DRUG ABUSE!

                 Cannabis is commonly used to prepare Bhang, Hasish, Hash, Marijuana, Charas & Ganja. All these names are familiar to most of us. No No! I don’t mean we use it, but somewhere or the other we would have definitely heard about it. Cannabis grows like any other plant in most parts of the world. The key ingredient is THC – TetraHydroCannabino. This results in relaxed state of mind, lowering of worry, hunger and finally the person falls asleep. Cannabis can be smoked or consumed. The effects of THC last for 2-3hours when smoked, and for 24hours when ingested. The stems of Cannabis (Hemp) are used to prepare ropes.

Cannabis has been tried as medicine also. It is said to activate receptors in body, control vomiting, affect appetite, control cancer symptoms. Cannabis has also been tried in treating pain, anxiety and muscle spasticity.

Flowers, Buds, Leaves, Dried plant material, Resins, Powder and Oil are used.

 Known to India for more than 5000 years.  This wonderful plant has been mentioned in our ancient literature for its magical properties. Vedas refer to cannabis as one of the five sacred plants. It has been referred as a source of joy giver, happiness and liberator. In old times cannabis was used to relieve people from fear. Mythology says that once Lord Shiva was wandering in fields after a family tiff, he got tired and slept off near some leaves. On getting up he had those leaves and felt rejunuvated. After this incident it seems Lord Shiva made cannabis his favourite food.

                In the middle ages soldiers drank Bhang prepared from cannabis before going for battle. Bhang is prepared by mixing Nuts, Spices, Sugar, and Cannabis and is boiled in milk or yogurt. This preparation can also be rolled and eaten as small balls. Other preparations are ganja and charas. Cannabis is used in several parts of the country for religious purposes.

 IT IS LESS HARMFUL THAN ALCOHOL.

SCENARIO OF DRUG USAGE IN DIABETES

                The bad effect of these drugs is well known and has been publicised in the media very well. So I am not gonna go into details of drug abuse in general population but restrict myself to specific effects of these drugs in Diabetes.

Illicit drug use is extremely common amongst young people including many with type 1 or type 2 Diabetes. Cocaine, heroin and ecstasy appear to most severely affect glycemic control and the number of emergency hospital admissions and long-term complications. In addition, clinic attendance is much worse in illicit drug users. Some studies suggest that the onset of diabetes may be hastened by regular use but further research is needed. Questioning patients with diabetes regarding illicit drug use and adopting a non-judgemental approach would seem to be appropriate.

               

GENERAL EFFECTS –

Smokers have 3 times more risk of developing Diabetes compared to general population

Drug addicts develop diabetes earlier compared to general population

Risk of developing diabetes is more when drug abuse is combined with alcohol abuse (>15 alcohol beverages per week)

Risk is more when bad habits are combined with Obesity and family history of Diabetes

Drug abusers have poor glycemic control, tend to ignore their treatment regimens, have erratic lifestyle and do not attend reviews regularly. Final effect is they have high HbA1c.

SPECIFIC EFFECTS –

COCAINE – Acts as CNS stimulant. It also acts on adrenal medulla to release hormones which in abnormal amounts can lead to disastrous effects. These hormones increase blood glucose levels by altering carbohydrate metabolism, they inhibit insulin secretion.  Final effect – increased glucose production and decreased glucose clearance.

HEROIN – acts on opoid receptors in the body. Heroin stimulates both insulin & glucagon. There is defective pancreatic beta cell response to glucose stimulation.

ECSTASY – used most commonly as recreation drug. Diabetics using this drug are at risk of developing ketoacidosis and hyponatremia.

OTHER DRUGS – there have been some reports of associated serious hypoglycaemia.

CONCLUSION

                The data regarding drug abuse in India is minimal. I have not come across any statistics which deals with drug abuse in diabetics in India. But that doesn’t mean no diabetic in India is addicted to drugs. We do not bother to go into relevant details and ask leading questions regarding drug abuse. Reason may be due to social stigma or maybe fear of losing the patient. Well in this article I have put in some facts of drugs and also their effects in diabetes. I hope there will be population based studies to give attention to this problem in the future.