Drug Abuse

ABSTRACT
The first section of this paper traces the history of cannabis as it relates to ancient Greece, Byzantium, the Greek-speaking populations under Ottoman domination, and modern Greece. While it is clear that ancient Greeks were aware of the use of the plant by neighboring peoples, there is no evidence to indicate that they utilized it in any way or that hashish was incorporated into the Greek cultural inventory before the mid-nineteenth century. Socioeconomic conditions and geographical centrality are posited as key factors which led to the introduction of hashish to modern Greece, first in the island of Syros and then to other port cities. A second section deals with demographic and epidemiological data on current hashish use and compares the total hashish using population to the general Greek population and to a sample of subjects in a clinical study in Athens on chronic effects of hashish use.

This paper has two objectives: first, to present the principal historical and cultural reasons why Greeks did not incorporate hashish smoking into their cultural inventory until the middle of the nineteenth century and the reasons which led to its adoption by one section of the Greek population, a section best considered as a cultural subgroup; and second, to present the results of a study of the sociocultural and epidemiological characteristics of this subgroup, utilizing data from the archives of the Greek narcotics control authorities. The goal of this latter study was to determine the representativeness of the total hashish smoking population of Greece in terms of the general Greek population and to what extent the experimental sample from our earlier clinical studies' is representative of the total Greek hashish using population.

HISTORICAL BACKGROUND

Cannabis in Europe

Presently available facts convince us that cannabis was not long in moving from the highlands of Central Asia to the European mainland. Reiniger (1967) describes the presence of cannabis seeds and hulls among remnants of herbs in a pot found in a tomb of the third century B.C. discovered near Wilmersdorf, Germany. These are the only known facts from antiquity. Other published sources supporting the archaeological findings do not exist. It is well known that no reference to cannabis is made either in the Egyptian papyri or in the New Testament.

The first reference revealing the use of cannabis in Europe appears in Herodotus (Book IV) about 450 B.C. The Greek historian mentions that the Scyths not only cultivated cannabis several centuries before Christ but used it also as an euphoriant, "they threw cannabis seeds on red-hot stones and become drunk by inhaling the smoke." It seems certain that the Scyths, as mentioned by Papadopoulos (1959), were using not only the seeds, which are devoid of euphoriant properties, bti, also the tufts of the female plant. Herodotus further mentions that cannabis grew wild in Thrace but was also cultivated for its fiber which was used for weaving.

The widespread use of cannabis in Western Europe, at least for commercial purposes, during the pre-Roman period is well documented by the following characteristic references: Athenaeus (A.D. 170-230) mentioned that the tyrant of Syracuse, Hieron II, who lived between 270-215 B.C., obtained cannabis from the valley of the Rhône in order to manufacture rope for his navy. Pliny the Elder (A.D. 23-79) notes that the sails and canvas of the Roman galleys were made from cannabis fiber.

It has not yet been established how cannabis reached Europe from Asia. Did it first arrive through Russia to northern Europe or from the Middle East through the Mediterranean ports and the Aenos peninsula to southeastern Europe? Both routes are probable. The possibility should not be overlooked, however, that cannabis may have been cultivated in northern Europe at the same time as it was in Asia, a view supported by Hartwich (1911). Nevertheless, the derivation of the word cannabis favors the view that the Middle East area was the main avenue of cannabis traffic from Asia to Europe. It is probable that the word cannabis derives its origin from the Assyrian words qunubu and qunabu which signify "a way to produce smoke."

Cannabis and Ancient Greece

There is no evidence that cannabis was used by ancient Greeks for commercial, ritual, or euphoriant purposes. Herodotus, a profound observer of their mores and customs, mentions as noteworthy that "some other people" [the Scyths] were using cannabis. There is no reference indicating that nectar, the "sweet drink" of the Olympian gods, contained cannabis as did soma, the favorite drink of the God Indra, which was offered to mortals so they might find happiness. Furthermore, there is no evidence to indicate that cannabis was used at the Aesculapian shrines or at the Oracles. The plants principally used at these sites to modify consciousness were the solanoids, i.e. hyoscyanus albus, datura stramonium, and mandragora. It has been maintained that the prophetic delirium of Pythia was du,e to the inhalation of cannabis, but no evidence exists to corroborate this hypothesis (Ballas 1968).

