to Wootton Report Index
Review of the International Clinical Literature by Sir Aubrey Lewis,
Professor of Psychiatry, University of London
physical effects of cannabis intoxication are raised pulse rate and blood pressure,
dilated sluggish pupils, injected conjunctival vessels, tremor of tongue and mouth,
cold extremities, rapid shallow breathing, ataxia and active deep reflexes. The
severity of the symptoms depends not only on the dose and preparation but on the
individual. A young English-woman on one occasion smoked two-thirds of a home-made
hashish cigarette which had not upset her husband; she promptly developed gross
incoordination of the hands, astasia, rapid pulse, and dyspnoea. In soldiers who
took cannabis a temporary loss of consciousness has been reported with slow irregular
pulse and low blood pressure. Others have described vertigo and vomiting, and
death is said to have occurred from cardiac failure or intestinal distention after
gross overeating. But severe physical disturbance is rare. A common initial effect
of smoking the drug is intense cough or burning feeling in the throat and chest.
psychological effects of acute intoxication were first described in detail by
Moreau de Tours: euphoria; excitement; disturbed associations; changes in the
appreciation of time and space; raised auditory sensitivity with elaboration of
simple phrases or tunes: fixed ideas: emotional upheaval; and illusions and hallucinations.
is much increased (the assassination of General Kleber is supposed to have been
carried out by a fanatic whose heightened suggestibility under cannabis made him
a pliant catspaw).
are no aphrodisiac effects, in spite of widespread popular belief. Erotic fantasies
may be well to the fore, but they do not lead to action.
is much individual variation in the psychological effects. Perhaps because of
ethnic and social differences and the effects of different preparations of the
drug, widely divergent accounts are to be found in published papers. Lord Todd
put it succinctly: "To give an accurate picture of the effects of hashish
is extremely difficult, partly because they are more subjective than objective
and because individual variation in response is probable greater with this than
with any other drug.... Among the commonest recorded effects are the feeling of
well-being alternating with depression, distortion of time and space, and double
consciousness. Objectively there is a period of excitation and exaltation, followed
often by sleep or coma".
subjects feel acute anxiety as soon as the drug takes effect; others are pleased,
amused, elated, although they may be aware that their thought processes are somewhat
disordered, their memory impaired and their self-control diminished. The phases
of abnormality might come in waves, heralded by sudden violent headaches. The
emotional state is not in keeping with the subjects situation, and as the
intoxication grows less, subjects mostly feel apathetic and depressed. During
the acute stage of intoxication they may have become suspicious and afraid that
they will be permanently insane, or that their friends are trying to find grounds
for shutting them up in a mental hospital. Characteristic visual phenomena are
almost invariably reported; they are not true hallucinations but illusionary falsification,
greatly elaborated by some subjects. Perception of ones own body is commonly
interfered with and outright depersonalization may occur. With small doses of
cannabis the effect may be wholly subjective, mild and gratifying.
first signs of intoxication, appearing about three hours after consuming the drug
by mouth may be nausea or vomiting, with gross movements and loquacity. Disorders
of thinking may be overt, or detectable by close examination. Intoxicated persons
may be unable to retain more than a single sentence so that conversation is disjointed
and may be unintelligible; a communication that has been heard and understood
may be lost in a few seconds; in the middle of a lively conversation, speech may
stop abruptly and the intended remark is gone beyond recovery. The disturbance
of memory may be severe in one person and negligible in another. The time schedule
varies according to the mode of consumption. After smoking hashish resin, acute
anxiety and restlessness may come on within about half-an-hour; then calm and
pleasant sensations supervene with visual imagery; and in one to two hours the
subject becomes sleepy; when be wakes from the ensuing sleep he may be able to
recall details of the intoxication. If, however, he has taken the cannabis in
powder form it may take three to six hours for sleepiness to come on.
Europeans, though the order of events may vary a great deal, a typical sequence
is eupnoria with restlessness; then confusion, disturbed visual and auditory perception;
then a dreamy state; and finally depression and sleep. On waking after this sleep,
there may be numbness, dysarthria and some amnesia. Many Moroccans, when under
the influence of the drug, become gay or relaxed, though it is not rare for anger
to be expressed in some act of violence. According to one observer, they value
cannabis because it frees them temporarily from moral and cultural restraints
on conduct. In contrast to the torpor described in some subjects, the Moroccans
may feel that they can do difficult things easily, and they may jump and dance.
Hesnard, a psychiatrist who has observed Turkish and Syrian hemp addicts, described
them as incoherent in speech but self-observant; talkative, exuberant, gesticulating
and running hither and thither, but incapable of mental work, and agitated. Noisy
laughter may be incongruously accompanied by sadness. Intense depersonalization
have erotic desires which they do not translate into erotic behaviour. In Brazil,
according to Wolff and other Brazilian psychiatrists, the picture is different
from that described elsewhere; sexual orgies are alleged to take place.
discrepancies in published accounts of acute intoxication may be, in part, accounted
for not only by individual constitution and the effect of adulterants, but also
by differences in dosage. Practised hashish consumers have usually learned how
to regulate the dose of whatever preparation they use so that the disagreeable
effects are minimal.
the symptoms of acute intoxication, gross mental disturbances are described which
can properly be called psychotic. They are usually the outcome of taking a fairly
large dose of the drug; and the clinical picture is that of a severe exogenous
psychosis delirium with confusion, disorientation, terror or anger, and subsequent
amnesia about what happened during the period of intoxication. Although most often
described in countries where cannabis is widely resorted to, striking instances
are reported also in Europeans.
this acute setting, the most frequent psychotic features are: paranoid delusions
of being pursued or controlled: delusions of preternatural abilities; strong inclinations
to suicide which are not carried into action unless associated with panic: and
irritability. Waxy flexibility and other catatonic features have been observed.
