A Systematic Review of Abuse or Overprescription of Bupropion in American Prisons and a Synthesis of Case Reports on Bupropion Abuse in American Prison and Non-prison Systems

Abstract

Illicit drug use is a huge problem in the US prison system. The objectives of this study are (1) to systematically investigate the prevalence of bupropion abuse in American prisons along with associated problems, and (2) to synthesize available case reports on this topic in both prison and non-prison settings. Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses, we searched five databases (PubMed, Embase, Scopus, CINAHL, and PsycINFO) and used Covidence software for screening and reviewing identified articles. The final search date was February 21, 2023. Newcastle-Ottawa Scale and ROBINS-I tool were used for risk of bias assessment. We included original studies of populations aged 18 years and above in American prisons. We found 77 unique articles, none of which met our eligibility criteria. A synthesis of 22 case reports that we found showed bupropion abuse to be more common in young males, and intranasal administration was the most common method of abuse. More frequent desired and adverse effects were "cocaine-like highs" and seizures, respectively. Although several cases of bupropion abuse have been reported in US prisons, no study has been done to understand its prevalence and associated effects. The absence of original studies on bupropion abuse in US prisons and the observed patterns in this case report synthesis further highlight the need for a study to investigate the prevalence of bupropion abuse in US prisons. The limitations of this study include that it is an empty systematic review and the absence of all pertinent data in many of the included case reports. The authors did not receive any funding for this work. This systematic review was registered in PROSPERO with registration number CRD42021227561.

Clinical Presentations of Bupropion Prescription Drug Misuse

“…These accounts may have inaccuracies and selection bias 10 . The systematic review by Aikoye et al includes only studies with patients in the American prison system 13 …”

“…10 The systematic review by Aikoye et al includes only studies with patients in the American prison system. 13 Five additional case reports published after the review by Naglich et al were included in our systematic review, [20][21][22][23]29 along with 2 retrospective observational studies of bupropion overdose reports to regional poison control centers. 18,22 This large sample of patients contains percentage reports of presenting symptoms that add clinical value and enable physicians to identify possible bupropion overdoses by most frequent presenting symptoms.…”

“…Existing bupropion systematic reviews by Naglich et al and Aikoye et al focus primarily on dosages, effects, and subjective patient experiences and bupropion misuse exclusively in the American prison system, respectively. 10,13 Here, we review the extensive literature describing patients' presentations, clinical courses, interventions, and outcomes after acute ingestion of bupropion via oral route, intravenous route, and insufflation.…”

Analysis Model of Knowledge, Social Demographics, and Social Environment on Drug Abuse: A Case Study in Swamp Areas

“…Drug abuse is one of the serious health and social problems globally as well as in Indonesia. The high prevalence of drug use issues across various segments of society not only damages individual health but also has negative impacts on social and economic aspects, as well as posing a threat to the potential demographic dividend that is expected to be a strength in national development (Aikoye et al, 2023). Drug abuse problems are more prevalent in communities residing around swamp areas compared to those living on the mainland (Feinberg, 2012).…”