Drug interaction s in the constituents of street drug mixture“Nyaope”in South Africa: a mini-review

Abstract

Nyaope is a unique South African street drug mixture thought to contain illicit drugs and other compounds and is usually inhaled after wrapping in the Cannabis leaf. Despite its illegalization in March 2014, abuse of Nyaope is on the increase. While highly addictive, withdrawal symptoms are very severe, unbearable and drive the user to desperately seek for the next fix. Due to the lack of knowledge in its composition and how the constituents interact with each other, treatment for withdrawal symptoms and rehabilitation has been a challenge. A mini-literature review was done to explore how the major constituents of Nyaope relate to each other in their actions and in their path of breaking down (metabolism). The literature suggests that the inside opiate group, in between opiates and benzodiazepines, in between opiates and cannabis group, in between benzodiazepines and phenobarbitals, and also amongst the minor constituents, there are extensively shared the metabolic pathways which lead to longer plasma half-life in each of these drugs and thus synergistic effects. These shared pathways are via the cytochrome P450 family of enzymes in the liver cell cytoplasm and these enzyme actions are to inactivate or detoxify the drugs or convert them to more water soluble compounds in order to excrete them through the kidneys. Not only sharing the metabolic pathways, but also the actions of these drugs at certain receptors in the brain have either opposing or stimulating effects on one another, making the complex nature of their combined actions. Such findings can explain the unique withdrawal symptom complex of Nyaope, which is important for the clinicians and public health workers who are dealing with the users. Understanding the biochemical  and metabolic basis of Nyaope drug interactions provides valuable insight towards the development of withdrawal signs and symptoms which may contribute to the targeted treatment program. Keywords: Nyaope, drugs of abuse, withdrawal symptoms, drug synergy, metabolism