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.

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Available from: F. Saverio Bersani
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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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    • "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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