Drug Abuse

William McGlothlin, PhD, is a Harvard-trained psychologist, associated with the Rand Corporation, who is presently engaged in a research program to assess the effects of LSD on attitudes in normal subjects. This paper, a comprehensive work of genuine scholarship, is a segment of a larger study entitled Hallucinogenic Drugs: A Perspective with Special Reference to Peyote and Cannabis, which was presented in a modified version at The Second Conference on the Use of LSD in Psychotherapy, held in Amityville, New York, in May 1965.

HISTORY AND DESCRIPTION

The cannabis or hemp plant is probably indigenous to Central Asia and has a very long history. According to Taylor, it was described in Chinese literature in 2737 B.C. and introduced into India prior to 800 B.C. The drug cannabis is obtained from the flowering tops of the female plant, and it was used very early in China as an analgesic in surgery. It has had wide use in indigenous medicine, especially in India, and to some extent in modern medicine beginning about 1860; however, it is now considered obsolete.

The use of cannabis as an intoxicant was well known in India by the ninth or tenth century, and some authors place the date considerably earlier. From India, it spread to North Africa and then to Europe around 1800. It has a fairly long history in Mexico and Latin America, but was not introduced into the United States to any appreciable extent until about 1920. Cannabis currently grows wild in almost all countries and is cultivated for the drug in many. It is used throughout the world as an intoxicant in various degrees—a survey sponsored by the United Nations in 1950 estimated worldwide usage by 200 million persons, the large majority of them in Asia and Africa.

The potency of cannabis as an intoxicant varies widely depending on climate, cultivation, and preparation for use. There are three grades prepared in India. Bhang is cheap, low in potency, and usually ingested as a drink; ganja is two to three times as strong; the most potent is charas, the unadulterated resin obtained from the plant or dried flower. Smoking is the most common mode of consumption for ganja and charas. Cannabis preparations have many other names in various parts of the world—in Morocco it is called kif; in South America, dagga; and in the United States and Latin America, marihuana. These correspond roughly in potency to the bhang of India, though they are mostly smoked rather than ingested. The term hashish, when used correctly, is a powdered and sifted form of charas, or a preparation made from it; however, hashish is widely used in the literature to refer to any form of the cannabis drug. The marked differences in potency among the various preparations are probably responsible for some of the discrepancies between Eastern and Western findings that will be discussed later. From a consensus of several reports, the marihuana available in the United States is estimated to be one-fifth to one-eighth as potent as the charas resin in India.

The active ingredient of cannabis has been identified as tetrahydrocannabinol, but the chemistry is extremely complex and not completely understood. Some 80 derivatives of tetrahydrocannabinol have now been synthesized and studied pharmacologically, and most are active in various degrees.

Cannabis Intoxication and Its Similarity to That of Peyote and LSD

Pharmacology texts invariably classify cannabis as a hallucinogen, along with LSD, mescaline, and psilocybin. Recent interest, however, has concentrated on the last three, probably because the "model psychosis" hypothesis grew out of work with these more potent hallucinogens. Also, those interested in examining the therapeutic effects of these agents have preferred to avoid the stigma attached to marihuana. On examining descriptions of cannabis intoxication, however, it is clear that virtually all of the phenomena associated with LSD are, or can, also be produced with cannabis. The wavelike aspect of the experience is almost invariably reported for cannabis as well as for all the other hallucinogens. Reports of perceiving various parts of the body as distorted, and depersonalization, or "double consciousness," are very frequent, as well as spatial and temporal distortion. Visual hallucinations, seeing faces as grotesque, increased sensitivity to sound and merging of senses (synesthesia) are also common. Heightened suggestibility, perception of thinking more clearly, and deeper awareness of the meaning of things are characteristic. Anxiety and paranoid reactions may also accur. Walton writes:

The acute intoxication with hashish probably more nearly resembles that with mescaline than any of the other well-known drugs. Comparison with cocaine and the opiates does not bring out a very striking parallelism. With mescaline and hashish there are numerous common features which seem to differ only in degree.

