|Ahead of print publication
Methamphetamine abuse in the form of yaba pills
Soumi Ghosh, Disha Mukherjee, Arijit Mondal
Department of Psychiatry, Institute of Psychiatry – A Centre of Excellence, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
|Date of Submission||26-Nov-2021|
|Date of Decision||07-Jan-2022|
|Date of Acceptance||06-Feb-2022|
|Date of Web Publication||15-Mar-2022|
Room No. 450, SSKM Doctors Hostel, 242 Harish Mukherjee Road, Bhowanipore Kolkata - 700 020, West Bengal
Source of Support: None, Conflict of Interest: None
YABA, also known as “Nazi speed” is a relatively newer stimulant drug with abusive potential that contains methamphetamine and caffeine in various proportions and mostly available in Bangladesh and its subcontinent and relatively rare in Indian states. Here, we report a case of a 30-year-old male with history of Yaba abuse for the past 4 years currently complaining of withdrawal symptoms palpitation, dry mouth, irritability, and mood symptoms that managed symptomatically and with topiramate tablets to prevent future relapse.
Keywords: Caffeine, methamphetamine, Nazi speed, topiramate, YABA
| Introduction|| |
Stimulants are drugs that increase the level of dopamine in the brain causing a sense of euphoria and increase alertness. These drugs include amphetamine, methylphenidate, caffeine, nicotine, and others. However, they are potential agents for abuse and although they have been used widely in the past for various purposes, currently the majority of them are made illegal and their use also has been restricted. Among them, methamphetamine is a popular drug used for recreational purpose in various parts of the world in different forms such as powdered form, crystalline form, or it is also mixed often with other stimulants such as caffeine, ketamine, and sold illegally.
YABA, also popularly known as “Nazi speed” or “the madness drug” is a synthetic illicit drug of abuse in many parts of the world mainly in Thailand, Myanmar, Sri Lanka, and Bangladesh. The two major stimulants present in this drug are methamphetamine and caffeine, although occasionally it contains heroine in different proportions. The drug Yaba first manufactured in Myanmar in the early 20th century and then got popular in Thailand and Northeast Asian countries. It is commonly available in a tablet form that is red with artificial flavors added to it and the most common method of using Yaba is oral form, although it is often used in inhalational route by crushing the tablet then using it in a similar method of chasing heroine that is inhaling the fume by putting it in a foil and heating it from below.
Yaba is more dangerous than other stimulants because the major proportion of stimulant amphetamine in it remains unchanged in the body which causes its extended duration of action and more adverse effect to the body, it exerts its actions through stimulation of the brain and central nervous system that begins in as early as in 5 min and last for 8–12 h. Each tablet contains approximately 25–30 mg of amphetamine and 45–65 mg of caffeine, with a logo such as “WY” or “R” imprinted on it, generally methamphetamine constitutes approximately 20% of Yaba but a crystalline form of it known as “ice” is also available made entirely with methamphetamine.
Incidence of abuse of methamphetamine in the form of Yaba is found mainly in countries such as Bangladesh, Sri Lanka, and other Northeast countries and it is quite rare in India., Here, we are reporting a case of a 28-year-old male with history of Yaba tablets abuse for 8 years and comorbid multiple substance abuse currently in withdrawal, who was treated symptomatically and then prescribed with topiramate oral tablet to prevent future relapse.
| Case Report|| |
A 30-year-old unmarried, male from lower-middle socioeconomic background in Malda district of West Bengal attended our psychiatry outdoor with complaints of anger outburst on mild provocation, verbally abusive behavior toward family members, palpitation, dry mouth, rhinorrhea, easy fatigability, and increased sleep and appetite, for the past 6 days that was acute onset and gradually deteriorating in nature. According to his informant who has his brother, he had a history of intake of Yaba tablets since last 4 years on everyday basis and also multiple comorbid substance abuse in the past.
According to the patient, he is taking Yaba tablets for the past 4 years, he began using under the influence of his friends, who used to procure it from a local dealer who has been smuggling it from Bangladesh for the past 2–3 years. He first started with one Yaba pill orally every day, following which he experienced a sudden “kick” within minutes, felt very good and energetic, the surroundings started to seem brighter and everything appeared cheerful, all of which lasted for 12 h. Since then he increased the frequency of using the pills, about 3–4 times a week, each tablet would cost him 20/-and gradually in a span of 1 year he increased his intake to 4–5 tablets on everyday basis to get the same intensity of effect. He also smoked it sometimes by putting the tablet on an aluminum foil and heating it from below. On days when he did not take Yaba, he used to feel very restless, agitated, his mouth used to became dry, and he felt a strong desire to take the drug. According to his informant, he also became violent toward family members, broke household things, if they stopped him from taking it.
