Susanna Galea

Regulating new psychoactive drugs: innovation leading to compromise

Owing to the increasing availability of new, and legal, psychoactive drugs (NPDs),1 the New Zealand government enacted ground breaking legislation in May 2013; the Psychoactive Substance Act requires evidence of low risk before NPDs can be legally sold.2 3 A transitional period was created until safety testing regimes were finalised. Public outrage, however, grew as adverse effects of “interim approved” drugs …

The Effect of Varenicline Administration on Cannabis and Tobacco Use in Cannabis and Nicotine Dependent Individuals ? A Case-Series

Introduction: Cannabis users may also use tobacco products which increases the potential for drug-induced harm over and above that caused by one substance on its own. Therefore, a pharmacotherapy that treats dependence on both substances would be beneficial. Tetrahydrocannabinol and varenicline act at the α7 subtype of the nicotinic receptor and so it was hypothesised that varenicline may also effect cannabis use. Methods: Five nicotine and cannabis dependent individuals (median age 37), who were attending a community alcohol and drug service, and who expressed a desire to quit tobacco smoking, were prescribed 12 weeks of varenicline and were followed up weekly for the first month, then fortnightly for as long as possible over this time. Results: Four of the five cases reported reducing their use of both substances after commencing varenicline, and also of experiencing less enjoyment from using these substances. The remaining case withdrew early in the study due to a migraine. No participant reported taking varenicline for more than 6 weeks, and only one could be followed up for 12 weeks. The reasons reported by participants for ceasing varenicline included feeling flat, experiencing nausea and vomiting, feeling angry and being short tempered, and as a result of a variety of family stressors. Conclusion: The administration of varenicline to cannabis users was associated with reductions in the enjoyment reported from using cannabis, and the amount of cannabis used. These results support further investigation of varenicline’s potential as a therapeutic intervention to treat dependence on nicotine and cannabis.

Ibogaine for treating drug dependence. What is a safe dose

The indole alkaloid ibogaine, present in the root bark of the West African rain forest shrub Tabernanthe iboga, has been adopted in the West as a treatment for drug dependence. Treatment of patients requires large doses of the alkaloid to cause hallucinations, an alleged integral part of the patients treatment regime. However, case reports and case series continue to describe evidences of ataxia, gastrointestinal distress, ventricular arrhythmias and sudden and unexplained deaths of patients undergoing treatment for drug dependence. High doses of ibogaine act on several classes of neurological receptors and transporters to achieve pharmacological responses associated with drug aversion; limited toxicology research suggests that intraperitoneal doses used to successfully treat rodents, for example, have also been shown to cause neuronal injury (purkinje cells) in the rat cerebellum. Limited research suggests lethality in rodents by the oral route can be achieved at approximately 263mg/kg body weight. To consider an appropriate and safe initial dose for humans, necessary safety factors need to be applied to the animal data; these would include factors such as intra- and inter-species variability and for susceptible people in a population (such as drug users). A calculated initial dose to treat patients could be approximated at 0.87mg/kg body weight, substantially lower than those presently being administered to treat drug users. Morbidities and mortalities will continue to occur unless practitioners reconsider doses being administered to their susceptible patients.

Smoking Cessation in a Community Alcohol and Drug Service: Acceptability and Feasibility

Objectives: This study was undertaken to determine if delivering smoking cessation (SC) treatment within a Community Alcohol and Drug Service (CADS) is feasible and/or effective. Materials and Methods: Clinicians (n=16) from a single CADS received SC training, then implemented that training with clients who smoked tobacco. Participating clients (n=16) received a box containing 5 different nicotine replacement therapies (NRT) to try out in any combination over 1 week. Clients were then encouraged to choose 1 or 2 NRT products to use for an additional 4 weeks. Data collection from both clinicians and CADS clients occurred at baseline, 1 week, 2 to 4 weeks, and 5 weeks. Results: Clinicians: Many clinicians regarded the training positively and felt confident in providing SC treatment to their clients. At the end of the study, 88% felt that SC treatment should become part of routine clinical practice. Clients: At 5 weeks, 2 clients had achieved verified continuous abstinence, and 6 clients (50%) had reduced the number of cigarettes smoked per day. Most clients preferred to use combination NRT therapy. Conclusions: Providing SC support to smokers within a substance abuse treatment service in New Zealand is feasible and effective in motivating clients to make a quit attempt or at least reduce their cigarette consumption.