The difference between cannabis and the other hallucinogens must be understood in terms of the motivation of the user as well as the strength of the reaction. This is not to say that the set of the user is not very important for the others as well, but cannabis is especially amenable to control and direction so that the desired effects can usually be obtained at will. Michaux, a French writer, has repeatedly explored his own reactions to the various hallucinogens and writes, "Compared to other hallucinogenic drugs, hashish is feeble, without great range, but easy to handle, convenient, repeatable without immediate danger." (83) It is these features, plus the fact that consumption by smoking enables the experienced user to accurately control the amount absorbed, that makes cannabis a dependable producer of the desired euphoria and sense of well-being. This aspect is pointed up in the study by the New York Mayor's Committee which examined the reaction of experienced users to smoking and ingesting marihuana extract. When smoking, the effect was almost immediate, and the subjects carefully limited the intake to produce the desired "high" feeling. They had no difficulty maintaining a "euphoric state with its feeling of well-being, contentment, sociability, mental and physical relaxation, which usually ended in a feeling of drowsiness." When ingested, the effect could not be accurately controlled, and although the most common experience was still euphoria, users also frequently showed anxiety, irritability, and antagonism. It is common knowledge among marihuana users that one must learn to use the drug effectively, and that beginners are often disappointed in the effect.

With the much stronger and longer-lasting hallucinogens, LSD and mescaline, there is much less control and direction possible, and even the experienced user may find himself plunged into an agonizing hell. In summary, it appears that the reaction to cannabis is on a continuum with the other hallucinogens and, given the same motivation on the part of the user, will produce some of the same effects. On the other hand, cannabis permits a dependable controlled usage that is very difficult if not impossible with LSD and mescaline.

One distinct difference that does exist between cannabis and the other hallucinogens is its tendency to act as a true narcotic and produce sleep, whereas LSD and mescaline cause a long period of wakefulness. One other very important difference from the sociological standpoint is the lack of rapid onset of tolerance that occurs with the other hallucinogens. The cannabis intoxication may be maintained continuously through repeated doses, whereas the intake of LSD and mescaline must usually be spaced over several days to be effective. In addition, the evidence on the use of these drugs indicates that, although the mild euphoria obtained from cannabis may be desirable daily, or even more frequently, the overwhelming impact of the peyote and LSD experience generally results in a psychological satiation that lasts much longer than the tolerance effect.

Motivation

In this country marihuana users almost invariably report the motivation is to attain a "high" feeling which is generally described as "a feeling of adequacy and efficiency" in which mental conflicts are allayed. (79) The experienced user is able to achieve consistently a state of self-confidence, satisfaction, and relaxation, and he much prefers a congenial group setting to experiencing the effects alone. Unlike the reasons the Indian gives for taking peyote, the marihuana user typically does not claim any lasting benefits beyond the immediate pleasure obtained.

In India and the Middle East, cannabis is apparently taken under a much wider range of circumstances and motivations. The long history, wide range of amount used, and the fact that legal restrictions do not require its concealment permit investigation under a variety of conditions. Most Eastern investigators draw a clear distinction between the occasional or moderate regular user and those who indulge to excess. Chopra states that cannabis is still used fairly extensively in Indian indigenous medicine, and that it is also frequently taken in small quantities by laborers to alleviate fatigue. (29) In certain parts of India this results in a 50 percent increase in consumption during the harvest season. Chopra writes:

A common practice amongst laborers engaged on building or excavation work is to have a few pulls at a ganja pipe or to drink a glass of bhang towards the evening. This produces a sense of well-being, relieves fatigue, stimulates the appetite, and induces a feeling of mild stimulation, which enables the worker to bear more cheerfully the strain and perhaps the monotony of the daily routine of life.

Similarly, Benabud found moderate use of kif by the country people in Morocco to "keep spirits up." The need for moderation is expressed in the folk saying, "Kif is like fire; a little warms, a lot burns." (13) Bhang is also frequently used as a cooling drink or food supplement.

The habitual use of cannabis as an intoxicant is also considerable, although Chopra states that it has gradually declined over the past thirty years and "at the present time it is almost entirely confined to the lower strata of society. Amongst the upper and middle classes, the use of cannabis is nowadays considered to be derogatory, in spite of the fact that the practice was held in great esteem in ancient India, and early literature is full of references to the virtues of this drug." Chopra found that the current usage is only one-fourth that consumed around 1900, and that the decline is largely due to government reduction of the area under cannabis cultivation and higher excise duty. He estimates the current number of regular users to be between 0.5 and 1.0 percent of the population.

Cannabis also has a long history of religious use in India, being taken at various ceremonies and for "clearing the head and stimulating the brain to think" in meditation. It also plays a central role in the religions of certain primitive African and South American tribes. In India, the religious use of cannabis is by no means always moderate. Chopra writes, "The deliberate abuse of bhang is met with almost entirely among certain classes of religious mendicants."