impulse to suicide may be very strong; a doctor who took forty drops of tincture
of cannabis indica developed at first great anxiety and fear of death, then I
was possessed with an almost irresistible desire to commit suicide by rushing
to the adjoining canal or cutting my throat with the knives on the table close
by, though no attempt was made at doing so. Shortly upon this, I was seized with
fits of alternate laughter and crying, without any apparent cause. When the symptoms
were subsiding my appetite became ravenous accompanied by great thirst.... I experienced
no pleasurable intoxication or feeling of happiness. but the very reverse".
is a sharp contrast between the ecstatic and relaxed state described in many reports
and the restless activity occasionally observed (along with exaltation, irritability,
emotional excess, noisiness and even reckless violence) in some subjects,
especially in the Punjab or in Brazil. Evidently, large doses produce anomalous
effects, seldom seen in mentally stable persons or in those who have learned to
regulate their intake so that it should be pleasurable. An example of how excess
can affect the individual is provided by a French youth aged 20 who smoked five
hashish cigarettes straight off. He became very agitated and restless, rushed
around Pans and eventually, fourteen hours after he had taken the drug, he went
into a police station to give himself up for having murdered his step-father (an
entirely baseless delusion). The duration of the psychotic intoxication was longer
in his case than is usual; as a rule, the condition clears up in three to six
studies of the effects of cannabis have suffered from the limitation that they
were carried out either on highly selected subjects - prisoners and drug addicts
- or on very small samples, sometimes only two or three persons. The main findings
have been that simple functions like tapping speed and reaction time were very
little affected by moderate doses of cannabis, but that steadiness of hand movements
and complex reaction time were adversely affected, the maximum change occurring
about four hours after ingestion.
intellectual tasks speed and accuracy were impaired, the degree depending on the
dose. Surprisingly, the ability to estimate short periods of time was not reduced
in an American study, but the subjects were chronic addicts; whereas in an experiment
carried out by two psychiatrists on each other, under laboratory conditions. time
intervals were overestimated. Two German psychiatrists examined thirty normal
subjects, and found three types of intellectual disorder - incapacity to fuse
details into a whole; reduced memory storage; and blocking; these observations
were made, however, after the drug had been administered in the form of cannabinol
on Persons already Pschotic
the 1930s experiments were carried out on schizophrenic and depressed patients
in mental hospitals to see what cannabis would do to them and how far the drugs,
alleged to be psychotomimetic, would intensify psychotic symptoms. The findings
were not uniform. Affectivity was altered but in different ways and degrees; some
schizophrenics became euphoric and hyperactive, others became catatonic; surprisingly,
only two-thirds of the schizophrenics developed hallucinations. Some of the depressed
subjects became euphoric, others passed into a depressive stupor. Autism was intensified
in some schizophrenics and symptoms that had previously cleared up were revived.
The schizophrenic patients showed less change in time and space perception than
normal subjects while under the influence of the drug. Impulsive acts were more
prone to occur in schizophrenic subjects than in normal cannabis users.
of those who take cannabis in any society have been introduced to the habit by
an acquaintance. The amount of pressure varies from country to country - the commoner
the habit, the more ready the compliance - and from group to group. In Egypt (where
penalties are severe and include capital punishment for trafficking), the habit
is nevertheless very widespread; and, as was shown by a recent investigation on
253 men who had used hashish at least once a month during the previous year, conformity
to the ways of the group emerges as a powerful factor, especially among those
who have been led to expect a blissful experience and sexual stimulation from
it. Taking it is a convivial affair; four to six friends meet in the evening,
smoke and engage in light conversation. Similarly, an American report confirmed
the view that marihuana is a socially utilized intoxicant, seldom taken in solitude.
Those who have studied American college students who smoke marihuana conclude
that they do so because they are alienated from the values of adult society. which
exposes them to conflicting demands; through this habit they can mortify their
parents and flout authorities. This is a speculative interpretation of their motives.
fullest available description of the social conditions which foster the marihuana
habit comes from Oakland, California. It counterbalances, and perhaps corrects,
the picturesque and alarming observations made on more degraded, psychopathic,
criminal, or poverty-stricken and under-nourished groups. The investigators obtained
the confidence of the youngsters, mostly Negroes and Mexicans, through providing
them with club amenities, without strings. They were firm in their convictions
based on their own experience, that the use of such drugs as marihuana results
in harmless pleasure and increased conviviality, does not lead to violence or
madness. can be regulated, does not lead to addiction, and is less harmful than
alcohol. They were not interested in being helped to abstain from marihuana, and
they cited case after case of individuals known to them who had not suffered deterioration
in health, school achievement, athletics or career as a result of their habit
of smoking marihuana. Boys who take the drug in excess were considered by the
rest to have a weak personality.
are several patterns of use and users among these youths. They themselves recognize
four types, for which they have cant names. The "rowdy dude" Wants to
impress and frighten others and has difficulty in getting marihuana from other
youths because he is reckless and irresponsible and they fear he will get them
into trouble with the police: he is subject to pressures which direct him towards
becoming a criminal or an opiate addict. The "rowdy dude" may settle
down, when he stops taking alcohol or sniffing glue, and starts to take marihuana
instead. In that case he becomes a "pot head" who limits himself to
marihuana smoking. or a "mellow dude" who uses amphetamines or barbiturates
or methedrine as well as marihuana. Both the "pot heads" and the "mellow
dudes" value sang-froid. They believe themselves to be intelligent, daring,
cool-headed, worthy of respect, and they do not resort to violence they remain
at school or at work and engage in athletics. They will smoke marihuana three
or four times a day, especially if they are going to a party; they believe it
breaks through their shyness in approaching girls and increases the pleasure of
sexual intercourse. Thc fourth type is the "player", an older youth
who sells drugs and becomes a violent criminal or a pimp or fence; he may take
to heroin but will mostly be on his guard against any drug that may reduce his
into marihuana-smoking in this group is usually effected through the desire to
emulate older boys. The Oakland investigators reject firmly the usual assumption,
that those who take to the habit are mainly influenced by emotional disturbances
and social stresses. Their observations do not support the explanation which regards
marihuana use as an effort to escape from reality or to vent underlying hatred
of organized society. They conclude that "induction into drug use is a developing
experience that depends on access to drugs, acceptance by drug-using associates
and kinds of image that youngsters have of drugs". So far from retreating
from reality, marihuana-users are held to be making a positive effort to be in
the mainstream. The investigators likewise reject the notion of a steady progression
from marihuana to crime and opiate addiction. It may occur, as the four types
indicate, but most users steer away from these courses. Many of the Oakland youths
had experimented with heroin, but only four had become addicts.
summary conclusion by the Oakland observers is unequivocal: "Youthful drug
use in Oakland is an appreciable extensive and deeply rooted practice, lodged
primarily in the lower strata but currently expanding into middle and upper class
strata. It is woven into a round of adolescent life as a collective practice .
