To the Editor: To our knowledge, this letter represents the first effort to document the monetary value of several antipsychotic and antidepressant medications outside of a custody setting on the black-market in a major U.S. city. The monetary value of benzodiazepines and narcotics in Canada has been previously published (1), and we include a few of these medications in this letter as well. Stimulants are not included in this letter because of insufficient reports of street prices in our cohort.
Several reports have documented the potential misuse of medications, not traditionally considered to be addictive, for recreational purposes, primarily in custody settings. These include quetiapine (2, 3), anticholinergics (4), and tricyclics (5).
When publicly funded outpatient clinic staff members were asked if they had any suspicions about misuse of these medications, many said that they had heard of patients selling their medications on the street, and several suspected that some patients feigned psychosis to obtain medications to sell.
Between Oct. and Dec. of 2005, a variety of health professionals were asked if they had heard the street prices of medications. The results from sixty-one buyer and seller reports are summarized in Table 1.
Sellers reported that it was relatively easy to sell the medications they had received free of charge from the clinics and convert them into money for rent, utilities, food, illicit drugs, or alcohol. Buyers reported that they use these medications for their sedative effect as a sleep aid, to “zone-out” or to “take the edge off.” Buyers included individuals attempting to self-medicate, not having a third-party method of payment.
More detailed studies should be performed to elucidate the abuse potential of these and other medications as well as the epidemiology of their misuse. The health effects of black-market use are as yet unstudied, and physicians should be aware that patients might be covertly taking psychotropic medicines. Diversion of these medications may represent a significant expense for public and private agencies, and suspected malingering or other requests for early refills should alert agencies to the possibility of black-market activity.
1.Sajan A, Corneil T, Grzybowski S: The street value of prescription drugs. CMAJ 1998; 159:139–142
2.Pierre JM, Shnayder I, Wirshing DA, Wirshing WC: Intranasal quetiapine abuse (letter). Am J Psychiatry 2004; 161:1718
3.Hussain MZ, Waheed W, Hussain S: Intravenous quetiapine abuse (letter). Am J Psychiatry 2005; 162:1755–1756
4.Buhrich N, Weller A, Kevans P: Misuse of anticholinergic drugs by people with serious mental illness. Psychiatr Serv 2000; 51:928–929
5.Hepburn S, Harden J, Grieve JHK, Hiscox J: Deliberate misuse of tricyclic antidepressants by intravenous drug users: case studies and report. Scott Med J 2005; 50:131–133