Lockup Doc

Bupropion (Wellbutrin, Zyban) is a unique but commonly prescribed antidepressant that inhibits the reuptake of dopamine and norepinephrine. It is FDA approved for the treatment of major depressive disorder, seasonal affective disorder, and smoking cessation. It is commonly used off-label for the treatment of attention deficit hyperactivity disorder (ADHD).

Anecdotally there have long been reports of abuse and diversion of bupropion in jails and prisons. In my own personal experience in these settings, I have not seen much evidence of such misuse. Inmates rarely present to me seeking this medication. By contrast, and about which I have previously written, quetiapine (Seroquel) is highly desired medication in corrections.

I conducted a literature search on this topic and was not able to find many articles. There are a few case reports of bupropion nasal insufflation (snorting). In one description it appears to have caused a “brief buzz” lasting only a few seconds.

In 1983 a study in Psychopharmacology compared bupropion, dextroamphetamine, and placebo in mixed substance abusers. According to the abstract:

Results indicated that the subjective effects of amphetamine as measured by the Addiction Research Center Inventory (ARCI) differed markedly from bupropion and placebo. Bupropion, in contrast to amphetamine, had no peripheral sympathomimetic effects and did not reduce appetite or caloric intake.

In another study comparing the abuse potential of bupropion with that of caffeine, it appeared that caffeine was a more reinforcing substance to ingest. From the abstract:

CAF significantly increased ratings of ‘pleasant effects’ (p = 0.008) and ‘high’ (p = 0.03), whereas BUP produced a ‘high’ of only very moderate size (p = 0.02). In 3 subjects each, BUP or CAF produced ratings of ‘pleasant effects’ that were >9-fold higher than those for PLC.

My opinion at this point, based on my own clinical practice experience and the paucity of available scientific evidence is that bupropion is not likely very amphetamine-like in the subjective effects it produces. In the community, I would guess that some adolescents and young adults experiment with crushing and snorting it but quickly lose interest in doing so because of its lack of reinforcing properties. In prisons and jails where inmates lack ready access to prescription and illicit substances that they might abuse on the streets, there is probably a higher incidence of abuse and diversion of bupropion. However, it does not appear to be nearly as coveted as quetiapine, benzodiazepines, or opioid analgesics.

Since there is little data on the abuse potential of bupropion, I am very interested in hearing from other health care workers who may have experience with or thoughts about this issue.