The principal sources on ancient Greece which would be likely to refer to cannabis, should it have been used in ancient Greece at all, make no mention of the substance. It is significant that Theophrastus (372-287 B.C.) the famous master of the Peripatetic School, who described in great detail the plants known at the time on Grecian soil, makes no mention of cannabis. The restriction of cannabis to neighboring populations of Greece and the lack of its dissemination to the Greeks even during the first post-Christian period, is documented by a reference made by Plutarch (A.D. 46-127). In his work On rivers' and mountains' names (1615) he mentions, some four hundred years after Herodotus, that the people of Thrace used a herb similar to oregano, the tops of which they threw into the fire after meals and, inhaling their smoke, became drunk and fell into deep sleep. Cannabis is described in detail by Dioscorides (A.D. 59-79), a Greek doctor of the Roman army, whose Materia medica remained standard for centuries. Dioscorides wrote that cannabis has two varieties, "wild" and "domestic." The domestic variety produced a tall plant; the stems were used for making strong rope and the seeds were used pharmaceutically. He recommended the seeds for curbing sexual desire and the fluid extract for earaches. According to Papadopoulos (1959), the plant that Dioscorides described as "wild" was not cannabis at all since Dioscorides mentioned that it had red flowers.

Galen (A.D. 131-201), the famous Greek doctor of Pergamum, whose medical discoveries remained unchallenged until the sixteenth century, emphasized the euphoriant qualities of cannabis. He also observed that abuse or overdose of cannabis causes sterility (Galen 1821-1833: XII) and that "The seeds produce stomach trouble, headache and a disturbance of the body 'humours'. However, some people use them with other `tragimata', beverages that are taken after dinner to produce pleasure" (Galen 1821-1833 :V).

Cannabis is also mentioned by Pausanias, the geographer and traveller who lived in the second century A.D. His Description of Greece (1966) remains an invaluable source of information on the topography and legends of ancient Greece. The reference he makes to cannabis, however, does not provide evidence for or against its use by the Greeks during the Roman period. Reiniger (1962) misquotes him when he claims that Pausanias mentions that cannabis was cultivated in Efis in northwestern Peloponnesus. The pertinent reference in Pausanias runs as follows: "The land of Elis is fruitful, being especially suited to the growth of fine flax. Now while hemp and flax, both the ordinary and the fine variety, are sown by those whose soil is suited to grow it, the threads from which the Seres make the dresses are not produced from bark, but in a different way...." (Pausanias 1966).

The Byzantine Empire

The Byzantine Empire constituted a state combining Hellenic culture, Greek language, Christian religious beliefs, and Roman political traditions. Within its boundaries it encompassed several ethnic groups: Greeks, Latins, Syrians, Armenians, peoples of Mesopotamia, and even North Africans. It has been categorized primarily as an Orthodox-Christian state and only secondly as a Greek state.

The Greek inhabitants of the Byzantine Empire had come into contact with Moslem Arabs many centuries before the conquest of Byzantium by the Turks. Since the seventh century A.D., the Arabs had captured many provinces from Byzantium, including Alexandria and Jerusalem. Crete and Cyprus were only recaptured by the Byzantines after lengthy wars. The close geographical and social contact of Arabs and Byzantines enabled the former to become acquainted with the Greek language and to familiarize themselves with Greek culture. The influence of this relationship was such that the Arabs gradually adopted Greek as an international language of communication with other nations.

The Moslem Turks, who replaced the Arabs in occupying the outer rim of Byzantine provinces and who by A.D. 1250 had expanded their domination to a much larger part of the Byzantine Empire, continued this tradition and also adopted Greek as their diplomatic lingua franca. It is not surprising, therefore, that Mohammed II, the conqueror of Constantinople, spoke Greek to perfection. The cultural influence of Hellenism in the Moslem world before the total conquest of Byzantium was matched to some degree by Moslem influence on Byzantine cultural patterns. There is no evidence, however, to indicate that Byzantine Greeks, conquered first by Arabs and then by Turks, acquired the use of narcotics, either opium or hashish.

From the above, we can conclude that cannabis was not used by the Greeks during the classical era or the Roman period. For these times, it was described by historians and chroniclers as a somewhat exotic plant used by non-Greek nations, i.e. Thracians and Scyths. We can also extend this conclusion for the Greeks of the Byzantine period. Not because of any source material to verify it but because of the lack of written evidence to the contrary. It appears certain that cannabis, in contrai to alcohol, was never introduced into the cultural life of Byzantium. It is clear that it was neither used for ritual nor medicinal purposes and its possible use as an euphoriant does not appear consistent with the austere Christian atmosphere of the Byzantine period.

