Menu Icon Search
Close Search

Atypical Drugs of Abuse

Created July 27, 2008 by Emily Forest


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 //

  • What New Doctors Should Know About the Greenhouse Movement

  • Posted October 25, 2016 by Brian Wu
  • America is an aging country, with the fastest-growing segment of the population in the 85+ category. This large number of elders has created the social problem of how to give this population the care that they need, particularly those who are physically frail or suffer from Alzheimer’s or dementia. Oftentimes, the solution to this has...VIEW >
  • A Bygone Era: When Bipartisanship Led To Health Care Transformation

  • Posted October 24, 2016 by John Henning Schumann
  • People might be forgiven for thinking that the Affordable Care Act is the federal government’s boldest intrusion into the private business of health care. But few know about a 70-year-old law that is responsible for the construction of much of our health system’s infrastructure. The law’s latest anniversary came and went without much notice in...VIEW >
short coat logo 2015 with title
  • Against Logic There Is No Armor Like Ignorance

  • Posted October 21, 2016 by Short Coat Podcast
  • WHO researchers in Uganda are keen to teach schoolchildren there how to spot dubious health claims. This leads Dave to ask Levi Endelman, John Pienta, and newcomers Alice Ye and Adam Erwood whether their generation was taught the principles of logic and scientific thought in a way more effective than his own generation was taught, while Alice questions...VIEW >
IOTW-SDN small
  • Figure 1 Case of the Week: Did a hot tub make this child sick?

  • Posted October 21, 2016 by Figure 1
  • An 11-year-old female presents with a pruritic rash, a fever, and fatigue after returning from a family vacation two days earlier. Her mother mentions she spent the last days of their holiday in the hotel hot tub. On examination, a papular, erythematous rash is seen on the skin that was covered by her bathing suit....VIEW >
Chronicles of a Med Student
  • It’s Real: The Sophomore Slump

  • Posted October 17, 2016 by Adelle
  • I strolled into second year, fresh off the plane from my South American adventures and ready to hit the ground running, expecting another experience like first year. It would be smooth sailing as long as I stuck to my schedule and my friends. I was good to go. Little did I know, the “second year...VIEW >

// Forums //