroquel addiction [absurd, if you ask me]: » LlurpsieBlossom, posted by ed_uk on January 7, 2007, at 13:17:32
Use and abuse as determined by the authorities vs. the subject vs. the researcher. Often shades of grey... but! IV injection of seroquel is pretty gnarly, in my opinion. I would probably have orthostatic jelly legs for sure!
am I dependent on shampoo?
do I abuse it when I rinse and REPEAT?
hmm?
I think that taking away ruminative thoughts is indeed a therapeutic benefit of seroquel. Are ruminative thoughts very common in folks that have no Dx of mental illness? I honestly don't know. I bet that a lot of people have them, but? When do they become an issue?
my ruminative thoughts are silent, but my body is saying... NAPTIME!!!!
Posted by Manuchehr on March 20, 2010, at 2:04:08
In reply to Seroquel addiction [absurd, if you ask me]:, posted by halcyondaze on January 6, 2007, at 19:50:25
Seroquel may have withdrawal symptoms,but when I take it at night, it really doesn't make me happy or any thing.If I miss an appointment and run out of it , I don't rush to the Dr's office and desperately ask them for a few samples because I love how I feel right after taking this drug. It is because,if I don't take it, I can't sleep, I have anxiety,and I feel like my manic symptoms are coming back,and I feel like I am losing it. I have severe bipolar disorder. Usually ,200 mg of seroquel at night suddenly makes me very depressed ,and then, I have to go to bed. I would never continue taking this med, if it wasn't very effective in reducing my psychotic symptoms.
Posted by Deneb on March 20, 2010, at 15:50:26
In reply to Re: Seroquel addiction [absurd, if you ask me]:, posted by Manuchehr on March 20, 2010, at 2:04:08
Hello Manuchehr
Welcome to Psycho-Babble. Thanks for letting us know about your experiences with Seroquel. I think there are some misconceptions about how some psych meds can be addictive.
Deneb
Posted by Jeroen on March 23, 2010, at 3:48:07
In reply to Re: Seroquel addiction [absurd, if you ask me]:, posted by Manuchehr on March 20, 2010, at 2:04:08
yes thanks for sharing
Posted by desolationrower on March 26, 2010, at 0:03:33
In reply to Re: Seroquel addiction [absurd, if you ask me]:, posted by Jeroen on March 23, 2010, at 3:48:07
christ. prison is especially designed to be as cruel as possible, and its a sign of psychopathology to want to be too f*ck*d inthe head to vividly experience every hour spent staring at the wall or getting raped? i would like to 'misuse' this doctors face.
-d/r
Posted by Leo33 on March 31, 2010, at 16:40:26
In reply to Re: Seroquel addiction [absurd, if you ask me]:, posted by desolationrower on March 26, 2010, at 0:03:33
I have been told most of the meds are addictive and if you have gone thru med changes and addiction training, it is hard to tell the difference.
This is the end of the thread.
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