Period of the Ottoman Occupation

The fall of Constantinople in 1453 was followed by the official dissolution of Byzantium. Within two centuries the occupation of the entire Greek polity, with the exception of the Ionian Islands, was completed. A large number of the Greeks escaped to western countries; many were lost during the persecutions and slaughters that followed each new conquest, especially the conquest of the capital city of Constantinople. The largest part of the Greek population, however, survived and remained under Ottoman rule.

The cultural survival of this population was due largely to the policies inaugurated by Mohammed the Conqueror after the fall of Constantinople. Almost immediately following the conquest, he granted substantial religious and administrative privileges to the Christians, recognized the Patriarchate and allowed the organization of autonomous community life. These policies, which had incalculable consequences for the survival of Hellenism, were demonstrably dictated by the need to secure financial support from Christian subjects, primarily for the maintenance of the army since at that time the fledgling empire relied entirely on the strength of the Ottoman armed forces. Mohammed could have easily destroyed or "islamized" the occupied Christian-Greek population, but this was an option never seriously considered (Paparigopoulos 1932).

The political consideration that privileges to Christian subjects would widen the gap between the Eastern and Western Church contributed heavily to the issuance of these benevolent policies. Tolerance toward Christian subjects, which persisted throughout the four centuries of Ottoman occupation, allowed the subjugated Hellenes to organize themselves into separate legal communities of an autonomous nature, to enjoy a certain degree of freedom of movement and to worship more or less freely. As a consequence, they were able to preserve their customs, their religious and educational institutions and even their national and cultural identity. There were Greeks, the "Phanariotes," who were in such favor that they were able to occupy the highest posts in the Ottoman civil service. For about two centuries before the War of Independence of 1821, these individuals almost continuously held three of the highest Ottoman positions: Great Interpreter of the Court (equivalent to Minister of Foreign Affairs), Dragoman of the Navy and the Ruler of the Lands along the Danube. On the other hand, hardships, persecutions, and attempts to islamize the population (e.g. janissaries, paidomazoma) were not absent during the Ottoman occupation. Revolutionary movements, attempts to overthrow Ottoman domination and to restore freedom and Greek national life, were also continuous. It is noteworthy that of the Greek favorites of the Court, Rulers of Danubian Lands, Great Interpreters, and the like, thirty-eight were beheaded or slain "because they did not want to serve their masters as much as the subjugated Greek Nation" (Koukou 1971).

All available, unbiased sources (Pentzopoulos 1962) indicate that the Christian population and particularly the Greeks did not assimilate into Moslem society and throughout the occupation they kept alive their religious and national consciousness. The fact that a thorough search of the literature covering the period of the Turkish occupation does not even reveal suggestive references to the use of hashish by the occupied Greeks, must be placed within the context of their communal and cultural autonomy. The basic euphoriant for the Greeks continued to be alcohol. Absolutely no reference to hashish exists in the Greek demotic songs which were disseminated throughout the Ottoman Empire and contain a wealth of information about Greek mores and folk customs. No historian or traveller of that period mentions the use of hashish by the Greek, or Christian population under the Turkish occupation (Simopoulos 1973).

What was the relation of the Turks to hashish? Hashish smoking was undoubtedly widespread among the Moslems of the Ottoman Empire. It appears, however, that its use was not as prevalent among Turks as among the Moslem inhabitants of Arabic origin. A painting in Nicolas de Nicolay's book, reproduced by Stringaris (1964), depicts a group of Turkish soldiers in the streets of Constantinople, around 1500, inebriated by hashish. A very typical epic poem, the "Benk u Bôde," by the Turkish poet Mohammed Ebn Soleiman Foruli from Bagdad (Gelpke 1966) written in the middle of the sixteenth century, deals in allegorical form, with the dialectical battle between wine and hashish. Under the guise of a fencing match between alcohol and hashish, this most interesting poem describes with surprising accuracy the euphoriant properties of these to substances as well as their consequences. Significantly, Foruli's poetry ranks the two substances on the basis of social criteria. (This was also emphasized by Brunel [1955].) Foruli considers wine the drink of the rich and the powerful (he likens it to a Sheikh, a guest of the Sultan), "while hashish," he says, "is the friend of the poor, the Dervishes and the men of knowledge, i.e., of all those who are not blessed with earthly goods and social power." This description gives us further illumination: that in spite of Quranic prohibition, the Turks, or at least those of the higher social classes, by the sixteenth century had already begun to adopt the habits of the conquered population and were indulging in alcohol.