. . and is buttressed by a body of justifying beliefs and convictions, involves
a repertoire of practical knowledge and incorporates a body of precautions and
protections against apprehension or arrest. Drug use constitutes for the users
a natural way of life and does not represent a pathological phenomena".
age at which use of the drug began. according to practically all the studies reported,
was in adolescence, though children have sometimes begun before puberty. In a
group of American negro soldiers who had been admitted to hospital because of
their cannabis-taking and its ill effects, 13% said they had started doing so
before adolescence and two-thirds had started before they were seventeen.
majority of users apart from university students. belonged to the urban proletariat.
In Nigeria, where the habit has only recenty been developing on a large scale,
the people mostly affected had drifted to the city and live on the fringe of organised
society. Others who take it are long distance lorry drivers who believe that it
increases staying power and courage, enabling them to take daredevil risks: among
twenty-six cannabis-using patients admitted to Aro Hospital in Abeokuta, eight
were lorry or taxi drivers. In North Africa. the rural population is also affected
but much less so than the industrial workers and the unemployed who are often
under-nourished. During Ramadan there is a rise in the number of cannabis-takers
that has to be admitted to the mental hospital. Among cannabis users from Upper
Egypt, who are predominently rural, there is a larger proportion of people with
average or above average incomes than in those from Cairo. In several Asiatic
countries the well-to-do smoke or otherwise consume their cannabis in private
and in moderation; they do not get into the statistics or serve to tone down the
published description of the coarse effects of cannabis.
Morocco and Nigeria and some other African countries, cannabis-taking is not exclusively
a masculine preserve, though women who do so are far fewer than men. In South
Africa, 10,044 male Africans and 632 females were convicted of possessing cannabis;
for Europeans, the corresponding figures were respectively 181 male and 4 female.
is no convincing evidence that, other things being equal, the nationals of any
particular country are more prone to take cannabis than, say, Englishmen or Burmese.
In American reports, especially those based on military experience. Negroes and
Puerto Ricans are to the fore but this is adequately accounted for in terms of
the psychological, economic and civic background of their lives.
is impossible at present to disentangle the psychological, climatic, social and
religious factors which may determine the range and style of cannabis-taking.
Confident statements about one or other such influence rest on impressions and
conjecture. There are sweeping generalizations (such as that Moslems use cannabis
because they are forbidden alcohol, whereas Hindus prefer opium) and detailed
accounts of the extraordinarily diverse ways in which the drug is prepared and
taken in different countries. Ethnic factors are loosely invoked. But never with
adequate evidence. It has been asserted, for example, by a Psychiatrist who had
had extensive experience in Algeria, that hashish is suited to the dreamy and
contemplative temperament of the Moslem, alcohol to the hyperactice Westerner.
Another authority, well acquainted with the Moroccan situation, says that the
people of that country are imaginative and emotional and that they gain relief
through the drug when they are in distress. A German psychiatrist who had spent
two years in Morocco reported this year, that impulsive behaviour under hashish
can be attributed to "the Moroccan mentality", which is also "prone
to trance states". Another, with long Egyptian experience, attributes the
growth of the practice there to foreign domination, the prohibition of alcohol,
and the special tribunals for foreigners which made illicit traffic easy and safe.
A Brazilian doctor maintains that dwellers in the lowlands need cannabis while
those who live and work in the high plateaux of the Andes need the coca leaf to
sustain them amid the extreme rigours of their lives.
from the Brazilians and adherents of the Ras Tafari cult in Jamaica, a direct
association with contemporary religions had not been reported; the continuing
role of cannabis in Ayurvedic and Unani medicine cannot be regarded as of a religious
attitude of the general public towards cannabis is not constant, nor evenly spread
through the different sections of society. In India, and particularly in Bengal,
taking the drug is not regarded with disapproval, according to most observers.
Sixty or seventy years ago, however, most of the population looked down on the
drug-takers, largely because of the degraded class they came from; but consumption
of the drug by sadhus who were, in many cases, deeply committed to the habit,
was viewed tolerantly. The public attitude in Mexico has also been reported to
be tolerant. Satisfactory information about the attitude of various sections of
Western society does not exist; inference from newspapers tends to be inconsistent.
or how far particular features of personality conduce to the establishment of
the cannabis habit is a highly contentious question, as much so as in the case
of alcohol. At one extreme are those (like P. O. Wolff reporting on the peasants
of Brazil) who deny that there is any predisposition, and at the other extreme
those who regard defects of personality as prepotent - not only in bringing about
habituation but also in determining the form of psychological disturbance produced.
Since the estimates of personality are made in almost all cases retrospectively
on persons known to be cannabis-users, there is much uncertainty as to whether
the traits described were consequences of the habit or had preceded it and favoured
its development. The temperamental qualities most often cited as predisposing
are anxiety and impulsiveness, shyness combined with a longing for social contacts,
immaturity and emotional instability, and various neurotic and psychopathic features.
They are clearly unspecific.
