Successful removal of quetiapine from a correctional formulary

The abuse of medications in prison is a phenomenon well known among correctional health care professionals, and quetiapine has emerged as a drug of abuse in these settings. Considering the risks of abuse and diversion and the high cost compared with effective alternative antipsychotic medications, the New Jersey Department of Corrections (NJDOC) Pharmacy and Therapeutics Committee voted to remove quetiapine from the formulary. In a retrospective chart review, clinically relevant outcome measures were evaluated in patients prescribed quetiapine at the time of this change. Psychiatrists attempted to stop the quetiapine in 63.4 percent of the cases and were successful (not requiring continuation or restarting of the medicine) 95.7 percent of the time. There were no statistically significant differences in the number of patients who needed a higher level of care, days in a higher level of care, number of patients needing constant (e.g., suicide) watch, days on constant watch, suicidal behavior, or disciplinary charges when the subjects in whom an attempt to discontinue quetiapine was made was compared with those in whom it was continued. In 44.7 percent of cases in which an attempt was made to stop quetiapine (and in 28.3% of cases in the entire NJDOC population as of January 2009), no antipsychotic medication was needed to manage the patients during the study period. This study supports the decision to remove quetiapine from the NJDOC formulary.