A New, Peculiar Drug of Abuse: Atypical Antipsychotics

antipsychoticsNot typically considered drugs of abuse, atypical antipsychotics are now being used to either enhance the effects of other drugs or to counter the adverse effects of illicit substances.[1]

Columbia University College of Physicians and Surgeons and Director of Psychiatric Research at St. Luke’s and Roosevelt Hospitals, Deborah L. Haller, Ph.D. said, “Clinicians should screen their patients for substance use disorders before prescribing atypical antipsychotics for problems other than psychosis and closely monitor those who are taking them for psychosis who are known substance abusers.”1

There are many case reports regarding the misuse of atypical antipsychotics—quetiapine, in particular—and Haller and colleagues conducted a study to take a closer look at the role antipsychotics play when combined with alcohol and other drugs.1

Of the 429 patients from the detox and rehabilitation units of the Addiction Institute of New York, 73, or 17 percent, reported illegal or non-medical use of prescribed atypical antipsychotics in combination with alcohol, opioids, cocaine, methamphetamine, and/or cannabis.1

A majority of the antipsychotic users were polysubstance users, and quetiapine was the most abused antipsychotic (84.9 percent).1 Other abused antipsychotics included olanzapine (17.8 percent), risperidone (24.7 percent), aripipriazole (20.5 percent), ziprasidone (8.1 percent), and asenapine (2.9 percent).1 A large percentage of the antipsychotics abused were received through family and friends—a pattern seen often with prescription opioid abuse.1

Haller said, “It is important to note that most of our participants obtained these drugs illegally—from family and friends or from a drug dealer, indicating their street value. This is similar to what is seen with opioid analgesics.”1

The most common reasons for taking atypical antipsychotics were to recover from the side effects from using drugs and alcohol or to enhance the effects of other substances.1 Atypical antipsychotic abusers report that taking the drugs allowed them to mellow-out and slow down.1

The long-term effects of abusing atypical antipsychotics remain unknown, and as they play an extremely important role in the treatment of psychotic disorders, the off-label use may be extremely risky, especially when combined with other substances.1

According to Michael M. Miller, M.D., of the University of Wisconsin School of Medicine and Public Health and Medical Director of Herrington Recovery Center at Rogers Memorial Hospital, patients often misuse atypical antipsychotics to self-detox, trying to medicate the symptoms of withdrawal.1

“If someone is taking a drug that can produce hallucinations or delusions, such as cocaine or methamphetamine, in addition to the euphoria the person desires, they may want to reduce the uncomfortable experience, and they may know an atypical antipsychotic can do that for them,” said Miller. “On the other hand, even if a drug doesn’t produce the kind of high that traditional addictive drugs do, it just has the ability to make them feel different, and that’s enough for them to take it.”1

According to Haller, as the marketing of atypical antipsychotics continue to expand beyond the treatment of psychosis, the potential for misuse could increase.1

“As atypical antipsychotics are being promoted, including on TV, for problems other than psychosis—such as aripipriazole for depression—it seemly likely that increasingly more of these drugs will be in circulation and thus available to those who might misuse them,” Haller said. “Requests for specific atypical antipsychotics should perk the clinician’s interest, as patients obviously have had prior experience with them or have learned of their effects from other users. This is especially true if the patient has no history of a psychotic disorder.”1

[1] Atypical Antipsychotics New Drugs of Abuse. Medscape. Dec 17, 2013.

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