American psychiatrists who studied a hospital group of cannabis-takers concluded
that "the personality pattern of these men is one of strong libidinous desires
resulting from early home conflict, a weak ego which identifies with an undesirable
father image. and a super ego created by the moral mother.... Use Of marihuana
removes the super ego which, in turn, strengthens the ego and enables it to satisfy
the libidinous desires at various levels of infantile behaviour". Another
writer, less psychoanalytically recondite, has found that homosexual tendencies
are at work among the men who take cannabis to excess. A respectable body of opinion
is to the effect that, though there is no doubt that faults of character may be
found in those chronic users who reach hospital or prison, the majority of moderate
users are within the normal range of personality. This is in sharp contrast to
reports like that on the United States marihuana-smoking soldiers in the Panama
Canal Zone, which found that 85% of the men were mentally abnormal - 62% were
classified as constitutional psychopaths and 23 % as morons.
are notoriously great differences between countries in the prevalence of cannabis
use, but reliable estimates do not exist. Surmises are based on the quantities
of the drug seized by the police, the number of convictions, and the proportion
of people in mental hospitals who admit to having taken it. The figures thus arrived
at are very high for some countries. Thus the most recent assessment for Egypt
is that 27,000 kilograms of hashish were smuggled into the country, to be used
by about 80,000 habitués (out of a total young male population of some three million
persons). Gross figures are calculated for Morocco (50% of the population-"a
million habitués"), and for some other countries. It is difficult to regard
these as more than guesses.
same uncertainty holds good of current estimates in North America and in Europe.
A recent cautious statement, based on United Kingdom convictions for possessing
or using cannabis, arrived at a figure of 30 regular users per 100,000 of population,
and as many more who have tried it a few times.
has centred on university students. In a sample of London students, 4% have been
said to be steady users and 10% occasional users; because of penalties, fluctuations
of opinion and other obstacles in the way of a trustworthy survey, such a finding
cannot be generalized. It has been reasonably stated that the amount of addiction
to a drug in any given population is a composite of availability, price, legal
codes. suggestion, cultural attitudes, psychological needs and socio-economic
factors; the product of such mixed influences could hardly be unchanging. In a
questionnaire to which 1,245 students replied at Brooklyn College, New York, it
emerged that progression to other drugs very seldom occurred though three-quarters
of the students had, at one time or another, experimented with marihuana. One-third
had done so on only one occasion.
EFFECTS OF ABUSE
Effects apart from Crime and Psychosis
with long experience concur in the opinion that continued excessive use of cannabis
over a period of years leads to moral and social decay; countries from, which
such reports come are South Africa, Morocco, Algeria, Tunisia, Syria, Turkey,
Astrakhan and India. In a few reports, such conclusions are extended to cover
chronic use of the drug in only moderate doses but the majority of observers distinguish
between heavy dosage and restrained use, restrained use is widely regarded as
harmless in its effects, provided the consumer had, from the outset, a healthy
mental constitution. In defining healthy mental constitution, circular reasoning
is apt to creep in.
Mayor of New Yorks Committee on Marihuana found that people who had been
smoking marihuana daily for years showed no abnormal psychological functioning
which would differentiate them from non-users. The population selected for study,
however, was composed mainly of men in prison who had volunteered for the study;
they were hardly a representative sample of users and non-users. The Indian Hemp
Commission of 1894 reported, after an elaborate enquiry, that moderate use produces
no injurious effects except in persons with neurotic diathesis but that excessive
use may intensify mental instability and moral weakness, and lead to loss of self
that most writers report in the excessive chronic cannabis-user is apparent in
several ways. He is irritable and impulsive, or inert and dreamy; he neglects
himself grossly and is incapable of sustained effort; he may become a beggar or
a vagrant, taking no responsibility for his family; he may practise homosexual
or other sexual abnormalities or become impotent; he may be hypochondriacal or
apathetic. His unkempt and prematurely aged appearance, inflamed eyes, tremor,
and malnutrition are said to make up a fairly characteristic picture.
on Occupational Capacity
of his impaired judgment, especially of space relations, and his irresponsibility,
the chronic user - as well as the person acutely intoxicated - is dangerous when
driving a car or lorry; this has been reported particularly from African countries.
But the general occupational record of chronic users is not invariably bad, and
no one has succeeded in determining how many continuous users become incapable
of regular work. Bouquet and others have pointed out that there are some men who
have been smoking hemp for thirty or more years and continue to follow their occupations
satisfactorily: "A few daily pipes of kif are merely an agreeable weakness,
enough to produce the condition of wellbeing they desire. They rest content with
that". In contrast, a pronouncement in the United Nations Commission on Narcotic
Drugs, E/CN/7/L.91, stated that "the study points up unequivocally the danger
of cannabis from every point of view, whether physical, mental, social or criminological".
statements regarding the association between crime and cannabis illustrate the
confused and contradictory standpoint taken up by experts, and the loose reasoning
evident when a causal nexus is being considered.
the views first of those who believe that cannabis can bring about criminal behaviour,
some uncompromising conclusions are put forward, e.g. "literature surveys
and personal contacts have clearly demonstrated the association between the use
of marihuana and the commission of various crimes". Several describe outbursts
by chronic users, in which they are wildly agitated and, seizing some handy weapon,
attack a nearby person, often without the faintest motive for hostility: "murders
are frequent and motiveless". A Greek investigator inquired into the subsequent
history of 170 people who were arrested for possessing cannabis between 1919 and
1950 but had not previously been before a court for any offence; he found that
117 of these were subsequently sentenced for crimes of violence, blackmail and
similar serious offences. P.O. Wolff wrote in 1949 that the drug had given rise
to "a most appalling percentage of the tragedies and crimes in Cuban society",
and he described similar consequences in Brazil. One of the outstanding French
authorities on cannabis recounts the sequence of events he has often observed
in victims of chronic intoxication: they pass into a state of torpor in some secluded
spot; then abruptly they become agitated and the slightest opposition now moves
them to violence and perhaps to sexual crimes (especially if they combine other
drugs with their cannabis). A Moroccan investigator also emphasizes the lack of
adequate motive or premeditation in the outburst of persistent, often murderous,
violence; arson is fairly common; the impulsive attacks may be in several respects
like those of an epileptic, occurring in a state of disturbed consciousness. Lesser
crimes, such as theft and procuring, are common but do not seem to have evoked
in observers the strong feeling indicated by such epithets as "heinous".
