What is Bupropion?
Bupropion is an antidepressant medication primarily prescribed for major depressive disorder and seasonal affective disorder [1.2.4, 1.8.2]. Marketed under brand names like Wellbutrin and Zyban, it is also an effective aid for smoking cessation [1.2.4, 1.8.2]. Unlike many other antidepressants that work on serotonin, bupropion is a norepinephrine-dopamine reuptake inhibitor (NDRI) [1.7.2]. This means it increases the levels of the neurotransmitters norepinephrine and dopamine in the brain, which can lead to its desired therapeutic effects but also contributes to its abuse potential [1.7.2, 1.7.4].
Why and How Is Bupropion Abused?
Bupropion is abused for the stimulant-like, euphoric effects it can produce, particularly at high doses or when the extended-release mechanism is bypassed [1.2.5, 1.7.6]. These effects have been compared to those of cocaine or amphetamines, leading to the street name "poor man's cocaine" due to its lower cost and easier accessibility [1.4.2, 1.8.1, 1.8.2].
Abuse often occurs in individuals with a history of substance use disorders [1.2.3]. Common methods of bupropion abuse include [1.2.2, 1.2.5]:
- Oral Ingestion of High Doses: Taking doses far exceeding the prescribed amount (up to ten times) to intensify effects [1.2.2].
- Nasal Insufflation (Snorting): Crushing the pills into a powder and snorting it. This method bypasses the digestive system and time-release formulations, allowing the drug to enter the bloodstream rapidly for an immediate, intense high [1.2.2, 1.3.7]. Insufflation is one of the most common routes of non-medical administration [1.2.5].
- Intravenous Injection: Dissolving the crushed tablets in a liquid and injecting the solution. This is a particularly dangerous method that can lead to severe complications like vascular damage and tissue necrosis [1.2.2, 1.3.4].
The Pharmacology of Abuse
Bupropion's chemical structure is related to synthetic cathinones, a class of drugs commonly known as "bath salts" [1.4.7]. As an NDRI, it blocks the reuptake of dopamine and norepinephrine, increasing their concentration in the brain's synapses [1.7.2]. This action is similar to that of stimulants like cocaine [1.8.1]. When taken orally as prescribed, the drug is absorbed slowly. However, methods like snorting or injecting bypass this slow absorption and the extensive first-pass metabolism in the liver, leading to a rapid spike in brain concentration and a more potent, rewarding high [1.3.1, 1.3.4].
Serious Risks and Side Effects of Bupropion Abuse
Abusing bupropion is extremely dangerous and can lead to severe, life-threatening health consequences. The risk of adverse effects increases exponentially when the drug is taken in high doses or via non-prescribed routes [1.2.4].
Major Health Risks:
- Seizures: This is one of the most significant and well-documented risks of bupropion abuse. The drug lowers the seizure threshold, and the risk is highly dose-dependent [1.2.5, 1.3.4]. In one study of abuse cases, seizures were reported in 33.5% of patients [1.5.1]. In another review, bupropion overdose accounted for 23% of all drug-induced seizures reported to a poison control system [1.3.4].
- Cardiovascular Effects: Tachycardia (rapid heartbeat) is the most common side effect of bupropion abuse [1.5.1]. Misuse can also lead to hypertension (high blood pressure), heart rhythm disturbances (arrhythmias), QRS widening, QTc prolongation, and, in severe cases, cardiogenic shock or heart attack [1.3.1, 1.3.5, 1.6.1].
- Psychiatric Symptoms: The stimulant effects can trigger severe agitation, anxiety, paranoia, hallucinations (both auditory and visual), delusions, and psychosis [1.2.2, 1.6.3, 1.6.6].
- Tissue Damage: Injecting bupropion can cause serious local complications, including skin ulcers, vascular damage, and tissue necrosis (death of tissue) [1.2.5, 1.3.4].
Comparison of Bupropion, Cocaine, and Amphetamine
| Feature | Bupropion (Abused) | Cocaine | Amphetamine |
|---|---|---|---|
| Drug Class | Atypical Antidepressant (NDRI), Synthetic Cathinone structure [1.4.7, 1.7.2] | Stimulant | Stimulant |
| Mechanism | Inhibits dopamine and norepinephrine reuptake [1.7.2] | Blocks dopamine, norepinephrine, and serotonin reuptake [1.4.4] | Releases and blocks reuptake of dopamine and norepinephrine [1.4.4] |
| Desired Effect | Euphoria, stimulation, "high" similar to cocaine but less intense [1.3.4, 1.6.4] | Intense euphoria, increased energy, confidence | Euphoria, alertness, increased focus |
| Primary Risk | Seizures [1.5.1] | Cardiac arrest, stroke, addiction | Psychosis, cardiac events, neurotoxicity |
| Accessibility | Prescription medication, relatively low cost [1.8.1, 1.8.3] | Illicit street drug, high cost [1.8.1] | Prescription (e.g., Adderall) and illicit street drug |
| Street Name | "Poor Man's Cocaine", "Wellies", "Dubs" [1.2.1, 1.8.3] | Coke, Blow, Snow | Speed, Uppers |
Recognizing and Treating Bupropion Abuse
Recognizing the signs of bupropion abuse is crucial for early intervention. Behavioral signs include doctor shopping, requesting early refills, and a suspicious preference for bupropion over other antidepressants [1.2.5, 1.6.2]. Physical and psychological symptoms can include intense cravings, using more than prescribed, insomnia, agitation, and paranoia [1.6.1, 1.6.3].
Withdrawal from bupropion after a period of abuse can lead to irritability, anxiety, fatigue, and depressive episodes, and should be managed under medical supervision [1.6.1]. Treatment for bupropion addiction often involves behavioral therapies like Cognitive Behavioral Therapy (CBT) to address the underlying reasons for substance misuse, combined with support groups [1.2.3].
Conclusion
While bupropion is an effective medication for many when used as directed, the answer to 'Is bupropion abused?' is a definitive yes. Its unique pharmacological profile gives it a significant potential for misuse, producing stimulant-like effects that have earned it the nickname "poor man's cocaine" [1.4.2]. Abusing bupropion by taking high doses or using it through insufflation or injection is extremely hazardous, with the risk of seizures being a primary and life-threatening concern [1.3.2, 1.5.1]. Awareness among patients and prescribers of these risks is essential to prevent misuse and ensure this medication is used safely and effectively.
For more information on substance abuse and treatment, you can visit the Substance Abuse and Mental Health Services Administration (SAMHSA).
