Cognitive Functions in IV Heroin Users Using Anticholinergic Eye Drops vs IV Heroin Users Not Using Them

Background Misuse of anticholinergic eye drops by people who inject drugs (PWID) and especially heroin became an increasingly concerning phenomenon worldwide, and in the last decade the clinical practice in Egypt started to notice this trend as well. However, the data regarding the prevalence of their misuse and abuse is very scarce worldwide and almost absent in Egypt. It’s known from previous research that heroin use can lead to deficits in cognitive functions. In addition to that, it’s also known that systemic anticholinergics use has been correlated with diminished cognitive performance. However, there’s a scarcity of data and research that addressed the emerging phenomenon of concomitant use of Iv Heroin and anticholinergic eye drops and their effect on cognitive functions. Therefore, the purpose of the present study was to investigate the cognitive functions of IV heroin users who concomitantly use anticholinergic eye drops compared to IV heroin users who don’t use them. Objectives To measure and compare cognitive functions between healthy controls VS heroin users only VS IV heroin users using anticholinergic eye drops on top. And to assess the association between cognitive functions and other factors (socio- economic, and addiction severity). Subjects and Methods This study was conducted at Okasha Institute of psychiatry, Ain Shams University, Cairo, Egypt. The study included 60 participants, 40 diagnosed to have Heroin use disorder who were further divided into 20 patients using eye drops concomitantly and 20 ones using heroin alone, together with 20 healthy adults as a control group who were age and sex matched, recruited from the employees and workers at Okasha Institute of Psychiatry, Ain Shams University. All subjects of the study were assessed by using: The Mini-International Neuropsychiatric Interview (M.I.N.I.): to serve as a rapid tool for diagnoses of substance use disorder and to exclude the presence of any other psychiatric disorder; Urine Drug test: to confirm recent opioid use, Fahmy and Sherbiny Socio-Economic Status scale, Addiction severity index (ASI): to assess the severity of addiction; trail making test A&B: for assessment of attention and processing speed; Benton visual retention test (BVRT): for assessment of visual memory, visual reconstruction ability and processing and delayed memory; Wechsler memory scale (WMS): for assessment of visual, auditory, immediate, delayed & working memory, and Wisconsin card sorting test (WCST): for assessment of abstract reasoning, problem solving and cognitive flexibility . Results This study showed that the cases of Heroin use disorder who concomitantly inject eye drops are more impaired in attention and processing speed (75% in TMT A) than those who inject Heroin alone without using the eye drops (45% in TMT A) using Trail Making Test, and that was statistically significant difference. But there was no statistically significant difference between them using Benton Visual Retention Test, Wechsler Memory Scale and Wisconsin Card Sorting Test (computerized version). Conclusion our study highlighted that disruptions in cognitive functions such as attention, memory, executive and visual-spatial functions were identified in individuals with heroin use disorder and these disruptions were found to be significantly more than healthy control group participants. Additionally, it was identified that the concomitant use of anticholinergic eye drops in heroin use disorder patients lead specifically to more impairment in attention and processing speed compared to patients who didn’t use the anticholinergics. Also, there was a negative correlation between age as well as duration of heroin use and Addiction Severity Index in relation to cognitive functions.