Pan Masala - a New Substance of Dependence

It is commonly known that patients with dependence on alcohol and drugs like opiates are psychoactive substances likecannabis and benzodiazepines as sustitutes or additions to tthe primary substance of dependence. At the alcohol and deaddiction centre at Sri Ramachandra Medical College and Research Institute, where we have so far registered nearly 2300 cases of alcohol and drug dependence in the past 3 years, we have been observing a new phenomenon of use of a special type of 'PAN'-Pan Masala, in patients especially with cannabis and opiate dependence as a substitute or an adjuvant: In the past one month 4 patients, all male, educated married and employed, aged 30 to 35 years, have been seen for exclusive dependence on this sustance. Their substance abuse had most of the features of substance dependence in the form of tolerance, which developed rapidly within 2 to 3 months, craving and substance seeking behaviour. They experienced a withdrawal syndrome with physical and behavioral symptoms within 2-3 hours of abstinence characterized by generalized body pain, insomnia, restlessness anxiety irritability lack of concentration, tremulousness, lacrimation, breathlessness, giddiness, vomiting, loss of appetite and intense craving. The patients ensured availablity of the substance by carrying a stock of it with them at all times. The cost of procuring the Pan was between Rs. 75 and Rs. 100 per day with its consequent adverse effect on the economic front. Three of the patients were successfully withdrawn from the substance using benzodiazepines as inpatients and the other patient abruptly discontinued treatment and absconded from the ward. Though we are not clearly aware of the contents of this Pan product, the accruing experience suggests strongly that it contains substances with serious addictive properties. Some of the withdrawal symptoms are like those seen in opiate withdrawal,. Experience at other centres in India dealing with substance dependence need to be collected to measure the nature and extent of the problem of dependence on this type of pan. It should be noted that there are several brands of Pan Masala products available in the market. The advertisement of this product in the mass media and public hoardings should be viewed seriously and measures undertaken to prevent its developement into a public health problem. The mere statutory warning given is not sufficient to highlight the serious risk of using Pan Masala as it is marketed. The ARDSI is an affiliated member of Alzhemer's Disease International (ADI), …