Intravenous Quetiapine Abuse

Ms. A was a 34-year-old woman with a history of polysubstance dependence (alcohol, cannabis, and cocaine), depressive episodes associated with multiple suicide attempts, and borderline personality disorder who was incarcerated after conviction on charges of physical assault and possession of controlled substances. She had a history of incarceration on multiple occasions for similar charges. She complained of difficulty sleeping, poor impulse control, irritability, and depressed mood. For these symptoms, she was given oral quetiapine, 600 mg at bedtime. On one occasion, she took the pills provided to her but did not ingest them. Instead, she crushed the two 300-mg tablets, dissolved them in water, boiled them, drew the solution through a cotton swab, and while lying in bed, covered by blankets, intravenously injected the solution.

Twelve hours later, she was awoken by facility guards who found the syringe she used still in place on her arm. She informed the guards that she had intravenously injected herself with quetiapine the previous evening and became rapidly sedated, falling asleep before she could remove the syringe. She additionally admitted to previous intranasal abuse of crushed quetiapine tablets. Apart from “the best sleep I ever had,” she described no dysphoric, euphoric, or other effects.