Cannabis is widely believed to have aphrodisiac properties. Bouquet states that in North Africa the belief that cannabis will preserve, maintain, or improve sexual powers is an important initiating cause of the habit. In a sample of some 1,200, Chopra found 10 percent listed sexual factors as the exciting cause leading to the cannabis habit. While cannabis intoxication may be sexually stimulating for some, several authors have claimed that prolonged and excessive use will eventually cause impotence. (13, 17, 29)

In the United States, two studies of marihuana use in the Army concluded that it frequently produced various homosexual and heterosexual perversions. (28, 76) On the other hand, the Mayor's Committee study in New York concluded "that in the main, marihuana was not used for direct sexual stimulation." Their conclusions were based on the findings of six police men and women who, for a period of one year, posed as marihuana habitués and visited numerous intimate marihuana gatherings and "tea pads," some of which were also brothels. The experimental portion of the study found that in about 10 percent of the 150 marihuana administrations there was some evidence of eroticism. Whatever aphrodisiac qualities cannabis may possess, virtually all investigators agree these are cerebral in nature and due to the reduction in inhibition and increased suggestibility. It is probable that it is little, if any, more effective than alcohol in this respect. In fact, Chopra writes, "Amongst profligate women and prostitutes bhang-sherbet used to be a popular drink in the course of the evening when their paramours visited them. This practice has, however, been largely replaced by the drinking of alcohol which is much more harmful." (30) Chopra also mentions that certain "saintly people who wish to renounce world pleasure use cannabis drugs for suppressing sexual desires." (29)

One final motivation should be mentioned—that of musicians who feel marihuana improves their ability. Walton writes, "The habit is so common among this professional group that it may properly be considered a special occupational hazard." (119) Aldrich and Williams both found that experienced marihuana users perform worse on musical tests under the effects of the drug, whereas the self-evaluation of the subjects indicated the majority felt they had performed better. (3, 122) Williams did report, however, that three out of twelve subjects tested showed "marked improvement" in auditory acuity. Morrow found no change in either musical ability or auditory acuity. ( 79 )

In addition to the stated motivations for using cannabis, evaluations of the underlying sociological and psychological basis are of interest, particularly in instances of excessive indulgence. In this country there is very little evidence of excessive use approaching that of some groups in the East; there is general agreement, however, that the majority of regular marihuana users suffer from basic personality defects. The Mayor's Committee study in New York found that most marihuana users "were unemployed and of the others most had part-time employment." This study also administered extensive personality tests to 48 users and 24 nonusers. The subjects were prisoners, and therefore the sample is somewhat biased; they found, however, that the user group when undrugged was differentiated from the nonuser group by greater emotional inhibition and introversion. Maurer and Vogel characterize the marihuana user as follows:

Most of them appear to be rather indolent, ineffectual young men and women who are, on the whole, not very productive. . . . Most habitual users suffer from basic personality defects similar to those which characterize the alcoholic. (77)

According to the literature, most marihuana users come from the lower socio-economic classes and there is a preponderance of Negroes and Latin Americans. Four studies of marihuana use in the Army found 90 percent or more of the samples were Negro. (28, 50, 51, 76) In recent years there appears to be an increasing use of marihuana by college students, and by middle- and upper-class groups in certain urban centers.

In the Eastern countries, most investigators dismiss the occasional or moderate regular use of cannabis in about the same way as moderate use of alcohol is considered in this country. Excessive indulgence, however, particularly with the more potent preparations, is invariably considered indicative of serious personality defects. As in the United States, the majority of users are in the lower socio-economic classes.
Benabud stresses that the major problems with cannabis in Morocco exist among the urban slum dwellers, especially among those who have newly come from the country and are "no longer buttressed by traditional customs." By contrast, he points out that although kif is widely used among the country people, there is no sign of compulsive need, such as exists "among the uprooted and poverty-stricken proletariat of the large town." Benabud also cites individual psycho-pathological factors as prominent causes of excessive indulgence:

The mental attitudes and behavior usual in the emotionally immature are extremely common—prevalence of the imaginary over the real, of the present over the future, with the impulsive need of the habitually frustrated for immediate satisfaction of desire. . . . Thus, the importance and the frequency of constitutional predispositions are clear, a fact which justifies the adaptation of the well-known saying "You are a kif addict long before you smoke your first pipe."

Frequency of Use and the Question of Addiction

The confirmed user takes cannabis at least once per day; however, many others indulge only occasionally. There are no statistics on the ratio of regular to occasional users, but Bromberg found that only a small proportion of those who smoked marihuana in New York used it regularly. (24) Of those who use it regularly in the United States, most report they have voluntarily or involuntarily discontinued the habit from time to time without difficulty.

