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Letter to the Editor

Do Not Overlook Bupropion Misuse

Jasleen Kaur, MD; Vania Modesto-Lowe, MD, MPH; Roberto León-Barriera, MD

Published: April 30, 2024

See case report by Noe et al

A recent case report by Noe et al1 described a young man who endorsed bupropion misuse by insufflation and presented with mania following an overdose. This case highlights the need to increase awareness about bupropion misuse.1 Medications with misuse potential include gabapentinoids, anticholinergics, antipsychotics, and antidepressants.2 Bupropion misuse is gaining popularity and is of growing concern.2,3 Bupropion is approved for the treatment of major depressive disorder, seasonal affective disorder, and smoking cessation.2 It is sometimes preferred over selective serotonin reuptake inhibitors due to lack of sexual dysfunction and its weight-neutral profile.4 It is also used off label for attention-deficit disorder.5 Since most misusers will seek a prescription, prescribers must be aware of its misuse potential and related complications.6

Prescribers can suspect bupropion misuse in patients who insist on a bupropion prescription or seek out multiple prescribers.4 Red flags of misuse include euphoria, excess energy, insomnia, and previous illicit drug use.4 Physical clues manifest as nonhealing skin ulcers, damage to nostrils, and new-onset unexplained seizures.3,4 In the United States, young males are at particular risk to misuse bupropion.7 Street names such as “wellies,” “dubs,” “welbys,” and “barnies” may exhibit regional variations with highest prevalence in California, New England, Utah, and New Mexico.2,5 Oral bupropion undergoes extensive first-pass hepatic metabolism, which is why recreational users prefer nasal insufflation or injection due to immediate absorption and higher plasma levels, leading to euphoria.8 The effect of bupropion when insufflated resembles the effects of cocaine with less intensity,8 hence the term poor person’s cocaine as described by Noe and colleagues.1

Parenteral routes make toxic effects more likely due to increased serum concentration.5 These patients are more frequently admitted to critical care compared to other routes.5 The main undesirable effects are dose dependent seizures, usually present at a median dose of about 4.4 g.9 In terms of cardiovascular effects, bupropion overdose can cause QRS and corrected QT interval prolongation, potentially leading to ventricular dysrhythmias and cardiovascular collapse.4

Careful documentation and tracking of bupropion prescriptions is important to identify potential misuse. From a public health perspective, adding bupropion to state prescription monitoring programs could help identify misuse.6 In the meantime, prescribers should be aware of the misuse potential of this medication and screen appropriately. Further research is needed to identify the epidemiologic and clinical impact of a poor person’s cocaine in high risk populations.

Article Information

Published Online: April 30, 2024.
© 2024 Physicians Postgraduate Press, Inc.
Prim Care Companion CNS Disord 2024;26(2):23lr03685
Submitted: December 16, 2023; accepted January 19, 2024.
To Cite: Kaur J, Modesto-Lowe V, León-Barriera R. Do not overlook bupropion misuse. Prim Care Companion CNS Disord. 2024;26(2):23lr03685.
Author Affiliations: Connecticut Valley Hospital, Middletown, Connecticut (Kaur); Hartford Behavioral Health, Hartford, Connecticut (Modesto-Lowe); Department of Psychiatry, University of Connecticut, Farmington, Connecticut (Modesto-Lowe); School of Health Sciences, Quinnipiac University, Hamden, Connecticut (Modesto-Lowe); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (León-Barriera).
Corresponding Author: Jasleen Kaur, MD, Connecticut Valley Hospital, Middletown, CT (
Relevant Financial Relationships: None.
Funding/Support: None.

Volume: 26

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