The distribution of hashish, alcohol, and opium use among the population of occupied Constantinople was reported by Eulogio Efendi (Stringaris 1964), the Turkish historian of the seventeenth century. He relates that during his days in Constantinople there were more than 1000 beer shops, 104 wine distributors, and only 60 "tekés," i.e. hashish smoking places. The view that hashish was disseminated mainly by Dervish sects (a Dervish religious school even existed in Athens under Turkish rule and its building may still be seen in Monastiraki) and among the poor Turks is supported also by other sources. Kerim (1930) mentions that hashish was widely known in Syria, Asia Minor, Constantinople, and especially Prusa and in the area of Smyrna. In all these places, Greeks, although in separate communities, lived in symbiosis with the Turks. However, no evidence exists indicating that Greeks adopted hashish use, which they considered antithetical to their own mores and customs.

Hashish in Greece after the Liberation

When the modern Greek nation was founded in 1830 after the 1821 War of Independence, only one geographical section of the area then inhabited by Greeks was included in the new state. In total area, it encompassed 47,516 square kilometers with a population of 753,000. In 1870, with the annexation of the Ionian Islands, the Greek land mass increased to 50,221 square kilometers and the population to 1,457,000. By 1920, with the annexation of Macedonia, Epirus (in 1912), and West Thrace, Greece had expanded to 127,000 square kilometers with a population of 5,016,889. By 1928, after the arrival in 1922 of the displaced Greeks from Turkish Asia Minor, the population had swelled to 6,204,684 and with the annexation of the Dodecanesus in 1947, its geographical expanse had been enlarged to its present size of 131,944 square kilometers. The present population of Greece, as of the census of 1971, amounts to 8,768,641. In 150 years there was a tenfold increase in population and a tripling of its physical size. Perhaps more significantly, Greeks living outside the boundaries of the state had been brought within the polity and, as a consequence, the total Greek population acquired greater homogeneity in language, religion, and national identity (Sandis 1973). The economic base of the nation, at least to the end of the last century, was predominantly agricultural. It is significant that in 1853 only three cities existed with a population of over 10,000: Hermoupolis, capital of the island of Syros; Athens; and Patras, the port of western Peloponnesus (Tsaousis 1971).

It appears that hashish was not traditionally used as a folk medicine in Greece. Dionysos Pyrros, a Thessalian who studied medicine in Italy and had a vast knowledge of folk remedies, does not mention hashish in his Doctors' textbook which was printed in 1832. However, "Cannabis semen — Cannabis sativa" is mentioned in the first official Greek pharmacopoeia issued in 1837 based on a Bavarian text. It reads as follows: "a yearly plant, indigenous in the East but also growing in Europe when planted." It can be argued that this indicates that the introduction of cannabis into Greek therapeutics was influenced by Western European medicine. "Cannabis semen — Cannabis sativa" is also mentioned by the first Professor of Pharmacology at the University of Athens, N. Kostis, in his 1855 Handbook of pharmacology: "a plant, indigenous in the East and especially in Persia, but cultivated in many areas of Europe and Greece...." He classifies this plant in his section on "Pharmaca Mucilaginosa" but not in the narcotics category. Cannabis is first mentioned as a narcotic in 1875 by Th. Afendoulis in his Pharmacology, described as follows:

Herrba siva Summitates floribuendae Cannabis indicae, a plant, indigenous in India and cultivated there as well as in Egypt, recently also in Greece in the areas of Argolis and Navpaktos in the Peloponnesus. In medicine as well as in everyday life, flowering tops of the female plant are used by Indian, Egyptian and Arab peoples.

This author also refers to the use of cannabis derivatives by Easterners and Egyptians in the diet.

All pertinent sources refer to hashish as definitely appearing in Greece after 1850. Introduced from the East, its starting point was the island of Syros in the Cyclades (Kouretas 1937; Papadopoulos 1959; Stringaris 1964). An analysis of the demographic, social, and cultural status of this island, therefore, is of considerable interest.

Until 1790 the population of Syros was 4,000, the majority Catholic (as a result of the Venetian occupation) and Greek-speaking. As a result of the War of Independence in 1821 and the persecution of the inhabitants of other Aegean islands (Chios, Psara, Crete, Rhodes) by the Turks, a large number of displaced Greek Orthodox people flooded into Syros. These refugees were instrumental in establishing the town of Hermoupolis around the harbor while the older stratum of Catholic inhabitants remained in Ano Hora, the old village in the hills above the new town. The development of Hermoupolis was meteoric. Within a very short period of time it grew into the leading port of the nation, to such a degree that English businessmen of the day were identifying Syros as Greece. These developments came at a time when the bulk of the Greek bourgeoisie (important merchants and wealthy professionals) was living outside of Greece in such places as Constantinople, Austria, Rumania, or Russia.

