Quetiapine, an antipsychotic medication sold under the brand name Seroquel, is the most frequently abused drug in its class. Among all second-generation antipsychotics reported to U.S. poison centers for recreational abuse, quetiapine accounts for roughly 60% of cases. That a medication designed to treat schizophrenia and bipolar disorder has developed a reputation as a drug of abuse surprises many people, but the pattern is well documented in emergency rooms, addiction clinics, and correctional facilities.
How Widespread the Problem Is
The numbers paint a clear picture. A study of U.S. poison center data identified over 3,100 cases of quetiapine misuse or abuse that met researchers’ criteria, with abuse most common among adolescents and misuse (taking it in ways not prescribed) most common among adults. The median age was 23, and about three-quarters of cases ended up in an emergency department or required hospital admission.1PubMed. Evaluation of quetiapine abuse and misuse reported to poison centers A separate poison center analysis confirmed that quetiapine was the most commonly abused second-generation antipsychotic during its study period, responsible for about 61% of all cases in the category.2PubMed Central. Intentional Recreational Abuse of Quetiapine Compared to Other Second-generation Antipsychotics
Emergency department visits tell the same story. National surveillance data from the Drug Abuse Warning Network showed that quetiapine-related ED visits climbed roughly 90% between 2005 and 2011, rising from about 35,600 visits to over 67,000. That increase was especially pronounced among people combining quetiapine with other substances and among women.3PubMed Central. Emergency Department Visits Involving Misuse and Abuse of the Antipsychotic Quetiapine: Results from the Drug Abuse Warning Network (DAWN)
Compared to other medications in the same drug class, quetiapine’s abuse signal stands out. An analysis of FDA adverse-event reports found that about 11% of all quetiapine-related reports involved abuse, versus 8% for olanzapine, 5% for aripiprazole, and 3% for risperidone. The likelihood of an abuse-related report was over four times higher for quetiapine than for risperidone.4PubMed Central. Comparison of Quetiapine Abuse and Misuse Reports to the FDA Adverse Event Reporting System With Other Second-Generation Antipsychotics
Why an Antipsychotic Gets Abused
This is the part that puzzles clinicians. Traditional drugs of abuse hijack the brain’s dopamine reward system. Quetiapine actually blocks dopamine receptors, which is the opposite of what you would expect from a drug people seek out for a high. The leading explanation centers on quetiapine’s unusually strong antihistamine activity. Quetiapine binds powerfully to histamine H1 receptors while having a relatively low affinity for dopamine receptors, a pharmacological profile that sets it apart from most other antipsychotics. Researchers have hypothesized that this antihistamine action is the key driver behind its misuse potential.5PubMed. The role of antihistaminic effects in the misuse of quetiapine: a case report and review of the literature
In practical terms, what people report seeking from quetiapine is sedation: a heavy, calming feeling that helps them sleep or dampens the agitation and anxiety that come with withdrawal from other substances. Some users describe an initial “rush,” particularly at higher doses, though the subjective experience varies widely. People coming off stimulants, opioids, or alcohol sometimes turn to quetiapine to manage the distress of withdrawal on their own, which is how recreational abuse and self-medication blur together in this context.
The widespread off-label prescribing of quetiapine has almost certainly fed the problem. Although it is approved only for schizophrenia and bipolar disorder, quetiapine is commonly prescribed at low doses for insomnia and anxiety because of those same sedative properties. This means the drug is in many more medicine cabinets than its on-label uses would predict, creating supply that can be shared, sold, or diverted.6Biomedical Pharmacology Journal. Trends in the Use of Antipsychotics for Off-Label Indications: Clinical and Ethical Considerations
Who Is Most at Risk
Quetiapine abuse does not look like a random cross-section of the population. The pattern leans heavily toward people who already struggle with substance use. One study screened over 400 inpatients at an addiction treatment facility and found that 17% reported misusing antipsychotics alongside alcohol, opioids, cocaine, or other drugs. Among those who had misused an antipsychotic within the past year, 96% named quetiapine specifically. Most were male and most were polysubstance users. They obtained the drug either through their own doctors or from family and friends.7PubMed. Misuse of atypical antipsychotics in conjunction with alcohol and other drugs of abuse
Incarcerated populations face particular risk. Quetiapine has long had a reputation in jails and prisons, where it is one of the most commonly diverted psychiatric medications. The drug’s sedative effects are valued in environments where sleep is difficult and access to other substances is limited. Reviews of published case reports consistently find a male predominance, administration by oral, intranasal, or even intravenous routes, and subjects with extensive histories of polysubstance abuse, often within jail or inpatient psychiatric settings.8PubMed Central. Is seroquel developing an illicit reputation for misuse/abuse?
