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Quetiapine abuse

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Quetiapine abuseQuetiapine (often branded as Seroquel) is an antipsychotic drug used for schizophrenia and bipolar disorder. It’s also prescribed off-license in the UK for anxiety. That means that a fair few people with alcohol and other drug dependence end up on it. Recent experience makes me wonder if prescribers are as aware of the risks as they might be.

The National Institute for Health and Care Excellence (NICE) says that although there is some evidence that quetiapine can reduce anxiety, it’s not any better at this than antidepressants are. On the other hand, quetiapine can cause problems in the long term including parkinson’s like symptoms, severe reduction in white cells, neuroleptic malignant syndrome (albeit rarely) and has been associated with withdrawal symptoms.

Quetiapine makes number nine on Listverse’s top ten abused prescription drugs. Called ‘Suzy-Q’ they say the drug has a ‘huge recreational value in prison.’

…the tranquilizer has earned the name “Jailhouse Heroin” among our citizens who are paying their debts to society. Abusers seek its anxiolytic (anxiety reducing) effects, as well as its tendency to reduce feelings and provide a careless state of mind. Prisoners commonly trade their meals and money for these pills…

Sansone and Sansone flagged up the risk in 2010:

Quetiapine, an atypical antipsychotic, has been the subject of a series of case reports that suggest a potential for misuse/abuse. The available cases indicate a male predominance; oral, intranasal, or intravenous routes of administration; misuse/abuse in jail or inpatient psychiatric settings; and subjects with extensive histories of polysubstance abuse.

This year Polish researchers looked at 25 case reports of quetiapine abuse. What did they find?

Higher frequency of abuse/dependence was observed in men and people being in their mid-thirties. Only half of the cases reported a positive history of substance abuse. The most prominent phenomenon associated with quetiapine abuse/dependence was marked withdrawal symptoms.

They advised caution when prescribing to patients with a history of addiction.

Research presented last year examined over 400 patients going through a treatment centre in New York and found that 17% were abusing new antipsychotics (89% of these were quetiapine). They were mostly used in combination with other drugs and most were obtained illicitly. The reasons for quetiapine abuse? ‘Coming down’ from other drugs or enhancing the effect of other drugs. For those who were prescribed them legitimately the indications were for sleep, anxiety and mood symptoms, not psychosis. But ‘the risk for misuse may override any therapeutic benefit in these cases.’

So why take the risk at all?

    3 Responses to "Quetiapine abuse"
    1. Detox Nurse says:

      I wonder why it seems to be limited to one particular atypical. The mechanism of action is broadly the same across all the medications within the class. I understand that quetiapine is seen as having a more favourable side-effect profile so it could just be that it’s the most commonly prescribed atypical for conditions other than schizophrenia and bipolar.

      What’s interesting is that these drugs are dopamine antagonist; the opposite of many traditional drugs of abuse.

      As always, I think we need to be careful about conflating the occurrence of withdrawal symptoms with a dependence syndrome.

      • djmac says:

        I wondered why quetiapine was favoured too. Possibly a combination of subtle pharmacological differences and some street-cred that it has built up. What concerns me is the level of off-label prescribing in vulnerable groups.

    2. Detox Nurse says:

      I have to say it’s not something that I’ve come across much, unlike pregabalin/gabapentin abuse. That said, I do remember doing an ECG on a service user last year. They’d been prescribed olanzapine which they’d taken mid-afternoon. To put it bluntly, the service user was ‘off their face’. Perhaps a sign of things to come.

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