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 Table of Contents  
Year : 2022  |  Volume : 5  |  Issue : 3  |  Page : 122-124

Management of smack addiction through adjuvant Ayurvedic treatment

Department of Agad Tantra and Vidhi Vaidyaka, National Institute of Ayurveda (De-Novo), Jaipur, Rajasthan, India

Date of Submission29-Dec-2021
Date of Acceptance22-Aug-2022
Date of Web Publication03-Oct-2022

Correspondence Address:
Dr. Rinkesh Vishnoi
Department of Agad Tantra and Vidhi Vaidyaka, National Institute of Ayurveda (De-Novo), Jorawar Singh Gate, Amer Road, Jaipur - 302 002, Rajasthan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jacr.jacr_115_21

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The smack addiction is very much spreading nowadays among the youth, which is injurious for a healthy society. Opiates are highly addictive. Long-term use of opiates causes dependence, leading to tolerance. Overdose incidents occur due to chronic intake or addiction that can lead to life-threatening complications. In the present case, a 21-year-old male with a history of smack addiction for the last three years presented to the outpatient department with withdrawal symptoms including tremors, running nose, watering eyes, body ache, sleeplessness, sweating, nausea, irritability, and diarrhea. The assessment of withdrawal symptoms was based on Clinical Opiate Withdrawal Scale (COWS). The multimodal treatment including Shirodhara (~oil dripping on the forehead) with Ashwagandha taila and Tila taila, Sarvanga abhyanga (~synchronized whole body massage with medicated oil) with Dashmoola taila, Svedana (~sudation) using Dashmoola kwatha, and Nasya (~medications through nasal route) with Jatamansi taila along with internal medications of Vishatinduka vati and Sameeragaja kesari rasa showed promising results. Within one month of the treatment, the withdrawal symptoms of smack addiction were reduced considerably. The COWS score decreased to 3 from 22 after three weeks of treatment, inferring that multimodal Ayurvedic treatment can be an effective and safe solution in case of smack addictions.

Keywords: Addiction, Opiates, Withdrawal symptoms

How to cite this article:
Sharma A, Vishnoi R, Yadav S. Management of smack addiction through adjuvant Ayurvedic treatment. J Ayurveda Case Rep 2022;5:122-4

How to cite this URL:
Sharma A, Vishnoi R, Yadav S. Management of smack addiction through adjuvant Ayurvedic treatment. J Ayurveda Case Rep [serial online] 2022 [cited 2023 Mar 29];5:122-4. Available from: http://www.ayucare.org/text.asp?2022/5/3/122/357786

  Introduction Top

About 2.1% of India's population use opioids, which include opium (or its variants such as poppy husk known as Doda/Phukki), heroin (or its impure form – smack or brown sugar), and a variety of pharmaceutical opioids.[1] Papaver somniferum Linn. is an annual plant with white or red blooms growing on a central bulbous pod and is the source of opium (Poppy, Afim, Kasoomba, or Madak chandu). Crude opium has a characteristic odor and bitter taste.[2] Pure smack (diacetylmorphine) is a white powder with a bitter taste abused for its euphoric effect. Smack is roughly two to three times more potent than morphine. Typically, smack is injected, smoked, or snorted up the nose. It exhibits euphoric, antianxiety, and analgesic properties.[3]

Opium and its poisoning were described in Ayurveda under “Aaphuka.”[4] Further, opium is described under the heading of “Upavisha.”[5] Ayurvedic texts discuss (opium) both therapeutic and poisonous properties. In the present case, the patient was smack addicted for the last 3 years and was suffering from withdrawal symptoms at the time of admission. With the help of the Panchakarma procedure and oral medication, patient's condition improved within three weeks.

  Patient Information Top

A 21-year-old college-going student presented in the outpatient department on February 24, 2020, with withdrawal symptoms. After taking a history and physical examination, the patient was admitted into the de-addiction unit. The patient was taking 1 g of smack daily by smoke for the last three years. Initially, he started consuming smack with his friends (3–4 days in a week). Gradually, he addicted and started to increase the quantity and frequency to get the euphoric effect.

  Clinical Findings Top

The withdrawal signs and symptoms were assessed on the basis of Clinical Opiate Withdrawal Scale (COWS).[6] As per the COWS readings, the patient had moderate withdrawal symptoms of smack addiction [Table 1]. Thorough counseling of the patient was done on daily basis, with a focus on de-addiction and rehabilitation. The counseling 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 counseling.
Table 1: Assessment of Clinical Opiate Withdrawal Scale

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  Timeline and Therapeutic Intervention Top

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 Ashwagandha taila and Tila taila, Sarvanga abhyanga (~synchronized whole body massage with medicated oil) with Dashmoola taila and Svedana (~sudation) using Dashmoola kwatha. Vishatinduka vati,[7] Sameeragaja kesari rasa,[8] and Nasya (~medications through nasal route) with Jatamansi taila were prescribed internally considering the condition of the patient [Table 2].
Table 2: Therapeutic intervention

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  Follow-up and outcome Top

The withdrawal symptoms were assessed on the basis of COWS at the time of admission. Changes in COWS were assessed at regular interval of a week for three weeks. Moderate withdrawal symptoms of smack were observed when the patient was admitted, mild after two weeks, and negligible after three weeks of management. [Table 1] shows that before treatment, the total COWS were 22 which were reduced to 9 after 2 weeks of the treatment and to 3 after 3 weeks of treatment. No adverse events were noted during the treatment period. At the time of discharge, polyherbal capsules were prescribed for one month as Rasaynic chikitsa to build the immunity and for longevity. He was healthy both physically and mentally; his Jathragani got ignited with the time, withdrawal symptoms declined, the patient and his attendant was well satisfied. After 21 days, he was discharged and was on follow-up for a period of 45 days of regular follow-up and 60 days telephonically just after the treatment, in which he did not take a smack in any form.