Several studies have reported that the average number of marihuana cigarettes smoked by regular users in the United States is around 6 to 10 per day. Two experiments in which regular marihuana users were encouraged to consume as much as desired found no evidence of tolerance or withdrawal symptoms. (101, 122)

Chopra collected detailed statistics on the sample of 1,200 regular users in India. Seventy percent had practiced the habit for more than ten years. Seventy-two percent used only can-* nabis, while the others also took alcohol, opium, or other drugs. Most of those using the bhang drink did not take excessive amounts, but 46 percent of the ganja and charas smokers consumed in excess of 90 grains per day (18 percent used in excess of 180 grains). More than half of both groups used the drug two or more times per day.

Benabud states that confirmed kif smokers in Morocco consumed from 20 to 30 pipes a day and 40 to 50 is not infrequent. As mentioned at the beginning of this section, marihuana available in the United States is, at most, only one-fifth as potent as charas and probably about one-third as potent as ganja. An average consumption of eight marihuana cigarettes (0.5 gram each) per day would thus be roughly equivalent to 12 grains of charas or 21 grains of ganja. When we consider that almost one-half of the ganja and charm smokers in Chopra's sample used from 90 to 360 grains per day, it is clear that the average consumption of marihuana by regular users in the United States is very mild in comparison.

Regarding the question of addiction to cannabis, most investigators agree there is generally no physiological dependence developed and only slight tolerance. This applies particularly to the moderate use observed in the United States. In the Mayor's Committee study, the officers who posed as marihuana habitués found no evidence of compulsion on the part of the user—there was no particular sign of frustration or compulsive seeking of a source of marihuana when it was not immediately available.

Concerning the use of cannabis in India, Chopra writes:

The tolerance developed in both animals and man was generally slight, if any, and was in no way comparable to that tolerance developed to opiates. Its occurrence was observed only in those individuals who took excessive doses, after its prolonged use.. .. Habitual use of bhang can be discontinued without much trouble, but withdrawal from ganja and charas habits, in our experience, is more difficult to achieve, and is sometimes accompanied by unpleasant symptoms, though they are negligible compared with those associated with withdrawal from opiates and even cocaine.(29)

Chopra writes that many persons indulge in the milder bhang drinks in summer and discontinue it during the winter. (31) In Morocco Benabud found that kif smokers did not show progressively increased consumption, that habituation was not appreciable—only about one-third using it regularly—and that withdrawal was not usually followed by psychic or somatic effects. The only report differing from these findings is one by Fraser who indicated rather severe withdrawal symptoms in nine Indian soldiers addicted to ganja. (49)

Physical and Mental Effects

Some features of the cannabis intoxication have already been discussed. When taken orally, the effects begin in one-half to one hour and usually last from two to four hours. The effects of smoking are almost immediate and typically last from one to three hours. The safety factor is enormous—Walton lists only two deaths due to overdoses which have been reported in the literature.

The Mayor's Committee administered a wide range of physical, mental and personality tests to 72 prisoners under the effects of various dose levels, both ingested and smoked. The physiological effects were minimal—increased pulse rate, hunger and frequency of urination. The major psychomotor effect was decreased body and hand steadiness. Intellectual functions are impaired, and the effect is greater for complex tasks, large doses, and nonusers. Emotional and personality measures showed feelings of relaxation, disinhibition, and self-confidence, but basic personality structures did not change.

Although the dominant emotional reaction is euphoria, acute intoxication can cause severe anxiety, panic, and paranoid reactions. Six of the subjects in the Mayor's Committee study experienced such episodes lasting from three to six hours, all occurring after the drug was ingested rather than smoked.

The Mayor's Committee compared the 48 users and 24 nonusers from the standpoint of mental and physical deterioration resulting from long-term use of marihuana. They also conducted detailed quantitative measures on 17 of those who had used it the longest (mean 8 years, range 2 to 16; mean dose per day 7 cigarettes, range 2 to 18). They conclude that the subjects "had suffered no mental or physical deterioration as a result of their use of the drug." Freedman and Rockmore also report that their sample of 310, who had used marihuana an average of seven years, showed no mental or physical deterioration.