An urban-commercial society, with the first beginnings of industry, was formed in Hermoupolis. By 1828, it was the largest city of Greece with a population of 14,167 drawn from various parts of the nation. The majority were from Chios and other islands of the Aegean, later followed by Greeks from Asia Minor; the new inhabitants concentrated on new commercial enterprises and related industry. Hermoupolis quickly gained fame as an important port of call, a necessary stopover between East and West, between North Asia and the Black Sea. Until 1880 it maintained its national leadership in commerce and industry; the first Greek shipyards and factories were established in Hermoupolis. As a result, this city developed the first urban proletariat of Greece, the first labor syndicates, and experienced the first strikes and labor unrests. As social counterpoint to this laboring class, a strong bourgeois class emerged and flourished. In its social activities, lifestyle, and habits this latter group had close resemblance to the Western European bourgeoisie of the time.

The older Catholic stratum of Syros was initially contained in the area known as the Kastro, in the hills above the city. These Catholic Greeks retained a traditional style of life based on agriculture and were culturally alienated from the urban life of the port city. Nevertheless, from 1890 and on, given the growing demands of new enterprises, they began to be drawn into the urban labor pool. In spite of the antipathy between the Catholic inhabitants of Kastro and the rich Greek Orthodox newcomers of the port (numerous clashes have been recorded), the Catholics were eventually forced to seek wage work as longshoremen, shipyard hands, and in the tanning factories of Hermoupolis, coming to the port to work by day and returning to their village by night — the first Greek example of migration for Urban work without physical abandonment of the village. Although the needs of the port and of the flourishing factories and commerce lured workers from all of Greece, the first true proletariat was recruited from Kastro.

These workers, over time, developed a distinctive social form with a characteristic cultural style. Syros became the meeting place of Eastern, primarily Arabian, and Western European influences. In Hermoupolis, laborers were exposed to both as ships and crews from Europe, Egpyt, and the Middle East made it a regular port of call. Among other elements of culture, Syros was introduced to Western European music, which was quickly adopted by the upper class, and to Arabic and Middle Eastern musical forms (Vamvakaris 1973). As important, however, the refugees from the Peloponnesus, mainland Greece, and from Pontos brought along with them the tradition of Greek demotic songs.

The blending of these elements created a variant type of folk culture, tangentially related to that of the middle class but clearly differentiated. Within this multi-cultural context a music form developed with overt oriental characteristics and influence; the basic instruments were the bouzouki and the baglamas which bear resemblance to the mandolin and guitar. This new music developed in Syros but was soon transplanted to Piraeus, the seaport of Athens, from there to be spread to working people in all the harbors of mainland Greece. After World War II, this music acquired significant dimensions and diffused rapidly throughout the Greek lower class. From 1950 on, it could be considered as the national music of the country. Popularly known as rebetiko music, it is socially akin to American blues and jazz (Vamvakaris 1973).

From 1870, due to economic developments in continental Greece, Piraeus began to compete commercially with Syros. By 1880 it had gained ascendancy, and with the opening of the Corinth Canal in 1893 the decline of Hermoupolis commenced. At this point the labor force gravitated away from Syros toward Athens and Piraeus. We would maintain that the roots of hashish use in Greece are to be found in the Syros type of sociocultural setting. During the cultural florescence of this island, similar social, economic, and cultural events took place in Smyrna, an important port city of Turkish Asia Minor that had a basically Greek population which dominated local trade and industry. In view of close similarities between the development of Smyrna and Syros, the use of hashish by the inhabitants of the former place cannot be dismissed. In fact, this view is strongly supported by the fact that there was a considerable number of known hashish users among the Asia Minor Greeks repatriated in 1922.

It is not coincidental that all sources place the appearance of the first cases of hashish smoking on the mainland around 1870-1880, that is, at the time that socioeconomic conditions, comparable to those experienced by Syros, were developing in Piraeus. Stringaris (1964) reports that hashish appeared on the Greek scene during this decade, Kouretas (1937) places its use by prisoners around 1885, Petropoulos (1971) mentions that it was introduced by the prisoners of Smyrna, Mysiri, and Prusa as the "weed of the poor," hashish-el-foukara. Indeed it was the poor of Piraeus and its surrounding neighborhoods that constituted the bulk of the hashish smoking population of the region.

