Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

ABSTRACT

Introduction: Case reports and poison center data have demonstrated that the second-generation antipsychotic quetiapine is being obtained and utilized for recreational abuse.  The purpose of this study was to describe the relative rates of abuse for different atypical antipsychotics, and compare their demographic and clinical features.

Methods: A 10-year retrospective analysis of the National Poison Data System (NPDS) database was conducted (2003 – 2013).  Trained nurses and pharmacists with specialty training in toxicology prospectively collect all NPDS data at poison control centers around the United States.  The NPDS was queried for all cases of single-substance second-generation antipsychotic exposures coded as “intentional abuse”.  The data provided by the NPDS regarding rates and clinical features of quetiapine abuse and the abuse of all other second-generation antipsychotics were compared and described descriptively.

Results: During the study period, there were 2118 cases of quetiapine abuse and 1379 cases of other second generation antipsychotic abuse identified. Quetiapine abuse was more common than the abuse of other second-generation antipsychotics, compromising 60.7% of all abuse cases during the study period. After quetiapine, the next most frequently abused medications were risperidone (530 cases, 15.2%) and olanzapine (246 cases, 7.0%). For all second-generation antipsychotics including quetiapine, central nervous system clinical effects were most common, including drowsiness, confusion, and agitation. Other serious clinical effects observed with second-generation antipsychotic abuse included hypotension, respiratory depression, and seizures.