Hab-o Shefa, a Persian Medicine Compound for Maintenance Treatment of Opioid Dependence: Randomized Placebo-Controlled Clinical Trial

Natural products as the therapeutic strategies for addiction

World Drug Report 2023 concluded that 296 million people abused drugs, 39.5 million became addiction and 494,000 died as a direct or indirect result of addiction. Addiction has become a growing problem that affects individuals, their families, societies, countries and even the world. However, treatment for addiction is only limited to some developed countries because of the high cost, difficult implementation, and time consuming. Therefore, there is an urgent need to develop a low-cost, effective drug for the development of addiction treatment in more countries, which is essential for the stability and sustainable development of the world. In this review, it provided an overview of the abuse of common addictive drugs, related disorders, and current therapeutic regimen worldwide, and summarized the mechanisms of drug addiction as reward circuits, neuroadaptation and plasticity, cognitive decision-making, genetics, and environment. According to their chemical structure, 43 natural products and 5 herbal combinations with potential to treat addiction were classified, and their sources, pharmacological effects and clinical trials were introduced. It was also found that mitragine, ibogine, L-tetrahydropalmatine and crocin had greater potential for anti-addiction.

Herbal therapy in opioid withdrawal syndrome: A systematic review of randomized clinical trials

Background

Medicinal plants have revealed much attention as an alternative or complementary treatment for opioid withdrawal syndrome. The current review collects all available literature to verify the efficiency of herbal remedies in the management of symptoms associated with opioid withdrawal.

Methods

A systematic literature search was conducted from January 1990 to May 2021 on four bibliographic databases (Scopus, PubMed, Embase, and Web of Science) using the search terms "medicinal plant", "withdrawal syndrome", "opioid", and all their equivalents. All randomized controlled trials (RCTs), published in the English language were included for data synthesis. The search was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA). The Cochrane risk of bias tool was used to verify the quality of the included clinical trials.

Findings

A total of 12 RCTs were collected and used for data synthesis. The results of these studies indicated that herbal medicines were effective in treating opioid withdrawal syndrome and could alleviate the withdrawal symptoms, such as abdominal constrictions, diarrhea, bone pain, perspiration, and insomnia, when compared to conventional medications such as buprenorphine, clonidine, and methadone. However, more than 30% of RCTs were found to be at high risk of bias in the areas of selection, performance, detection, attrition, and reporting.

Conclusion

Although several RCTs have proven that herbal remedies are effective in reducing opioid withdrawal symptoms, the findings need to be viewed more carefully. Further RCTs with more participants, longer duration, and less risk of bias are needed in the claimed cases.

Preliminary results of effect of barley (<em>Hordeum vulgare L.</em>) extract on liver, pancreas, kidneys and cardiac tissues in streptozotocin induced diabetic rats

Diabetes mellitus (DM) and its complications impose a significant burden on patients and the health care system. In the Traditional Persian Medicine (TPM), barley is recommended for treatment of DM. This study sought to assess the effect of barley seed aqueous extract on hepatic, pancreatic, renal and cardiac tissues in normal (non-diabetic) and Streptozotocin-induced diabetic rats. Twenty-one male Wistar rats were randomly divided into diabetic and non-diabetic groups. Diabetes was induced by single intraperitoneal injection of Streptozotocin. After one week, the diabetic and non-diabetic groups were randomly divided into control and barley seed extract subgroups namely N group (non-diabetic control rats), S group (seed extract treated non-diabetic rats), D group (diabetic control rats) and DS group (seed extract treated diabetic rats). After 6 weeks, all rats were sacrificed for histopathological analysis and specimens were stained routinely for histological studies. The abnormal histological signs significantly decreased in the DS group compared to D group. Also, protective effects of barley seed extract against histopathological changes were seen in S group compared to N group.These findings suggest that barley seed extract exerts a protective effect on different tissues in diabetes.