It appears from a report of the mayor of Orchomenus in Peloponnesus, requested by the government, that the cultivation of hashish was introduced in Greece about 1875 by immigrants from Egypt, Cyprus, and other eastern areas and by the last decades of the nineteenth century it was being openly and systematically cultivated for local use and export. Excerpts of this official statement follow:

Ten years ago the cultivation of hashish was disseminated to Orchomenus from the surrounding boroughs of Mantinea. Cultivation tests in these boroughs were made previously by Egyptians, Cypriots and other immigrants from the East, who had come to Greece and taught the cultivation and processing of this product.... As soon as the cultivation of this product was started in the borough of Orchomenus, great agricultural activity was observed among the people .... Hashish by the leaf costs 50-80-90-100 lepta (100 lepta r= one drachma) per oka (one oka = 2.82 lbs), the price depending upon quality and demand, while the price of the powder varies from 10 to 20 drachmas per oka. Abroad the price is triple or quadruple (On hashish: a report by the Mayor of Orchomenus in Montinea 1887).

Papadopoulos (1959) estimates that before 1915 about 26,000 acres in Greece were put to hashish cultivation.

From the onset, and up until the 1960s, hashish use in Greece was limited to the working class, widely used by longshoremen, boatmen, sailors, porters, skinners and slaughterers, as well as by cart drivers (Stringaris 1964) and later by truckdrivers, who still utilize the substance. Examples of hashish smoking and implements are shown in Plates 1-5. Significantly, the spread of hashish use is correlated with the development and dissemination of rebetiko music (Petropoulos 1971). The use of hashish constituted an essential element in the behavior and personality of rebetiko musicians and singers and the evidence indicates that the development of this musical genre and the proliferation of its practitioners is intimately linked to the dynamics of the hashish cult in Greece (Stringaris 1964).

Stringaris also reports that the first admissions to the newly established mental hospital "Dromokaiteion," of hashish users, diagnosed as mentally disturbed, were in 1885. Our own investigation of the hospital's files casts doubt on this assertion: the first admissions of mentally disturbed hashish users appear to have been in 1912, while admissions of morphine and cocaine addicts are recorded as starting in 1901. Up to 1937 the prevailing term for institutionalization due to hashish use was "hashish mania"; after that date the term is replaced by "hashish psychosis." Even up to 1941 there were some admissions utilizing this terminology. From 1943 to 1947, hashish users admitted to the Dromokaiteion mental hospital were diagnosed as having "mixed or other toxicomanias."

On March 27, 1890, following a decision of the Medical Council, the Department of Interior issued a circular prohibiting the importation, cultivation, and use of hashish as an imminent threat to society (Excerpt of the 1890 report of the Health Council 1892). Despite passage of this restrictive law, in force until 1920, hashish was regularly used in the tekedes, cafes frequented by hashish smokers, in the harbor area of Piraeus and in the center of Athens. The habitués of tekedes were mostly younger, jobless, tough guys who, as a rule, existed by underground activities and were usually at odds with the law and the authorities. Known quite widely in Greece as manges (Petropoulos 1971), they had their own code of honor, a paradoxically tender and touchy personality, and fiercely rejected the established social order.

In the 1920's hashish use flourished. The reasons were primarily twofold: Greek soldiers, returning home after the disastrous war in Asia Minor, brought back hashish smoking habits which they had adopted in Turkey; and about one and one-half million Greek refugees from the destroyed areas of Asia Minor were repatriated to Greece. Among this latter population were individuals who either smoked or knew about hashish. It is more than probable that the poor living conditions to which they were subjected after repatriation in such slum areas as Tavros, Assyrmatos, Kokkinia, and Drapetsona, contributed to an increase of hashish smoking and to the establishment of more tekedes. But the problem is more complex. The population that came from Asia Minor consisted primarily of war widows and children (Zabathas 1969) in need of immediate relief and support which was hardly available and certainly not forthcoming. Hygienic conditions were very poor and death rates exceptionally high. Given these conditions, this population by 1923 had shrunk by 45 percent; in some parts of Greece no children of refugee parents were born during an entire year. Such social and physical hardships might well have contributed to the further spread of hashish use among-this large minority population. In the years that followed, hashish use persisted in spite of proscriptive legislation. The retail price was low making it accessible to the majority of the population (Vouyoucas 1971).

