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Misuse of Anticholinergic Medications: A Systematic Review. Biomedicines 2022; 10:biomedicines10020355. [PMID: 35203563 PMCID: PMC8962297 DOI: 10.3390/biomedicines10020355] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/21/2022] [Accepted: 01/28/2022] [Indexed: 01/27/2023] Open
Abstract
(1) Background: Over the last decade, misuse and diversion of medications has appeared to be increasingly concerning phenomena, including a range of different molecules. As current knowledge on the abuse of centrally acting anticholinergics is limited, the aim of the present study is to review the relevant published data, focusing on the following molecules: benztropine, biperiden, scopolamine, orphenadrine, and benzhexol/trihexyphenidyl (THP). (2) Methods: A systematic literature review was carried out using Pubmed, Scopus, and Web of Science databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Research methods were registered on PROSPERO (CRD42021257293). (3) Results: A total of 48 articles, including case reports, surveys, and retrospective case series analyses, were included. Most articles focused on benzhexol/THP (n = 25), and benztropine (n = 4). The routes of administration were mostly oral, and macrodoses together concomitant illicit drugs, e.g., cocaine, have been recorded. Toxidromes included both physical (e.g., tachycardia, tachypnoea, dilatated pupils, dry skin, urinary retention, ataxia, etc.) and psychiatric symptoms (e.g., anxiety, agitation, delirium, etc.). Fatal outcomes were very rare but reported. (4) Conclusion: Results from the present study show that anticholinergic misusing issues are both widespread worldwide and popular. Considering the potential adverse effects associated, healthcare professionals should be vigilant and monitor eventual misusing issues.
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Ophthalmic Drug Abuse: Knowledge, Attitude, and Practice of Ophthalmologists in Jordan. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-019-00216-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Verri P, Rustichelli C, Ferrari A, Marchesi F, Baraldi C, Licata M, Vandelli D, Palazzoli F, Potì F, Silingardi E. Seizures of illicit substances for personal use in two Italian provinces: analysis of trends by type and purity from 2008 to 2017. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2019; 14:41. [PMID: 31533834 PMCID: PMC6751801 DOI: 10.1186/s13011-019-0229-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/10/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The use of illicit substances represents one of the most difficult problems to confront in the health system. Drug use is a global problem but is not uniform throughout the world, within the same country and changes over time. Therefore, knowing the illicit substances that are used in a territory is essential to better organize health services in that specific geographical area. To this aim, we analysed 4200 samples confiscated from individuals who held them for personal use by police forces in the Italian provinces of Modena and Reggio Emilia from 2008 to 2017. METHODS The suspected samples were screened by gas-chromatography-mass spectrometry (GC-MS) and by liquid chromatography-tandem mass spectrometry (LC-MS/MS); all samples were subsequently analysed by gas chromatography-flame ionization detector (GC-FID) for quantitative analyses. RESULTS Cannabis was the most seized illicit substance (70.7%). Over the study period, the number of seizures of herb with a high content of Δ9-THC increased. The number of cocaine seizures remained stable (total 16.1%), but the median purity of seized cocaine increased to 75% in 2017. Heroin seizures decreased over time, but the median purity of seized heroin reached 16.8% in 2017. In almost all the years, heroin samples with a purity exceeding the 97.5 percentile were found. Especially from 2014, the range of seized substances increased and started to include synthetic cathinones, phenylethylamines, UR-144, LSD, psilocybe, prescription opioid and hypnotics. In two cases, tramadol together with tropicamide was seized. Most of the seizures involved male subjects and 82% of the seizures were from individuals younger than 35 years of age. CONCLUSIONS The persistence of old illicit drugs and the rapid emergence of new psychoactive substances represented a serious challenge for public health in the studied Italian area. Some useful interventions might be: informing mainly young people about the possible complications of cannabis use; implementing standardized procedures to diagnose and treat cocaine-related emergencies in hospitals; increasing the distribution of naloxone to antagonize possible heroin overdoses; equipping laboratories to be able to identify the new psychoactive substances.
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Affiliation(s)
- Patrizia Verri
- Forensic Toxicology Laboratory; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Cecilia Rustichelli
- Department of Life Sciences, University of Modena and Reggio Emilia, via G. Campi, 103, 41125, Modena, Italy.
| | - Anna Ferrari
- Unit of Medical Toxicology, Headache Centre and Drug Abuse; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Filippo Marchesi
- Forensic Toxicology Laboratory; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Carlo Baraldi
- School of Medical Toxicology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Manuela Licata
- Forensic Toxicology Laboratory; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Daniele Vandelli
- Forensic Toxicology Laboratory; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Federica Palazzoli
- Forensic Toxicology Laboratory; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Francesco Potì
- Unit of Neuroscience, Department of Medicine and Surgery, University of Parma, Via Volturno, 39F, 43125, Parma, Italy
| | - Enrico Silingardi
- Forensic Toxicology Laboratory; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
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Lakstygal AM, Kolesnikova TO, Khatsko SL, Zabegalov KN, Volgin AD, Demin KA, Shevyrin VA, Wappler-Guzzetta EA, Kalueff AV. DARK Classics in Chemical Neuroscience: Atropine, Scopolamine, and Other Anticholinergic Deliriant Hallucinogens. ACS Chem Neurosci 2019; 10:2144-2159. [PMID: 30566832 DOI: 10.1021/acschemneuro.8b00615] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Anticholinergic drugs based on tropane alkaloids, including atropine, scopolamine, and hyoscyamine, have been used for various medicinal and toxic purposes for millennia. These drugs are competitive antagonists of acetylcholine muscarinic (M-) receptors that potently modulate the central nervous system (CNS). Currently used clinically to treat vomiting, nausea, and bradycardia, as well as alongside other anesthetics to avoid vagal inhibition, these drugs also evoke potent psychotropic effects, including characteristic delirium-like states with hallucinations, altered mood, and cognitive deficits. Given the growing clinical importance of anti-M deliriant hallucinogens, here we discuss their use and abuse, clinical importance, and the growing value in preclinical (experimental) animal models relevant to modeling CNS functions and dysfunctions.
