Deliriants: Cannabis

Introduction:

• Cannabis,  also known  as  marijuana, is  obtained  from  the  flowering  tops and  leaves  of the  Indian Hemp  plant  or Cannabis indica (Cannabs sativa).
• Preparation  of cannabis  are  Bhang, Gania and hashish  (charas)

Active Principle

• It is not an alkaloid, but a fat-soluble oleoresin, cannabinol, the active form being δ-9-tetrahydrocannabinol (THC).
• It also contains benzopyrene, a known carcinogen which is also found in tobacco.

Features	Bhang (siddhi, patti)	Ganja	Charas (hashish)
Source	Dried leaves and shoots	Flowering tops of female plant	Resinous exudates from  leaves, flowers and stems
color	Brownish	Rusty green color	Dark green or brown
Active principle	2–5%(least potent)	5–8%	10–20% (most potent)3
Uses	Beverage	Mixed with tobacco and smoked in pipe/hukka	Mixed with tobacco and smoked in pipe/huk

Cannabls  intoxication

• The  most common physical  effects  are  red  eye (coniunctival  iniection)  and  mild  tachycardia.
• Increased  appetite (“the  munchie”), Dry mouth, synesthesia ((stimulation  of  one  sensory  modality produces  sensation  of  other  modality).
• There is characteristic burnt rope smell in cannabis poisoning.

Fatal dose

• There is no authentic reported case of death attributable to cannabis, however researchers have estimated the fatal dose as follows:

1. Bhang: 10 g/kg body wt.
2. Charas: 2 g.
3. Ganja: 8 g

Fatal period: About 12 h.

Treatment:

1. Gastric lavage with warm water.
2. Strong tea/coffee.
3. Artificial Respiration
4. Saline purgatives.
5. 100 ml of 50% glucose or dextrose, 2 mg naloxone and 100 mg thiamine IV.
6. Diazepam, 5–10 mg, if patient is violent and aggressive.
7. Haloperidol to control psychotic manifestations.

Complications

• Flash  back phenomenon, also  seen  in  abuse  of  hallucinogens  LSD, Psilocybin.
• Transient  psychiatric disorders
• Amotivational  syndrome
• Hemp.  insanity  or  cannabis  psychosis.
• Running  amok  (Run  amok): psychotic  episode  where he goes on  the  rampage  destroying things  and killing others.
• Post Mortem Findings: Non-specific. Mostly Features of asphyxia are seen.

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