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Official websites use. Share sensitive information only on official, secure websites. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. Poisoning is a frequent cause of referral to medical emergencies and a major health problem around the world, especially in developing countries. We aimed to review the epidemiology and pattern of adult poisoning in Iran in order to facilitate the early diagnosis and management of poisoning. The pattern of poisoning is different in various parts of Iran. Pharmaceutical compounds were the most common cause of poisoning in most parts of Iran. Pesticide-related toxicities were more common in northern agricultural regions, whereas bites and stings were seen more commonly in southern Iran. Carbon monoxide poisoning was common in cities with many motor vehicles such as Tehran and in colder climates such as in northern and western regions due to inadequately vented gas appliances such as stoves and heaters. Majoon Birjandi containing cannabis is a unique substance used in eastern Iran. Poisoning by opioids, tramadol, and pesticides organophosphate and aluminum phosphide has remained a common hazard in Iran. Poisoning-associated morbidity and mortality rates vary by region and have changed over time due to the introduction of new drugs and chemicals. Early diagnosis and proper treatment may be lifesaving; thus, understanding the general pattern of poisoning in different regions is important. In Iran, poisoning is one of the most common causes of hospitalization and the 2nd leading cause of mortality. The pattern of poisoning is dissimilar in different regions of Iran. Understanding the common pattern of poisoning in different regions can contribute to early diagnosis and treatment of poisoning. Pharmaceutical compounds, pesticides, stings, and bites are the most common causes of poisoning in Iran. Medications were the most common cause of poisoning in most parts of Iran. Pesticides were more common in northern regions, whereas bites and stings were more commonly reported in southern Iran. Poisoning by opioids, tramadol, and pesticides organophosphate and aluminum phosphide remains common in Iran. Moreover, lead poisoning due to opium use is another recently recognized hazard in Iran. In addition, medicinal plants, often considered safe, could also be toxic. Intentional or accidental exposure to poisons and drugs is a typical problem in medical emergencies and a major health problem in developed or developing countries. In developing countries with insufficient drug and chemical regulations, lack of surveillance systems and easy access to more toxic drugs or chemicals have been blamed for higher poisoning rates. Iran is a developing country with almost 80 million residents. Poison-associated morbidity and mortality rates vary by region and may change over a certain period of time as new drugs and chemicals are introduced. Understanding the pattern of intoxication in a certain region would possibly contribute to the early diagnosis and treatment of poisoning. Due to the general increase in the availability of medications, especially over-the-counter OTC products, pharmaceuticals were the most common cause of poisoning In Iran. Of the analgesics, acetaminophen is the most commonly used poison in some regions of developing countries. In studies conducted in Shiraz, Kermanshah, Isfahan, Tehran, and Razavi Khorasan Neishabour , pharmaceutical compounds were the most common causes of poisoning table 1. Intoxication with antidepressants, particularly tricyclic antidepressants TCAs , is one of the most common causes of admission to Iranian poisoning emergency departments. A very commonly prescribed group of medications consists of antiepileptic drugs AEDs. The epidemiology of AED poisoning has not yet been well evaluated in developing countries such as Iran. Although benzodiazepines, TCAs, other antidepressants, and antihypertensives were easily available in this country, 2 the main cause of poisoning varied in different parts of Iran. For instance, diazepam was found in Tehran, Mashhad, and Babol to be the most typical source of pharmaceutical drug-associated poisonings. In another study conducted in the city of Karaj, acetaminophen was found as the commonest cause of poisoning. In summary, antidepressants, especially TCAs, are the 1st and in some cases the 2nd cause of drug poisoning in the north and northwest of Iran. Poisoning with sedative-hypnotic drugs and acetaminophen is common in the north and east of Iran and multidrug toxicity is the 1st cause of drug poisoning in the center and west of Iran. Herbal medicines are extracted from different parts of various plants. Annually, many people turn to herbal medicine since they believe them to be free of side effects. Finally, there are groups of herbs that may cause specific patterns of toxicity such as pyrrolizidine-alkaloid-containing plants Comfrey, Dryopteris, Viscum, and Corynanthe and may induce hepatotoxicity. Substance abuse is a serious and complicated health problem worldwide. The pattern of drug abuse varies across the globe. There was no general population-based survey to determine the prevalence of illicit drug addiction in Iran, and it seems that the patterns of abuse vary in this country. Globally, narcotic use has extended and changed to an important health problem, especially in developing countries such