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

OBJECTIVES: The intravenous (IV) injection of tropicamide for non-clinical purposes is a new and widespread drug trend. The aim of this study is to provide the first literature review on the topic.

METHODS: Relevant literature was identified through a search of MEDLINE, Psycinfo, Google Scholar, conference proceedings and select citations.

RESULTS: Cases of tropicamide (IV) injection have been reported in Russia, Italy, Turkey and Kazakhstan. This phenomenon is mainly secondary to primary opioid (especially heroin) addiction. Several key factors can be associated with its rapid diffusion: (i) enhancement of the 'positive' effects of heroin; (ii) decrease and delay of heroin withdrawal symptoms; (iii) easy availability; (iv) low costs; (v) fast effects; and (vi) visibility of self-reported experiences on Internet. Acute tropicamide intoxications can lead to anticholinergic syndrome, hyperthermia, tremors and convulsions. Chronic tropicamide-related problems include cardiovascular toxicity, psychosis, renal or liver failures, severe weight loss and infections. Fatalities due to tropicamide IV injection have been reported in non evidence-based/peer-reviewed sources, such as drug fora, websites and media news.

CONCLUSIONS: Tropicamide IV injections represent a serious health risk. Specific prevention programmes should be implemented for the general population as well as for the high-risk population of polydrug abusers.