Itraconazole-induced Torsade de Pointes in a patient receiving methadone substitution therapy

Issues. Methadone, a pharmacological agent used to treat heroin dependence is relatively safe, but may cause cardiac arrhythmias in the concurrent presence of other risk factors. Approach and Key Findings. This case report highlights the risk of Torsade de Pointes, a life-threatening cardiac arrhythmia, in a heroin-dependent patient receiving methadone substitution therapy who was prescribed itraconazole for vaginal thrush. The patient presented to the accident and emergency department for chest discomfort and an episode of syncope following two doses of itraconazole (200 mg). Electrocardiogram monitoring at the accident and emergency department showed prolonged rate-corrected QT interval leading to Torsade de Pointes. The patient was admitted for cardiac monitoring, and electrocardiogram returned to normal upon discontinuation of methadone. Implication. This cardiac arrhythmia was most likely as a result of a drug interaction between methadone and itraconazole because the patient presented with no other risk factors. Conclusion. Given the benefits of methadone as a substitution treatment for heroin-dependent individuals, the association between methadone and cardiac arrhythmias is of great concern. Physicians treating heroin-dependent patients on methadone substitution therapy should therefore be cautious of the potential risk of drug interactions that may lead to fatal cardiac arrhythmias

Illicit ketamine induced frequency of micturition in a young Malay woman

Issues. The growing use of illicit ketamine among young adults poses a public health concern in Malaysia. In contrast to medical use of ketamine, illicit use has been reported to produce adverse effects on the urinary tract and, in particular the bladder. Approach and Key Findings. This case report describes a young Malay woman who developed severe bladder symptoms (urinary frequency) after consuming illicit ketamine. A history of illicit ketamine use was initially missed, and she was consequently diagnosed and treated for a urinary tract infection. Her symptoms persisted despite several courses of antibiotics. The patient was subsequently referred to an urologist where cystoscopic examination and biopsy of the bladder found changes consistent with interstitial cystitis. This was despite the absence of haematuria. Renal function was normal. Implication. The patient's ketamine use was the most likely cause for the urinary symptoms and bladder changes. Conclusion. Illicit ketamine use may lead to severe urinary tract problems that can be irreversible even after ketamine has ceased. Early diagnosis is critical although difficult when ketamine use is not divulged during the consultation with the physician. Physician consideration of this new clinical entity is important, particularly in cases where the symptoms do not resolve with usual treatment

The transition to harm reduction: Understanding the role of non-governmental organisations in Malaysia

Background: The transition of drug policy from prohibition to harm reduction has never been easy. The deeply entrenched belief in prohibition shared by policy makers and religious leaders provided little room for alternatives, and change came only slowly. The non-governmental organisations (NGOs) in Malaysia played a pivotal role in effecting such a change. Understanding how they did so may be instructive for other similarly placed countries. Methods: Data collected via reviews of published secondary sources, media reports and in-depth interviews with pioneers of harm reduction drawn from NGOs, medical practitioners and the police were analysed to construct the paper. Results: The policy change was the outcome of competition between three groups in the drug policy subsystem - the state, the Muslim religious lobby and the NGOs. Developments such as the poor outcomes from the prohibition programmes and the outbreak of HIV/AIDS did not change policy but did lead to a rethink of core beliefs in the state alliance and spawned a state-NGO partnership. The subsequent failure to meet the Millennium Development Goal with respect to HIV/AIDS in 2005 - was seen as a failure of the Health Ministry which then led the final charge for a policy change arguing that a health crisis was imminent. The NGOs played a pivotal role in this process by educating their partners in the state coalition, by drawing academics and medical practitioners into advocacy and by engaging the religious lobby (albeit with varying success). They were also frontline players in implementing harm reduction programmes and successfully deflected criticisms from unconvinced Islamic groups away from the state. Conclusion: Given their central role in the needle-syringe exchange programme, the NGOs are well positioned to convince injecting drug users to opt for voluntary medical treatment. This can potentially reduce both the harm from drug use and the prevalence of it. (C) 2011 Elsevier B.V. All rights reserved. This record was migrated from the OpenDepot repository service in June, 2017 before shutting down

The use of Rapid Assessment Methodology to Compliment Existing National Assessment/Surveillance System : A Study among Injecting Drug Users in Kepala Batas, Penang, Malaysia

The study aims to show how data from a rapid assessment study can compliment data produced by the existing National Drug Information (NADI) system. Qualitative data gathering techniques was used and the WHO guide for conduction rapid assessment among injecting drug users was used as a guide. We used and inductive research strategy using the principles of triangulation. Results from the rapid assessment showed us how specific information provided by the rapid assessment include information about the use of heroin with other substances, the context in which risky injecting practices are being practiced (sharing injecting paraphernalia but not needles), the reasons for increase in frequency of injecting, the price of drugs, the types of injecting networks, context of sexual behavior, information regarding the health and social consequences of drug use are needed to understand the problem of substance abuse more effectively. We suggest the current NADI system need to include more socio-behavioral and health related variables in its database in order to understand particularly the substance abuse HIV/AIDS relationshi