as Iran. In another study by Farzaneh et al. In another study conducted in Shiraz, the majority of the participants were multidrug abusers and opium was the most commonly abused agent solely or in combination with other drugs. Methadone is a synthetic opioid generally used for opioid dependence in methadone maintenance treatment MMT protocols. Increased use of methadone has added to the prevalence of its toxicity. A centrally acting analgesic, tramadol is applied to cure moderate to severe pain. Its use has been confirmed in some countries dating back to and now it is the most prescribed opioid worldwide. In recent years, tramadol poisoning has turned into a major cause of admission to Iranian emergency departments, especially among young males who have a history of mental disorders and substance abuse. Important complications of tramadol poisoning include seizure, depression of the CNS and respiratory systems, and renal dysfunction. In another study from Ardabil, tramadol, followed by benzodiazepines, was the leading cause of poisoning. This leads to the consumption of homemade alcohol, which in turn increases the probability of toxic alcohol poisoning. Recently, it has been suggested that the number of alcohol poisoning cases is growing in Iran. Methamphetamine, a potent neurotoxin, may result in dopaminergic degeneration. In Iran, it has recently become a serious health problem. Methamphetamine was alleged to be the most common cause of new-onset seizures 86 as well as the main cause of complications and death. Majoon Birjandi is a kind of processed cannabis in eastern Iran especially Birjand and Khorasan. It is frequently abused by youngsters to induce euphoria. Given its solid nature, Majoon Birjandi is easily smuggled and stored for long periods of time. Because of its localized use, toxicologists from other parts of the country are not very familiar with it. Although cannabis tends to be regarded a safe drug, Majoon Birjandi can cause panic attack with palpitations, hallucinations, and illusions. Major effects may continue for about 6 hours. Increase in populations necessitates more agricultural products and more pesticide use. Acute poisoning with organophosphates is a significant cause of morbidity and mortality the world over. The majority of poisonings in northern Iran are due to organophosphates. In Guilan, organophosphates were reported to be the most common agents that led to poisoning. Studies on pesticides and organophosphates have been conducted in parts of Iran other than Mazandaran and Guilan provinces, as well. In the 2 studies carried out in Chaharmahal and Bakhtiari and Razavi Khorasan provinces, organophosphates were the most common cause of acute chemical poisoning, with the highest morbidity and mortality. Aluminum phosphide rice tablet and zinc phosphide are solid compounds that repel stored rice pests. Patients usually ingest these compounds intentionally to commit suicide. Mazandaran and Guilan provinces are located by the Caspian Sea and are ideal for the production of rice. People in the urban areas can easily purchase cheap aluminum phosphide tablets from the black market. Suicidal ingestion of aluminum phosphide is, therefore, a common toxicity in northern Iran. Two other pesticides less frequent in Iran are 2, 4-dichlorophenoxyacetic acid 2, 4-D and amitraz. Animal bites and stings are among the most common injuries worldwide. In Asia, the highest rates of mortality and morbidity due to animal bites are observed in developing countries, including Iran. Study of the scorpion faunae in Iran began in , when Androctonus Crassicauda was identified from Kashan. Iranian scorpion faunae consist of more than 44 named species from 23 genera in the 2 families of Buthidae and Scorpionidae. Nonetheless, Hemiscorpius lepturus of the Hemiscorpiidae family is the most medically significant scorpion in Iran. Crassicauda was the most frequent scorpion causing poisoning in Khuzestan. Snake bite is a significant health problem in tropical and subtropical regions. In Iran, 83 species have been identified, 45 of which are nonvenomous, 27 are venomous, and 11 are semivenomous. The recorded number of snake bites was approximately 5, to 7, annually from to with an annual death rate of 7. Another study in Kashan showed that most of the envenomations took place in summer. Spiders are the most abundant predators in ecosystems. Lead is a heavy metal that is commonly found in the environment, especially in developing countries. The effect of fluoride on human health has been studied for over years. However, at higher concentrations, it is a health hazard. In some regions of the world, plant poisoning is an important clinical problem causing morbidity and mortality. Datura Stramonium or Tatoore is a weed from the Solanaceae family and may be present at roadsides, in cornfields, and in pastures. Most victims of this poisoning are teenagers who voluntarily ingest it for hallucinogenic and euphoric effects. Due to the content of anticholinergic alkaloids, anticholinergic signs and symptoms may develop. Toxicity with this plant as well as Citrullus colocynthis Schrad Cucurbitaceae , also known as bitter apple, has been reported in the south, center, and east of Iran. There are approximately 10, mushroom species, and 50 to of them are poisonous. The most dangerous poisonous mushrooms are the Amanita species A. Phalloides contains amatoxin, which can