In India, the study of the mental, moral and physical effects of cannabis has had a long history, beginning with a seven-volume report issued by the Indian Hemp-Drug Commission in 1894. Their conclusions, as quoted by Walton, are as fol-
lows:

The evidence shows the moderate use of ganja or charas not to be appreciably harmful, while in the case of bhang drinking, the evidence shows the habit to be quite harmless. . . . The excessive use does cause injury . . . tends to weaken the constitution and to render the consumer more susceptible to disease. . . . Moderate use of hemp drugs produces no injurious effects on the mind . . . excessive use indicates and intensifies mental instability.(119)

The commission continued, as quoted by Chopra: (30) "It [bhang] is the refreshing beverage of the people corresponding to beer in England and moderate indulgence in it is attended with less injurious consequences than similar consumption of alcohol in Europe." Chopra writes, "This view has been corroborated by our own experience in the field."

Chopra provides numerous statistics on the effect of cannabis on health by dose size and mode of consumption. In the previously mentioned sample of 1,200 regular users, there was a distinct difference in the effects on health, as reported by the user, depending on the amount consumed. For those using 'less than ten grains, none claimed impairment- of health, whereas 75 percent of those using in excess of 90 grains per day indicated some impairment.

The most common physical symptom found by Chopra was conjunctivitis (72 percent); this effect is frequently reported by other investigators and is a well-known means of detecting cannabis users. Chopra also found chronic bronchitis was frequent among ganja and charas smokers, as well as a higher than average incidence of tuberculosis. Various digestive ailments were reported, and habitual use of large doses resulted in defective nutrition and a deterioration of general health. The fact that excessive use and the resulting impairment of health are much more common among users of the more potent preparations (ganja and charas) has been recognized by the various governments, and the use of charas is now illegal in all countries. Bhang and comparable preparations in other Eastern countries are often legal, but the cultivation and sale are generally controlled by the government.

Turning now to the relation between cannabis and psychosis, it is well established that transient psychotic reactions can be precipitated by using the drug, and, in susceptible individuals, this may occur even with moderate or occasional use. Out of a total of 72 persons used as experimental subjects the Mayor's Committee reports three cases of psychosis: one lasted four days, another six months, and one became psychotic two weeks after being returned to prison (duration not noted). The Committee concludes, "that given the potential personality makeup and the right time and environment, marihuana may bring on a true psychotic state." On the other hand, Freedman and Rockmore report no history of mental hospitalization in their sample of 310 who had an average of seven years' usage. Similarly, the United States Army investigation in Panama found no report of psychosis due to marihuana smoking in a sample of several hundred users over a period of one year. (101)

Bromberg reported on thirty-one cases admitted to the hospital as a result of using marihuana. (23, 24) Fourteen were described as "acute intoxication" that lasted from several hours to several days and was often accompanied by severe anxiety or hysterical reaction and transient panic states or depressions.

In India and other Eastern countries, cannabis has long been considered an important cause of psychosis, and many of the early authors classified 30 to 50 percent of hospitalized mental cases as cannabis psychosis. It is now considered that the causal effects of cannabis were somewhat exaggerated, but there is general agreement among Eastern writers that the drug plays a significant role in the precipitation of transient psychoses. Benabud cites the following data on psychiatric admissions to one hospital in Morocco. In the two-year period (1955-1956), 25 percent of the some 2,300 male admissions were diagnosed as "genuine" cannabis psychoses, and 70 percent of the total admitted to smoking kif (one-third were regular users). Since the incidence of cannabis use in Morocco is estimated to be considerably less than 10 percent of the population, it is clear that there is a definite associative, if not causative, relationship between cannabis and psychosis. Benabud estimates that of the total population of kif smokers, the number "suffering from recurrent mental derangement" is not more than five per thousand. Of Chopra's sample of 1,200 regular users, 13 were classified as psychotic. Benabud especially stresses excessive use and environmental factors, pointing out that the rate of psychosis among the moderate-smoking country people is only one-tenth that in the large cities.

Benabud classifies the cannabis psychosis as acute or subacute (74 percent), residual (17 percent) and psychical deterioration (9 percent). He describes the first category as usually resulting from a sharp toxic overdose and lasting for several days. The main features are excitation and impulsivity which may produce acts of violence. Sometimes there are continuing disassociations or "spectator ego" and delusions of grandeur, especially identification or kinship with God. Patients in the residual classification have longer lasting syndromes, including schizophrenic-like withdrawal, mental confusion, and mild residual hallucinations. There is little tendency for symptoms to become organind and proliferate, but rather to disappear gradually after a few months. The third class (cannabis deterioration) is described as the result of prolonged, excessive use of cannabis, resulting in precocious senility and over-all physical and mental deterioration. "These are the old addicts, exuberant, friendly, kif-happy vagabonds, often oddly dressed and living by begging."