Adolescents also appear in the data at notable rates. Poison center analyses found that while misuse was reported most often in adults, outright abuse for recreational purposes occurred most frequently among adolescents.9PubMed. Evaluation of quetiapine abuse and misuse reported to poison centers Young people in custodial settings face a combination of both age-related and institutional risk factors.
How People Take It and Where They Get It
Oral ingestion is the most common route, but quetiapine abuse is not limited to swallowing pills. Reports document intranasal use (snorting crushed tablets) and, less commonly, intravenous injection. A case report described a patient who had been crushing and snorting quetiapine, noting that antipsychotics are not typically thought of as drugs with abuse potential, yet reports of intranasal and even IV use among prison inmates indicated otherwise.10PubMed. Possible intranasal quetiapine misuse
Intranasal use carries its own medical consequences. In one juvenile detention center, staff had been crushing quetiapine for easier administration. Incarcerated adolescents began diverting the powder and snorting it after hours. Two young people developed neutropenia, a dangerous drop in white blood cells, which resolved once the drug was removed from the facility. The authors noted that quetiapine should never be crushed, because doing so increases the potential for diversion and serious side effects, and recommended that unexplained neutropenia in custodial settings should raise suspicion for quetiapine misuse.11PubMed. Neutropenia in Incarcerated Adolescents Secondary to Intranasal Quetiapine Misuse
Supply comes from many directions. Among addiction treatment inpatients who admitted to misusing antipsychotics, about half obtained the drug from their own doctors and the other half from family or friends.12PubMed. Misuse of atypical antipsychotics in conjunction with alcohol and other drugs of abuse More broadly, research into prescription drug diversion has documented sources ranging from doctor shopping and leftover prescriptions to pharmacy theft and direct street sales.13PubMed Central. Mechanisms of prescription drug diversion among drug-involved club- and street-based populations Online pharmacies have also been found selling bipolar-disorder medications, including quetiapine, with or without requiring a prescription, sometimes offering unapproved formulations or strengths.14PubMed. Availability of prescription drugs for bipolar disorder at online pharmacies
What Overdose Looks Like
Quetiapine overdose can be life-threatening, and it tends to be more dangerous than overdose with other antipsychotics. A five-year retrospective case series found that the most common effects of acute quetiapine overdose were drowsiness (76% of cases) and fast heart rate (56%). More severe outcomes included coma in about 10% of cases, dangerously low blood pressure in 18%, and breathing problems requiring intubation in some patients. Compared to overdose on all other antipsychotics combined, quetiapine was roughly twice as likely to cause coma, about twice as likely to cause dangerously low blood pressure, and over twice as likely to result in death or a major medical outcome.15PubMed. Acute quetiapine overdose in adults: a 5-year retrospective case series
Case reports illustrate the severity. A 71-year-old man who intentionally ingested 20 grams of extended-release quetiapine developed deep coma, severe respiratory failure requiring mechanical ventilation, dangerously low blood pressure needing IV fluid resuscitation, fast heart rate, and prolongation of the heart’s QT interval. He survived after days of intensive care.16PubMed Central. Coma After Quetiapine Fumarate Intentional Overdose in a 71-year-old Man: A Case Report In the broader poison center data, about a quarter of abuse cases and a similar fraction of misuse cases resulted in moderate or major toxicity, though no deaths were recorded in that particular dataset.17PubMed. Evaluation of quetiapine abuse and misuse reported to poison centers
Combining quetiapine with other depressants, which is common among the population that misuses it, increases the danger considerably. Opioids, alcohol, and benzodiazepines each independently suppress breathing and lower blood pressure. Adding quetiapine on top amplifies those effects.
Withdrawal and Dependence
One of the more counterintuitive aspects of quetiapine abuse is that real physical dependence can develop. A systematic review of quetiapine withdrawal found a consistent pattern: rapid cessation of the drug was associated with nausea, vomiting, agitation, restlessness, sweating, irritability, anxiety, low mood, insomnia, fast heart rate, high blood pressure, and dizziness. Some cases also involved withdrawal dyskinesia, characterized by abnormal involuntary movements along with confusion and speech problems.18PubMed. Quetiapine withdrawal: A systematic review
Individual case reports describe people who feel a “rush” from quetiapine and then struggle to stop using it, experiencing classic withdrawal symptoms when they try to taper off.19PubMed. Quetiapine dependence and withdrawal: a case report This matters because clinicians sometimes dismiss the idea that quetiapine could be habit-forming. When patients describe difficulty stopping, they may be experiencing genuine physiological withdrawal rather than drug-seeking behavior, and the clinical response should be different in each case.
