Recreational use and overdose of ingested processed cannabis (Majoon Birjandi) in the eastern Iran.
ABSTRACT In the eastern Iran including Birjand and Greater Khorasan areas, a special traditional solid pie, locally called Majoon Birjandi (MB), is frequently abused by youngsters to induce a feel of high, special, euphoria, and energy. Cannabioid ingredients of this illicit solid lozenge are confirmed by clinical findings as well as positive urinary delta-q-tetrahydrocannabinol (THC) test. Because of its solid nature, it is easily smuggled and stored for a long time. Due to its localized usage in the eastern Iran, diagnosis of MB abuse is not known to toxicologists even from other parts of this country. We would like to bring to the attention of the readers the effects and cannabioid composition of this concoction and present the potential recreational ingestion root of processed cannabis for the first time.
- SourceAvailable from: Omid MehrpourJournal of research in medical sciences 02/2012; 17(2):203-4. · 0.68 Impact Factor
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ABSTRACT: This study examines the relation between seizure and plasma tramadol concentration in patients with tramadol poisoning, as a novel centrally acting analgesic used for the treatment of mild to severe pain. All patients admitted with a history of tramadol overdose accompanied by unconsciousness or seizures referred to Baharloo Hospital Poison Center, Tehran, Iran from March 2008 to March 2009 were included. Demographic information, clinical findings, and blood tramadol concentrations were studied. There were 401 patients with a history of tramadol overdose; 121 (30.2%) with a history of seizure and 14 (3.5%) with a history of unconsciousness were included. Most of overdoses involved men (83%). The mean age was 22.9 years (range, 14-50 years). Intentional overdose was the most common mode of poisoning (51.9%). The mean dose ingested was 1,511 mg (SD, 1,353; range, 200-7,000). Mean back-extrapolated tramadol blood concentrations were 3,843 ng/mL (3,715; 269-20,049). Back-extrapolated blood concentrations were correlated with dose (r = 0.313; P < 0.001) as well as blood concentration levels (r = 0.801; P < 0.001). Seizure was significantly correlated to higher reported dose (P < 0.001) and tramadol only to overdose (P < 0.001). However, it was neither related to higher tramadol blood concentrations, nor related to time elapsed, age, sex, history of addiction, and observed Glasgow Coma Scale of patients. Most patients experienced just one seizure (76%). The tramadol-induced seizure is dose dependent. Although higher doses of tramadol was related to higher blood concentration, blood tramadol concentrations was not associated with seizure.Journal of medical toxicology: official journal of the American College of Medical Toxicology 09/2011; 7(3):183-8.
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ABSTRACT: Drugs and chemicals are almost easily available in Iran. Natural toxins as poisonous plants and animals also exist in most parts of the country. Therefore, acute poisonings, either intentional or accidental and also drug abuse/addiction are common in Iran. In spite of these difficulties there is no center for poison control and surveillance in this country to gather information and analyse data. The files of a systematic randomised ten percent of all hospital-referred poisoned patients from 21 March 1993 to 20 March 2000 in Imam Reza (p) University Hospital of Mashhad (71589 cases) were screened retrospectively. Young adults (40.3%) and school children (22.9%) were the most vulnerable group. Mean age was 22.3 (S.D. 14.38) years with a minimum of less than one and a maximum of 98 years old. A female predominance was found (53.4%). Intentional poisoning was more common (54.4%) than accidental exposures (45.2%). Fourteen cases were classified as criminal poisoning. 79.7% of exposures were via ingestion, followed by dermal exposures (14.1%), and inhalation (6.2%). The majority (83.7%) of patients were from urban areas. Most patients (68.6%) were treated in the Emergency Toxicology Clinic and discharged, 19.2% were temporarily hospitalized and 11.3% were hospitalized for 24 hr. Main groups of poisons were pharmaceuticals (61.4%), chemicals (22.8%), and natural toxins (16.6%). The overall number of poisoned patients was higher in spring and summer (62.8%). In conclusion, acute poisonings, particularly self-poisonings, are common in Iran. Since medical documentation is not routinely provided in this country the results of this retrospective study can be used for surveillance. Establishment of fluent data gathering and analysis within the local health system are challenges for the future.Journal of toxicology. Clinical toxicology 02/2004; 42(7):965-75.
