title: Injecting eye-drops: a mini-review on the non-clinical use of tropicamide.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.|School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.
authors.forename: Francesco Saverio
authors.identifier: http://orcid.org/0000-0002-7555-8020
authors.initials: FS
authors.lastname: Bersani
authors.affiliation: Department of Human Sciences, European University of Rome, Rome, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Imperatori
authors.affiliation: Republican Scientific and Practical Centre for Medical and Social Problems of Drug Addiction, Semey State Medical University, Semey, Kazakhstan.
authors.forename: Mariya
authors.initials: M
authors.lastname: Prilutskaya
authors.affiliation: Republican Scientific and Practical Centre for Medical and Social Problems of Drug Addiction, Semey State Medical University, Semey, Kazakhstan.
authors.forename: Ramiz
authors.initials: R
authors.lastname: Kuliev
authors.affiliation: School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.
authors.forename: Ornella
authors.initials: O
authors.lastname: Corazza
mesh_terms: D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D006801:Humans; D007275:Injections, Intravenous; D009184:Mydriatics / Q000008:administration & dosage / Q000009:adverse effects*; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000209:etiology*; D014331:Tropicamide / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D009184:Mydriatics; D014331:Tropicamide
keywords: eye-drops; heroin; intravenous injection; polydrug abuse; tropicamide