Bouquet feels the fact that male hospitalized psychotics outnumber females three to one in North Africa is a consequence of cannabis use being almost entirely restricted to males. He considers charas to be much more dangerous in this regard than the milder forms of cannabis, and states that the incidence of cannabis psychosis has appreciably declined because charas is now prohibited and only the "raw cannabis ends" are used.

The chronic cannabis psychosis reported by Eastern writers has not been observed in this country. Most Western authors, while recognizing the role of cannabis in precipitating acute transient psychoses, have questioned the casual role in chronic cases. Mayer-Gross writes: "The chronic hashish psychoses described by earlier observers have proved to be cases of schizophrenia complicated by symptoms of cannabis intoxication." (78) Allentuck states that "a characteristic cannabis psychosis does not exist. Marihuana will not produce a psychosis de novo in a well-integrated, stable person." (4) And Murphy writes: "The prevalence of major mental disorder among cannabis users appears to be little, if any, higher than that in the general population." (86) Since it is well established that cannabis use attracts the mentally unstable, Murphy raises the interesting question of "whether the use of cannabis may not be protecting some individuals from a psychosis." Regardless of the issue of chronic psychosis, it is clear from Eastern descriptions that gross personality changes do result from very prolonged and excessive use of cannabis. The complete loss of ambition and the neglect of personal habits, dress, and hygiene resemble characteristics of the skid-row alcoholic in this country.

Cannabis and Crime

The association of crime with the use of cannabis goes back at least to around 1300 when Marco Polo described Hasan and his band of assassins. The drug was reportedly used to fortify courage for committing assassinations and other violent crimes, and the words hashish and assassin are supposed to be derived from this source. In certain parts of this country, a near hysteria developed about 1930 when the use of marihuana was claimed to be related to a violent crime wave and the widespread corruption of school children. Dr. Gomila, who was Commissioner of Public Safety in New Orleans, wrote that some homes for boys were "full of children who had become habituated to the use of cannabis," and that "Youngsters known as muggle-heads' fortified themselves with the narcotic and proceeded to shoot down police, bank clerks, and casual by-standers." (53) Sixty percent of the crimes committed in New Orleans in 1936 were attributed to marihuana users.

Despite these lurid claims, subsequent studies have, for the most part, failed to substantiate a causal relationship between major crime and cannabis. Bromberg conducted two large statistical studies and found very little relation between crime and the use of marihuana. The Mayor's Committee found that many marihuana smokers were guilty of petty crimes, but there was no evidence that the practice was associated with major crimes.

More recent assessments tend to agree with these findings. The Ad Hoc panel on Drug Abuse at the 1962 White House Conference states, "Although marihuana has long held the reputation of inciting individuals to commit sexual offenses and other anti-social acts, evidence is inadequate to substantiate this." (121) Maurer and Vogel write:

It would seem that, from the point of view of public health and safety, the effects of marihuana present a very minor problem compared with the abusive use of alcohol, and that the drug has received a disproportionate share of publicity as an inciter of violent crime.

Chopra found that the crime rate for the sample of 1,200 regular cannabis users in India was higher than that for the general population. For bhang users, 6 percent had one conviction and 3 percent had more than one; for ganja and charas users, the comparable percentages were 12 and 17. In a further study of serious, violent crimes, however, especially murder cases, Chopra found that cannabis intoxication was responsible for only 1 to 2 percent of the cases. In addition to impulsive acts performed under acute cannabis intoxication, there are frequent references in the literature to criminals using the drug to provide courage to commit violent acts. There has been no evidence offered to substantiate this claim; rather, Chopra writes as follows regarding premeditated crime:

In some cases these drugs not only do not lead to it, but actually act as deterrents. We have already observed that one of the important actions of these drugs is to quieten and stupefy the individual so that there is no tendency to violence, as is not infrequently found in cases of alcoholic intoxication.(29)

Similarly, Murphy writes:

Most serious observers agree that cannabis does not, per se, induce aggressive or criminal activities, and that the reduction of the work drive leads to a negative correlation with criminality rather than a positive one.

It is interesting that a number of observers, particularly in countries other than the United States, consider alcohol to be a worse offender than cannabis in causing crime. For instance, an editorial in the South African Medical Journal states:

Dagga produces in the smoker drowsiness, euphoria and occasional psychotic episodes, but alcohol is guilty of even graver action. It is not certain to what extent dagga contributes to the - commission of crime in this country. Alcohol does so in undeniable measure. (42)

In the United States, probably the most serious accusation made regarding marihuana smoking is that it often leads to the use of heroin. The Mayor's Committee found no evidence of this, stating, "The instances are extremely rare where the habit of marihuana smoking is associated with addiction to these other narcotics." Nevertheless, it is difficult to see how the association with criminal peddlers, who often also sell heroin, can fail to influence some marihuana users to become addicted to heroin.

