Case PresentationĪ 35-year-old African-American male with schizophrenia and a history of several prior inpatient psychiatric admissions presented to the ED for auditory hallucinations, suicidal ideation, and “locked-up muscle” (sic) after smoking cannabis mixed with haloperidol. Here, we describe a patient who initially presented to an ED for psychosis, suicidal ideation, and EPS in the context of smoking marijuana mixed with powdered haloperidol tablets. To our knowledge, there has been no report of the misuse or abuse of haloperidol via smoking or, more generally, inhalation. Another paper depicted a patient who used haloperidol tablets concurrently with street-made “designer drugs” to counteract their undesirable psychotropic actions and to potentially enhance euphoria this patient later presented to an emergency department (ED) with torticollis. One article described an individual who developed catatonia after using haloperidol tablets purchased from the streets to “get high”. įew anecdotal reports have been published on the deliberate misuse of haloperidol tablets. This can be explained by the broader pharmacodynamic properties of SGAs, with their sedative and anxiolytic effects that may augment the desired effects of abused substances and limit the associated dysphoria. In contrast, second-generation antipsychotics (SGAs) have been widely misused or abused. Widespread recreational use of haloperidol or other FGAs has not previously been reported. High-potency first-generation antipsychotics (FGAs) such as haloperidol, especially when used at high doses and without coadministration of anticholinergics, carry a significant risk of developing extrapyramidal symptoms (EPS) including dystonia, Parkinsonism, akathisia, and tardive dyskinesia. It is accepted that antagonism of dopamine (D2) receptors mainly accounts for the efficacy of haloperidol in reducing positive symptoms of schizophrenia. Haloperidol is a butyrophenone antipsychotic that has been widely used in the treatment of patients with psychotic disorders, such as schizophrenia. Clinicians should be aware that patients might misuse prescribed antipsychotics via unconventional routes, potentially combined with other substances. To our knowledge, this is the first report on haloperidol misuse by smoking. With the administration of intramuscular diphenhydramine at the ED, the dystonia resolved in less than an hour.
After the smoking of cannabis and haloperidol, the patient presented to the emergency department (ED) with suicidal ideation, psychosis, and acute dystonia. We describe a patient with schizophrenia who smoked marijuana mixed with crushed haloperidol tablets. Few cases of haloperidol misuse are found in the medical literature. Especially at high doses, haloperidol carries a higher risk of extrapyramidal symptoms (EPS) compared to second-generation antipsychotics. Haloperidol is a dopamine receptor antagonist used to treat patients with psychotic disorders.
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