Quetiapine, commonly known by the brand name Seroquel, is an atypical antipsychotic medication prescribed for serious mental health conditions like schizophrenia, bipolar disorder, and major depressive disorder. While intended to stabilize mood and diminish psychotic thoughts, its misuse can produce a profound and dangerous state of sedation. The 'high' from quetiapine is not a euphoric experience akin to recreational drugs but rather an intense, and often frightening, set of central nervous system depressant effects. This is primarily due to its potent antihistamine activity, which causes significant drowsiness and sedation, particularly at low doses.
The Sedative Effects of a Quetiapine 'High'
When misused, the initial impact of quetiapine is a heavy sedative effect. Users often describe feeling intensely drowsy, sluggish, and confused. This is far from the pleasurable experience typically associated with recreational drug use. In fact, many reports describe the experience as disorienting and unpleasant, with symptoms that can include:
- Profound drowsiness and lethargy
- Confusion and disorientation
- Slurred speech
- Dizziness and lightheadedness (orthostatic hypotension)
- Feeling 'mellow' or calmed, which appeals to some users trying to come down from stimulants or manage anxiety
At higher, non-prescribed doses, these effects are amplified, leading to a state of near-sleep or stupor. Some users, particularly in settings like prisons where access to other substances is limited, seek this extreme sedation. This is a crucial distinction: the appeal of quetiapine for recreational purposes is less about a euphoric 'high' and more about the powerful, intoxicating sedative and anxiolytic effects it produces.
The Dangers of Different Routes of Administration
Quetiapine is most commonly misused by crushing the tablets and snorting or injecting the powder. This is far more dangerous than taking the pill orally and exponentially increases the risks. The drug is not designed for these routes of administration, and the practice bypasses the body's controlled-release mechanisms, causing a rapid and overwhelming flood of the drug into the bloodstream.
Snorting quetiapine can have particularly severe and immediate consequences:
- Intensified Side Effects: The sedative effects are much more rapid and intense, leading to an increased risk of severe central nervous system depression.
- Nasal Damage: Insufflation can cause significant damage to nasal passages, sinuses, and respiratory tissues, resulting in chronic congestion, nosebleeds, and loss of smell.
- Respiratory Issues: The practice increases the risk of respiratory complications like pneumonia and sleep apnea.
Intravenous (IV) injection is the most hazardous method, carrying the highest risk of overdose and other deadly outcomes. Injecting crushed tablets can lead to pulmonary complications and the transmission of blood-borne diseases like HIV and hepatitis.
Quetiapine Misuse Compared to Other Substances
To understand the distinct risks of quetiapine misuse, it's helpful to compare its effects and abuse potential with other commonly abused substances. This comparison highlights why quetiapine is particularly hazardous.
| Feature | Quetiapine (Misused) | Opioids (e.g., Heroin) | Benzodiazepines (e.g., Xanax) |
|---|---|---|---|
| Primary Effect | Intense sedation, confusion, and disorientation | Euphoria, pain relief, and sedation | Anxiety reduction, sedation, and muscle relaxation |
| Mechanism | Antagonizes multiple brain receptors, including histamine (H1) for sedation | Binds to opioid receptors, reducing pain perception and creating euphoria | |
| Abuse Potential | Significant, especially in polysubstance users; street value and names exist | High potential for physical dependence and addiction | High potential for dependence, especially with long-term use |
| Overdose Risk | High risk of respiratory depression, coma, seizures, and hypotension | Very high risk of fatal respiratory depression | High risk, especially when combined with alcohol or other depressants |
| Route-Specific Risks | Nasal damage, pulmonary issues, and blood-borne disease risk with snorting/injecting | Skin abscesses, blood-borne diseases with injecting | Psychological and physical dependence; dangerous withdrawal |
Polysubstance Abuse and Long-Term Consequences
Quetiapine is frequently used in combination with other drugs, a practice known as polysubstance abuse, to either enhance the effects of other substances or to manage their withdrawal symptoms. A notorious example is the combination of injected quetiapine and cocaine, known as a 'Q-ball'. This practice is extremely dangerous as quetiapine can amplify the cardiovascular risks of stimulants. Abusers of opioids or cocaine sometimes use quetiapine to mitigate the dysphoria and agitation associated with coming down from these drugs.
The long-term health consequences of misusing quetiapine are severe and include:
- Metabolic Syndrome: Significant weight gain, increased blood sugar (hyperglycemia), high cholesterol, and elevated triglycerides are common, increasing the risk of cardiovascular disease and diabetes.
- Tardive Dyskinesia (TD): A movement disorder that causes involuntary, repetitive body movements, which can be permanent.
- Dependence and Withdrawal: Psychological dependence can develop, and abrupt cessation can lead to withdrawal symptoms like irritability, nausea, and severe agitation.
Conclusion
The perception of a quetiapine 'high' is dangerously misleading. Unlike true euphoric drugs, the desired effect for misusers is the powerful sedative and tranquilizing properties of the medication. This misuse is a high-risk behavior that can lead to severe central nervous system depression, overdose, and fatal cardiovascular events. For those with a history of substance abuse, the temptation to exploit quetiapine's sedative properties is a serious concern, and heightened vigilance is required by both clinicians and individuals to prevent misuse. The street names and illicit market for quetiapine underscore its abuse potential, but the reality of a quetiapine high is a perilous path to serious health consequences, not a recreational pleasure. The safest course is to use quetiapine only as prescribed by a healthcare professional and to seek immediate help for any substance misuse issues. An excellent resource for mental health information and support can be found on the National Institute of Mental Health's website (https://www.nimh.nih.gov/).
What are the risks of quetiapine high?
- Central Nervous System Depression: The most prominent risk is severe CNS depression, causing extreme drowsiness, confusion, and potential loss of consciousness.
- Overdose: Quetiapine overdose can cause a rapid heart rate, low blood pressure, seizures, coma, and even death.
- Cardiovascular Issues: Misuse, especially with other substances, can lead to serious heart problems, including irregular heartbeats and cardiac arrest.
- Respiratory Failure: High doses can cause respiratory depression, where breathing becomes dangerously slow or stops.
- Polysubstance Interaction: When combined with other depressants like alcohol or opioids, the sedative and respiratory effects are magnified, dramatically increasing the risk of overdose.
- Tardive Dyskinesia: Long-term misuse can lead to this irreversible movement disorder.
