Correctional Health

Comorbidity: 72 % of inmates with mental illness have substance abuse/dependence. In this population in the jail/prison setting, it is recognized that drug seeking behavior is frequently encountered. Although prescribers usually take into account the potential for abuse before prescribing pain medications, benzodiazepines, and other hypnotic/sedative drugs, practitioners appear less likely to consider medications such as atypical antipsychotics and antidepressants as having the potential for abuse or dependence. Quetiapine (Seroquel®) and Bupropion (Wellbutrin®) have been identified as possible drugs of abuse within the correctional setting (3). Seroquel ® (known as "Quell " (4) and "Baby Heroin " (3), and in combination with cocaine, "Q-ball " (5)) is sought for its soporific effects. Wellbutrin ® (nicknamed "Welbys") tablets may be crushed and snorted intranasally to achieve a “rush”. Gabapentin (Neurontin®) is said to be sought, and used to reduce the irritant effect of intranasally snorted Wellbutrin®(6). Some facilities have made efforts to address the problem: Alameda County, California removed Seroquel ® and Wellbutrin ® from the formulary in 2004 (3); Ohio does not include Seroquel ® in its state correctional system formulary (5); CDCR removed Seroquel from its formulary in mid- to late 2008