Smoking: A novel route of olanzapine abuse

Although antipsychotics are generally not considered to be drugs of abuse, an Internet drug advocacy site has devoted an entire "vault" to the discussion of olanzapine and promotes euphoria as one of its positive effects. While there have been numerous reports of olanzapine toxicity, there are no reported cases of olanzapine abuse. Additionally, although the MSDS warns of "toxic fumes" from burning olanzapine, no clinical data refer to smoking as a route of exposure. We report a case of toxicity following inhalational olanzapine abuse. A 24 year-old man with a history of depression and heroin and cannabis use was found obtunded at home. Initial vital signs were: blood pressure, 120/80 mmHg; pulse, 90 min super(-1); respirations, 14 min super(-1); afebrile. Physical examination was remarkable only for deep obtundation and an absent gag reflex. Finger stick glucose was normal, and an initial ECG showed sinus tachycardia at 110 min super(-1) with normal intervals. He was intubated for airway protection, lavaged (no pills or fragments were retrieved), and given activated charcoal by nasogastric tube. The patient remained stable in the ICU and was extubated the following day. He later admitted to lacing a cannabis cigarette with approximately 20 tablets of crushed olanzapine and smoking it. A serum olanzapine level drawn approximately 36-48 hours after presentation was 150 ng/mL, twice the upper limit of the therapeutic range. Olanzapine may be abused and although unstudied, appears to be bioavailable through pyrolysis and inhalation. The pharmacokinetics and stability of olanzapine by this route are unknown. Further investigation of its abuse potential is warranted.