"savage", which are applied to the outbursts of violence. Running amuck
is considered by some to be a manifestation of chronic cannabism.
these supporters of the view that cannabis causes crime, are the almost equally
numerous and authoritative writers who deny any direct causal connection though
they do not dispute the frequent concomitance of cannabis and crime. The most
influential and in some respects, the most thorough enquiries were made by the
Indian Hemp Commission of 1894 and the Mayor of New York's Committee in 1944.
The former concluded that "the connection between hemp drugs and ordinary
crime is very slight indeed" but that excessive use does, in some very rare
cases, make the consumer violent; six hundred witnesses were asked by the Commission
whether they knew of cases of homicidal frenzy, and very few had. A considerable
majority of the witnesses did not consider that the drugs produced unpremeditated
crimes of violence and some said (as other Writers have since) that there is a
negative relation because cannabis makes men quiet as a rule. The Mayor's Committee
reported to a similar effect; many criminals might use the drug but it was not
the determining factor in the commission of major crimes.
observers in Brazil reported in 1962 that an exhaustive inquiry which they had
made in the jails and hospitals had not produced any evidence that cannabis is
an important cause of crime. This finding runs sharply counter to Pablo Wolff's
observations in the same country.
negative conclusions about the causation of crime in cannabis-takers come from
Vancouver; the American Armed Forces abroad; New York and California and Nigeria.
The Nigerian psychiatrist (Asuni), who examined a series of cannabis-takers, found
no major crime among them except in one man who was schizophrenic, and another
imprisoned for reckless driving. His general findings are in keeping with the
moderate contemporary view, viz. that there is an antecedent predisposition towards
psychopathic or criminal behaviour in those cannabis-user who do commit crimes,
the cannabis often merely revealing or intensifying abnormal tendencies; and that
circumstances arising from cannabis-taking may have fomented criminal conduct;
"The people involved in cannabis-smoking . . . tend to be driven underground.
In this situation their sense of isolation from the main body of society gets
intensified. Their sense of value also changes to that of their new subculture,
and this new sense of values may be generally asocial or anti-social". The
Medical Director of the Lexington Narcotic Center in 1947 described the same downward
progression: "It would be difficult for a normal personality to undergo such
experiences without harm; for the type of personality that seems to be the background
for addiction, they may cause irreversible distortions". Unfortunately, the
type of personality that pre-disposes to cannabis-taking has not so far been described
or identified convincingly.
reasons why there should be fiat contradiction between the findings of different
observers are: criminals in some countries base their defence on alleged cannabis
intoxication which provoked behaviour that they cannot remember and for which
they cannot be held fully responsible (just as epilepsy is often entered as the
defence in our courts for crimes of violence); many who use cannabis in various
countries combine it with opium, heroin, amphetamine, barbiturate or alcohol,
and it is impossible to tell which, if any, of these is to blame for the criminal
behaviour observed in a given individual; the samples of persons investigated
have mostly been small and the history of drug-taking, its duration and degree
in each individual has been provided by the man himself, who often believes it
to be to his interest to lie about it. When criminal behaviour occurs in people
who take cannabis steadily, it is by some confidently assumed, and by others confidently
denied, that the crime was caused by the cannabis, though thc available data are
insufficient to permit a judgment either way. Only rarely in published reports
on criminals and cannabis has a satisfactory effort been made to distinguish between
chronic cannabis-use and infrequent or casual experimentation, or between criminals
who have recognizable mental disorders and those who are mentally normal, apart
from the criminal episode.
one delinquency which receives general reprobation is driving while under the
influence of cannabis whether on an isolated occasion or when bemused by chronic
excess. The old story that cannabis was taken to nerve men to go into battle and
to commit murders to order, has little or no foundation except perhaps that the
mercenaries employed to put down riots and revolts in lndia were, according to
the Indian Hemp Commission, habitual consumers of cannabis who acquired "Dutch
courage" thereby. As mentioned earlier, advantage may be taken of the heightened
suggestibility of the cannabis-user.
most likely relation that emerges from the welter of connecting statements is
that chronic or excessive indulgence in cannabis may, in some people - a small
minority ofthe male public at risk - lead to attacks of disturbed consciousness,
excitement, agitation, or panic, and reduce self control. The extent to which
the affected person may commit a crime in this state of mind depends more on his
personality than on the dose or preparation of cannabis which he has been taking.
psychoses" have been frequently described and the accounts include practically
every known variety of mental disorder. The predominant and most frequently put
forward are schizophrenia and especially catatonia; paranoid states; manic excitement;
depression and anxiety; and dementia. A writer on the subject whose report (1903)
has been often quoted or borrowed, was Warnock, the Medical Superintendent of
the mental hospital in Cairo. He had recognized as hashish psychoses an acute
hallucinosis with restlessness and incoherence, and a manic condition; but he
added that "besides these types, there are numbers of cases of chronic mania,
mania of persecution and chronic dementia, alleged to be produced by hasheesh,
but I have no means of verifying these allegations". He also wrote: "I
doubt very much if hasheesh insanity can be at present diagnosed by its clinical
characters alone". This is a cautious view; other observers who have seen
many patients to whom they gave this diagnosis, dwell on dementia as a fairly
common outcome of chronic use of the drug, or assert that there is a typical and
striking uniformity of symptoms in the cannabis psychosis. An Indian psychiatrist.
