Is Kamini becoming an endemic within the migrant Indian community in Australia?

To the Editor

Multani Kamini Vidrawan Rasand and Ayurvedant Kamini Vidrawan Ras tablets, commonly known as ‘Kamini Tablets’, are opiate-based herbal medications imported from India. In Australia, they are routinely sold over the counter, in Asian grocery stores (Kainth and Singh, 2017). The Therapeutic Goods Administration (TGA) found Kamini tablets contained substances only available by prescription and the supply of these tablets is illegal in Australia (TGA Kamini Warning, 2016). Furthermore, these tablets have not been assessed for quality, safety or efficacy. Testing on Kamini tablets revealed they contained codeine, morphine and papaverine. The estimated proportion of opium in a typical tablet is approximately 2–20 mg per tablet (Singh and Kainth, 2017).

To the best of our knowledge, this is the first case report discussing Kamini dependence published in Australia.

JB is a 35-year-old male who presented to Alcohol and Other Drugs Services (AODS) for opioid dependence due to the use of Kamini tablets. JB was born in India, immigrated to Australia in 2008. In 2010, he commenced using Kamini to relieve hay fever symptoms. He reported the tablets alleviated the symptoms and increased alertness. However, during the initial assessment, clinician noted him to be drowsy. JB initially used one tablet/week, which rapidly escalated to 25–30 tablets/day (one bottle), which cost $70–100. According to JB, he was using one bottle/week and the amount escalated with the change to a new brand to experience the same effect. JB denied use of other illicit substances, alcohol or prescription medications. JB was commenced on buprenorphine and naloxone combination and stabilised on 32 mg/day. Later, JB’s brother was also treated with buprenorphine and naloxone due to Kamini dependence. According to JB, many of the local Indian community in Australia are abusing Kamini.

To combat this, Australian Border Force (ABF) issued a statement stating, ‘the Customs (Prohibited Imports) Regulation 1956 prohibits the importation of medications which contain Opium and the ABF will seize the goods’ (Singh and Kainth, 2017). Hence, any detected importations of Kamini will be abruptly intervened upon. The Victorian Health Department, aware of the risks, issued a warning to local Governments regarding its implications. In addition, the TGA released a warning against Kamini consumption, stating ‘Kamini tablets pose a serious risk to health and should not be taken’ (TGA Kamini Warning, 2016).

Further action should revolve around media-driven public education, informing the community about the contents of Kamini and the strong link to dependence and overdose. Hopefully, such action will act as a catalyst towards the discontinuation of Kamini and reduction of further potential harm like opioid dependence, accidental overdose and death.