From 1932 until 1970, the narcotics laws of Greece became increasingly severe and passed through various stages. Up to the end of the civil war in 1950, these laws were not strictly enforced and hashish use flourished. After this date a gradual decrease in the illegal cultivation and use of hashish took place. The latest version of the law, which is enforced, can be summarized as follows: a drug addict has to be confirmed as such by designated officials of the government medical service. Such an addict is then considered sick and subject to "attenuating circumstances" in the court trial required by law. As an addict, he will be given a lighter sentence than the non-addict. Punitive and corrective measures that may be imposed by the courts include imprisonment from 1 to 10 years; fines ranging from 50,000 to 10,000,000 drachmas; deprivation of driver's license for at least two years and up to life; confiscation of private property where the drug was found; dishonorable discharge from the armed forces; and prohibition against foreign travel.

Finally, while the rate of hashish use among the lower class continues to fall, a rise in hashish use may be observed among the teenage and student population of the middle and higher classes.

STUDY OF THE HASHISH SMOKING POPULATION

As stated earlier, this section reports on the epidemiological and sociocultural profile of the entire reported hashish using population based on data generated from the official Greek narcotic archives. We compare this population to the general Greek population and then to our experimental sample, utilized in previous clinical studies, in order to assess its representativeness.

Data Sources

In order to reach these objectives, a search of the archives of the following three narcotic units was undertaken: (1) Athens Metropolitan Police, (2) Piraeus Metropolitan Police, and (3) Athens Suburban Constabulary. These three archives encompass information for all of Greece with the exception of the city of Patras and the island of Corfu. The records studied cover the period 1958-1973.

Methodology and Methodological Problems

The archival search was conducted by a psychiatrist and a social worker who systematically collected data in the headquarters of the three narcotic units for two to three hours per day over a period of five months. Each narcotic unit has devised its own system of record keeping so that any given drug abuser may have a record in two or even all three units. Adding to the complexity, the archives of each unit include different kinds of information and the range of information recorded by each unit may vary depending on the time period in which they were collected. Practically all records, however, contain the following data: (1) name and surname, (2) nickname, (3) parents' name, (4) place of birth, (5) date of birth, (6) place of residence, (7) occupation, and (8) other illegal activities.

Only the oldest files of one unit provide data such as starting age and events associated with initiation to hashish smoking. Some files include information about imprisonments, although most of these only include dates of arrest for drug abuse without mentioning if the user was released after identification or remanded for trial. In a number of cases, records list the characterization "drug abuser" without indicating the type of drug used. In such cases the researchers, who had established good working relations with the narcotic squads, discussed the question in detail with pertinent police officials. In a very few cases, where only ambiguous or very incomplete information was available, such files were excluded from the study.

After this process, all usable records (5,589) were compared and cross-referenced so that for every drug abuser one final card was generated, as complete and inclusive as possible. Of the 5,589 records 1,893 were duplicates, leaving 3,696 as the basic pool of information. Subjects were classified by drug used and identified as hashish users only if they were utilizing this substance exclusively. Out of the total of 3,696 drug users, 3,128 were males who used only hashish, 107 were female hashish users, 330 were heroin addicts, 52 used other drugs such as amphetamines, barbiturates, etc., and 186 were foreigners arrested in Greece.

Since the experimental sample of our previous studies included only males, women were excluded from the archival analysis. Individuals arrested in Greece but residing permanently abroad were also excluded. Out of 3,021 males classified as exclusive hashish users, 125 had incomplete records. Due to the lack of standard classification of socioeconomic status in Greece, categorization of subjects' status was empirically determined according to educational background, occupation, and place of residence. On this basis, five categories were generated: (1) high, (2) middle, (3) working, (4) illicit activities, dependent, etc., and (5) peasantry. With regard to place of birth and place of residence, subjects were allocated into nine geographical areas. The Department of Attika was separated from the rest of central Greece, as it includes the two major urban centers, Athens and Piraeus.

Results

As previously mentioned, we attempted: (A) to analyze, given all their limitations, the data from the police archives concerning the total hashish population of Greece; (B) to compare the characteristics of the hashish population to the general population based on the 1971 census; and (C) to compare the total hashish population to the experimental sample.

A. Over the past twenty years Greece has become an industrially developed country; the proportion of the agricultural population has shifted from 55 percent to 35 percent. This has been accompanied by the large-scale movement of people from rural to urban areas, primarily to Greater Athens including Piraeus, which now contains one-fourth of the entire population of Greece. The urbanization process appears to be even more significant for hashish users, as revealed by a comparison of places of birth and present residence of the total hashish population. In the region of Athens, for example, the locally born hashish using population is 50 percent less than the provincially born hashish using population which migrated to the urban center. A striking finding is that the incidence of hashish users in the borough of Tavros (Greater Athens) has increased in the last decade from 0.39 percent to 2.54 percent (see Table 1).

