Drops of madness? Recreational misuse of tropicamide collyrium; early warning alerts from Russia and Italy

Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy. Electronic address: .
General hospital psychiatry (Impact Factor: 2.61). 05/2013; 35(5). DOI: 10.1016/j.genhosppsych.2013.04.013
Source: PubMed


Tropicamide is an antimuscarinic drug usually prescribed as an ophthalmic solution to induce short-term mydriasis and cycloplegia. Over the last 2 years, tropicamide has been reported in both Russia and Italy to be self-administered intravenously (IV) for recreational purposes.

The literature on tropicamide was searched in PsycInfo and Pubmed databases. Considering the absence of peer-reviewed data, results were integrated with a multilingual qualitative assessment of a range of Web sites, drug fora and other online resources (i.e., e-newsgroups, chat rooms, mailing lists, e-newsletters and bulletin boards): between January 2012 and January 2013, exploratory qualitative searches of more than 100 Web sites have been carried out in English and Italian using generic and specific keywords such as "legal highs," "research chemicals," "online pharmacy," "tropicamide," "mydriacil," "tropicacyl," "visumidriatic," "online pharmacies" and "tropicamide recreational abuse" in the Google search engine.

Misuse of tropicamide typically occurs through IV injection; its effects last from 30 min to 6 h, and it is often taken in combination with other psychoactive compounds, most typically alcohol, marijuana and opiates. Medical effects of tropicamide misuse include slurred speech, persistent mydriasis, unconsciousness/unresponsiveness, hallucinations, kidney pain, dysphoria, "open eye dreams," hyperthermia, tremors, suicidal feelings, convulsions, psychomotor agitation, tachycardia and headache.

More large-scale studies need to be carried out to confirm and better describe the extent of tropicamide misuse in the European Union and elsewhere. Health and other professionals should be rapidly informed about this new and alerting trend of misuse.


Available from: F. Saverio Bersani
    • "This is unsurprising as it is prescribed for neuropathic pain, anxiety and epilepsy, is misused (Schifano, 2014) and is increasingly associated with drug-related deaths (Corkery et al., 2013). Of the other well-recognised NPS, benzydamine is found in oral rinses for sore throats and tropicamide is used to dilate the pupil in diagnostic eye test; both these drugs are misused (Anand et al., 2007; Bersani et al., 2013). Thus the number of genuinely " novel " psychoactive substance known by pharmacists is small, with the stimulant mephedrone and the synthetic cannabinoid " Spice " drugs the best known. "
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    ABSTRACT: Purpose – The purpose of this paper is to determine pharmacists’ knowledge of legal highs (novel psychoactive substances (NPS)). Design/methodology/approach – A questionnaire was handed out at two London pharmacist continuing education events in mid-2014. These events update pharmacists about developments of interest/relevance to the profession and to improve their practice. A total of 54 forms were returned; a response rate of 26 percent. Findings – Most pharmacists had poor knowledge of NPS and many considered that NPS were not important to their work, with few having had to advise customers in this area. Despite this, the majority thought that they had insufficient information about NPS. There was a negative correlation between the age of the pharmacist and knowledge of NPS. Research limitations/implications – The sample is a self-selected one drawn from registered pharmacists working in community pharmacies in northwest London, and thus does not include hospital pharmacies. Self-selection means that respondents may only reflect those who are interested in the NPS phenomenon and not the wider pharmacy community. The geographical area covered may not be representative of London as a whole, or indeed other parts of the UK or other EU countries. Practical implications – It is clear that pharmacists do not know much about NPS but would like to know more. This information might improve their practice. Social implications – Pharmacists, easier to see than general practitioners, could be a useful source of information for NPS misusers. Originality/value – There have been no previous attempts to gauge the level of knowledge by pharmacists of legal highs/NPS in the UK or elsewhere to our knowledge.
    Drugs and Alcohol Today 06/2015; 15(2):93-99. DOI:10.1108/DAT-03-2015-0012
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    • "Very recently there have been reports of novel, and legally available, opioid-based analogues such as AH-791, but data are so sparse that they have been excluded from this paper. As well as OTC medications, there have been concerning reports of some legitimately prescribed nonopioid medications also being used, or having the potential to be used, as drugs of abuse (the issue of benzodiazepines being so used will be addressed later in this paper), including: pregabalin and gabapentin, posited due to their GABAmimetic properties [Schifano, 2014; Carrus and Schifano, 2012]; bupropion, which may be perceived as a stimulant in those with a history of cocaine misuse [Vento et al. 2013], and the antimuscarinic tropicamide that when injected can induce quasi-psychotic phenomena [Bersani et al. 2013]. It should also be noted that several otherwise illegal classical hallucinogens are legally obtainable in their plant form, including psilocybin in sclerotia of the psilocybe genus, mescaline in the peyote cactus (Lophophora williamsii), and dimethyltryptamine (DMT) in a brew of Banisteriopsis caapi and Psychotria viridis commonly known as ayahuasca. "
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    ABSTRACT: There has been growing clinical, public, and media awareness and concern about the availability and potential harmfulness of so-called ‘legal highs’, which are more appropriately called new or novel psychoactive substances (NPS). A cat-and-mouse process has emerged wherein unknown chemists and laboratories are producing new, and as yet nonproscribed, compounds for human consumption; and as soon as they are banned, which they inevitably are, slightly modified analogues are produced to circumvent new laws. This rapidly changing environment, 81 new substances were identified in 2013 alone, has led to confusion for clinicians, psychopharmacologists, and the public at large. Our difficulties in keeping up with the process has had a two-fold negative effect: the danger of ignoring what is confusing; and the problem that some of the newer synthesized compounds appear ever more potent. This review aims to circumscribe a quick moving and growing field, and to categorize NPS into five major groups based upon their ‘parent’ compounds: stimulants similar to cocaine, amphetamines and ecstasy; cannabinoids; benzodiazepine based drugs; dissociatives similar to ketamine and phencyclidine (PCP); and those modelled after classic hallucinogens such as LSD and psilocybin. Pharmacodynamic actions, subjective and physical effects, harmfulness, risk of dependency and, where appropriate, putative clinical potentials are described for each class. Clinicians might encounter NPS in various ways: anecdotal reportage; acute intoxication; as part of a substance misuse profile; and as a precipitant or perpetuating factor for longer-term physical and psychological ill health. Current data are overall limited, and much of our knowledge and treatment strategies are based upon those of the ‘parent’ compound. There is a critical need for more research in this field, and for professionals to make themselves more aware of this growing issue and how it might affect those we see clinically and try to help: a brave new world of so-called ‘psychonauts’ consuming NPS will also need informed ‘psychotherapeutonauts’. The paper should serve as a primer for clinicians and interested readers, as well as provide a framework into which to place the new substances that will inevitably be synthesized in the future.
    Therapeutic Advances in Psychopharmacology 03/2015; 5(2):97-132. DOI:10.1177/2045125314559539 · 1.53 Impact Factor
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    • "They can also communicate with other users on their experiences, the effects of the substances, and the recommended sources and avenues of delivery [53] (see Re: Camfetamine). The apparent possibility to purchase Camfetamine from Websites makes this drug very easily available to vulnerable individuals, including children and adolescents [54]. Vulnerable individuals might be encouraged by a range of widely available online comments/messages/videos related to Camfetamine intake experiences. "
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    BioMed Research International 07/2014; 2014(3):419026. DOI:10.1155/2014/419026 · 1.58 Impact Factor
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