Emergency Department Visits for Misuse and Abuse of Atypical Antipsychotic Medications

Although antipsychotic medications are not typically used recreationally, concerns about abuse of certain atypical (“second generation”) antipsychotics are emerging. Quetiapine is approved for treatment of schizophrenia, bipolar disorder, and major depressive disorder. Abusers cite desirable effects of deep sleep/relaxation and recovery from cocaine, heroin and marijuana highs. Olanzapine has also been implicated. We analyzed Drug Abuse Warning Network (DAWN) Emergency Department (ED) visits involving atypical and older antipsychotics to ascertain proportion of visits classified as misuse/abuse and combination use with other medications and/or illicits. DAWN uses a probability sample of US hospitals serving the general population to produce annual national estimates of licit and illicit drug-related ED visits. In 2010, an estimated 174,700 ED visits involved antipsychotics (mostly atypicals) with 39% classified as misuse and abuse (M/A). Of the 70,486 visits involving quetiapine, 54% were M/A visits; next highest was olanzapine (12,091, 43% M/A.) M/A proportions for other atypical antipsychotic-related visits ranged from 19% to 32%. Compared to all other types of antipsychotics, the proportions of M/A visits for atypicals and for quetiapine were significantly higher (p values <0.001.) 82% of M/A quetiapine cases involved at least one other drug, with CNS pharmaceuticals the major class, and benzodiazepines the predominant drug. Combination with illicit drugs was 21% overall. ED visits for quetiapine suggest that abuse/misuse may be more prevalent among the general population than expected, and not restricted to prisoners, psychiatric inpatients and polydrug abusers as initially reported. Combinations with antianxiety/sedative drugs were more frequent than combination with illicit drugs.