cause acute liver failure and death. Exposure to carbon monoxide CO can be especially hazardous given that the early effects of poisoning may often go unnoticed. Air pollution can be another cause of CO poisoning. Its low cost and high availability make it an ideal method of suicide. After , there was a significant decrease in the mortality rate of this poisoning because of the introduction of new arsenic-free depilatory products. Approximately 30, poisonings occur in Tehran each year, lading to almost 12, admissions to toxicology wards, 1, admissions to toxicology ICUs, and a minimum of deaths. Hence, acute or chronic exposures to chemicals are common. There are also natural toxins such as poisonous plants and venomous animals in various parts of the country. In different studies, the most common intentional poisonings were due to sedative-hypnotics, pesticides, and opiates. Alcohol use and abuse are, therefore, probably much more frequent than what is reported. Scorpion sting and some poisonings due to spiders are common important health problems in the south and southwest regions of Iran. It is also a threat due to incompetently ventilated gas appliances like heaters and stoves. People who live in areas with cold climates such as the north and west of Iran are, thus, at risk of CO poisoning. The clinical patterns of severe poisoning vary strikingly among study centers. The accessibility of prescribed and nonprescribed drugs in the developed countries has been linked with a significantly increased number of patients needing hospital admissions for drug overdose. Instances of pesticide poisoning have occurred during the past decades, resulting in a considerable number of fatal outcomes, although ICU facilities have been increasingly available. Recently published data on Iran reveal a dramatic rise in aluminum phosphide poisoning, whereas opioid and tramadol poisoning are still a major challenge for poisoning centers and hospitals. It is understood that the most common causes of poisoning in most of these studies were pharmaceutical compounds, especially CNS drugs. The availability of pharmaceutical compounds, increase in the sale of OTC drugs, and increase in prescribing CNS drugs by physicians, especially benzodiazepines, have contributed to the increase. Also, individuals using CNS drugs are those who often suffer from psychosocial problems and depression and this can increase the tendency for suicide. For example, envenomation was the major cause of poisoning in a study conducted by Jalali et al. Similar results were reported by Kassiri et al. In a study from Guilan, organophosphates were responsible for most of the poisonings. This group of people, perhaps as a result of more socioeconomic stress and depression, are susceptible to attempt suicide. Men are the dominant group in most studies. One explanation is that men use illegal drugs more frequently and commit suicide more than women. However, in general, bachelorhood and loneliness can increase stressful factors. The mortality rate was dissimilar in different studies. Vahdati et al. One explanation for such a high rate is the type of drug used by the patients. In a study by Taghaddosinejad et al. The mortality rate in a study by Karbakhsh et al. All the patients in that study were older than 60 years, and it goes without saying that this group of people is more susceptible to the side effects of drugs. The treatment of poisoned patients has been growing more sophisticated in recent decades in Iran. In many cities, poisoned patients are managed under the supervision of trained clinical toxicologists. Drug and poison information centers DPICs work across the country under the supervision of medical universities and the Food and Drug Department of the Ministry of Health. Limitations: One of the limitations of the current study is the changing pattern of the poisoning in our country over time. As this is a review article, the studies were evaluated during a relatively long period of time 16 years. Performing studies to evaluate the poisoning trend in different periods is, therefore, recommended. Morbidity and mortality due to poisoning vary from place to place and over time. Pharmaceutical compounds are responsible for most cases of poisoning in most parts of the country. Thus, steps should be taken in order to reduce the availability of OTC drugs and decrease the prescription of unnecessary pharmaceutical compounds, especially CNS drugs. Consequently, awareness of the general patterns of poisoning in different regions would contribute to the early diagnosis and management of poisoning. This can subsequently result in reduced rates of morbidity and mortality. As a library, NLM provides access to scientific literature. Iran J Med Sci. Find articles by Samira Alinejad. Find articles by Nasim Zamani. Find articles by Mohammad Abdollahi. Find articles by Omid Mehrpour. Open in a new tab. Hashemnezhad and Fatehi Karaj Pharmaceuticals benzodiazepines years Male and females were equal Married Hosseinian Moghaddam et al. Mehdizadeh et al. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. North of Iran 1. South of Iran 2. East of Iran 3. West of Iran 4. Most of the cases were discharged with recovery Pharmaceuticals antiepileptic, sedative hypnotic and antiparkinsonism drugs. Pharmaceuticals antiepileptic and sedative hypnotic. Female dominancy in attempted suicide Male dominancy in complete suicide.
