Purpose. A possible case of intranasal quetiapine misuse in a patient with schizoaffective disorder and substance abuse is presented
Summary. A 28-year-old Caucasian female with schizoaffective disorder (bipolar type), comorbid polysubstance abuse, tobacco dependence, and personality disorder was admitted to an inpatient psychiatric facility following a hit-and-run conviction. Medications on admission included quetiapine, benztropine, haloperidol, lorazepam, diphenhydramine, and trazodone. As-needed medication orders included benztropine and lorazepam. The patient was hospitalized in order to undergo rehabilitation and psychiatric stabilization. During the first four weeks of the patient’s hospital stay, the nursing staff suspected her of "cheeking" or "palming" her quetiapine dose on several occasions. During this time she was also suspected of using cocaine and alcohol while away from the hospital. The patient demonstrated symptoms that are consistent with cocaine withdrawal, but the patient denied the use of cocaine. Aspirin tablets, quetiapine tablets, and white powder were found in her room. The patient stated that the white powder was aspirin. It was suspected that it also contained quetiapine, which the patient later admitted to crushing and snorting for its "calming" effects. Quetiapine was discontinued. There have been reports in the literature of oral and intranasal quetiapine abuse among prison inmates.
Conclusion. Possible intranasal quetiapine misuse was detected in a patient with schizoaffective disorder and a history of substance abuse. While antipsychotic medications are not typically thought of as drugs with an abuse potential, reports of the use and diversion of intranasal quetiapine among prison inmates, i.v. quetiapine abuse, and this case report indicate otherwise.
Index terms: Alcohols, ethyl; Antipsychotic agents; Benztropine; Bipolar disorder; Cocaine; Diphenhydramine; Drug abuse; Drug administration routes; Haloperidol; Lorazepam; Quetiapine; Trazodone
