From the Wake Forest University School of Medicine, Winston-Salem, NC.
Department of Psychiatry, Atrium Wake Forest Baptist Health, Winston-Salem, NC.
J Clin Psychopharmacol. 2024;44(3):284-290. doi: 10.1097/JCP.0000000000001858.
Among prescribers, bupropion is considered a substance of low misuse potential, with some studies showing lesser misuse potential than caffeine. However, several case reports exist of recreational bupropion misuse and diversion. Our goal is to understand at-risk populations, clinical courses, interventions, and outcomes after acute ingestion of bupropion via oral, intravenous route, and insufflation.
The systematic review was registered with PROSPERO on August 5, 2023. We conducted a systematic literature search on July 30, 2023, utilizing 8 databases with the help of the Medical Subject Headings (MeSH) term "Bupropion" in the context of misuse and abuse. Ultimately, we found 17 articles with qualitative synthesis relevant to our study objective and meeting our inclusion/exclusion criteria.
Bupropion insufflation and intravenous injection occur almost exclusively in patients with a substance use disorder history, with a preponderance of patients with stimulant use disorder or multiple substance use disorders. Additionally, many were dual-diagnosis patients with a history of attention deficit hyperactivity disorder and stimulant use disorder, treated with bupropion. Patients describe the effects of bupropion insufflation/IV injection as a milder "cocaine-like" high that is brief, with less severe withdrawal effects of anxiety and agitation. The most common side effect at presentation was tachycardia, followed by seizures responsive to IV benzodiazepines. IV injection seems particularly insulting to the vascular system, with cellulitis, tissue necrosis, and digital ischemia as documented adverse effects.
This systematic review highlights the bupropion misuse potential in certain patient populations and serves to increase awareness among clinicians. Additional patient screening, monitoring and follow-up, surveillance, and further research are needed to investigate and prevent bupropion misuse in at-risk patient populations entirely.
在开具处方的医生中，安非他酮被认为是一种潜在滥用可能性较低的物质，一些研究表明其潜在滥用可能性小于咖啡因。然而，也有一些娱乐性安非他酮滥用和转移的病例报告。我们的目标是了解高危人群、临床病程、干预措施以及通过口服、静脉途径和鼻吸摄入安非他酮后的急性摄入后的结果。
系统评价于 2023 年 8 月 5 日在 PROSPERO 上注册。我们于 2023 年 7 月 30 日在 8 个数据库中进行了系统文献检索，在“Bupropion”的主题词下检索了滥用和误用相关文献。最终，我们找到了 17 篇符合我们研究目的和纳入/排除标准的定性合成相关文章。
安非他酮鼻吸和静脉注射几乎仅发生在有物质使用障碍史的患者中，其中大多数患者有兴奋剂使用障碍或多种物质使用障碍。此外，许多患者是双诊断患者，有注意力缺陷多动障碍和兴奋剂使用障碍病史，正在接受安非他酮治疗。患者描述安非他酮鼻吸/静脉注射的效果是一种较轻的“可卡因样”兴奋，持续时间短，焦虑和激动的戒断症状不那么严重。最常见的首发症状是心动过速，随后是静脉注射苯二氮䓬类药物可治疗的癫痫发作。静脉注射似乎对血管系统特别具有损伤性，有记录的不良影响包括蜂窝织炎、组织坏死和手指缺血。
这项系统评价强调了某些患者人群中安非他酮的潜在滥用可能性，旨在提高临床医生的认识。需要进一步的患者筛查、监测和随访、监测以及进一步的研究，以调查和预防高危患者人群中的安非他酮滥用。