Dhunjibhoy, defines it: "A patient admitted to an Indian mental hospital
with intense excitement, grandiose ideas, tendency to wilful violence, a peculiar
eye condition (marked conjunctival congestion), total amnesia of all events, attacks
of short duration, followed by complete recovery, with a history of the drug habit
and without a psychopathic or neuropathic heredity, is a typical case of "hemp
insanity." Some obsersers describe severe mental deterioration as a familiar
outcome while others with much experience say this does not occur at all.
term "Cannabis psychoses" begs the question of the existence of such
a syndrome. On the one hand, there is a cloud of witnesses qualified to speak
by lifelong contact with the problem in mental hospitals of countries in which
cannabism is very common: they are convinced that the condition is correctly identified.
"The effects of the drug are detailed in all the well known text-books and
that its abuse is a direct source of serious mental disorder is indisputable",
wrote a senior doctor of the I.M.S. in 1923. A high proportion of the patients
admitted to mental hospitals in India and Egypt and elsewhere were diagnosed as
falling in this category.
the other hand. there were equally informed doubts as to the legitimacy of the
diagnosis in many cases. These doubts were cogently expressed by the Indian Hemp
Commission in 1894. Out of 1,344 admissions to the asylums of India during 1892,
there were only 98 patients in whom the use of hemp drugs could reasonably be
regarded as a factor in causing the insanity, and in 37 of these there was a clear
history of some other cause which might have co-operated with the hemp drugs.
The Commissioners concluded, after an enquiry of still unequalled scope, that
"the usual mode of differentiating between hemp drug insanity and ordinary
mania was in the highest degree uncertain and therefore fallacious.... The excessive
use of hemp drugs may, especially in cases where there is any weakness or hereditary
predisposition, induce insanity. It has been shown that the effect of hemp drugs
in this respect has hitherto been greatly exaggerated, but that they do sometimes
produce insanity seems beyond question". Nevertheless, it bas been questioned.
Even so guarded a statement implies that there are some sure criteria for establishing
the causal role of the cannabis, either when it has been established that a man
exhibiting a so-called "functional psychosis" had previously been for
years smoking or eating cannabis: or when such a history precedes the onset of
an "exogenous psychosis" exhibiting the cognitive and other defects
attributable to physical or chemical damage to the brain. As a rule the writers
on the subject do not give enough detail to warrant any attempt at retrospective
diagnosis; but in those who do, there are instances of persistent confusional
syndromes shading off with the passage of time into chronic dementia, in which
the cannabis seems to have been the major cause.
reasons for the discrepancy in opinion expressed by equally experienced observers
seem to be:
The motion of a single cause for mental disorder, widely held in the last century,
is no longer regarded as tenable. Consequently the last two decades have seen
few assertions about cannabis being the cause of insanity, but many espousing
the view that it has been either a necessary or a contributory cause, especially
where evidence of predisposition to psychosis is forthcoming from a patients
previous personality and health record.
The clinical picture of what has been regarded as cannabis psychosis has not had
any characteristic features (such as delirium tremens has. for example). It has
often been indistinguishable from schizophrenia.
The reasons put forward earlier (page 48) for the discrepant opinion about crime
and hashish, apply here.
In many of the published reports it is made clear that the hashish was combined
with other substances - datura, alcohol, heroin or amphetamine - which could be
responsible for the psychosis which developed. The cannabis might have had nothing
to do with it.
The history of the patients previous mental state has been only cursorily
enquired into, often for lack of dependable informants. Many of these patients
may have had established or incipient mental illness; quite independently of cannabis,
before the incident - a crime or a catastrophe - which brought them into a mental
The diagnostic methods employed in many studies were, by any reasonable standard,
woefully inadequate. In one large area, the diagnoses might be made by a policeman.
The long-standing belief that cannabis causes insanity could strengthen this diagnosis
in a doubtful case. Ingrained beliefs and habits are known to be powerful enemies
of unbiased diagnosis.
is no unequivocal evidence that cannabis can be the major or sufficient cause
of any form of psychosis. Neither is there clear evidence that moderate euphoriant
or tranquillizing doses, even if taken over a long period, do mental harm in the
majority of people of average mental stability, though rare isolated cases are
on record in which persons apparently in good mental health have reacted with
a pronounced mental disturbance to moderate doses. In large doses, cannabis can
result in severe psychosis which may not clear up; it can be of the schizophrenic
paranoid form, anxiety, or excitement. It is usually assumed that persons constitutionally
predisposed to psychosis will be those most vulnerable to cannabis; but although
this is in keeping with current psychiatric theory, it lacks experimental or statistical
confirmation. In many cases it could be argued that the patient would have fallen
ill with schizophrenia or other psychosis even if he had not had any cannabis.
This would be a weak contention if it were not so often stated by clinicians that
the "hashish psychosis" may be indistinguishable from schizophrenia.
AND THERAPEUTIC USE
have been claimed from cannabis, but trustworthy reports have been few and vague.
It is said to promote relaxation and calm after the trials of daily life, and
to assist shy people to enter into warm social relations; it lessens awareness
of pain and misery; it helps to allay neurotic anxiety; and it is an aid to religious
fervour. A prominent American psychiatrist recently wrote, apropos of eleven university
students who had had severe adverse reactions from cannabis:
evaluation of harm a drug does requires some consideration of its benefits. Users
of marihuana state that it is a source of positive pleasure, that it enhances
creativity, that it provides insight, and that it enriches their lives. These
are hardly minor claims. All but two of the eleven individuals reporting adverse
reactions considered the benefits to far outweigh the unfortunate aspects and
they planned to continue use of the drug".
ancient times, cannabis has been credited with therapeutic powers, especially
in India. Its introduction into Europe in the mid-nineteenth century led to the
familiar burst of enthusiasm for a new remedy. This dwindled as time passed but
died slowly: "During the period 1840 to 1900, there were something over one
hundred articles published which recommended cannabis for one disorder or another".
Its vogue preceded the advent or synthetic hypnotics and analgesics, and it was
lauded for its effect in alleviating pain, migraine, insomnia, dysmenorrhea, difficult
parturition and cramps. In 1890. Russell Reynolds wrote that "when pure and
administered carefully it is one of the most valuable medicines we possess".
was also said to be good for mental disturbances though its proponents rather
shamefacedly acknowledged that this line of treatment had a homeopathic flavour.