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Affiliation(s)
- Anton M. Lakstygal
- Graduate School of Biology, St. Petersburg State University, St. Petersburg 199034, Russia
| | | | | | | | - Andrey D. Volgin
- Institute of Experimental Medicine, Almazov National Medical Research Centre, Ministry of Healthcare of Russian Federation, St. Petersburg 197341, Russia
| | - Konstantin A. Demin
- Institute of Experimental Medicine, Almazov National Medical Research Centre, Ministry of Healthcare of Russian Federation, St. Petersburg 197341, Russia
- Institute of Translational Biomedicine (ITBM), St. Petersburg State University, St. Petersburg 199034, Russia
| | | | | | - Allan V. Kalueff
- School of Pharmacy, Southwest University, Chongqing 400700, China
- Anatomy and Physiology Laboratory, Ural Federal University, Ekaterinburg 620002, Russia
- Laboratory of Biological Psychiatry, ITBM, St Petersburg State University, St. Petersburg 199034, Russia
- Scientific Research Institute of Physiology and Basic Medicine, Novosibirsk 630117, Russia
- Granov Russian Scientific Center of Radiology and Surgical Technologies, Ministry of Healthcare of Russian Federation, St. Petersburg 197758, Russia
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The Misuse and Abuse of Ophthalmic Preparations: a Scoping Review of Clinical Case Presentations and Extant Literature. Int J Ment Health Addict 2018. [DOI: 10.1007/s11469-017-9868-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Ponté C, Pi C, Palmaro A, Jouanjus E, Lapeyre‐Mestre M. Early signal of diverted use of tropicamide eye drops in France. Br J Clin Pharmacol 2017; 83:1791-1800. [PMID: 28239898 PMCID: PMC5510080 DOI: 10.1111/bcp.13272] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/31/2017] [Accepted: 02/18/2017] [Indexed: 01/16/2023] Open
Abstract
AIMS 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Camille Ponté
- CEIP‐Addictovigilance, Service de Pharmacologie Médicale et CliniqueUMR1027 Inserm‐Université Paul Sabatier Toulouse III37 allées Jules Guesde31000ToulouseFrance
| | - Christian Pi
- Direction de la Santé Publique, Pôle Alertes, Risques et VigilancesARS Languedoc‐Roussillon‐Midi‐Pyrénées26–28 Parc club du Millénaire, 1 025, rue Henri BecquerelCS30001, 34067Montpellier Cedex 2France
| | - Aurore Palmaro
- CEIP‐Addictovigilance, Service de Pharmacologie Médicale et CliniqueUMR1027 Inserm‐Université Paul Sabatier Toulouse III37 allées Jules Guesde31000ToulouseFrance
- Service de Pharmacologie Médicale et CliniqueCHU ToulouseToulouseFrance
| | - Emilie Jouanjus
- CEIP‐Addictovigilance, Service de Pharmacologie Médicale et CliniqueUMR1027 Inserm‐Université Paul Sabatier Toulouse III37 allées Jules Guesde31000ToulouseFrance
| | - Maryse Lapeyre‐Mestre
- CEIP‐Addictovigilance, Service de Pharmacologie Médicale et CliniqueUMR1027 Inserm‐Université Paul Sabatier Toulouse III37 allées Jules Guesde31000ToulouseFrance
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Wazaify M, Alali MB, Yousef MA, Qammaz S. Ophthalmic drops abuse in community pharmacy setting: A cross-sectional study from Jordan. JOURNAL OF SUBSTANCE USE 2017. [DOI: 10.1080/14659891.2016.1271041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mayyada Wazaify
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Mahmoud B. Alali
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Mahmood A. Yousef
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Samir Qammaz
- Department of Forensic Medicine and Toxicology, School of Medicine, National and Kapodistrian University of Athens, Greece
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Émergence d’un signal d’utilisation détournée de collyre à base de tropicamide en France : un exemple d’enquête d’addictovigilance. Therapie 2017. [DOI: 10.1016/j.therap.2016.11.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Wazaify M, Abood E, Tahaineh L, Albsoul-Younes A. Jordanian community pharmacists’ experience regarding prescription and nonprescription drug abuse and misuse in Jordan – An update. JOURNAL OF SUBSTANCE USE 2016. [DOI: 10.1080/14659891.2016.1235734] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Mayyada Wazaify
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan
| | - Ebtesam Abood
- Department of Clinical Pharmacy, Faculty of Pharmacy, Lebanese International University, Aden, Yemen
| | - Linda Tahaineh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Ar Ramtha, Irbid, Jordan
| | - Abla Albsoul-Younes
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan
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