A Narrative Review of Acute Adult Poisoning in Iran
Buying Cannabis Taraz
Data collected from the last UNODC survey conducted in indicates that cannabis cultivation and wild growth was present in Zhambyl 49, Zhambyl was noted for producing cannabis with a higher THC which is preferred by traffickers. The most famous cannabis products from Kazakhstan come from the Chuy Valley, a France-size region that straddles the Kazakhstan-Kyrgyzstan border. The heartland of cannabis in Kazakhstan is the Chuy Valley; in season, locals descend on the plants at night to conduct clandestine harvests, as restrictive laws now prohibit its use While continuing to crack down on illegal trafficking, Kazakhstani authorities are beginning to consider legitimising the domestic cannabis industry to some extent; recently, a Kazakhstani MP, Dariga Nazarbayeva who is also the daughter of President Nursultan Nazarbayeva called for vast swathes of the Chuy Valley to be leased to pharmaceutical companies for medical research and manufacture of drugs. Officially, the Kazakh government reports 0. However, a UNODC mission to the Chu valley indicates that wild growth and cultivation was well above the , ha officially reported. Furthermore, over half of the cannabis is being harvested. Illicit cultivation is noted in Kiziklarda and Shimkent in According to Sensi Seeds: It is believed that cannabis originated in present-day Kazakhstan and surrounding parts of central Asia, and that humans began to utilise it from as early as 10, BCE. Cannabis was probably originally utilised for fibre and seed, with its medicinal and psychoactive properties being discovered later. Another barrow dated to around BCE was excavated in and found to contain various cauldrons and flasks containing burnt and unburnt cannabis seeds. Herodotus as a historical source is not entirely trustworthy, and as such many have disputed the veracity of these claims, but the discovery of several Scythian tombs containing preserved cannabis has proved the truth of his statements on this topic at least. There is little evidence of a trade in cannabis and hashish as an intoxicant throughout much of this period, but as it lies along the route of the ancient Silk Road that ran from East Africa and the Arabian Peninsula all the way to China Kazakhstan undoubtedly has a long history of trading in cannabis. Furthermore, the sturdy, two metre tall Kazakhstani type is an ideal backbone for breeding high quality indoor genetics, and throughout the world, we are losing these landraces at an alarming rate—to habitat fragmentation, eradication, and introduction of foreign genetics. As Kazakhstan occupies an important position on the Silk Road that interlinks many cannabis-producing countries of antiquity, there may have been repeated influence on Kazakhstani genetics from other sources in the wider region such as China, India or Pakistan, prior to the first recorded instance in It appears that non-hybrid types are still dominant elsewhere in Kazakhstan; it would be highly advantageous to collate as much of this genetic material as possible and preserve the genetics in case they become threatened in their natural habitats. An astonishing diversity of cannabis types are thought to exist in the region, including high-cannabinoid, fibre hemp, and autoflowering varieties. The percentage of young people who had used cannabis ten times or more in their lifetime was 4. Within the past 30 days, 7. A Cannabis use among registered drug users in Kazakhstan in registered cannabis users: ; cumulative total percent of all RDUs: 20 percent; prevalence per , population: B Estimated annual prevalence of cannabis use as a percentage of the adult population annual prevalence, year of estimate : 4. C Percentage of students age 16 who reported using cannabis by frequency: lifetime use: boys: Since then, prices have risen and sale is not as open and ubiquitous. In tourist areas, especially those with numerous bars and nightclubs, sourcing a supply should be as easy as starting a conversation with a bartender or local. It is advisable to remain cautious at all times when attempting to make purchases in urban areas, as police may exact heavy fines or bribes if given the opportunity. There are even a handful of Kazakhstani rap groups who regularly make Chuy Valley cannabis the focus of their lyrics. Almaty-based film director Jantik released a movie in called Shu-Chu, a story of four young friends who travel to the Chuy Valley from Almaty and become involved in the cannabis industry. Although the film was not particularly