As late as 1928, an article appeared reporting that cannabis was valuable for
severe melancholia. There are still a few who assert the therapeutic value of
the drug: because it heightens suggestibility and weakens inhibitions, they find
it a useful adjuvant in eliciting submerged memories and feelings which the patient
cannot otherwise communicate. Its antibiotic powers have also been explored in
on such straight-forward matters as tolerance and the development of physiological
dependence, there are contradictory statements. Practically all informed opinion
is satisfied that neither of these develops; yet there are statements to the contrary.
"Quite serious disorders are observed in those addicted to the drug over
a long period when their poison is removed. Attacks of physical prostration and
intellectual apathy, especially, are noted". (Bouquet). A Turkish and an
Egyptian observer separately describe how the patients increase the quantity of
cannabis they take in order to maximize the pleasurable effects. In Russia, Skliar
has observed severe symptoms after withdrawal of "anascha": among them
were anxiety, pains in the limbs, vomiting, diarrhoea. Sweating, yawning and depression,
all of which would clear up quickly if some of the drug was administered. (There
seems. however, doubt as to whether opium and cocaine may have been mixed with
the cannabis in "anascha".) Frazer in 1949 observed states of extreme
violence and confusion developing in Indian soldiers whose supply of cannabis
had been abruptly stopped. To round off the picture with a paradox, Meunier and
Richet found that the human organism becomes more sensitive to hashish the more
it is taken, with the result that the dose could be gradually lessened to half
without diminishing the effects.
it is said that many of those who take to cannabis prefer it because they know
they can stop it without any disagreeable withdrawal symptoms, several observers
agree that the psychological symptoms which develop on withdrawal can be very
disagreeable, the main ones being loss of appetite, dyspepsia, pain in the abdomen,
fatigue, insomnia, agitation, palpitations and headache.
some countries, notably India and North Africa, it was not uncommon for cannabis
to be combined with datura or with opium, alcohol or heroin. Immigrants into Israel
from North Africa, the Near East or the Middle East were "prone to take any
narcotic drug they could lay their hands on".
from cannabis to heroin, morphia or cocaine is the subject of discordant conclusions,
often based on concordant data. From many countries, including the United States,
come reports that a very high proportion of all heroin addicts have previously
taken cannabis and that once they have progressed to this stage, they seldom return
to cannabis. What determines the progression is contested. The majority of observers
attribute it to association with friends or acquaintances who have themselves
become heroin or cocaine addicts; others suppose that it arises from dissatisfaction
with the relief or pleasure to be obtained from cannabis; and a minority postulate
a predisposition to marihuana which is also a predisposition to heroin. No one
suggests that there is a truly pharmacological reason why such "escalation"
should occur. Some hold that in a large proportion of cannabis-users, especially
adolescents, there is Some obscure but powerful factor (which could be psychological
or social) greatly increasing the risk that they will take to opiates sooner or
later; other authorities maintain that the transition from the marihuana stage
to the heroin stage occurs only in a small minority of marihuana-users and that
there is no more justification for indicting marihuana as a preliminary to dependence
on narcotics than for indicting coffee or tobacco.
this darkness some light is cast by a recent study of 2,213 addicts admitted to
Lexington and Fort Worth hospitals during 1965. The patients were classified according
to the state they came from, the opiate they had been taking and whether they
had been marihuana-users or not In each of sixteen states, more than 50% of the
subjects had used marihuana as well as opiates. In each of twelve other states,
most of the opiate addicts had never used marihuana. The dominant sequence of
events had been marihuana-smoking, arrest, and then opiate use; the respective
mean ages for these three events were, first, marihuana-use at 17, arrest at 19,
and then onset of heroin use at 20. When the marihuana-users were compared with
the non-users of this drug, it was found that the former were twice as likely
to be heroin addicts and to secure their drugs from underworld pushers as the
addicts who said they had never used marihuana. They also had an earlier age of
arrest and of onset of opiate use. Ball and his colleagues who made this study
conclude: "As to the issue of association, marihuana-smoking is seen as a
predisposing influence in the aetiology of opiate addiction in the United States.
Among metropolitan residents of the high addiction Eastern and Western states,
opiate use is commonly preceeded by the smoking of marihuana cigarettes and arrest.
Thus, both marihuana-use and delinquency are predisposing factors within the metropolitan
Enough is now known about the association of marihuana
and opiate use to delineate the dominant relationship of these two events. The
incipient addict is predisposed to opiate addiction by his use of marihuana, for
the following reasons: marihuana is taken for its euphoric effects, it produces
a "high; both marihuana and heroin are only available from underworld
sources of supply; both are initially taken within a peer group recreational setting;
both are illegal; the neighbourhood friends with whom marihuana-use begins are
often the same friends who initiate the incipient addict to the use of opiates.
. Data of the present study support the conclusion that marihuana-use is closely
associated with opiate addiction in the high drug use metropolitan areas of the
East and West, but not associated with opiate addiction in twelve Southern states".
detailed and temperate study lends support to the view that marihuana-users are
more likely than non-users to progress to opiate addiction.
many countries laws have been passed which make possession and use of cannabis
an offence; in some, the penalties are very severe, and may include capital punishment
for trafficking in the drug. The extent to which the laws are enforced varies
greatly. Penalties and sentences are often equated with those considered appropriate
for heroin and morphine addicts: the Medical Director of the Federal Bureau of
Prisons in Washington, D.C. said in 1962: In our Federal prisons we
have about 160 marihuana offenders; the average sentence of the group is nearly
six years, which is approximately what the average sentence for (all) drug offenders
are diverse opinions about the effectiveness of penal legislation. A few believe
that it has a deterrent effect; thus a Greek observer is sure that if the sale
of hashish were legal in his country, the power of advertising is so great that
very large numbers of people would take to the drug. Others review the fluctuations
of state policy in their own country, veering from rigorous application of severe
laws to lax administration and tolerance, and conclude that the laws have not
achieved their purpose. It seems, reading the contrasting statements on this matter,
that most persons with relevant experience would like to have legislation applicable
to the excessive user and the trafficker, but they object to blanket legislation
which permits and even encourages, the imposition of long terms of imprisonment
or other stringent punitive measures. It is generally acknowledged that it is
not so much the law as the way it is acted on by the police, customs officers
and magistrates that determines its efficacy (which is, in any case. limited).
