Dr. Hisham Zein Elabdin

Dr. Hisham Zein Elabdin

CANNABIS

(HASHISH,BANGO,MARIHUANA)

It is a resinous brownish green material prepared by compressing the flowering tops of cannabis sativa plant.

Bango is drived from the leaves and stem of cannabis sativa plant.

The active principle

Is delta-9- tetrahydro- cannabinol which is rapidly oxidized into

cannabinol.

Ways of intake

1-Smoking

2-As a drink with coffee.

3-Swallowed as cabsules or paste.

Toxicokinetics:

• It absorbed from the GIT especially if it is an oily solution.
• It is rapidly metabolized by the lung and liver.
• It is stored in fatty tissue.
• Excretion take place by the kidney over 24-48 hours.

Pathophysiology

It is a hallucinogenic drug causing mixture of stimulation and depression of the CNS. The action appears withen 10-20 minutes following smoking and withen 1-3 hours after ingestion.

Clinical picture

It depends upon the dose, route of administration, expectation of the user and company with which the drug is consumed and whether it is alone or with other drugs or drink as alcohol.

Mild toxicity: euphoria with a sense of well being,relaxation and sleepiness. The person becomes pleased with himself, cheerful and talkative. There is increased appetite resulting in gaining of weight. There may be impaired coordination.

Moderate toxicity:

Psychological and neurological manifestations:

1-perceptual accentuation occurs. This includes visual (bright colour), auditory, taste and small accentuation.

2-The person passes into a dreamy semiconscious state with flashing of ideas, lack of concentration.

3-Loss of judgment of time and space and diminished ability to perform complex motor functions leading to road traffic and machinery accidents.

4-Ataxia and loss of memory resulting in deterioration of occupational performance.

Cardiovascular manifestation:

1- The pulse is rapid, and there may be palpitation

2-Orthostatic hypotension, but if sympathetic stimulation increases there may be hypertension.

Eye signs

The eyes are red with normal pupils (dilatation is due to associated datura) and decreased intraocular pressure.

Severe toxicity:

Acute toxic psychosis will result. There will be confusion, hallucination, paranoid feeling. Then the patient gets periods of complete loss of consciousness and soon passes into deep sleep form which he awakes hungry thirsty. If the drug is taken with alcoholic drinks, excitement may appear.

Intravenous use of the drug will lead to collapse and death

Long term use

Cannabis causes psychological dependence, but tolerance and physical dependence can occur.

Irreversible effects occur in the form of:

1-Cerebral degeneration leading to psychomotor dysfunction and dementia

2-Hoarseness of voice, chronic bronchitis with decreased pulmonary function and carcinogenic effects.

3-On the reproductive system, it causes diminished sperm count and testosterone level in males and in female it suppresses ovulation. All these effects lead to infertility.

4-General manifestations in the form of loss of energy, desire to work and productivity with increased rate of infectious diseases due to group smoking.

Withdrawal of cannabis: Will lead to sleep disturbance, mild anxiety and fine tremors, nausea and diarrhea. They are self limited and treatment is not required.

Management

Investigations:

Screening tests as enzyme multiplied Immunoassay technique

Confirmatory tests as TLC,HPLC, and GC/MS

Treatment of acute cannabis poisoning:

1-ABC

2-Decontamination: stomach lavage, activated charcoal if cannabis is taken orally.

3-Diazepam for agitation and excitement.