Jan 01, 2007 03:00 AM

http://ajp.psychiatryonline.org/cgi/content/full/164/1/174

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.