Medicinal products detected as novel psychoactive substances: The case of intravenous use of tropicamide (2018)

Use and abuse of novel psychoactive substances (NPS) remains a public health and law enforcement challenge across Europe and bordering countries. Increasingly NPS detected on the drug market include those with legitimate use as medicines or active pharmaceutical ingredients in medicines. This Short Communication wishes to draw attention to reports on the concerning upward trend of intravenous (IV) use of eyedrops containing tropicamide by problematic opiate users. Since 2013, trends of diversion by IV route are identified as a new phenomenon in Europe. Sales in Russia and Eastern Europe in particular have increased significantly in the past five years. Key indicators of suspected misuse include online interest particularly from Russia, Ukraine and other Eastern European countries, and pharmacovigilance and clinical alerts from Turkey, Italy, France, Georgia, Russia, Tajikistan, and Kazakhstan. Tropicamide is injected as secondary to the primary opiate addiction, and reportedly occurs as self-sufficient means to get high amongst opiate injectors when primary opiates such as heroin are not available, and as poly-substitute to further enhance the opiate effect and manage heroin (and to a lesser extent methadone) withdrawals. Anecdotally, injection of tropicamide is known as the 'seven monther' in relation to the length of time it takes to kill the user. The diversion of tropicamide is high risk, concentrated within problematic drug user networks, and conducted by individuals who may not be engaging with social and medical systems. Aside from dependence and physical/psychiatric harms, the risk pertaining to this injecting phenomenon as potential contribution toward virus transmission (HIV, Hepatitis C) within injecting networks are present. The Short Communication presents extant literature on the topic, and discusses implications for drug policy and service delivery.