Intravenous Abuse of Tropicamide in Opioid Use Disorder: Presentation of 2 Cases

Abstract

Although anticholinergics have been known to be abused for their euphoric effects, these cases' motivation to use tropicamide seemed to extend beyond its euphoric effect and was also based on its interaction with heroin. It is feared that tropicamide abuse may become more frequent. Health professionals should be aware of this trend so that symptoms of misuse and intoxication can be recognized, and ophthalmologists should consider the abuse potential of anticholinergic eye drops when prescribing them.

Injecting eye‐drops: a mini‐review on the non‐clinical use of tropicamide

“…tramadol and desomorphine). Consistently with the findings of Bozkurt et al (), tropicamide was found to be used (i) to compensate the lack of the primary drug (44.1%) and (ii) in order to avoid the withdrawal symptoms of the primary drug (39.8%). The 43.2% and 33.1% of the sample referred that key factors involved in the systematic tropicamide use after the first tries were respectively the ‘cheap price when compared with traditional drugs’ and ‘the general over the counter availability’.…”

“…The relation between tropicamide and heroin use was also observed in two patients by Bozkurt et al (). Patients reported that tropicamide increased the pleasurable and durable effect of heroin and decreased and delayed the heroin withdrawal symptoms; IV injection of tropicamide was associated with dissociation, hallucinations, blurred vision, severe weight loss, decline of concentration and forgetfulness (Bozkurt et al ., ).…”

“…Patients reported that tropicamide increased the pleasurable and durable effect of heroin and decreased and delayed the heroin withdrawal symptoms; IV injection of tropicamide was associated with dissociation, hallucinations, blurred vision, severe weight loss, decline of concentration and forgetfulness (Bozkurt et al ., ). In addition, Bozkurt et al () observed how the effects of tropicamide were especially relevant in the first hour of injection, and then gradually subsided in 5–6 h. Differences in the dosages of IV tropicamide was also observed: patient 1 had been injecting tropicamide with heroin for 1 year by mixing 1 ml tropicamide with 0.25‐mg heroin, 3 to 5 times a day; patient 2 used 800–1250 mg of tropicamide daily.…”

“…The first published evidence on IV injection of tropicamide was based on the analysis of users' self‐reported experiences available on the Internet and explored the main effects as well as the risks associated with this new trend (Bersani et al ., ). Later studies (4) described cases of abuse of the drug in Italy (Spagnolo et al ., ), Turkey (Bozkurt et al ., ) and Kazakhstan (Prilutskaya and Kuliev, ; Prilutskaya and Kuliev, ).…”

“…This new drug trend is particularly diffuse in Eastern European Countries (especially in Russia) (Bersani et al ., ; Vladimirov and Kaimak, ), although recent alerts have also been recorded in Italy, Turkey and Kazakhstan (Bozkurt et al ., ; Prilutskaya and Kuliev, ; Spagnolo et al ., ). According to Vladimirov & Kaimak (), the sales of tropicamide in Russia have increased about 13‐fold over the last 5 years because of its popularity for non‐clinical purposes; similarly, in 2013 the retail sales of tropicamide in Kazakhstan increased of 226% (Prilutskaya and Kuliev, ; Prilutskaya and Kuliev, ).…”