title: Early signal of diverted use of tropicamide eye drops in France.
abstract: Tropicamide is a mydriatic drug used as eye-drops for diagnostic or therapeutic purposes. From 2013, a diverted use by intravenous route has been suspected in Eastern Europe in opioids users. To date, no signal of misuse has been identified in France. The aims of this study were to investigate any early signals of a diverted use of tropicamide eye drops and to collect information regarding motives for the misuse and tropicamide-induced effects.
  
  
  
  Information was obtained at three levels: (1) at regional level (Midi-Pyrénées area), from reimbursement data and pharmacists' reports on suspicious requests; (2) at national level: from reimbursement data and prescriptions suggesting possible abuse from the OSIAP (Ordonnances Suspectes, Indicateur d'Abus Possible) survey; and (3) at international level: from VigiBase®reports and Web sources. Beta-blocker eye-drops were used as comparators.
  
  
  
  In France, in 2014-2015, 17 (0.91%, 95% CI [0.53-1.46%]) falsified prescriptions involving tropicamide were identified in the OSIAP survey (compared with 0%, 95% CI [0-0.19%] for beta-blockers). Moreover, 37 other suspicious prescriptions were presented in 2015 (notified in 2016). In Midi-Pyrénées, seven patients aged 35-49 were reimbursed for 19-45 vials of 10 ml, in a year. Since September 2014, the regional Addictovigilance Centre has received 91 notifications of suspicious requests to obtain tropicamide. In VigiBase®, two cases were identified but none in France. An increased interest in tropicamide-related Internet searches was observed from Russia and Ukraine.
  
  
  
  These results represent the first early warnings of a tropicamide diverted use in France. Tropicamide abusers would seek euphoria or hallucinations. The high doses involved in intravenous administration could lead to serious complications.
authors.affiliation: CEIP-Addictovigilance, Service de Pharmacologie Médicale et Clinique, UMR1027 Inserm-Université Paul Sabatier Toulouse III, 37 allées Jules Guesde, 31000, Toulouse, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Ponté
authors.affiliation: Direction de la Santé Publique, Pôle Alertes, Risques et Vigilances, ARS Languedoc-Roussillon-Midi-Pyrénées, 26-28 Parc club du Millénaire, 1 025, rue Henri Becquerel, CS, 30001, 34067, Montpellier Cedex 2, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Pi
authors.affiliation: CEIP-Addictovigilance, Service de Pharmacologie Médicale et Clinique, UMR1027 Inserm-Université Paul Sabatier Toulouse III, 37 allées Jules Guesde, 31000, Toulouse, France.|Service de Pharmacologie Médicale et Clinique, CHU Toulouse, Toulouse, France.
authors.forename: Aurore
authors.identifier: 0000-0002-5660-9224
authors.initials: A
authors.lastname: Palmaro
authors.affiliation: CEIP-Addictovigilance, Service de Pharmacologie Médicale et Clinique, UMR1027 Inserm-Université Paul Sabatier Toulouse III, 37 allées Jules Guesde, 31000, Toulouse, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Jouanjus
authors.affiliation: CEIP-Addictovigilance, Service de Pharmacologie Médicale et Clinique, UMR1027 Inserm-Université Paul Sabatier Toulouse III, 37 allées Jules Guesde, 31000, Toulouse, France.
authors.forename: Maryse
authors.identifier: 0000-0002-5494-5873
authors.initials: M
authors.lastname: Lapeyre-Mestre
mesh_terms: D000328:Adult; D003157:Community Pharmacy Services / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005059:Euphoria / Q000187:drug effects; D005260:Female; D005602:France / Q000453:epidemiology; D006212:Hallucinations / Q000139:chemically induced; D006801:Humans; D057226:Information Seeking Behavior; D007275:Injections, Intravenous; D020407:Internet / Q000639:trends; D008297:Male; D008875:Middle Aged; D009184:Mydriatics / Q000008:administration & dosage / Q000633:toxicity*; D009883:Ophthalmic Solutions / Q000008:administration & dosage / Q000633:toxicity*; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*; D012426:Russia; D011795:Surveys and Questionnaires; D014331:Tropicamide / Q000008:administration & dosage / Q000633:toxicity*; D014455:Ukraine
chemical_list: D009184:Mydriatics; D009883:Ophthalmic Solutions; D014331:Tropicamide
keywords: abuse; addictovigilance warning; diverted use; new psychoactive substance; tropicamide