Menu Icon Search
Close Search

Atypical Drugs of Abuse

Created July 27, 2008 by Emily Forest
Share

 

While some associate prescription drugs with expense and inconvenience, others seek out the drugs, lying to get prescriptions, and buying pills illegally. Such “drug seeking behavior,” familiar to medical professionals when it involves Ritalin, OxyContin, Xanax, or any number of drugs noted to increase productivity, sink patients into an opiate-induced haze, or sedate those wishing to evade the stresses of life, abuse of anticonvulsants, antipsychotics, antihistamines, and others, represents a new frontier of drug abuse.

One of the more well-known and well-documented drugs of abuse, diphenhydramine is an antagonist to the H1 receptor, which seems, given its over-the-counter status, to be innocuous. Like many sleep aids, including the more recently developed Ambien, the drug was at first touted as having low associated risk of dependency (1). However, there has been much evidence to the contrary.  In low doses, the drug has its indicated sedating effects while in larger quantities it can produce a euphoric high and possible associated hallucinations (2). Diphenhydramine is particularly desirable as it is cheap and requires no prescription. Thus it is especially hazardous to adolescent populations unable to obtain more hard-core street drugs.

Some newer drugs, including Seroquel and Neurontin, have also demonstrated abuse potential. Seroquel, an atypical antipsychotic familiar to psychiatrists as a treatment for schizophrenia and bipolar disorder, is known on the streets as quell, Suzie Q, baby heroin, and, when combined with cocaine, a Q-ball. In the latter example, Seroquel replaces heroin in the usual cocaine-heroin speedball recipe (3). The abuse potential is thought to be due to its sedating effects, most likely secondary to histamine H1 receptor antagonism. There is much anecdotal evidence to bolster this theory as one patient reportedly took the drug to “mellow out” and another compared the drug to clonazepam.

Drug seeking and Seroquel abuse have been particularly problematic in prison populations. One report on the Los Angeles County Jail states that about a third of those prisoners seeking psychiatric help may be malingering to obtain Seroquel. Knowing that the drug is used to treat psychosis, prisoners mimic these symptoms, often reporting that they hear voices (4). Such drug-seeking behavior has also been noted outside of the prison population, including the case of one man who stole his girlfriend’s Seroquel. In another case, a patient who was prescribed the drug legitimately, for bipolar disorder, resorted to taking more than his prescribed dose.

While Seroquel has received much recent attention as an insidious drug of abuse, other drugs outside of the usual stimulants and benzodiazepines have been noted to have abuse potential. Neurontin, used to treat both epilepsy and neuropathic pain, has recently been noted as a potential drug of abuse.

The drug is known also to have a sedating effects with an accompanying high similar to that produced by marijuana (5). This is somewhat less well-documented. One patient, known to have a history of alcoholism, reported that it reduced his cravings (6) and another patient resorted to drug-seeking behaviors (5). Both experienced withdrawal symptoms upon cessation of the drug.

Abuse of diphenhydramine, Neurontin and Seroquel illustrates the point that doctors must proceed cautiously when dealing with patients who appear to exhibit drug-seeking behavior towards drugs not normally known to be abused.

(1) Roberts, K., Gruer, L., Gilhooly, T. Misuse of diphenhydramine soft gel capsules (Sleepia): a cautionary tale from Glasgow. Addiction. 94; 10, 1999.

(2) Halpert, AG., Olmsead, MC., Beninger, RJ. Mechanisms and Abuse Liability of the Anti Histamine Diphenhydramine. Neuroscience and Behavioral Reviews. 26, 2002

(3) Waters, BM., Joshi, KG. Intravenous Quetiapine- Cocaine Use (Q Ball). Am J Psychiatry 164:1, 2007.

(4) Pierre, JM., Shnayder, I., Wirshing, DA., Wirshing, WC. Intranasal Quetiapine Abuse. Am J Psychiatry. 161:9, 2004

(5) Vigneau, CV., Guerlials, M., Jolliet, P. Abuse, Dependency, and Withdrawal with Gabapentin: A first Case Report. Pharmacopsychiatry. 40, 2007.

(6) Pittenger, C, Desan, PH. Gabapentin Abuse and Delierium Tremens Upon Gabapentin Withdrawal. J. Clin. Psychiatry. 68:8. 2007.

// Share //

// Recent Articles //

IOTW-SDN small
  • Figure 1 Case of the Week: “I recognized it immediately”

  • Posted August 26, 2016 by Figure 1
  • While red macules on the palms are the hallmark of hand, foot, and mouth disease (HFMD), lesions like these can also be present in Rocky Mountain spotted fever, erythema multiforme, and syphillis. HFMD can typically be differentiated from other conditions with a careful history. Knowing this key differential can help clinicians make important decisions quickly....VIEW >
20160824_anonymous
  • Anonymous: How Mental Illness Gets Overlooked In The Hospital

  • Posted August 24, 2016 by Katelee Barrett Mueller, Contributing Writer for in-Training
  • Reposted from here with permission The day Mr. Webster appeared on our service, I was late for morning rounds with our resident. Morning rounds are the time set aside for each medical student to present a summary of their patients: why they required surgery, how their recovery is progressing and what the plan for their care will...VIEW >
Brian Baxter
  • 20 Questions: Brian Baxter, PhD

  • Posted August 22, 2016 by Juliet Farmer
  • Brian Baxter, PhD, is a current postdoctoral scholar with the DeRisi Group at University of California, San Francisco (2011-present), where he is working to optically encode polymer microbeads containing rare-earth nanophosphors and produce them using an automated microfluidic device. Baxter received his bachelor’s degree in chemistry at University of California Davis (summa cum laude, 1994)....VIEW >
short coat logo 2015 with title
  • The Short Coat Podcast – The Ultimate Taboo: Medicine and Suicide

  • Posted August 19, 2016 by Short Coat Podcast
  • Just hours before a new crop of medical students are to be welcomed into the world of medicine, Kaci McCleary, John Pienta, Aline Sandouk, Mark Moubarek, and Lisa Wehr confront one of the most uncomfortable topics in medical education: resident and student suicide. Among doctors, suicide rates are much higher than among the general population. The long hours, high pressure...VIEW >
IOTW-SDN small
  • Figure 1 Case of the Week: Seeking Asylum and a Diagnosis

  • Posted August 19, 2016 by Figure 1
  • A 19-year-old Somali refugee presents with an eight-week history of non-pruritic verrucous growths on his face and ears. He has no significant medical history and is homeless. Do you recognize this presentation? Help solve this and other cases on Figure 1. Related...VIEW >
Chronicles of a Med Student
  • Chronicles of a Med Student: Gearing Up For Round Two!

  • Posted August 15, 2016 by Adelle
  • Welcome back! I’m so excited to start my second year (and write about it, of course), but first things first: my amazing summer experience! I went to South America for a few weeks to work at a women’s health clinic. It was an incredible experience. I don’t say that only because I’ve lived to tell...VIEW >

// Forums //