Changing Trends in the Use of Kratom (Mitragyna speciosa) in Southeast Asia

This is the pre-peer reviewed version of the following article: Darshan Singh, Suresh Narayanan, Balasingam Vicknasingam, Ornella Corazza, Rita Santacroce, and Andres Roman-Urrestarazu, ‘Changing trends in the use of kratom (Mitragyna speciosa) in Southeast Asia, Human Psychopharmacology: Clinical & Experimental, Vol. 32 (3), e2582, May 2017, which has been published in final form at https://doi.org/10.1002/hup.2582. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. Under embargo. Embargo end date: 24 May 2018. Copyright © 2017 John Wiley & Sons, Ltd.Objective: Kratom (Mitragyna speciosa. Korth) is an indigenous medicinal plant of Southeast Asia. This review paper aims to describe the trends of kratom use in Southeast Asia, particularly, in Malaysia and Thailand, where its use has been extensively studied by social scientists. Design: A literature review search was conducted through the internet. Nineteen articles illustrating kratom use in humans in Southeast Asia were reviewed. Results: The kratom has long been used by rural folk in Southeast Asia as a remedy for common ailments, to fight fatigue from hard manual work, as a drink during social interaction among men and in village religious functions. Studies based on self-reports suggest that prolonged kratom use does not result in serious health risks or impair socialfunctioning. Two recent trends have emerged: kratom is reportedly being used to ease withdrawal from opioid dependence in rural settings, while in urban areas, adulterated kratom cocktails are being consumed by younger people to induce euphoria. Meanwhile, kratom use is no longer classified under the Dangerous Drug Act in Thailand and attempts to classify it under the Dangerous Drug Act in Malaysia have not been successful. Conclusions: Legal sanctions appear to have preceded serious scientific investigations into the claimed benefits of ketum. More objective controlled trials and experiments on humans need to be conducted to validate self-report claims by kratom users in the community.Peer reviewe

HIV Risk Behaviours And Depression Among Female Drug Users (FDUs) In Malaysia

Background: Female drug users (FDUs) dependent on amphetamine-type-stimulants (ATS) are predisposed to risky HIV behaviours and psychological problems. Objectives: This study aims to determine HIV risk behaviours and prevalence of depression among FDUs in Malaysia. Method: A total of 202 FDUs currently undergoing rehabilitation at an institutional rehabilitation centre in Bachok, Kelantan were surveyed. Respondents self-administered the behavioural survey questionnaire, and the Malay version Beck Depression Scale (BDS). Results: Most of the FDUs were Malays (87%, n=176/202), with a mean age of 29.47 years-old. Sixty-two percent (n=125/202) were above 26 years-old, two-third (67%, n=136/202) married, more than half (56%, n=114/202) have nine years of education, while 62% held employments prior to their detention. Majority (54%, n=109/202) self-reported to have used amphetamine-type-stimulants (ATS), while 46% (n=93/202) reported opiate + ATS use. Two-third (67%, n=136/202) reported living with a drug using male partner prior to their detention, 58% (n=118/202) were involved in illegal drug distribution activities, and only 10% (n=20/202) work as sex-workers. Seventy-seven percent (n=156/202) of the FDUs have no knowledge about female condom use. Results showed those who used only ATS and those who used opiate and ATS, were more likely to have irregular sex partners (OR: 1.3: 0.72-2.40: p<.371); to have never used condom with irregular sex partners (OR: 1.1: 0.39-2.91: p<.888); and used drugs during sex (OR: 1.4: 0.67-2.75: p<.393). Opiate + ATS users were more likely to inject (OR: 2.7: 1.31-5.46: p<.005); lend their injecting equipment (OR: 2.9: 1.09-7.56: p<.028); ask help during injection (OR: 2.6: 1.18-5.73: p<.015); and experience drug overdose (OR: 3.2: 1.69-5.97: p<.001), compared to those using only ATS. Notably, 75% (n=151/202) of the FDUs were found to be depress. Conclusion: Female drug users in Malaysia are vulnerable to HIV infections. Our findings suggest that proper harm reduction interventions targeting FDUs are needed

Novel Psychoactive Substances 14Recent Progress on Neuropharmacological Mechanisms of Action for Selected Drugs

A feature of human culture is that we can learn to consume chemical compounds, derived from natural plants or synthetic fabrication, for their psychoactive effects. These drugs change the mental state and/or the behavioral performance of an individual and can be instrumentalized for various purposes. After the emergence of a novel psychoactive substance (NPS) and a period of experimental consumption, personal and medical benefits and harm potential of the NPS can be estimated on evidence base. This may lead to a legal classification of the NPS, which may range from limited medical use, controlled availability up to a complete ban of the drug form publically accepted use. With these measures, however, a drug does not disappear, but frequently continues to be used, which eventually allows an even better estimate of the drug 19s properties. Thus, only in rare cases, there is a final verdict that is no more questioned. Instead, the view on a drug can change from tolerable to harmful but may also involve the new establishment of a desired medical application to a previously harmful drug. Here, we provide a summary review on a number of NPS for which the neuropharmacological evaluation has made important progress in recent years. They include mitragynine ( 1CKratom 1D), synthetic cannabinoids (e.g., 1CSpice 1D), dimethyltryptamine and novel serotonergic hallucinogens, the cathinones mephedrone and methylone, ketamine and novel dissociative drugs, ;3-hydroxybutyrate, ;3-butyrolactone, and 1,4-butanediol. This review shows not only emerging harm potentials but also some potential medical applications

