CANNABIS POISONING TYPES OF CANNABIS PLANTS Cannabis is

CANNABIS POISONING

TYPES OF CANNABIS PLANTS • Cannabis is a psychoactive product of the plant Cannabis also called Dagga (Africa), Hashish (Egypt) and Indian Hemp • Two recognized types of the plant are: 1. Cannabis Indica 2. Cannabis Sativa

Cannabis Plant & Its Leaves

Flowering Buds of Cannabis Plant

Active Principal • It contains many euphoric principles The major biologically active chemical compound in cannabis is (delta-9 -tetrahydrocannabinol), commonly referred to as THC.

Derivatives of Cannabis Plant 1. Bhang (also called Siddi, Patti, Sabji) It is least potent from (THC is 15%) Consists of dried leaves & flowering or fruiting shoots which are rubbed on the stone, mixed with beverages & consumed orally as drink. 2. Majun: It is confection prepared by treating Bhang with sugar, flour, milk & butter. It is sweet in taste & taken orally.

3. Ganja: Concentration of THC is 25% It is resinous extract of flowering tops or fruiting tops of female plants 4. Charas ( Also called Hashish) Concentration of THC is 25 – 60% It is concentrated resin obtained from leaves & stem of plant. It is dark green or brown in color. It is most potent form of Cannabis. It is smoked with tobacco in pipes or in cigarette

5. Marijuana: ( Also called Marihuana, pot, weed or grass) It is similar to Ganja. This form of Cannabis is generally used in America. The term Marijuana is Maxican in origin meaning a “Pleasurable feeling” The cut leaves & flowering tops are crushed and smoked in a pipe along with tobacco or in cigarette ( Joint or Reefer ).

Bhang

Chars or Hashish

Chars or Hashish

ROUTES OF ADMINISTRATION • Ingestion ( Bhang & Majun) • Inhalation ( Chars, Ganja, Marijuana) The effect of Cannabis is more when it is inhaled rather than ingested in food

Joint

Cannabis Smoking

Uses of Cannabis 1) Recreational 2) Religious or spiritual 3) Medicinal The most famous users of cannabis in this region were the ancient Hindus of India and Nepal. It is estimated that about four percent of the world's adult population use cannabis annually and 0. 6 percent daily.

EFFECTS OF CANNABIS • Cannabis has Two types of effects: 1. Psychoactive 2. Physiological The state of intoxication due to cannabis consumption is known as a “high”

SYMPTOMS AND SIGNS • There are two stages of Symptoms 1. Stage of inebriation and release of inhibitions 2. Stage of Narcosis

Stage of inebriation and release of inhibitions • • Excitement & feeling of cheerfulness Talkativeness & Uncontrollable Laughter Increased Appetite (Specially of Sweets) Muscular in coordination Ataxia Impaired Perception of Time and Space Hallucinations

STAGE OF NARCOSIS • • If the dose is severe person may pass into Stage of Narcosis Drowsiness and Confusion Bloodshot Eyes Deep Sleep (Recovery occurs after prolonged sleep) Rarely Person may go into Coma and Death may occur due to Respiratory Failure

CHRONIC POISONING • • Occurs in Chronic addicts of Cannabis Loss of Weight General Weakness Emaciation Tremors Impotence Moral and Mental Deterioration Psychosis with Delusions and Hallucinations (Hashish insanity)

• Auto motivational Syndrome: • This is characterized by apathy, social withdrawal, poor concentration and lack of motivation to study or work. • Heavy users have the risk to develop manic, schizophrenic and confusional psychosis.

• • • Medical complications: Chronic lung disease Lung cancer Cancer of the mouth and larynx Aspergillosis Digital clubbing

• • With drawl symptoms: Tremors Nystagmus Sweating Nausea, vomiting and diarrhea Irritability Anorexia Sleep disturbances

• Diagnosis: • By clinical S/S • Characteristic burnt rope odor in the breath of recent smoker • Cystolith hairs: suspend leaf or stem fragment in chloral hydrate sol. on a slide and examine under low power microscope. It will show these hairs as bear claws or elephant tusks. At the base of these claws is a wart like cluster of calcium carbonate deposits. Add a drop of 20% HCL and note the effervescent release of carbon dioxide.

• Urine level of Cannabinoids: the screening test may be positive for up to 70 or more days. It may be false positive in use of ibuprofen, fenoprofen and Naproxen.

FATAL DOSE & FATAL PERIOD Fatal Dose: • Charas 2 gm, Ganja 8 gm, Bhang 10 gm per kilogram body weight • Death is very rare in cannabis poisoning however may occur due to inhalation of Vomitus, accidental injuries, drowning, electrocution or suicide. Fatal Period: • In acute poisoning death may occur in 12 – 24 hours

TREATMENT • • • Seldom required Gastric Lavage may be helpful if ingested Rest of the treatment is symptomatic Recovery is seen with prolonged sleep In agitated subjects 5 – 10 mg diazepam may be given

POSTMORTEM APPERANCE • Non Specific • Congestion of Organs may be present • Bhang Leaves may be present in the stomach • Characteristic Smell (Burnt Rope) may be present on opening the body • Chloroform swabs from hands, tongue and lips are taken to collect any residues of drug

MEDICO LEGAL ASPECTS • It is a “Gateway Drug” and can lead to more severe addiction • Can be used as Stupefying Agent • Chronic abuse may lead to run amoke • Injuries on the body may be sustained due to effects on the mind and motor system

RUN - AMOKE • This is temporary insanity in chronic cannabis abusers • Person becomes violent and runs wildly • Person may commit homicide or suicide • This condition results from continued use of cannabis or even in first time users as well. There is frenzied desire on the part of the person to commit murders. A number

• A number of individuals are killed the first one being those with whom he has some real or imaginary enmity, followed by others who are in the way, until the homicidal tendency lasts. The person may then commit suicide or surrender himself to the police.

• Ganja is taken to steady nerves(doping) before performing some bold act. • Body Packer’s Syndrome.