Dr William H. McGlothlin
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 possible 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.12 3 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 occur. 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.
Similarly, De Ropp states:
We have no reason to suppose that Gautier had ever heard of peyote but his descriptions of his experience under the influence of hashish are so like those of other investigators under the spell of the sacred cactus that one is tempted to suppose that the two drugs must produce within the brain a similar reaction, despite the chemical dissimilarity of their active principles.4
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.'5 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.6 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.7
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, instead of experiencing satori. 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 wake-fulness. 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 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. These aspects will be discussed further in Section V.
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. 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 his-story, wide range of amount used, and the fact that legal restrictions do not require its concealment permits 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 and sometimes hunger.8 In certain parts of India this results in a fifty per cent 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 bums'.9 Bhang is also frequently used as a cooling drink or food supplement.
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.10 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.'
Whatever aphrodisiac qualities cannabis may possess, virtually all investigators agree these are cerebral in nature and due to the reduction of 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.'11 Chopra also mentions that certain 'saintly people who wish to renounce world pleasure use cannabis drugs for suppressing sexual desires.'
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.' He grants that the release of inhibitions may intensify the 'emotional character of the performance' for certain audiences, but doubts that technical performance is improved.
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.'
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.12 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, (v. P-2, 94.)
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. In the studies mentioned above, where experienced subjects were allowed to smoke marihuana at will, no behavioral evidence of discomfort was observed when it was abruptly withdrawn.
Concerning the use of cannabis in India, Chopra writes:
In contrast to the other narcotic drugs, we found that the necessity for increase of dosage in order to produce the same effects subsequently was only rarely observed in those who took cannabis drugs habitually. The tolerance developed both in 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. Even then, it was hardly appreciable when cannabis was taken, orally, but sometimes occurred when it was smoked ... 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.
The Mayor's Committee compared the forty-eight users and twenty-four non-users from the standpoint of mental and physical deterioration resulting from long-term use of marihuana. They also conducted detailed quantitative measures on seventeen of those who had used it the longest (mean eight years, range two to sixteen; mean dose per day seven cigarettes, range two to eighteen). 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 three hundred and ten, who had used marihuana an average of seven years, showed no mental or physical deterioration.13
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 Drugs Commission in 1894. Their conclusions, as quoted by Walton are as follows:
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.
The commission continued, as quoted by Chopra: '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 whether bhang or ganja and charas were consumed. For bhang, sixty-five per cent reported no effect, nineteen per cent minor impairment, four per cent marked impairment and eleven per cent slight improvement. For ganja and charas the comparable percentages were thirty-one, thirty-three, thirty-two, and four.14 By dose level, seventy per cent of those using less than ten grains per day said there was no effect on health and thirty per cent reported improvement. By comparison, of those using more than ninety grains per day, twenty-five per cent claimed no effect, thirty-one per cent minor impairment, forty-four per cent marked impairment and none claimed improvement of health. Forty per cent of the ganja and charas users reported sleep disturbance and insomnia as compared to four per cent of the bhang drinkers.
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 seventy-two 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 make-up and the right time and environment, marihuana may bring on a true psychotic state.'
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.
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 causal 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.'15 Allentuck states that 'a characteristic cannabis psychosis does not exist. Marihuana will not produce a psychosis de novo in a well-integrated stable person.'16 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.' 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.'
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. On the contrary 'professional' criminals considered marihuana smokers to be inferior and unreliable and would not associate with them. The Committee also investigated thirty-nine schools and found that marihuana was used by small numbers in certain schools, but that it was not a large-scale practice. Finally, they report that although marihuana smoking causes disinhibition, it does not alter the basic personality of the user or 'evoke responses which would be totally alien to him in his undrugged state.'
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 offences and other anti-social acts, evidence is inadequate to substantiate this.'17 Maurer and Vogel write:
While there may be occasional violent psychopaths who have used marihuana, have committed crimes of violence, and who have, in court, explained their actions as uncontrollable violence resulting from the use of the drug, these are exceptions to the general run of marihuana users.18
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 quiet and stupefy the individual so that there is no tendency to violence, as is not infrequently found in cases of alcoholic intoxication. The result of continued and excessive use of these drugs in our experience in India is to make the individual timid rather than lead him to commit violent crimes.
