Credit: CFSRE
The Center for Forensic Science Research & Education (CFSRE) has released an alert after forensic scientists and coroners have identified quetiapine (Seroquel®) in the illicit drug supply as a cutting agent for fentanyl, cocaine and heroin.
Quetiapine, an atypical antipsychotic agent, is an FDA-approved medication for the treatment of schizophrenia, acute manic episodes and major depressive disorder. The drug also has several off-label indications, including for generalized anxiety disorder, insomnia and chronic PTSD. Daily doses in adults usually range from 150 to 800 mg, but higher doses are utilized with QT interval monitoring. Somnolence, dizziness and orthostatic hypotension are common adverse effects. QTc interval prolongation is associated with torsade de pointes, a potentially lethal dysrhythmia.
Quetiapine, like other atypical antipsychotics, carries an extremely low risk of adverse neurological reaction and extrapyramidal effects. This safer profile makes this class a more attractive treatment option than older antipsychotics. But it also makes it more attractive for illicit drug manufacturers.
“Misuse of pharmaceuticals occurs frequently with medications that produce euphoria or other desirable effects, such as relaxation or alertness. As such, quetiapine can be used to enhance the effects of illicit drugs and this use can contribute to an adverse or lethal outcome,” said CFSRE in a public notice.
While quetiapine as an adulterant was seen in U.S. illicit drug samples as early as 2018, fentanyl and quetiapine co-positivity has increased from then to the first quarter of 2023, earlier this year.
Analysis of 918 seized drug samples identified quetiapine as an adulterant in 11 samples (1.2%), while one contained only quetiapine. The drug samples were collected from West Virginia (6), Indiana (5) and Ohio (1).
Of the 11 samples, 10 of them contained both fentanyl and quetiapine, among a myriad of other drugs. Meanwhile, six tested positive for both cocaine and quetiapine, and three had heroine and quetiapine co-positivity. Five of the seized samples even tested positive for quetiapine and xylazine, the so-called zombie drug that is on the rise.
According to the CFSRE, quetiapine may increase the risk of fatal drug poisoning by enhancing sedation, particularly when combined with alcohol, benzodiazepines and opioids. Other indicators of toxicity include:
- Dizziness
- Delirium/confusion
- Orthostatic hypotension
- Cardiac dysthymia
- QTC prolongation
- Hyperglycemia
- Respiratory depression
The non-profit forensic organization suggests medical examiners and coroners consider testing for quetiapine when analysis of seized drug evidence shows its presence and/or the case is suspicious for overdose with fentanyl, cocaine or heroin. The organization also suggests forensic labs consider testing for quetiapine when case history supports the drug was used as an adulterating agent.
Data/information provided by CFSRE.