well-received, it is an interesting depiction of the cannabis industry and the culture surrounding it. Although locally-produced cannabis is available in many others areas of the country, it will often be cheaper and lower in quality than the famed Chuy Valley weed—which can be rare outside its immediate area of origin, due to high demand and limited availability. But Webehigh. Police seemed quite tough in Kazakhstan. If you get in trouble, prepare to pay A LOT in the best case to get away. This impression was confirmed by local friends which recommended extra attention. It seemed better not to risk anything and buying without being sure of the safety. According to marijuanatravels. Growth of cannabis, manufacturing and importation are punishable by spending 16 years to life incarceration and a fine. Users of marijuana under arrest in the city are taken to rehabilitation centers. In this country there are laws enforcement agencies such as the police who impose rigorous actions against marijuana abuse. It is important to be on the watch out because police appear to be somewhat tough and the probability of being sent to penitentiary once you are caught is very high. The Kazakhstani portion of the Chuy Valley lies in Jambyl region, southeast Kazakhstan; the area is famed for the quality of its cannabis and hashish, which is seen as far superior to that produced elsewhere in the country. Now it is generally accepted that the wild-type found in Chuy Valley is a hybrid between the typical Kazakhstani landrace and the introduced genetics from India and Pakistan. Although the Chuy Valley may produce as much as 6, tons of cannabis per year, it is thought that on average only around tons are harvested. However, deliberate cultivation of cannabis is becoming increasingly attractive, as the number of unemployed continues to rise in the region. Outside the Chu Valley, it is estimated that around 30, hectares of cannabis are cultivated in Taldy-Korgan, as well as smaller quantities in the Almaty, Kyzl-Orda and South Kazakhstan regions. Individuals and groups come from a wide area, from Tajikistan, Uzbekistan and Kyrgyzstan as well as Kazakhstan, and use sickles and scythes to cut the plants at the stalk. Police presence is high in the Chuy Valley at this time, as they prepare for Operation Kendir an annual drive to stamp down on cultivation and trafficking , which begins in June and lasts until October; as a result, the seasonal cannabis pickers utilise various strategies to avoid detection. The harvesters, who typically remain on-site for several days or even weeks at a time, will often construct makeshift shelters by digging holes in the ground and concealing them with foliage. Many of the people involved in cannabis harvesting are in extreme poverty—they may arrive independently, seeking to improve their fortunes, or they may be linked with criminal organisations, which require abundant low-cost labour each harvest season. The Chuy Valley is not apparently controlled by any single organisation or mafia, and anyone is free to harvest; beyond problems with law enforcement, it does not appear that competition for its resources have led to violence among the various groups that harvest there. The resin is scraped off the fingers, pressed and moulded to form sticky, dense hashish, and packed into matchboxes to be sold. The hashish is renowned for its potency, and has occasionally been known to make it as far as Europe where it may be mislabelled as Pakistani-made , although the majority is destined for sale in Russia and the Central Asian region. It may be that this ritual does occur in areas of particularly abundant growth, but visitors to the Chuy Valley have noted that much of the cannabis growth occurs in small patches rather than dense fields, and would yield a poor harvest through this method although the author also later points out that the crop that year was unusually sparse, perhaps as a result of heavy rains earlier in the season. It is thought that approximately 97 percent of all cannabis sold in Central Asia originates in Kazakhstan. According to Sensi Seeds: The bulk of domestically-produced cannabis and hashish is sold in Kazakhstan or in neighbouring countries, particularly Russia and Kyrgyzstan. As well as being a producer country for cannabis and hashish, Kazakhstani authorities are concerned that heroin is being trafficked through the country in increasing quantities from Afghanistan and Pakistan en route to Russia and Europe. It is reported that anti-drug units are so underfunded that their members