Bridging the data gaps in the epidemiology of hepatitis C virus infection in Malaysia using multi-parameter evidence synthesis

BACKGROUND: Collecting adequate information on key epidemiological indicators is a prerequisite to informing a public health response to reduce the impact of hepatitis C virus (HCV) infection in Malaysia. Our goal was to overcome the acute data shortage typical of low/middle income countries using statistical modelling to estimate the national HCV prevalence and the distribution over transmission pathways as of the end of 2009. METHODS: Multi-parameter evidence synthesis methods were applied to combine all available relevant data sources - both direct and indirect - that inform the epidemiological parameters of interest. RESULTS: An estimated 454,000 (95% credible interval [CrI]: 392,000 to 535,000) HCV antibody-positive individuals were living in Malaysia in 2009; this represents 2.5% (95% CrI: 2.2-3.0%) of the population aged 15-64 years. Among males of Malay ethnicity, for 77% (95% CrI: 69-85%) the route of probable transmission was active or a previous history of injecting drugs. The corresponding proportions were smaller for male Chinese and Indian/other ethnic groups (40% and 71%, respectively). The estimated prevalence in females of all ethnicities was 1% (95% CrI: 0.6 to 1.4%); 92% (95% CrI: 88 to 95%) of infections were attributable to non-drug injecting routes of transmission. CONCLUSIONS: The prevalent number of persons living with HCV infection in Malaysia is estimated to be very high. Low/middle income countries often lack a comprehensive evidence base; however, evidence synthesis methods can assist in filling the data gaps required for the development of effective policy to address the future public health and economic burden due to HCV. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12879-014-0564-6) contains supplementary material, which is available to authorized users

A comprehensive overview on Kratom

Kratom (Mitragyna speciosa Korth) is a tropical tree, indigenous to South East Asia. Historically, the plant is locally used as a stimulant, a remedy in traditional medicine and in social context. Imported to Western countries, Kratom is classified as a novel psychoactive substance (NPS). A systematic review of the literature on Mitragyna speciosa and its main constituents was carried by our international multidisciplinary group. Results were qualitatively analysed in three main areas of interest: in-vitro and preclinical data on pharmacology and behavioral effects, laboratoristic techniques for identification/characterization, epidemiological/toxicological reports on humans. At present, there is no systematic data on the prevalence of Kratom use in all the native countries, but it seems to be considerable. In South-East Asia, Kratom, even if banned, might be still considered a better option than other illicit drugs, an alternative opioid treatment, a “natural” remedy with no real social stigma attached to its consumption. In parallel, this ethno-drug seems to be popular in Western countries, largely unregulated, easily available on the Internet. Kratom pharmacology appears to be complex, with many alkaloids involved. The subjective effects in humans are very peculiar and seem to be dose-dependent, ranging from psycho-stimulant to sedative-narcotic. Available data on Kratom suggest caution: this psychoactive plant could exhibit a serious harmful potential. Kratom use seems to be associated with drug dependency, development of withdrawal symptoms, craving, serious adverse effects and life-threatening effects in a multidrug-intoxicating scenario. On the other hand, its anxyiolitic, antidepressant and analgesic properties deserve to be further studied

Projections of the current and future disease burden of hepatitis C virus infection in Malaysia

The prevalence of hepatitis C virus (HCV) infection in Malaysia has been estimated at 2.5% of the adult population. Our objective, satisfying one of the directives of the WHO Framework for Global Action on Viral Hepatitis, was to forecast the HCV disease burden in Malaysia using modelling methods.An age-structured multi-state Markov model was developed to simulate the natural history of HCV infection. We tested three historical incidence scenarios that would give rise to the estimated prevalence in 2009, and calculated the incidence of cirrhosis, end-stage liver disease, and death, and disability-adjusted life-years (DALYs) under each scenario, to the year 2039. In the baseline scenario, current antiviral treatment levels were extended from 2014 to the end of the simulation period. To estimate the disease burden averted under current sustained virological response rates and treatment levels, the baseline scenario was compared to a counterfactual scenario in which no past or future treatment is assumed.In the baseline scenario, the projected disease burden for the year 2039 is 94,900 DALYs/year (95% credible interval (CrI): 77,100 to 124,500), with 2,002 (95% CrI: 1340 to 3040) and 540 (95% CrI: 251 to 1,030) individuals predicted to develop decompensated cirrhosis and hepatocellular carcinoma, respectively, in that year. Although current treatment practice is estimated to avert a cumulative total of 2,200 deaths from DC or HCC, a cumulative total of 63,900 HCV-related deaths is projected by 2039.The HCV-related disease burden is already high and is forecast to rise steeply over the coming decades under current levels of antiviral treatment. Increased governmental resources to improve HCV screening and treatment rates and to reduce transmission are essential to address the high projected HCV disease burden in Malaysia