Rates of Anomalous Bupropion Prescriptions in Ontario, Canada

Reports of bupropion misuse have steadily increased since the phenomenon was first described in 2002. In a recent investigation published in this journal that included assessment of 1,780,802 prescriptions for bupropion in Ontario, Canada, Steele and colleagues [1] found that potentially duplicitous prescriptions for the drug increased almost ten-fold from 0.05% of all prescriptions for bupropion, sertraline, and citalopram in 2000 to 0.47% in 2013. These findings appear to strengthen previous suspicions about the abuse potential of bupropion [2,3] and to raise additional questions and concerns:
1.) Will intranasal abuse of bupropion increase as public awareness of this mode of misuse increases? Intranasal abuse apparently started in the prison system and is now spreading into the public sector. Intravenous misuse thus far appears to be rare, but has been reported4 and could also increase.
2.) Will bupropion abuse occur orally by use of very large doses in attempts to obtain effects similar to those produced by of intranasal bupropion?
3.) Will there be increased occurrences of seizures related to increasing misuse of bupropion in higher than recommended doses?

What will happen with trends in bupropion misuse is unclear, but reasons for concerns certainly exist. At the current time there does not appear to be a significant enough body of evidence to warrant actual classification of bupropion as a controlled substance. However there clearly is sufficient documentation of misuse to justify caution while prescribing the drug to patients who might misuse it (e.g., persons with a history of substance misuse and individuals discovered to be seeking potentially duplicitous prescriptions). Additional data collected over a period of time in the future could ultimately lead to classification of bupropion as a controlled substance.

REFERENCES
1. Steele LS, MacDonald EM, Gomes T, et al. Rates of anomalous bupropion prescriptions in Ontario, Canada. Ann Fam Med. 2015;13:343-346.
2. Reeves RR, Ladner ME. Additional evidence of the abuse potential of bupropion. J Clin Psychopharmacol. 2013;33:584-585.
3. Reeves RR, Ladner ME, Perry CL, et al. Abuse of medications that are theoretically without abuse potential. South Med J. 2015;108:151-157.
4. Baribeau D, Araki KF. Intravenous bupropion: a previously undocumented method of abuse of a commonly prescribed antidepressant. J Addict Med 2013;7:216-217.

Roy R. Reeves, D.O., Ph.D.

Dr. Reeves is Clinical Director at South Mississippi State Hospital and Professor of Clinical Science at William Carey College of Osteopathic Medicine, Hattiesburg, MS.

FOR CORRESPONDENCE: Roy R. Reeves, D.O., Ph.D., 823 Highway 523, Purvis, MS 39475. Phone: 601-794-0169 Email: rreeves@state.ms.us

Competing interests: None declared