Friedman Joseph R, Molina Caitlin A, Romero Ruby, Pyfrom Elise M, Appley Meghan G, Marienfeld Carla, Sisco Edward, Shover Chelsea L
J Addict Med. 2025 Jul 25. doi: 10.1097/ADM.0000000000001552.
The rise of the "fourth wave" of the US overdose crisis has been characterized by the increasing polysubstance use of illicit opioids combined with other drug classes. Polysubstance combinations are increasingly better understood through community-based drug checking. Here we share findings from a drug checking program in Los Angeles, California, highlighting quetiapine-a commonly used atypical antipsychotic-as a novel additive in heroin samples.
This study leveraged data from a community-based drug checking program in Los Angeles, CA. Substance determination was performed through direct analysis in real-time mass spectrometry (DART-MS). Fisher exact tests were used to assess differences in heroin samples containing versus not containing quetiapine.
Of n=52 samples containing heroin, n=13 (25.0%) contained quetiapine. Among quetiapine-positive heroin samples, n=4 (30.8%) contained fentanyl, compared with n=27 (69.2%) quetiapine-negative heroin samples (P=0.022). No significant differences were observed between quetiapine-positive and negative samples with respect to xylazine, cocaine, or methamphetamine prevalence. All quetiapine-positive samples were identified by clients as expected to contain black tar heroin, and no clients reported expecting their samples to contain quetiapine. Anecdotally, some participants identified increased euphoria and "pins and needles" sensations from quetiapine-positive samples.
This small observational study provides the first drug-checking-based evidence in the academic literature-to our knowledge-of quetiapine as an additive to the illicit heroin supply. The presence of quetiapine was associated with less fentanyl adulteration and may reflect an alternative augmentation strategy. Further confirmatory studies are needed to assess the degree to which this phenomenon exists in other locations and the potential health implications.
美国药物过量危机“第四波”的兴起，其特点是非法阿片类药物与其他药物种类的多药合用情况日益增加。通过基于社区的药物检测，人们对多药组合的了解越来越深入。在此，我们分享加利福尼亚州洛杉矶市一项药物检测项目的结果，强调喹硫平（一种常用的非典型抗精神病药物）作为海洛因样本中的新型添加剂。
本研究利用了加利福尼亚州洛杉矶市一个基于社区的药物检测项目的数据。通过实时质谱直接分析（DART-MS）进行物质测定。使用Fisher精确检验评估含喹硫平和不含喹硫平的海洛因样本之间的差异。
在n = 52个含海洛因的样本中，n = 13个（25.0%）含有喹硫平。在喹硫平阳性的海洛因样本中，n = 4个（30.8%）含有芬太尼，相比之下，喹硫平阴性的海洛因样本中有n = 27个（69.2%）含有芬太尼（P = 0.022）。在赛拉嗪、可卡因或甲基苯丙胺的流行率方面，喹硫平阳性和阴性样本之间未观察到显著差异。所有喹硫平阳性样本被客户认定预期含有黑焦油海洛因，且没有客户报告预期其样本中含有喹硫平。据传闻，一些参与者指出喹硫平阳性样本带来更强的欣快感和“刺痛”感。
这项小型观察性研究在学术文献中首次提供了基于药物检测的证据——据我们所知——表明喹硫平是非法海洛因供应中的一种添加剂。喹硫平的存在与芬太尼掺假较少有关，可能反映了一种替代的增强策略。需要进一步的验证性研究来评估这种现象在其他地区的存在程度以及潜在的健康影响。
