3lec Cannabis 3

Deliriants—
Cannabis
Deliriants—Cannabis
• Introduction: Cannabis sativa (marijuana/marihuana/ hashish), a
deliriant cerebral neurotic hemp plant which has several varieties:
Cannabis indica (India), Cannabis mexicana (Mexico) and Cannabis
americana (US). It is the most commonly abused illegal substance in
Pakistan and the US, particularly among adolescents, and the most
commonly abused substance in the world after nicotine, alcohol and
caffeine.
• Distribution: Grows in specific areas in pakistan. Whole plant is
poisonous.
• Active Principle
• It is not an alkaloid, but a fat-soluble cannabinol, the active form
being tetrahydrocannabinol (THC). It also contains benzopyrene, a
known carcinogen which is also found in tobacco.
• Preparations of Cannabis:
-Bhang
-Hashish
-Charas
-Marijuana
• THC is also available in synthetic forms (dronabinol and nabilone)
which are used as an appetite stimulant for AIDS-related anorexia and
as treatment for vomiting associated with cancer chemotherapy.
• Routes of intake: Cannabis is usually smoked in cigarettes or pipes,
added to food (usually cookies, brownies or sweetmeat) or mixed
with milk (bhang).
• Drug combinations: Cannabis is frequently combined with other
drugs, including heroin, cocaine.
Action
• THC which binds to anandamide receptors in the brain may have
stimulant, sedative or hallucinogenic actions, depending on the dose
and time after consumption.
• Both catecholamine release (resulting in tachycardia) and inhibition of
sympathetic reflexes (resulting in orthostatic hypotension) may be
seen.
Signs and Symptoms
• Onset of symptoms occurs within a few minutes of smoking and within
half hour of oral ingestion. The duration of action is usually 6–12 hours
(h); symptoms are most marked in the first 1–2 h.
• I. Stage of Excitement
i. Feeling of euphoria, detachment, well-being/grandiosity, dreaminess,
subjective sense of slowing of the passage of time, increased self-
confidence, rapidly changing emotions, talkativeness and laughing.
• ii. Impairment of thinking and short-term memory, decreased
concentration, disorientation, illusions, visual hallucinations, altered
sexual feelings, impaired judgment, and perceptual and psychomotor
dysfunctions resulting in impaired driving and motor vehicle accidents.
• iii. Increased appetite (the ‘munchies’) and thirst, nausea, headache,
conjunctival injection (bloodshot eyes), dizziness, dry mouth, slurred
speech, orthostatic hypotension, tachycardia and increased urinary
frequency.
• II. Stage of Narcosis
• i. Giddiness, incoordination, confusion and paraesthesias.
• ii. The person passes into deep sleep and wakes up without
depression/nausea/hangover.
• iii. Rarely, drowsiness may be followed by respiratory failure, coma,
collapse and death (due to cardiac arrest or apnea).
• Fatal dose
• There is no authentic reported case of death attributable to cannabis
in the medical literature. Most deaths are attributed to multiple drug
intoxication. However, researchers have estimated the fatal dose as
follows:
• Bhang: 10 g/kg body wt.
• Charas: 2 g.
• Fatal period: About 12 h.

• Diagnosis is based on the history and typical findings. Blood analysis
is the preferred method of detection for interpretation of acute
effects.
Treatment
• Immediate management is supportive, including cardiovascular and
neurological monitoring, and placement in a quiet room.
• i. Gastric lavage with warm water.
• ii. Strong tea/coffee.
• iii. Artificial respiration.
• iv. Saline purgatives.
• v. 100 ml of 50% glucose or dextrose, 2 mg naloxone and 100 mg
thiamine IV.
• vi. Diazepam, 5–10 mg, if patient is violent and aggressive.
• vii. Haloperidol to control psychotic manifestations.
• Postmortem findings: Non-specific. Mostly features of asphyxia are
seen.
Medico-legal Aspects
• Most cases of poisoning are accidental or due to overindulgence. It is
the most commonly used illicit drug among pregnant women and
women of childbearing age in most Western societies.
• Majum and charas are sometimes used by thieves to stupefy persons
to facilitate robbery.
• Sometimes, it is taken by criminals before committing a criminal act to
strengthen nerves.
• It is used as an aphrodisiac and is supposed to increase duration of
coitus.
• Its use in chocolates causes intense craving among children for its
euphoric effects.

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Deliriants—

• Fatal period: About 12 h.

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