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How safe are herbal medicines for travellers?

Researchers at the University of Adelaide School of Medicine in Australia recently published an article highlighting the possible dangers that herbal medicine poses to travellers.

Within the last few years, herbal medicine has become increasingly accepted as part of healthcare globally. These products have become popular in Western countries such as the United Kingdom, the United States, Canada, and Australia. An audit conducted in Australia looking at the complementary medicine industry showed that it has made a $4.7billion profit as a result of this broadening interest in herbal medicines.

Travellers often purchase herbal products in Asian countries

Western travellers now frequently visit herbal centres in Asian countries with the aim to receive a free health check and to buy various herbal products. The issue surrounding this form of tourism is that there is a misconception that it is “based upon learning about and consuming traditional medicinal herbs” and that “it treats patients without using harmful chemicals or drugs”.

However, the ingredients of these products are unpredictable and can be adulterated with various substances that can interact with prescription medications. These potential risks and negative impacts of herbal medicines are not generally perceived as medicolegal cases.

In light of these issues, researchers at the University of Adelaide School of Medicine in Australia investigated the forensic issues that have risen from herbal medicine. Problems seen with these herbal medicines included adulteration with drugs and toxic heavy metals above the legal limit. They published their results in the Journal of Forensic and Legal Medicine.

Certain herbal medicine was undeclared or banned

Certain herbal antidiabetic medicines were found to contain undeclared registered or banned oral antidiabetic agents such as glibenclamide, phenformin, metformin, rosiglitazone, gliclazide, glimepiride, nateglinide, and repaglinide.

Even more recent, and of major forensic significance, these researchers looked at a study of 61 patients in Hong Kong who ingested traditional Chinese medicines that had been adulterated with steroids. Seven patients had to be admitted to a hospital, two patients died within 30 days of presentation and 38 had serious complications. Lastly, another study showed 404 cases referred for analysis to a tertiary referral toxicology laboratory in Hong Kong that demonstrated the presence of 1234 adulterants including approved drugs, banned drugs, drug analogues and animal thyroid tissue.

Potential for more harm than good

The researchers argue that these published studies and reported analysis clearly show that Western travellers heading to Asia, in search of health and wellness through herbal medicines, may actually cause more harm than good as these products have the potential to contain extremely harmful substances or drugs which can contribute to, or cause—in the most extreme scenario—death.

The researchers at the University of Adelaide thus highlight that the severity of these potential outcomes means that they should be considered in all medicolegal cases involving recent overseas travel, especially to Asian destinations, and these products should be checked for at the time of post-mortems.

Written by Jade Marie Evans, MPharm, Medical Writer

Reference: Farrington , R. 2018. Potential forensic issues in overseas travellers exposed to local herbal products. Journal of Forensic and Legal Medicine.60, pp. 1-2.

Jade Evans MPharm
Jade Evans MPharm
Jade obtained her Master of Pharmacy degree from Cardiff University, UK in 2015 and then went on to work as a Pharmacist within the NHS, across both the hospital and community sectors. In 2017, she began her work for the medical news bulletin and moved to Perth, Australia. She is now working at Perth Children’s Hospital working in the Anaesthetic and Pain Management Research Group.
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