Recreational use and overdose of ingested processed cannabis (Majoon Birjandi) in the eastern Iran

Opium, heroin, tramadol, cannabis, and recently methamphetamines are common illicit substances used in Iran. ^{1 –4} Although cannabis is a drug that opened lively debates in media in the western countries, ⁵ the published literature does not demonstrate a large use of cannabis in this country. Youngsters, however, are mainly attracted to cannabis. ^1,4

Cannabis has long been used for medicinal (hemp seeds and hemp seed oil) as well as recreational purposes, in this part of the world. While the most common 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 Khorasan 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, ⁷ but this is the first time it is being reported in English. Urinary delta-q-tetrahydrocannabinol (THC) test for cannabis is positive in these cases. Because of its solid nature, it could easily 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

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Figure 1.

Four slice of Majoon Birjandi.

Classifying MB as a highly illicit drug is currently debated in this area. Although, cannabis is generally considered a drug of low toxicity, ⁹ these subjects are usually referred in panic attack with palpitation, illusion, and hallucination. In some cases, strange experience of cognition complications and miss perception happens. Major effects last for around 6 h. Due to its localized usage in the eastern Iran, the clinical 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 the effects and the composition of this concoction, which has main ingredient cannabis. Moreover, we are commenting on potential recreational ingestion of processed cannabis for the first time. Further research is required to investigate different pharmacologic and toxicologic characteristics of recruitional ingested cannabis.