Australia's coronavirus pandemic has revealed a little-known addiction to an illegally imported herbal product allegedly sold under the counter in some Asian grocery stores.
COVID-19 lockdowns have resulted in supply shortages and price increases for Kamini balls, which derive their major constituent from the opium poppy.
At least 12 people who had developed a dependence on Kamini balls sought help for withdrawal symptoms from four south-east Queensland opioid treatment clinics in the 18 months between January 2020 and June 2021.
They complained to doctors of poor sleep, agitation, craving and inability to stop using the Indian herbal product.
Brisbane addiction medicine specialist Jeremy Hayllar said he believed the problem was likely to be "fairly widespread", with other cases reported in Perth, Sydney and in Queensland's north.
A study of the south-east Queensland cases, published in Drug and Alcohol Review, found the majority were men with a median age of 32, who had been using Kamini balls for between six months and eight years.
They were in stable relationships and all but one were working.
Eleven of them were migrants born in India.
Seven of the 12 patients had worked in the ride-sharing industry.
Although Kamini balls are an Ayurvedic medicine promoted to enhance sexual function, Dr Hayllar said patients had told him they had started using the herbal product after being advised it would give them "more energy to enable them to work longer hours".
"It's a real paradox because opioids tend to make you lazy and sleepy — they generally don't give you more energy," he said.
One patient had started using Kamini balls for dental pain.
TGA banned Kamini balls
Australia's medicines regulator, the Therapeutic Goods Administration (TGA), has banned the importation and supply of Kamini balls.
But patients have told addiction specialists the product was readily available and sold "under the counter" in Asian grocery stores and through online retailers.
Dr Hayllar, clinical director of Metro North's Mental Health Alcohol and Drug Service based in Brisbane's inner-city, has been working in addiction medicine for 20 years, but had never previously treated a patient addicted to Kamini balls before the coronavirus pandemic hit.
He said supply shortages of Kamini balls and corresponding price hikes during the pandemic had prompted users to seek help through public opioid treatment clinics.
Writing in Drug and Alcohol Review, Queensland doctors said patients had told them prices had increased from $110 for a bottle of 40 Kamini balls to $180 a bottle during the COVID-19 pandemic.
They said the patients were using between two and 30 Kamini balls a day, with a median use of 13 balls per day.
Dr Hayllar said all 12 patients had been successfully treated with medications to suppress opioid withdrawal symptoms and cravings.
"Treatment allows people to live healthy lives once more," he said.
