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ARV meds for recreational drug use

An HIV-positive Filipino wants to know more about the practice of using Efavirenz as recreational drug, and Dr. Jose Narciso Melchor Sescon provides needed information on this.

Dr. Jose Narciso Melchor Sescon – president of the AIDS Society of the Philippines and current Chief of Clinics of Sta. Ana Hospital – answers all your HIV-related inquiries. For all your questions, email or

Dear Doc,

I am HIV-positive, and one of my meds is Efavirenz. My friends use double dosage of Efavirenz for recreational purposes. They said it can be alternative to other drugs when doing PNP (partee n play). What’s the consequence of doing this?

Mr. PNP curious

Efavirenz (EFV, brand names Sustiva, Stocrin, Efavir, et cetera) is an antiretroviral medication under the classification of a non-nucleoside reverse transcriptase inhibitor (NNRTI) and is used in combination therapy with other highly active antiretroviral drugs for the treatment of a human immunodeficiency virus (HIV) type 1.

In the Philippines, we have 2010 DOH Administrative guidelines on the use of ARV for HIV in adults in the country as reference guide for the clinicians and program managers. Unlike current recommendations from WHO and/or CDC, these guidelines are customized to respond to resource limited settings.

Efavirenz is also used in combination with other ARVs as part of an expanded post-exposure prophylaxis regimen to reduce the risk of HIV infection in people exposed to a significant risk (e.g. needlestick injuries, certain types of unprotected sex, et cetera). The usual adult dose is 600 mg once a day and is usually taken on an empty stomach at bedtime to reduce neurological and psychiatric adverse effects. A dose of 800 mg is given for those on anti-TB medication, such as rifampicin, to increase efficacy.

If your friends double the dose of EFV, this would intensify the neurologic and/or psychiatric side effects, such as hallucinations and delusions – in simple terms, the feeling of being “high”, and this could mimic the same effects of using recreational drugs (e.g. marijuana and methamphetamine). The reason for this is that it has the same target receptor as that of LSD, thus giving that feeling of being “high”.

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There have already been reports from such places as South Africa on the abuse of EFV by crushing and smoking the tablets for supposed hallucinogenic and dissociative effects.  However, we have yet to receive local reports on this.

The bottomline is, take ARV medications according to doctor’s prescriptions, so that the side effects are noted and can be managed by clinicians when they occur. Otherwise, this could be a ground for ARV resistances or treatment failures in the future, apart from damaging the liver and kidneys. One has to be aware and choose wisely: would you rather have that fleeting flying “high” moments, or a long term permanent damage to your organs?


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