Journal of Ayurveda and Integrated Medical Sciences

Introduction

Opium addiction is rampant in western Rajasthan especially in Vishnoi and Jaat community, with custom to feed opium to the guests coming to house as a treat, also it helps in enhancing the labourer working capacity, and this practice has now turned into an addiction. It’s prevalence along the regions of Rajasthan, (8.4 %) Barmer, Jaisalmer (79%) and (6.9%) in Bikaner.^[1]

Is typically grown in India. Opioid use is reported in 2.1% of the country's population, with heroin use being highest at 1.14% percent followed by pharmaceutical opioids at 0.96% and opium at 0.52%. Regarding the pattern of use, dependent use is highest among users. The prevalence of opioid use in India is three times the global average. In comparison to 2004, Smack is really dependent. Smacking is prohibited in India.^[2] Opioids, which include heroin (or its impure form, smack or brown sugar), opium (or its variations, such as poppy husk known as Doda / Phukki), and a range of medicinal opioids, are used by about 2.1% of the population in India. The plant Papaver somniferous Linn., also known as poppies, Afim, Kasoomba, or Madakchandu, is an annual that produces white or red blossoms on a central bulbous pod. The smell and taste of crude opium are distinctive.^[3] Diacetylmorphine, sometimes known as pure smack, is a white, bitter powder that is abused for its euphoric effects. Comparatively speaking smack has two to three times the potency of morphine. Smack is usually smoked, injected, or snorted up the nose. It exhibits euphoric, antianxiety, and analgesic properties.^[4] Opium and its poisoning were described in Ayurveda under Aaphuka.^[5] Further, opium is described under the heading of Upavisha.^[6]

In the classical text of the Ayurveda, opium was first described by Acharya Bhavprakasha, Properties are Tikta and Kashay Rasa, Laghu, Ruksha, Sukshma, Vyavayi, Vikasi, Vedanasthapana, Nindrajanana, Shothahara and Aakshepahara.^[7] In Ayurveda, substance abuse is to be identified as per the clinical presentation. The detailed history is to be taken from the accompanying person as well. A thorough mental status examination is done, and based on the severity; a protocol is formulated on an individual basis as per the Ayurvedic examination.

complaints of Anxiety, sneezing, restlessness, body-ache, anorexia, watery eye, running nose and constipation for more than 1- 2 days, for which he was admitted to the De-Addiction unit.

Case - 05: A 29 years old male patient was Asymptomatic before 13 years ago he presented on 17/07/2023 at De-Addiction OPD at National Institute of Ayurveda, Jaipur, (RAJ.) with the H/O Smack addiction 75 mg with avil per day by iv injectable, since 3 years. on withdrawal patient complaints of insomnia, nausea, restlessness, body-ache, anorexia, watery eye, running nose and constipation for more than 1- 2 days, for which he was admitted to the De-Addiction unit.

Diagnostic Assessment

After detailed history (table-1) of general examination of patients (table-2), the withdrawal signs and symptoms were assessed on the basis of Clinical Opiate Withdrawal Scale (COWS). As per the COWS readings, the patient had moderate withdrawal symptoms of smack addiction [Table 3]. Thorough counselling of the patient was done on daily basis, with a focus on de-addiction and rehabilitation. The counselling sessions were focused on the harm caused to the individual health, society, and surrounding; the sessions were made more effective by adding meditation and yoga along with the general counselling.

Therapeutic Intervention

The external and internal medications were prescribed as per the withdrawal symptoms of opiate addiction. The external procedures were Shirodhara (~oil dripping on the forehead) with Bhrami Tail and Tila Tail, Sarvanga Abhyanga (~synchronized whole body massage with medicated oil) with Dashmoola Taila and Svedana (~sudation) using Dashmoola Kwatha. The internal medicine namely Vishatinduka Vati, and Sameeragaja Kesari Rasa. [Table no.4]

Follow-up and outcome

At the end of the one - month treatment and one month follow-up all withdrawal symptoms of opiate withdrawal found reduced. The treatment protocol was found safe and effective. No adverse effects were noted during treatment period. The withdrawal symptoms were assessed on basis of COWS at time of admission. Changes in COWS were assessed at regular interval of a week for three weeks.

Table 3: Assessment of Clinical Opiate Withdrawal Scale

*5–12: Mild; 13–24: Moderate; 25–36: Moderately Severe; >36: Severe Withdrawal Score. COWS: Clinical Opiate Withdrawal Scale, *GI: Gastrointestinal

Table 4: Treatment Line Adopted in Patients

Table 5: Ingredients of Sameera Gaja Kesari Rasa^[8]

diarrhoea, running nose, appetite loss, and chronic pain conditions like joint and body aches. it is preferred. The principal applications of Sarvanga Abhyanga and Svedana are in Vataroga, Kampa (tremors), and Angmarda (body aches) and joint pain. Since all the above conditions are found in the form of withdrawal symptoms. It is preferred in the present case. Literature also suggested the use of Vishatinduka Vati in opium (smack) addiction.^[13] Sarvanga Abhyanga and Svedana are mainly used in Vata Roga, Kampa (~tremors), and Angmarda (~body ache) and are used as Vata Shamaka.^[14] Shramahara, Nidrakara, and Vatanashaka are the qualities of Abhyanga that also aid in treating withdrawal symptoms including tremors, sweating, anxiety, and restlessness. The patient began to sleep well after receiving regular doses of formulation that has been found to be beneficial is Sameeragaja Kesari Rasa. It has been found to relieve the following conditions: Asthishoola (pain in the bones), Sandhishoola (pain in the joints), Kampa, Pratishyaya (catarrh), and Ashrustarva (tears). In this instance, the medication was provided as Sameeragaja Kesari Rasa, which included opium as a significant component. According to COWS's observations, the patients experienced total relief from the withdrawals in less than three weeks. Since the analysis of the study data is centred on 5 patients.

Conclusion

Ayurveda treatment is very effective and safe treatment to reduce withdrawal symptoms of opium and its derivatives addiction. The present case series provide prominent evidence that Sameer Gaja Keshri Ras, Vishatinduka Vati, Abhyanga (Mahanarayan Taila), Swedana (Dashmool Kwath) and Shirodhara (Bhrami and Til Tail) have the potential to subside all the above - discussed cases have not presented with no any side effect seen. To make this study more significant, clinical trials need to be conducted on a large population.

Declaration of patient consent

Authors certify that they have obtained patient consent form, where the patient has given his consent for reporting the case along with the images and other clinical information in the journal. The patient understands that their name and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.