Letter to the Editor
Recreational use and overdose
of ingested processed cannabis
(Majoon Birjandi) in the eastern Iran
O Mehrpour1,2, P Karrari2,3and R Afshari3
In the eastern Iran including Birjand and Greater Khorasan areas, a special traditional solid pie, locally called
Majoon Birjandi (MB), is frequently abused by youngsters to induce a feel of high, special, euphoria, and energy.
Cannabioid ingredients of this illicit solid lozenge are confirmed by clinical findings as well as positive urinary
delta-q-tetrahydrocannabinol (THC) test. Because of its solid nature, it is easily smuggled and stored for a long
time. Due to its localized usage in the eastern Iran, diagnosis of MB abuse is not known to toxicologists even
from other parts of this country. We would like to bring to the attention of the readers the effects and can-
nabioid composition of this concoction and present the potential recreational ingestion root of processed can-
nabis for the first time.
Cannabioid, drug abuse, overdose
Opium, heroin, tramadol, cannabis, and recently
methamphetamines are common illicit substances
used in Iran.1–4Although cannabis is a drug that
opened lively debates in media in the western coun-
tries,5the published literature does not demonstrate a
large use of cannabis in this country. Youngsters, how-
ever, are mainly attracted to cannabis.1,4
Cannabis has long been used for medicinal (hemp
seeds and hemp seed oil) as well as recreational pur-
poses, in this part of the world. While the most com-
mon reason reported for initial cannabis use has been
curiosity and regular users seeking pleasure. The most
common method of using has been smoking.6
In eastern Iran including Birjand and Greater Khor-
asan areas, a special traditional solid pie, locally
called Majoon Birjandi (MB) is frequently abused.
Majoon in Persian means concoction, a mixture of
different materials. After ingestion, it leads to feeling
high or feeling special. We previously reported this
material in Persian literature,7but this is the first time
it is being reported in English. Urinary delta-q-tetra-
hydrocannabinol (THC) test for cannabis is positive
in these cases. Because of its solid nature, it could eas-
ily be smuggled and stored for a long time. The active
ingredient of this compound is cannabis, which is
extracted from Cannabis stiva plant.
This product is also mixed with several other plants
allegedly of warm nature in herbal medicine, namely
chickpea, pistachio, cinnamon, ginger, and coconut.
The final mixture is then processed to a solid form
of lozenge (cubical shape) and mainly ingested by
youngsters for inducing pleasure, euphoria, and
energy (Figure 1). In addition, MB overdosed subjects
are frequently referred to hospitals of South Khorasan
Provinces especially in the Vali Asr Hospital as
the main and referral hospital for poisoning cases
in this province.8
Classifying MB as a highly illicit drug is currently
debated in this area. Although, cannabis is generally
considered a drug of low toxicity,9these subjects are
usually referred in panic attack with palpitation,
1Department of Clinical Toxicology and Forensic Medicine, Vali-
Asr Hospital, Birjand University of Medical Sciences, Birjand, Iran
2Medical Toxicology and Drug Abuse Research Center, Birjand
University of Medical Sciences, Birjand, Iran
3Medical Toxicology Research Centre, Mashhad University of
Medical Sciences, Mashhad, Iran
Reza Afshari, Medical Toxicology Research Centre, Mashhad
University of Medical Sciences, Mashhad, Iran
Human and Experimental Toxicology
ª The Author(s) 2012
Reprints and permission:
illusion, and hallucination. In some cases, strange
experience of cognition complications and miss per-
ception happens. Major effects last for around 6 h.
Due to its localized usage in the eastern Iran, the clin-
ical signs and symptoms of poisoning with MB is not
known to toxicologist even from other parts of Iran.
We would like to bring to the attention of the readers
has main ingredient cannabis. Moreover, we are com-
investigate different pharmacologic and toxicologic
characteristics of recruitional ingested cannabis.
This research received no specific grant from any funding
agency in the public, commercial, or not-for-profit sectors.
The authors thank Dr Claudia Malic for her nice comments
in editing the manuscript.
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Figure 1. Four slice of Majoon Birjandi.
Mehrpour O et al.1189