Rates of Anomalous Bupropion Prescriptions in Ontario, Canada

Abstract

PURPOSE Reports of bupropion misuse have increased since it was first reported in 2002. The purpose of this study was to explore trends in bupropion prescribing suggestive of misuse or diversion in Ontario, Canada. METHODSA serial cross-sectional study was conducted of Ontarians aged younger than 65 years who received prescriptions under Ontario's public drug program from April 1, 2000, to March 31, 2013. We determined the number of potentially inappropriate prescriptions in each quarter, defined as early refills dispensed within 50% of the duration of the preceding prescription, as well as potentially duplicitous prescriptions, defined as similarly early refills originating from a different prescriber and different pharmacy. We replicated these analyses for citalopram and sertraline, antidepressants not known to be prone to abuse. RESULTSWe identified 1,780,802 prescriptions for bupropion, 3,402,462 for citalopram, and 1,775,285 for sertraline. Rates of early refills for bupropion declined during the study from 4.8% to 3.1%. In the final quarter, rates of early refills for bupropion were more common than for citalopram (3.1% vs 2.2%) (P <.001) but not for sertraline (3.1% vs 2.9%) (P = .16). Potentially duplicitous prescriptions for bupropion increased dramatically, from <0.05% of all prescriptions in early 2000 to 0.47% in early 2013 and by the final quarter were more common than both citalopram (0.11%) and sertraline (0.12%) (P <.001).CONCLUSIONS Although no marked differences were seen for early refills of bupropion relative to its comparators, potentially duplicitous prescriptions have increased dramatically in Ontario, suggesting growing misuse of the drug. 2015;13:343-346. doi: 10.1370/afm.1818. Ann Fam Med INTRODUCTION Bupropion is a drug widely prescribed for the treatment of depression and as an adjunct for smoking cessation. It is thought to work by inhibiting neuronal reuptake of dopamine and norepinephrine in the central nervous system. Although the drug was initially thought to confer no risk of addiction, 1,2 reports of bupropion misuse have grown since the phenomenon was first reported in 2002. 3People who misuse bupropion sometimes characterize its effects as a cocaine-like high. Bupropion can be misused by ingestion, nasal insufflation, or intravenous injection, although the latter often produces extensive local tissue necrosis.4-9 Reports of seizures following bupropion misuse have also been documented. 10,11 In May 2013, the Chief Coroner for Ontario issued a public health alert following 6 deaths involving bupropion insufflation or injection. 12There are no large-scale data on the prevalence of bupropion misuse in the general population. In light of increasing reports of bupropion misuse, we explored prescribing trends of bupropion in Ontario, Canada. METHODSWe conducted a population-based study of all publicly funded prescriptions for bupropion, citalopram, and sertraline dispensed between April 1, 2000, 1,5,7 Muhammad M. Mamdani, PharmD, MPH 1,[4][5][6]8 David N. Juurlink MD, ...

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