Bret S. Stetka, MD; Tara Malekshahi, MD; Nina Tioleco, MD


January 10, 2014

Editor's Note:
While browsing a poster session at the 2013 Annual Meeting of the American Psychiatric Association in Scottsdale, Arizona, Medscape spoke with Tara Malekshahi, MD, and Nina Tioleco, MD, from the Department of Psychiatry at St. Luke's-Roosevelt Hospital in New York City about their recent study on the misuse of atypical antipsychotics.[1]

Medscape: Drs. Malekshahi and Tioleco, what can you tell us about your study?

Dr. Malekshahi: We became interested in this study while working in our detox and rehab unit at the Addiction Institute in New York. We became aware that a lot of patients with an addiction were asking for atypical antipsychotics. We did a literature search and couldn't find much on the abuse of these drugs, so we wanted to explore what the prevalence of abuse of atypical antipsychotics is, who are the patients abusing them, and what type of other drugs these patients are typically using or addicted to.

Medscape: What were most patients being treated for?

Dr. Tioleco: Most of them were there for detox from either alcohol or opiates or there for rehab. They were also using stimulants, including cocaine, sedatives/hypnotics, cannabis, and others. In the past 30 days, 80% had used opioids, 76% had used alcohol, 64% had used cocaine, 52% had used sedatives/hypnotics, and 20% had used other substances. We found that about 67% were using atypical antipsychotics to deal with the bad effects from the other drugs. For example, with opiates and alcohol, they were often unable to sleep, and so were using an atypical to try and recover from insomnia.

Medscape: Were they prescribed the antipsychotics by healthcare providers in most cases?

Dr. Tioleco: Of note, only about one half were prescribed, whereas the rest were getting them on the streets or from family and friends.

Dr. Malekshahi: But there isn't really any street value for atypical antipsychotics, so most of them don't pay for the drugs; they just get them through friends and family.

Dr. Tioleco: They learn about these drugs from popular press, message boards, the Internet, and underground drug use networks.

Medscape: How many patients did you look at, and what did you find?

Dr. Malekshahi: We screened 543 patients from the detox/rehab unit and found that 17% were eligible for the study, meaning they'd used an atypical antipsychotic not as prescribed, as well as abused another substance within the past year.

Of the patients studied, 88% were polysubstance abusers. Most patients who received atypical antipsychotics were not being prescribed the medication for psychotic symptoms, and most self-reported being prescribed the medications for sleep problems, mood disturbance, and anxiety.

Dr. Tioleco: In terms of which atypicals the patients we interviewed were on, 96% of the patients were taking quetiapine. People are prescribed this agent often, and it's familiar to many people. Also, people are often prescribed it for less severe conditions -- such as insomnia, which is an off-label use.

Medscape: What is your take-home message for clinicians?

Dr. Tioleco: With this study, we want to make clinician more aware of the abuse of antipsychotics in mostly polysubstance abusers -- to make sure we think to ask about these agents and whether or not they're being used as prescribed.


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