He also had history of intake of heroin in the past but he stopped taking it 1 year ago due to financial problems and family conflict and also he felt Yaba gives him similar effect at a cheaper price so he shifted to Yaba completely. Currently, he was taking 5–6 tablets of Yaba per day which he stopped 7 days ago.
He involves in frequent fight with family members, and a majority of his income goes into buying the drug, and he got into a significant amount of debt from his friends and on top of that he lost his job few days ago, all this made him to decide to quit his addiction and he himself decided to stop taking it since past 7 days but unable to bear the withdrawal symptoms which made him to attend the hospital.
On examination, the patient was conscious, alert, cooperative, and oriented to time, place, and person. Physical examination revealed tremors of outstretched hands.
On mental status examination, his mood appeared to be low with an irritable affect, psychomotor activity was increased, but no disorder of thought and perception was noted, his level of motivation appeared to be in a preparation phase with locus of control being internal. All blood investigations, serology and ECG were within normal limit.
After thorough history taking and mental and physical status examination, a diagnosis of stimulant dependence was made which was currently in withdrawal state. Symptomatic management was given with tablet paracetamol 650 mg BD for 5 days, tablet quetiapine 50 mg at bedtime for 5 days and tablet cetrizine5 mg 1tablet at bedtime for 5 days to manage the withdrawal symptoms and after 5 days he was given tablet topiramate 25 mg/day which gradually increased up to tablet topiramate 200 mg/day over 4 weeks. The patient responded well and his craving was reduced within 1 month. The dose of topiramate was tapered gradually. The patient was also referred to the clinical psychology department for motivational enhancement therapy.
| Discussion|| |
Methamphetamine, the main component of Yaba is a neurostimulant with high addictive potential. It became illegal in 1970 and since then it has emerged as an illicit “street drug” and its popularity is increasing rapidly. It is available in various forms such as powdered meth, meth ice, or meth crystal and also combined with other stimulants and sold as tablets such as Yaba.
The clinical precursor of methamphetamine is phenylacetone (P2P), ephedrine, and pseudoephedrine and it causes rapid stimulation of the central nervous system characterized by a “rush” of euphoria, increased vigilance and energy, and intense emotional alterations. Structurally, it has similarity with dopamine and norepinephrine and causes increase of these neurotransmitters level at synaptic cleft by various mechanism which includes inhibition of dopamine transmitter functions, causing decreased dopamine uptake, monoamine oxidase inhibition, and facilitation of tyrosine hydroxylase activity. Due to blockade of reuptake, it depletes the availability of neurotransmitter at the synaptic cleft which causes rapid tolerance and withdrawal symptoms. Initially, it causes increased energy, euphoria, decreased need for sleep but long-term use can lead to neurotoxicity and nervous system degeneration, cognitive impairment, and increases the risk of psychosis and paranoia. Chronic use of methamphetamine also associated with kidney problems, increased risk of cardiac and lung disorder, unexplained choreiform movement of the body, compulsive skin picking, and compulsive high-risk sexual behaviors.
Withdrawal symptoms can be acute and chronic, acute withdrawal occurs within 1 week and is characterized by strong craving, mood disturbances, agitation, increased sleepiness, paranoia and even hallucination, suicidal ideation, and severe depression.
There are several drugs used in the treatment of methamphetamine dependence such as dopamine agonists which include modafinil, bupropion, which acts by restoration of depleted dopamine at the neural cleft thus prevents withdrawal.
In our case, our patient had responded with tablet topiramate which acts by facilitating GABAergic action and reduces glutaminergic neurotransmission at AMPA/Kainate receptors. Both these actions cause inhibition of brain reward activity cause by stimulant drug.
According to the national drug use survey 2019, 0.18% of Indian abuse methamphetamine and it is seen in the states of Haryana, Uttar Pradesh, and Punjab. Still it is rare in India and very few cases are found in Indian literature.
It is believed that its growing popularity in countries such as Bangladesh, Sri Lanka, and Myanmar which are neighboring countries to India, Yaba is slowly founding its way to states of India and if appropriate measures are not taken in future it will become a serious problem for India. With this case report, we wish to increase awareness among medical professionals regarding the illicit use of novel drugs such as Yaba in our country.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guarantee.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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