Summary and Appraisal

Cannabis is an hallucinogen whose effects are somewhat similar to, though much milder than, peyote and LSD. The confirmed user takes it daily or more frequently, and through experience and careful regulation of the dose is able to consistently limit the effects to euphoria and other desired qualities. Unlike peyote, there are typically no claims of benefit other than the immediate effects. Mild tolerance and physical dependence may develop when the more potent preparations are used to excess; however, they are virtually nonexistent for occasional or moderate regular users. There are apparently no deleterious physical effects resulting from moderate use, though excessive indulgence noted in some Eastern countries contributes to a variety of ailments. The most serious hazard is the precipitation of transient psychoses. Unstable individuals may experience a psychotic episode from even a small amount, and although they typically recover within a few days, some psychoses triggered by cannabis reactions may last for several months. In Eastern countries, where cannabis is taken in large amounts, some authors feel that it is directly or indirectly responsible for a sizable portion of the intakes in psychiatric hospitals.

In this country cannabis is not used to excess by Eastern standards; however, it does attract a disproportionate number of poorly adjusted and non-productive young persons in the lower socio-economic strata. There is some evidence that its use among other groups is increasing, but is not readily observable because of the lack of police harassment and publicity. In Eastern countries cannabis use is currently also more prevalent in the lower classes; however, moderate use is not illegal, socially condemned, or necessarily considered indicative of personality defects. The reputation of cannabis for inciting major crimes is unwarranted and it probably has no more effect than alcohol in this respect.

Of those familiar with the use of marihuana in this country, there is general agreement that the legal penalties imposed for its use are much too severe. Laws controlling marihuana are similar or identical to those pertaining to the opiates, including the mandatory imposition of long prison sentences for certain offenses. Many judges have complained that these laws have resulted in excessive sentences (five to ten years) for relatively minor offenses with marihuana. The 1962 White House Conference made the following recommendation: "It is the opinion of the Panel that the hazards of marihuana per se have been exaggerated and that long criminal sentences imposed on an occasional user or possessor are in poor social perspective."

The cultural attitude toward narcotics is, of course, a very Important determiner of legal and social measures adopted for their control. An interesting commentary on the extent to which these attitudes resist change and influence factual interpretation is afforded by the lively debate that followed the publishing of the Mayor's Committee Report on Marihuana in 1944. (7, 18, 19, 20, 43, 75, 120) This was an extensive study conducted under the auspices of the New York Academy of Medicine at the request of Mayor LaGuardia. Its findings tended to minimize the seriousness of the marihuana problem in New York and set off a series of attacks from those with opposing viewpoints. An American Medical Association editorial commented: "Public officials will do well to disregard this unscientific, uncritical study, and continue to regard marihuana as a menace wherever it is purveyed." (43) And, as Taylor points out, "We have done so ever since." (115) Anslinger, the Commissioner of Narcotics, wrote, "The Bureau immediately detected the superficiality and hollowness of its findings and denounced it." (8) The authors expressed dismay that the report was attacked on the grounds that the findings represented a public danger, rather than on its scientific aspects. (20) Walton, a leading authority on cannabis, wrote:

The report in question came generally to the same conclusion that any other group of competent investigators might reach if they repeated the inquiry under the same conditions. . . . A scientific study should be expected to report merely what it finds, avoid propaganda, and let the public do what it will with the results.( 120 )

Murphy raises the question of why cannabis is so regularly banned in countries where alcohol is permitted. He feels that ,one of the reasons is the positive value placed on action, and the hostility toward passivity:

In Anglo-Saxon cultures inaction is looked down on and often feared, whereas overactivity, aided by alcohol or independent of alcohol, is considerably tolerated despite the social disturbance produced. It may be that we can ban cannabis simply because the people who use it, or would do so, carry little weight in social matters and are relatively easy to control; whereas the alcohol user often carries plenty of weight in social matters and is difficult to control, as the United States prohibition era showed. It has yet to be shown, however, that the one is more socially or personally disruptive than the other.

References

The reference numbers below correspond to those in the original, un-shortened work on hallucinogenic drugs in generaL

3. Aldrich, C. K., "The Effect of a Synthetic Marihuana-like Compound on Musical Talent as Measured by the Seashore Test," Public Health Report, 59, 1944, pp. 431-433.

