title: Rates of Anomalous Bupropion Prescriptions in Ontario, Canada.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  We 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.
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada lssteele@gmail.com.
authors.forename: Leah S
authors.initials: LS
authors.lastname: Steele
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Erin M
authors.initials: EM
authors.lastname: Macdonald
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Tara
authors.initials: T
authors.lastname: Gomes
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Hollands
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Paterson
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Muhammad M
authors.initials: MM
authors.lastname: Mamdani
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada Sunnybrook Research Institute, Toronto, Ontario, Canada Departments of Medicine and Pediatrics, University of Toronto, Toronto, Ontario, Canada.
authors.forename: David N
authors.initials: DN
authors.lastname: Juurlink
mesh_terms: D000928:Antidepressive Agents / Q000008:administration & dosage*; D016642:Bupropion / Q000008:administration & dosage*; D015283:Citalopram / Q000008:administration & dosage; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D009864:Ontario; D010594:Pharmacies; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*; D020280:Sertraline / Q000008:administration & dosage
chemical_list: D000928:Antidepressive Agents; D016642:Bupropion; D015283:Citalopram; D020280:Sertraline
keywords: bupropion; drug abuse; prescription drug diversion