Seroquel (quetiapine), an atypical antipsychotic medication, is FDA approved for the treatment of schizophrenia, mania, bipolar depression, and maintenance treatment of bipolar disorder. It is used off-label for many different reasons. In a prison environment, it is often used to target problems with anxiety, sleep, and impulse control.
In the early 2000′s, Seroquel came up on the radar of my correctional system primarily because of cost. Not only was it expensive to use, but it was being greatly over-prescribed.
Shortly thereafter, it was recognized as not only costing money but also as likely being abused and diverted.
This suspicion was further validated when a somewhat famous letter to the editor of the American Journal of Psychiatry was printed in September 2004 detailing the extent of intranasal quetiapine abuse in the L.A. County Jail. An estimated 30% of inmates in their psychiatric services were malingering psychotic symptoms (typically reporting to hear voices that were not likely present) specifically to obtain Seroquel. In addition to taking the tablets orally, inmates were also crushing and snorting it. Typically inmates requesting it had histories of substance abuse.
Then in January 2007, a letter from the Ohio correctional system was published in the American Journal of Psychiatry expressing concern that quetiapine had significant addictive properties and detailing the formulary restrictions they had in place to restrict its use.
Over the past several years restrictions in many correctional settings have been implemented on the use of Seroquel both because of cost and potential for abuse. Anecdotally, from my own experience there has been a significant reduction in the number of inmates malingering psychosis.
So why do prisoners like Seroquel? Primarily because of its sedative properties. It’s pretty good at calming down people with anger and impulse control problems, it reduces anxiety, and in my experience it is more effective in helping many people sleep than many other medications. In a prison or jail setting many other substances that may be more likely to be abused on the streets often are not available.
I have been surprised at the number of non-correctional psychiatrists I know who still do not realize that quetiapine has abuse potential. In recent years, psychiatrists also have become more aware of the potential for atypical antipsychotics such as Seroquel to cause metabolic syndrome and weight gain. Combine the abuse issues and potential side effects with relatively high cost, and I would recommend that Seroquel be used very cautiously in all patients but especially in those who are incarcerated and/or have substance abuse histories.
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