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.19
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.
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 sizeable 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. The extent to which legal prohibition and social stigma prevent other groups from indulging is a matter of conjecture. In Eastern countries cannabis is currently also largely restricted to the lower classes; however, moderate use is not illegal, socially condemned, nor 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 offences. Many judges have complained that these laws have resulted in excessive sentences (five to ten years) for relatively minor offences 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. This was an extensive study conducted under the auspices of the New York Academy of Medicine at the request of Mayor La Guardia. 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."20 And, as Taylor points out, 'We have done so ever since.'21 Anslinger, the Commissioner of Narcotics, wrote, 'The Bureau immediately detected the superficiality and hollowness of its findings and denounced it.'22 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.23 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.24
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 towards passivity:
In Anglo-Saxon cultures inaction is looked down on and often feared, whereas over-activity, 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.
1 Ames, F., 'A Clinical and Metabolic Study of Acute Intoxication with Cannabis Sativa and Its Role in the Model Psychoses,' J. Mental Sei., 104, 1958, pp. 972-999.
2 Bouquet, R. J., 'Cannabis, Part III-V,' Bull, on Narcotics, 3, No. 1, 1951, pp. 22-43.
3 Walton, R. P., Marihuana, America's New Drug Problem, Lippincott, New York, 1938.
4 De Ropp, R. S., Drugs and the Mind, St Martin's Press, New York, 1957.
5 Michaux, H., Light Through Darkness, trans, by H. Chevalier, The Orion Press, New York, 1963.
6 Mayor's Committee on Marihuana, New York City, Cattell Press, Lancaster, Pa., 1944.
7 Becker, H. S., 'Becoming a Marihuana User', Amer. J. of Social., 59, 1953, pp. 235-242.
8 Chopra, I. C. and R. N. Chopra, 'The Use of Cannabis Drugs in India,' Bull, on Narcotics, 9, No. 1, 1957, pp. 4-29.
9 Benabud, A., 'Psycho-pathological Aspects of the Cannabis Situation in Morocco: Statistical Data for 1956,' Bull, on Narcotics, 9, No. 4, 1957, pp. 1-16.
10 Murphy, H. B. M., 'The Cannabis Habit: A Review of Recent Psychiatric Literature,' Bull, on Narcotics, 15, No. 1, 1963, pp. 15-23.
11 Chopra, R. N. and G. S. Chopra, 'The Present Position of Hemp-Drug Addiction in India,' Indian J. Med. Res. Memoirs, No. 31, 1930, pp. 1-119.
12 Bromberg, W., 'Marihuana Intoxication,' Amer. J. of Psychiat., 91, 1934, pp. 303-330.
13 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.
14 As described in the previous section the consumption of bhang was typically much lower and its effect less potent than ganja and charas.
15 Mayer-Gross, W., E. Slater and M. Roth, Clinical Psychiatry, Cassell and Co., London, 1954.
16 Allentuck, S., and K. M. Bowman, 'The Psychiatric Aspects of Marihuana Intoxication,' Amer. J. of Psychiat., 99, 1942, pp. 248-251.
17 White House Conference on Narcotic and Drug Abuse, U.S. Government Printing Office, Washington, 1963.
18 Maurer, D. W. and V. H. Vogel, Narcotics and Narcotics Addiction, Charles C. Thomas, Springfield, III. 1962.
19 Editorial, 'Dagga,' So. African Med. J., 25: 17, 1951, pp. 284-286.
20 Editorial, 'Marihuana Problems; J.A.M.A., 127, 1945, p. 1129.
21 Taylor, N., Flight from Reality, Duell, Sloan and Pearce, New York, 1949.
22 Anslinger, H. J. and W. G. Tompkins, The Traffic in Narcotics, Funk and Wagnalls, New York 1953.
23 Bowman, K. M., 'Psychiatric Aspects of Marihuana Intoxication,' J.A.M.A., 125, 1944, p. 376.
24 Walton, R. P., 'Marihuana Problems,' J.A.M.A., 128, 1945, p. 383.
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