Welcome to Insomnia and Sleeplessness

A 33 year-old slim cachetic, puffy eyed, strong smell of tabacco lady came in today requesting me to help her to quit her 21-year of marijuana use.  She is spending about $270 per week to buy marijuana.  She wakes up at 6am and the first thing she is does is to smoke her marijuana, until 6pm at night.  She has been having recurrent chest infection, daily sputum production, very tired, but difficulty to fall asleep at night, paranoid and unable to look after her 2 young kids.  She tried to move from where she lived for 3 months and did quit her marijuana, but this causing tremendous withdrawal symptoms and badly treated her children in that 3 months period.  Unfortunately, she reverted to smoking marijuana after 3 months.  She went to see counsellor, psychologist, psychiatrist and hospital, none of the measures helped her. 

She was very agitated, crying easily, but very aggressive in her behaviour,  in language especially.  She wanted help, yet she did not have the willpower to do it.  She wanted quick fix, yet she was angry with me as I could not recommended her the quick solution.  She ended storming out and kicked the door on her way out and screaming on the corridor.  She turned back and told my receptionist,”She is the nastiest, and worst person I have ever seen.” 

I felt annoyed with her behaviour, yet disappointed about what she said.  Interestingly, on the same day, a middle aged bearded but well kempt and well dressed male turned up at the end of the day.  He was the one I helped about 6 months ago to quit his long term marijuana used.  Now he has not touched a smoke, including tabacco since I last saw him months ago.  I was very proud of him when I saw him, furthermore more proud about myself of able to help a soul to pick up his life.  At the end of the consultation, I softly asked his permission to let the previous lady to talk to him as her mentor to give up marijuana.  I thought this might be the gateway for her to start.  Initially he was reluctant, then he said, “OK”.  He consoled me most likely she was ran out of money to buy more marijuana, and she would like to get some medications eg diazepam to calm her down to help her to sleep.  I thanked him for not blaming me as a “bad person”.

drug type (Cannabis)=common names(marijuana, grass, pot, dope, hashish, oil, buddha sticks)

Marijuana can be a stimulant or sedative/hypnotic depending on the herb types.

Stimulant withdrawal syndrome: The withdrawal state that results from either stopping or reducing the use of stimulants includes lethargy, fatigue, psychomotor retardation or agitation, craving, increased appetite, insomnia or hypersomnia, and bizarre or unpleasant dreams.

Sedative or hypnotic withdrawal syndrome: Sedative or hypnotic withdrawal states are characterised by tremor of the tongue, eyelids or outstretched hands, nausea or vomiting, tachycardia, postural hypotension, psychomotor agitation, headache, insomnia, malaise or weakness, transient visual tactile, or auditory hallucinations or illusions, paranoid ideation, and grand mal convulsions.