For people who need to come off quetiapine, whether they have been taking it as prescribed or misusing it, a slow taper is generally recommended. Quetiapine has a short half-life and what researchers call “fast off” characteristics at its receptor targets, meaning the brain notices its absence quickly. One proposed tapering framework suggests reducing the dose by very small increments every six to twelve weeks, with close monitoring for rebound symptoms.20PubMed Central. A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse
False-Positive Drug Tests
A practical complication worth knowing about: quetiapine can trigger false-positive results on urine drug screens for tricyclic antidepressants. This happens because standard immunoassay tests cannot always distinguish quetiapine’s molecular structure from that of older antidepressants. A laboratory analysis tested three common immunoassays and found significant variation between them. Two of the three produced false-positive results at both therapeutic and overdose levels of quetiapine, while one remained negative even at very high concentrations.21PubMed. Quetiapine cross-reactivity among three tricyclic antidepressant immunoassays
This is not just a laboratory curiosity. In clinical settings, a false-positive tricyclic antidepressant result can lead clinicians down the wrong diagnostic path. One case report described a patient taking quetiapine who tested positive for tricyclics on a urine screen, prompting the treatment team to initially consider a different psychiatric diagnosis based on the incorrect assumption that the patient was secretly taking a tricyclic antidepressant.22PubMed Central. False-Positive Urine Drug Screening in a Patient on Quetiapine If you take quetiapine and are tested, the possibility of a false positive is worth flagging with whoever ordered the test. Confirmatory testing with more specific methods can sort out the true result.
How Correctional Facilities Have Responded
Because the problem is so concentrated in jails and prisons, correctional systems have been some of the first institutions to take concrete policy action. The New Jersey Department of Corrections removed quetiapine from its medication formulary entirely, citing the combined risks of abuse, diversion, and high cost relative to alternative antipsychotics. A retrospective chart review after the change found that psychiatrists attempted to stop quetiapine in about 63% of the inmates who had been taking it, and they were successful over 95% of the time without needing to restart it. Nearly 45% of those inmates turned out not to need any antipsychotic medication at all during the study period. There were no significant differences in rates of needing a higher level of psychiatric care, suicidal behavior, or disciplinary charges between those who stopped quetiapine and those who continued on it.23PubMed. Successful removal of quetiapine from a correctional formulary
That finding is striking. It suggests that a substantial number of people receiving quetiapine in correctional settings were being prescribed it for reasons that did not hold up once the drug was removed as an option. Some were likely seeking it for its sedative effects rather than for a genuine psychiatric indication. Other correctional systems have followed similar paths, restricting quetiapine to cases with a confirmed diagnosis of schizophrenia or bipolar disorder, requiring extended-release formulations that are harder to crush and snort, and implementing directly observed therapy to prevent hoarding and diversion.
The Drug-Seeking Behavior Pattern
Clinicians working in emergency departments, addiction medicine, and correctional health increasingly recognize a pattern of drug-seeking behavior specifically oriented around quetiapine. Published reviews have documented patients feigning or exaggerating psychiatric symptoms to obtain prescriptions, using quetiapine alongside alcohol for enhanced sedation, and trading the drug on the street for money or other substances.24PubMed Central. Quetiapine Misuse and Abuse: Is it an Atypical Paradigm of Drug Seeking Behavior? The majority of documented quetiapine misuse involves people who already carry a diagnosis of a substance use disorder, making it a drug that tends to complicate existing addiction rather than create it from scratch in otherwise healthy individuals.
This creates an awkward clinical tension. Quetiapine is a genuinely useful medication for serious psychiatric conditions, and it would be harmful to deny it to people who need it just because some people misuse it. At the same time, prescribers have become more cautious, especially about writing low-dose quetiapine prescriptions for insomnia or anxiety in patients with a history of addiction. The evidence on quetiapine’s off-label sedative use has pushed some professional bodies to recommend alternatives with less abuse potential for sleep problems, particularly in people recovering from substance use disorders.25Biomedical Pharmacology Journal. Trends in the Use of Antipsychotics for Off-Label Indications: Clinical and Ethical Considerations The FDA adverse-event data underscores the stakes: more deaths were reported among quetiapine abuse-related events (673) than among similar events for olanzapine (200), aripiprazole (88), and risperidone (143) combined.26PubMed Central. Comparison of Quetiapine Abuse and Misuse Reports to the FDA Adverse Event Reporting System With Other Second-Generation Antipsychotics