On Tuesday, AstraZeneca settled federal charges about the marketing of Seroquel, which had become the latest pharmaceutical sold on the street as a knock-you-out antipsychotic. "AstraZeneca paid kickback to doctors as part of an illegal scheme to market the drug for unapproved uses," Health And Human Services Secretary Kathleen Sebelius explained at a news conference. Though AstraZeneca denies the allegations, the company agreed to pay a $520 million settlement. In October, Jeff Deeney talked to the dealers, users, and narcs in the “Suzie-Q” black market.
In one of Philadelphia’s many community substance-abuse treatment centers, Hector, a young Puerto Rican from the city’s heroin-swamped Badlands barrio, discusses with his outpatient counselor whether his medication is helping fight his insomnia.
"Are the ‘Quells workin'?" he asks rhetorically, using the drug’s street name. He laughs. "Man, I got to take them right before I hop in the shower and then run to make it to bed. Them shits knock me the fuck out, fast."
Seroquel’s action on dopamine in the brain makes it the perfect foil to a coke binge or meth tweak that’s overstayed its welcome.
If you want to know which prescription drugs are trading on the black market, take a ride up to 17th and Jefferson in North Philadelphia, aka “Pill Hill,” a corner dedicated to the sale of diverted pharmaceuticals. These days on Pill Hill, there’s a good chance you’ll get sold some Seroquels, also known on the street as ’Quells or Suzie-Qs. A powerful antipsychotic intended to treat schizophrenia and bipolar disorder, Seroquel can have serious side effects including diabetes, a permanent Parkinson’s-like palsy called tardive dyskinesia, and sudden cardiac death. Despite this, it’s increasingly prescribed off-label to substance abusers like Hector for less-serious illnesses, like insomnia and anxiety.
And Hector, like many of these Seroquel users, has prior arrests for drug dealing (in his case, crack cocaine). Which provides Seroquel the perfect middleman to usher it into the illicit drug trade. Drug dealers, mandated to treatment as a condition of their probation or parole, are given off-label prescriptions for Seroquel, then sent right back to the street, where the pills can be sold for cash to users and other dealers.
As a barometer for what pharmaceuticals are in demand, Pill Hill’s track record is well established. In the early ‘80s, the hot pill was a sedative-hypnotic called Doriden, a flat, white tablet often paired with codeine cough medicine, a combination known as “pancakes and syrup.” Pancakes and syrup became popular with nearby corner coke hustlers who were looking for a mellow high, and over the years Philly rappers from the Roots to Beanie Sigel have name-dropped the drug combo in their lyrics. After Doriden was discontinued in 1999, Xanax—the extra-potent bar-shaped 2mg doses, called “tombstones” on Pill Hill—took its place and has reigned supreme ever since. As for pain killers, Percocet was king until being unseated in the late ‘90s by OxyContin. Now Seroquel is swimming in the mix of medications trading on Pill Hill, though the drug is so new to the street scene that law-enforcement agents are still trying to pin down its target market.
But one thing is clear: It’s not just popular in Philly. Demand for the drug is based on the quick and powerful knockout punch it delivers to users whose coke binge or meth tweak has overstayed its welcome. Seroquel's action on dopamine in the brain makes it the perfect foil to the comedown from stimulants—there’s no euphoric high, it simply eases you to sleep when you’re “schizin’,” as the drug-induced psychosis commonly suffered by longtime users is known on the street. On Opiophile.org, a Web site where drug abusers talk about getting high, users from all over recommend Seroquel for coming off speed, and describe the lights-out experience of taking the drug. One poster’s experience echoes Hector's: "I took it for a while and I literally had to wait to take the pill until I was IN BED, under the covers, because otherwise I wouldn't even make it to bed without passing out first!" Another user corroborates: "I took one 50mg pill (chewed it a little) and I fell asleep with my glasses on and with my cellphone in my hand in the middle of a text."
A narcotics officer who worked undercover on Pill Hill says that in recent years Seroquel became a regular part of the mix of black-market pharmaceuticals they were taking off the streets. "I was seeing Seroquel a lot during raids on Pill Hill, and because it isn't [DEA] controlled didn’t think too much of it.” But although cokeheads and tweakers use it to come down from their highs, informants told him that Seroquel's real black-market value is to other dope dealers using it to cut heroin.
Whether Seroquel is really infiltrating the heroin supply depends on who you ask. One active hard-drug user who goes by the name Phrozen and has intimate knowledge of the Badlands heroin scene claims this theory doesn't make sense. "It's highly doubtful that Seroquel is being used to cut heroin, at least on the regular,” he says. “There are cheaper alternatives that are not as restricted. The cost would quickly add up if they're running a large operation. From the heroin user's standpoint, it wouldn't be tolerated. Its effects would be noticeable right away, especially by intravenous users. Heroin users are very fickle when it comes to their drug, one of the reasons why heroin 'brands' exist.” (In Philadelphia heroin comes in glassine envelopes ink-stamped with a brand name or logo).
Phrozen's reasoning is solid, but not necessarily airtight. Batches of heroin are occasionally cut with pharmaceuticals, even though those drugs may decrease the brand's potency. Last spring a bag branded "Comeback" made the rounds in the Badlands. It contained heroin cut with Suboxone, a medication used to help heroin users kick the habit by easing their withdrawal symptoms. When mixed with heroin, however, Suboxone decreased the drug's potency dramatically, presumably so users would quickly "comeback" to buy another bag of dope with a different brand from the same syndicate, thereby doubling sales.
If a dealer was able to lay his hands on a cheap supply of Seroquel in the quantities that circulate on Pill Hill, he could potentially stretch his heroin supply by cutting it with the ground-down pills. Hardcore users might catch on and start avoiding that dealer, but a lot of the heroin traffic in the Badlands—and many other urban centers—is driven by more casual users coming in from the suburbs who might not notice at all.
Online, you’ll also hear talk of users mixing Seroquel with cocaine to make a "Q-ball," a variation on the infamous heroin/cocaine intravenous speedball combo. There's no evidence that this is regular practice in the Philly drug scene, where there's plenty of heroin to go around, but it could be more common among users in rural areas where smack isn't readily available.
When questioned about Seroquel's widespread off-label usage for insomnia and anxiety in community addiction treatment centers and how this might have contributed to an illicit urban market for the drug, AstraZeneca said, "Seroquel is an effective medicine, FDA-approved to treat bipolar disorder and schizophrenia, which are serious mental illnesses. AstraZeneca does not recommend the use of Seroquel in areas outside of its FDA approved indications. Unfortunately, drug abuse extends not just to illicit substances but also to medicines that are safe, effective and necessary when used according to doctors' prescriptions and advice.”
It took little time for Seroquel to bleed from the urban community substance-abuse treatment system into the urban black market for diverted pharmaceutical drugs. Heroin dealers are curious to find out how this new drug might help them stretch their dope supply. And because narcotics officers aren’t yet targeting it in law enforcement efforts, Seroquel, the new kid on the block up on Pill Hill, is likely here to stay.
Jeff Deeney is a social worker and freelance writer from Philadelphia. He previously wrote about his experience scoring OxyContin on Pill Hill for the Philadelphia City Paper.