  Discussion Top

Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.[9] Smack addiction is a major problem worldwide. It is important for their families and general practitioners to understand the psychosomatic problems caused by smack abuse. Vishtinduka vati has four important constituents, viz. Kuchla (Strychnos nux-vomica L.), Pugaphala (Areca catechu L.), Maricha (Piper nigrum Linn.), and Chincha (Tamarindus indica L.). Vishatinduka vati can be used for various diseased conditions such as diarrhea, running nose, indigestion, loss of appetite, chronic pain conditions such as body ache 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.[7] Sarvanga abhyanga and Svedana are mainly used in Vataroga, Kampa (~tremors), and Angmarda (~body ache) and are used as Vata shamaka.[10] The characteristics of Abhyanga are Shramahara, Nidrakara, and Vatanashaka, which also help to address the withdrawal symptoms such as bone and joint ache, tremors, sweating, and restlessness anxiety.[11] After regular administration of Pratimarsha nasya (~low-dose medication through nasal route) of Jatamansi taila, the patient started sleeping peacefully.[12] Sameeragaja kesari rasa is another formulation found helpful in relieving Vishada (~depression), Asthishoola (~pain in the bones), Sandhishoola (~pain in the joints), Kampa, Pratishyaya (~catarrh), and Ashrustarva (~tears).[8] In the present case, Sameeragaja kesari rasa with opium being an important constituent the drug was administered starting with 375 mg twice a day after a meal for one week. Quantity was gradually reduced to 250 mg in the 2nd week and 125 mg in the 3rd week, and finally, the drug was stopped after three weeks of administration. Shirodhara with Ashwagandha taila and Tila taila was also performed for the duration of 45 min from 1st to 14th day. Insomnia, depression/and agitation were decreased.[13] The Snigdha guna (~unctuousness property) of oil and Ushna guna (~hotness property) of Ashwagandha help in pacifying Ruksha (~dryness) and Ushna guna of aggravated Vata. Counseling according to Ayurveda comes under Satvavjaya chikista or the holistic approach which is a nonpharmacological approach that aims at controlling the mind and its straining, Acharya charaka defines it as a mind-controlling therapy where he emphasizes the restraining of the mind from unwholesome objects or thoughts which includes Mano nigraha and Ashtanga yoga.

  Conclusion Top

Smack-addicted patient treated with Ayurvedic drugs, procedures, and Satvajaya chikitsa with the principles of gradual acquirement of wholesome and withdrawal of unwholesome habits did not show any complications. Based on the observation of COWS, the withdrawals were resolved completely, and the patient got complete relief within 3 weeks. As the study data analysis is based on a single patient, the treatment being used has to be performed on a larger sample in order to gain its wider acceptability.

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 his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Magnitude of Substance Use in India. Available from: https://pib.gov.in/Pressreleaseshare.aspx?PRID=1565001/. [Last accessed on 2022 Feb 10].  Back to cited text no. 1
Biswas G, editor. Forensic Medicine and Toxicology. 3rd ed. New Delhi: Jaypee Brother Medical Publisher; 2019. p. 543.  Back to cited text no. 2
Available from: https://en.wikipedia.org/wiki/Heroin/. [Last accessed on 2022 Feb 10].  Back to cited text no. 3
Chunekar K, Bhavprakasha Nighantu, Purvakhanda, Haritkyadivarga, 2nd Chapter//208. Available from https://niimh.nic.in/ebooks/e Nighantu/bhavapraka shanighantu/?mod=read&h=AphUka. [Last accessed on 2022 Feb 10].  Back to cited text no. 4
Shashtri K. Rastarangini. Vasranasi: Motilal Banarasidas; 2014. p. 675-6.  Back to cited text no. 5
Wesson DR, Ling W. The Clinical Opiate Withdrawal Scale (COWS). J Psychoactive Drugs 2003;35:253-59.  Back to cited text no. 6
Anonymus. Rastantrasarava Siddhaprayoga Samgraha. Part 1, Gutika Prakarana 46. Ajmer: Krishna Gopal Ayurveda Bhawan; 2017. p. 325-3.  Back to cited text no. 7
Anonymus. Rastantrasarava Siddhaprayoga Samgraha. Part 1, Kharaliya Rasayana 46. Ajmer: Krishna Gopal Ayurveda Bhawan; 2017. p. 232-2.  Back to cited text no. 8
The Science of Drug Use and Addiction. Available from: www. drugabuse.gov/. [Last accessed on 2021 Dec 20].  Back to cited text no. 9
Acharya YT, editor. Charaka Samhita of Agnivesha, Sutra Sthana. Ch. 14., Ver. 20-24. Varanasi: Chaukhambha Sanskrit Sansthan; 2013. p. 201.  Back to cited text no. 10
Murthy SK, editor. Astanga Sangraha of Vagbhata, Sutra Sthana. Ch. 3., Ver. 54-60. Varanasi: Chaukhambha Orientalia; 2012. p. 42.  Back to cited text no. 11
Sharma AK. Text Book of Kayachikitsa. 1st ed. Varanasi: Chaukhambha Orientalia; 2017. p. 272.  Back to cited text no. 12
Sharma AK. Text Book of Kayachikitsa. 1st ed. Varanasi: Chaukhambha Orientalia; 2017. p. 299.  Back to cited text no. 13


  [Table 1], [Table 2]


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