4. Allentuck, S. and K. M. Bowman, "The Psychiatric Aspects of Marihuana Intoxication," Amer. J. of Psychiat, 99, 1942, pp. 248- 251.

7. Anslinger, H. J., "More on Marihuana and Mayor LaGuardia's Committee Report," T. A. M. A., 128, 1945, p. 1187.

8. Anslinger, H. J. and W. G. Tompkins, The Traffic in Narcotics, Funk & Wagnalls, New York, 1953.

13. Benabud, A., "Psycho-pathological Aspects of the Cannabis Situation in Morocco: Statistical Data for 1956," Bulletin on Narcotics, 9, No. 4, 1957, pp. 1-16.

17. Bouquet, R. J., "Cannabis, Parts III-V," Bull. on Narcotics, 3, No. 1, 1951, pp. 22-43.

18.    "Marihuana Intoxication," I. A. M. A., 124, 1944, pp. 1010-1011.

19. Bowman, K. M., "Marihuana Problems," I. A. M. A., 128, 1945, pp. 899-900.

20.    "Psychiatric Aspects of Marihuana Intoxication," I. A. M. A., 125, 1944, p. 376.

23. Bromberg, W., "Marihuana: A Psychiatric Study," I. A. M. A., 113, 1939, pp. 4-12.

24.     , "Marihuana Intoxication," Amer. I. of Psychiat., 91, 1934, pp. 303-330.

28. Charen, S. and L. Perelman, "Personality Studies of Marihuana Addicts," Amer. I. of Psychiat, 102, 1946, pp. 674-682.

29. Chopra, I. C. and R. N. Chopra, "The Use of Cannabis Drugs in India," Bull. on Narcotics, 9, No. 1, 1957, pp. 4-29.

30. Chopra, R. N. and G. S. Chopra, "The Present Position of Hemp-Drug Addiction in India," Indian I. Med. Res. Memoirs, No. 31, 1939, pp. 1-119.

31. Chopra, R. N. and I. C. Chopra, "Treatment of Drug Addiction: Experience in India," Bull. on Narcotics, 9, No. 4, 1957, pp. 21-33.

42. Editorial, "Dagga," So. African Med. J., 25:17, 1951, pp. 284-286.

43. Editorial, "Marihuana Problems," T. A. M. A., 1945, p. 1129.

49. Fraser, J. D., "Withdrawal Symptoms in Cannabis-Indica Addicts," Lancet, Pt. 2, 1949, p. 747.

50. Freedman, H. L. and M. J. Rockmore, "Marihuana, Factor in Personality Evaluation and Army Maladjustment," J. Clin. Psychopathology, 7 and 8, 1946, pp. 765-782 and 221-236.

51. Gaskill, H. S., "Marihuana, an Intoxicant," Amer. J. of Psychiat., 102, 1945, pp. 202-204.

53. Gomila, F. R., "Present Status of the Marihuana Vice in the United States," in Marihuana, America's New Drug Problem, Lippincott, New York, 1938.

75. Marcovitz, E., "Marihuana Problems," J. A. M. A., 129, 1945, p. 378.

76. Marcovitz, E., and H. J. Myers, "The Marihuana Addict in the Army," War Medicine, 6, 1945, pp. 382-391.

77. Maurer, D. W., and V. H. Vogel, Narcotics and Narcotics Addiction, Charles C. Thomas, Springfield, Ill., 1962.

78. Mayer-Gross, W., E. Slater, and M. Roth, Clinical Psychiatry, Cassell and Co., London, 1954.

79. The Marihuana Problem in the City of New York, Jaques Catte11 Press, Lancaster, Pa., 1944.

83. Michaux, H. Light Through Darkness, trans. by H. Chevalier, The Orion Press, New York, 1963.

86. Murphy, H. B. M., "The Cannabis Habit: A Review of Recent Psychiatric Literature," Bull. on Narcotics, 15, No. 1, 1963, pp. 15-23.

101. Siler, J. F., et al., "Marihuana Smoking in Panama," The Military Surgeon, 73, 1933, pp. 269-280.

115. Taylor, N., Flight from Reality, Duell, Sloan and Pearce, New York, 1949.

119. Walton, R. P., Marihuana, America's New Drug Problem, Lippincott, New York, 1938.

120.     , "Marihuana Problems," J. A. M. A., 128, 1945, p. 383.

121. White House Conference on Narcotic and Drug Abuse, U. S. Government Printing Office, Washington, 1963.

122. Williams, E. G., et al., "Studies

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