A drug mystery in South Africa

The BBC and other sources have reported that some South Africans have taken to stealing an antiretroviral HIV medication, and using it as a street drug. That may or may not be true. But the drug in question, efavirenz, is known for producing temporary side-effects that can include altered dreams and mild hallucinations. And that's really weird, writes scientist-blogger Neuroskeptic, because, so far, nobody understands the chemical mechanism that could connect efavirenz to those sort of symptoms—either in legitimate users, or illegal ones.

Maggie Koerth-Baker is the science editor at BoingBoing.net. She writes a monthly column for The New York Times Magazine and is the author of Before the Lights Go Out, a book about electricity, infrastructure, and the future of energy. You can find Maggie on Twitter and Facebook.

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Chevan

It’s worth noting that someone brought up in the comments for the linked article, and the article was edited to reflect this, that the drug in question might be mostly heroin with the antiretroviral drug used to bulk it up.

Which really doesn’t change much, because regardless of whether or not the HIV drugs are causing the hallucinogenic effects, they’re still not being taken by the people who need them.
- Maggie Koerth-Baker
  
  That’s why the above post says “That may or may not be true.”
  - Chevan
    
    Ah, I see. I apologize; I misinterpreted the post on my first reading. I thought the “may or may not be true” referred to the drugs being stolen and used in street drugs – that it expressed uncertainty about whether the thefts were happening at all.
mgatch

This is actually old news. Yes, efavirenz is really psychoactive. A group of labs at my institution has been systematically looking at the brain & behavioral mechanisms of efavirenz for more than a year. The lead investigator is sitting on the punch line until publication, but yes, we do know a good part of the chemical mechanism for the psychoactive effects of efavirenz.

And this is a problem, since the people who need these drugs aren’t getting them in the right doses–contributing not only to further spread of the disease, but contributing to the development of resistance to efavirenz (and likely to it’s whole chemical family).

PS not connexins, though that is an interesting avenue to pursue. Thanks!
yrogerg

*Is* it terribly weird or uncommon not to know the method of action by which this drug causes psychogenic side-effects, though? This sort of thing crops up now and again; for example, we still don’t know the biological method of action behind most general anasthetics, if I recall correctly, despite the fact that we’ve been using general anasthesia for nearly 170 years now.
Rayonic

Don’t they have any “normal” illicit drugs in South Africa? Surely there are others that are cheaper/better (though preferably without needles). I guess stealing is free, so it’s hard to beat that.

On a related note, Australia has/had an issue with people sniffing gasoline fumes. But at least that’s less valuable stuff.
Lobster

Why do they need antiretrovirals? They have powdered tiger lung and the fingers of albino children.
- Anonymous
  
  Lions, we have lions in SA, not Tigers, that’s India.
  - Anonymous
    
    Nope. Tigers are from Kenya. They have Lions and Tigers.
    
    On a separate note, the reason why these might be used as drugs instead of “normal illicit drugs” is because they are provided free (once you get through the bureaucracy). Thus the low street value (R20 = +/- $3) while dagga (pot) would probably cost you about R40-200 depending on how much origanum you like in your pot.
    - Antinous / Moderator
      
      Nope. Tigers are from Kenya. They have Lions and Tigers.
      
      In fact, only in Kenya, they’ve got the tigers.
YarbroughFair

So strange! A group of my friends and I got into a passionate gripe session about this; We all felt extremely disgusted that people were using the drugs we needed to survive for recreational use. These side effects were terrible for most of us and one friend lives a life in severe pain and his home has had attempted break in’s. He was shocked to hear his pills were worth up to $20.00 each. Why? why would anybody want to take this shit for fun?

I haven taken two drugs in the past that resulted in severe side effect causing me to be hospitalized: Sustiva(Efavirenz) and Ambien which are used recreationally.

Sustiva: Severe vertigo, falling down stairs, holding on to the bed for dear life because it was spinning and flipping over like a pancake. Horrible violent gory nightmares of death and destruction and the end of the world. Vomiting. Mouth so dry I needed to shove 1 teaspoon of Vaseline into my craw to get it working again. Hospitalized for falling and splitting my head open.

Ambien: Hospitalized five times. Running down the street in my underwear at 2am. Walking dead, still asleep and having nightmares seeing people slaughtered in the middle of the street, burning building I would run into to save people, people randomly being murdered, driving the truck and suddenly it would start flying. Amnesia, I lost three years of college education. Groups of migrant workers huddled underneath every tree. And worst, every shadow or puddle on the ground was a chasm to hell, ready for me to fall in, traps lay everywhere. I made a fool out of myself as people watched me grab on to them to stop from falling in. And the drug companies loved me, my doctor just diagnosed me as paranoid schizophrenic and gave me more medications for this “new” mental disorder. We have not heard the last about Ambien.
Snig

It’s not weird or mysterious that we don’t know the mechanism of how it’s hallucinogenic. What’s weird and mysterious is consciousness. We have only a tenuos grasp at best on how that works. Plent of meds where the mechansim of action is unknown.
Praline

I’d be willing to wager a nickel that the solution to this drug mystery involves connexins.

They have been mooted as the neurological mechanism of action for the side-effects of mefloquine (Larium), the anti-malarial that was implicated in the horrific uxoricide/suicides at Fort Bragg about ten years ago. Both drugs occasionally have the same surprising–and utterly undesirable–CNS effects, including freaky dreams and hallucinations. The chemical structures are pretty close, too. (Well, at least as close as benzos, which is the blogger neuroskeptic’s tentative suggestion.)