Case series on treatment of dependence to Kamini Vidrawan Ras with opioid substitution therapy

Abstract

Introduction: A cohort of clients was recognised attending an addiction medicine clinic with similar presentations of opioid dependence from use of a rarely known Ayurvedic medication in a specific ethnic community. This retrospective case series was completed to promote wider recognition and further understanding of dependence on Kamini Vidrawan Ras (Kamini). Methods: A retrospective file audit of the electronic medical record for clients of an addiction medicine outpatient clinic with a history of dependent use of Kamini identified 12 clients meeting inclusion criteria. Results: All 12 clients were male, aged 27-41 years, all but one of north Indian origin, predominantly employed and predominantly (but not exclusively) without significant other substance use history. All 12 clients were treated with opioid substitution therapy.Discussion and Conclusions: This case series highlights an opioid dependence syndrome resulting from use of an Ayurvedic medicine by men from a specific area of India, highlighting a potential adverse effect of traditional medicines in ongoing use by migrant and ethnic populations that have emigrated to Australia.

Substance use concerns among Punjabi‐Indian communities in Australia: Kamini and alcohol

“…The Kamini tablets containing opiates were noted as the main drug of concern being supplied by these stores. These findings concur with the cases identified by previous studies done in Australia [1,9] as well as an investigation by Punjabi community radio in Australia that found Kamini tablets to be readily available as herbal products [10].…”

“…Perhaps surprisingly, alcohol was also noted to be on the rise among women within this community. Alcohol consumption together with Kamini consumption was noted as a concurrent factor by Naren et al [1] and Khan et al [9] in their study in south-east Queensland.…”

“…The findings from the recent case series by Naren and colleagues [1] on the use of Kamini Vidrawan Ras (also known as Kamini) by people attending their outpatient clinic are compelling. There is little research on alcohol and other drug use in Australia's migrant communities and the studies completed show rates to be lower than the general population [1].…”

“…The findings from the recent case series by Naren and colleagues [1] on the use of Kamini Vidrawan Ras (also known as Kamini) by people attending their outpatient clinic are compelling. There is little research on alcohol and other drug use in Australia's migrant communities and the studies completed show rates to be lower than the general population [1]. This phenomenon has been called the 'immigrant paradox', where migrant status appears to be protective against alcohol and other drug use despite migrants being exposed to conditions that are traditionally considered risk-factors for use [2,3].…”

The emerging issue of Kamini: A new source of opioid dependence

“…Two recently published unrelated case series have highlighted the issue of increasing presentations for opioid use disorder following use of Kamini, especially in patients from Southeast Asian communities. The first case series by Khan et al [1] described 12 cases identified through addiction clinics in South East Queensland, quickly followed by a second series by Naren et al of 12 patients in Melbourne [1,2]. Almost all the cases reported in both series were males from India.…”