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
poster:ed_uk
thread:593830
URL: http://www.dr-bob.org/babble/20051231/msgs/593830.html