Quetiapine Abuse

Quetiapine (branded as Seroquel in the US) is an antipsychotic drug used for schizophrenia and bipolar disorder. It’s also prescribed off-license in the UK for anxiety. That means that some people with substance use disorders who don’t have a major mental health diagnosis end up on it. 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 some antidepressants.

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 increasingly been noted to have addictive potential and has been associated with withdrawal symptoms.

Even back in 2014, quetiapine made number nine on Listverse’s top ten abused prescription drugs. Called ‘Suzy-Q’ they say the drug, known as ‘Jailhouse Heroin’ has a ‘huge recreational value in prison.’ A UK prison GP blogged this year about consultations for medications the patient “wants rather than needs”, writing: “consultations about pregabalin, gabapentin, quetiapine and mirtazapine are the ones that attract most conflict.”

Sansone and Sansone have also flagged up the risk: “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.”

Research from New York looked at over 400 patients going through a treatment centre and found that 17% were abusing new antipsychotics (89% of these were using 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.’

More recently Vento and colleagues reviewed the evidence base and “found quetiapine to be abused mainly by addict populations and people with law involvement.” They suggested that physicians and psychiatrists should “be aware of the addictive potential of quetiapine and adopt measures restricting its use.”