By contrast, the hashish using population of the provinces has been greatly reduced. For example, in the Peloponnesus the proportion of users has dropped from 17.57 percent to 4.83 percent; in Epirus from 3.77 percent to 0.29 percent (see Table 1). The question has yet to be resolved as to whether the movement of rural born hashish users into Athens means the gravitation of already socialized users to the center of hashish traffic or whether the urbanization process was instrumental in initiating the practice of hashish use.

The geographical distribution of the total hashish using population is shown in Table 2. Users tend to concentrate in certain areas but primarily in the general area of Athens: the borough of Tavros has the highest incidence of hashish users 0.48 percent, compared to the region of Piraeus with an incidence of 0.14 percent, and Athens proper with 0.06 percent (see Table 3). Thessaloniki in Macedonia and Kalamata in the Peloponnesus have a relatively high incidence of hashish users, 0.02 percent and 0.14 percent, respectively. These latter figures can be attributed to the fact that the two provincial centers are port cities.

Analyzing the total hashish population by socioeconomic status reveals that hashish users are predominantly working class (61.60 percent). A high proportion are unemployed or are supported by underground activities (21.38 percent). A smaller proportion (12.74 percent) belongs to the middle class. The peasantry (4.14 percent) and high class (0.11 percent) supply the smallest number of hashish users (see Table 4).

B. Eva Sandis, an American sociologist, who studied Nea Ionia, a refugee community in Attika (1973), found that occupational levels occupied by refugees from Asia Minor, migrants of rural Greece, and Athenian respondents are lower for refugees than for migrants and Athenians (Table 5). Her findings are in accord with ours, since we found that the rate of unemployment among the hashish users (21.38 percent) was higher than that of the general population (4.9 percent). This difference is of significant importance (P <0.001) (Table 6).

Comparing the total hashish using population to the general population with regard to marital status, we find significant differences in the "divorced, separated and cohabiting "and the "widowed" categories (P<0.001) while no significant differences were found in the "married" and "single" categories (Table 6).

The two populations under consideration, males above the age of 16 years, show significant differences in age composition and education (P<0.001). Hashish users tend to be older, with a mean age of 44.46 years (S.D.=13.06) than the general population, mean age 41.32 years (S.D.=13.93). Hashish users are also less educated, with a mean of 5.06 years of schooling (S.D.= 3.64), than the general population, mean of 5.49 (S.D.= 3.45) (Table 7).

C. A comparison of age in the total hashish population and our experimental sample indicates no significant difference between the two (Table 8). The total hashish population tends to be significantly more educated than the experimental sample (P<0.01). The mean years of schooling are 5.06 (S.D. = 3.64) for the total hashish population and 4.01 (S.D. = 3.23) for the experimental sample (Table 9). This difference is best explained by the fact that our experimental sample consisted primarily of lower working-class people.

As mentioned above, specifics on hashish smoking were available in the police archives for only a limited number of users (142 cases). Comparison of these data with those from our experimental sample focused on starting age of hashish smoking and years of use. The mean starting age for this accidental sample of the total hashish population is 23.52 (S.D. = 7.05) while that for the experimental sample is 18.05 (S.D. =- 4.32), significant at P <0.001 level. No significant difference exists for years of use of hashish between the two populations (Table 10).

We may conclude that hashish users in Greece are derived primarily from the working class and are differentiated from the general population with regard to age and education. On the other hand, our experimental sample is representative only of the lowest urban working class and is differentiated from the total hashish population of Greece by lower levels of education and earlier starting ages for the smoking of hashish. Differences between our experimental sample and the total hashish population may be attributed to the selection criteria imposed by clinical objectives which restricted admissions to the medical project to heavy chronic users only while the total hashish using population of Greece exhibits various degrees of use — from very occasional to heavy.

1 From 1971 to 1974, the Psychiatric Clinic of the University of Athens was engaged in an extensive and systematic investigation of the physical, psychiatric and psychological effects of chronic cannabis use. This work was supported by the National Institute of Mental Health (United States) by means of a subcontract with the International Association for Psychiatric Research. The mass of data obtained from an experimental subsample of hashish users and a control subsample are now being processed and only preliminary results have been reported thus far (Report on chronic hashish use in Greece, published by the National Institute n.d.). In order to better evaluate the data obtained in these clinical studies, a parallel investigation of the historical and cultural background of cannabis use in Greece was pursued. The results of this investigation are reported in this paper. These data, in turn, have stimulated an ongoing socioanthropological study of contemporary patterns of cannabis use in Greece.

 

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