Lindesmith, advocating that legislation should be on the same lines as for alcoholism,
gives an example: that persons driving a car while under the influence of
marihuana might be fined and deprived of their licences for a period of time:
such as this, with penalties of a reasonable nature would probably be more effective
than those now in effect because they would be more enforceable and more in accord
with the nature of the problem being dealt with. They would have the effect of
reducing the discrepancy that now exists between the laws as written and the laws
as they are actually enforced".
prohibition of all indulgence in cannabis was firmly rejected by the Indian Hemp
Commission in 1894: "The Commission now unhesitatingly give their verdict
against such a violent measure as total prohibition in respect of any of the hemp
drugs". Their chief reasons were that cannabis is, in moderation, harmless;
that its withdrawal would excite much resentment among the population, especially
the poorest sections; and that if it were forbidden, the people would take to
more dangerous drugs. But they went on to say: "While opposed to this amount
of interference, the Commission feels strongly that a regulating influence is
necessary and should, in future, be exercised by the Government of India over
the various systems of administration of the excise on hemp drugs .
fear that the prohibition of hashish would result in recourse to worse drugs such
as heroin, datura or alcohol, has been expressed by several workers, especially
those with Tunisian experience. An outstanding authority (Bouquet) wrote in 1951
that if cannabis had been absolutely prohibited thirty or thirty-five years ago
in North Africa, the problem would now be manageable but the point has been reached
at which suppression would result in an increase in heroin addiction. There is,
however, some inconsistency in this matter. Writers who fear that total prohibition
would lead to worse dependence on other drugs, at the same time advocate determined
police action to cut off all clandestine supplies of cannabis - a measure which
would surely have the same effect, if successful, as total prohibition. A variant
of this fear is voiced by the W.H.O. Expert Committee on Mental Health (1967)
who say that "condemnation by society may arouse guilt feelings in the user,
drive him to even greater dependence on drugs and prevent him from seeking treatment".
observer, chiefly concerned with comparing United States with English methods
of dealing with narcotic addiction, emphasized in 1962 that in America people
were driven by social. legal and economic pressures to band together to establish
their own group way of life, or subculture: "Addiction as such may not be
as antisocial as the kinds of behaviour forced on the addict by the punitive approach
to addiction". The more cannabis-taking is driven underground, or the more
it is punished by imprisonment, the greater, according to some writers, is the
likelihood of cannabis-smokers being corrupted and turned permanently towards
antisocial behaviour of other kinds.
prohibition or indirect measures of control have been tried in many countries.
The commonest methods are by taxation and setting up a government monopoly. Neither,
from the statements of those who have had experience of the effects, has proved
effective in limiting the spread or reducing the prevalence of the habit. A few
observers have urged that the risks can be reduced by suppressing the resin or
other concentrated form while tolerating the powder; or by harrying and supervising
adolescent marihuana-users, on the assumption that if they could consume as much
as they wished whenever they wished there would be a much larger number of serious
chronic victims - "wretched ragamuffins who are a danger and a burden to
society". But these assumptions and assurances are made on the strength of
the particular writers experience; they lack statistical or other firm support.
is generally agreed that taxing the drug does not deter the inquisitive or venturesome
experimenter, the adolescent who emulates his slightly older associates, or the
psychologically dependent man who craves the drug. They find the money somehow
to pay for it, as people do for alcohol.
by blocking the sources of illicit supply is evidently the ideal.The measures
taken have been described in official reports. They bypass the small fry - the
pedlars and carriers - and aim at catching the wholesale trafficker; they also
try to destroy the hemp crops: thus the United States Bureau of Customs and the
corresponding Mexican authorities collaborate in detecting the hemp fields and
rooting them out. A minority of those who discuss prohibition and its problems
are concerned with what moral justification the state has for interfering with
a citizens right to do as he pleases as long as he does not infringe the
rights of others or harm society. Some stress the alleged detriment caused by
cannabis to the users character and his occupational capacity, reducing
his social usefulness; or they point to injuries caused by his behaviour in driving
lorries or cars under the influence of the drug. On the other hand, some urge
that if alcohol and tobacco can be tolerated and taxed, there is no logical ground
for abstaining from doing likewise with cannabis (onto which, they suggest, an
unwarranted moralistic stigma has been pinned); they believe that if a drug, such
as alcohol or cannabis, is generally and readily obtainable in a given society,
most people learn to use it in moderation, while the psychopathic minority who
use it to excess would do so with some available alternative drug anyway. The
significant debacle of alcohol prohibition in the United States has a bearing
on the argument for treating cannabis like alcohol. A well established, socially
permissible drug is evidently ineradicable by total prohibition whereas a comparative
newcomer like cannabis in Western countries, is a weakling which might be kept
in check by firm action, some suppose.
the present time, it is widely accepted that dependence on a drug is a medical
condition calling for medical treatment. This contention is easily justified in
the case of drugs to which a physical dependence may develop. In the case of cannabis,
however, where the dependence is purely psychological, the issue has been contested.
The majority of writers are in favour of psychiatric treatment (provided that
the user wants to be treated), combined with social measures of rehabilitation
and appropriate social investigation. Broadly. of course, a medical approach is
concerned with the welfare of the individual. a social approach is directed more
at the protection of society: they complement each other. An antithesis between
medical research and social research in this field or between medical and social
treatment is forced.