buy their own nightsticks on the black market, and patrol cars are often left stranded due to insufficient fuel. The entire Chuy Valley is apparently patrolled by less than thirty officers, with a handful of cars and a single helicopter. However, their efforts are hampered by the severe lack of funding, poor coordination, and lack of equipment and resources. According to Sensi Seeds: Plans were recently announced to construct a hemp-processing plant in the Jambul region just north of the Chuy Valley, which would process the wild cannabis of the valley into various commodities including medicine and fibre. Initially, the enterprise would focus on pharmaceutical production of THC; in later stages, fibre, oil and other products would be produced. These stages involve acquisition of licenses and equipment, as well as development of a specific pharmaceutical process to extract the THC and other cannabinoids according to the profile of the Kazakhstani type. However, local residents are not all in favour of the plan, and some view it as a way to direct the potential profits from the wild crop straight into the hands of corporations and away from the wider rural population. Images from Astana City appear to show lush, green plants resembling marijuana thriving in lengthy plots. Local resident Mihail Malorod told Yahoo News he could not believe his eyes when he saw the plants. What a nice little flowerbed, I thought! If they are marijuana plants as is alleged on social media, we will remove them immediately. In , Kazakh law enforcement agencies seized over 22 tons 22, This follows a trend of steadily increasing cannabis seizures between and with the exception of , with an average increase of 10 percent per annum. It is also noteworthy that seizure increases have tended to flatten out in recent years: recorded only a 3 percent increase and reported a 1 percent increase. Of the identified locations, the largest volume of seizures are recorded in Karaganda 1, Interestingly, both of these areas reported large increases in percent and percent respectively. Given that overall seizures only increased marginally in , it means that seizures in other locations were declining. Hashish seizures in Kazakhstan, in tons : A 0. According to Sensi Seeds: In , Kazakhstani counternarcotics officials seized Between June and October that year, 1, drug related crimes were documented, including cases of sale or supply and 75 cases of cultivation. In , cannabis seizures climbed slightly to According to Webehigh. A mobile police detail patrolling the Chuya valley on Wednesday arrested a year-old resident of the neighboring Almaty region with kg of marijuana, the local interior department told Interfax. On August 19, anti-drug police in the Merkeny region seized 1. The Chuya valley is notorious for vast fields of wild cannabis, from which marijuana is produced. Use of herbicides was considered too potentially damaging to the environment and attempting to pull the plants out by the roots brought about its own set of problems. Due to this, attempts to eradicate the crop by pulling it out by the roots led to massive soil erosion, bringing sand into villages and even burying roads under it. Another factor complicating eradication is the fact that the stands are small and randomly scattered about the landscape, making location and coordination extremely difficult. Operation Kendir accounted for the destruction of approximately thirty hectares of wild cannabis plantations and over four tons of cannabis, as well as leading to the arrest of three hundred individuals. Page Top. This site contains copyrighted material the use of which has not always been authorized by the copyright owner. Such material is made available in an effort to advance understanding of country or topic discussed in the article. This constitutes 'fair use' of any such copyrighted material as provided for in section of the US Copyright Law. In accordance with Title 17 U. Section , the material on this site is distributed without profit. If you wish to use copyrighted material from this site for purposes of your own that go beyond 'fair use', you must obtain permission from the copyright owner. If you are the copyright owner and would like this content removed from factsanddetails. Last updated April
Buying Cannabis Taraz
CANNABIS IN KAZAKHSTAN
Buying Cannabis Taraz
Buying Cannabis Taraz
A Narrative Review of Acute Adult Poisoning in Iran
Buying Cannabis Taraz
Buying Cannabis Taraz
Buying Cannabis Taraz
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Buying Cannabis Taraz