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CANNABIS PDF Print E-mail
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Books - Grupp, Marihuana
Written by Advisory Committee on Drug Dependence   

Reprinted from Cannabis, London, 1968, pp. 5-16 with the permission of the Controller of Her Brittannic Majesty's Stationery Office.

 

CANNABIS AND ITS CLINICAL FEATURES

Cannabis is the generic name of Indian hemp (C.Sativa). Cannabis drugs are obtained from the unfertilized flowering tops and the leaves of the plant, which can be grown in climates varying from temperate to tropical. Cannabis Sativa is one species which may be divided into two groups: (i) C.Indica, which is grown in the Indian sub-continent or from seeds originating there, and (ii) C.non-Indica, which originates and is grown elsewhere. The potency does not differ as between these groups, provided that the conditions in which they are grown are the same. To yield a potent drug a high temperature and low humidity are necessary, and these conditions are seldom available naturally in the United Kingdom.
 
There are many local names for preparations of cannabis, e.g. the dried leaves may be termed marihuana, or dagga; the resin obtained from the flowering tops is usually called hashish, or charras. The Anglo-Saxon countries also have an extensive and continually changing vocabulary.
 
Cannabis contains a number of identifiable constituents. Recent research indicates that the tetrahydrocannabinols (THC) are active principles: some have been shown to be highly potent... .
 
Clinical Features
 
In the following paragraphs we try to portray, so far as possible in layman's language, the effects of cannabis smoking (a) in moderation, (b) in excessive use on a particular occasion, leading to acute intoxication, and (c) in chronic use. This digest reflects the experience of a number of different cultures. In Section III we try to relate United Kingdom experience to this picture.
 
The effects of drugs which act upon the central nervous system are not determined solely by the drug and its dose. They are dependent also upon the person taking it, upon the immediate setting in which it is taken, and upon the cultural background. These are liable, in certain persons and in certain situations, to produce unexpected effects. Any account of the effects of a drug can only be fully appreciated if this possibility is borne in mind. Some people can even take opiates regularly and become physically dependent on them without obvious deterioration in their health or social efficiency.
 
The response to cannabis may vary according to the form in which it is taken, and to the dose consumed. Where it is smoked, the effect normally comes on within half an hour, and lasts for two or three hours. When it is taken by mouth the onset is delayed sometimes up to two or three hours, and the effect may last twice as long. Because of the relatively rapid onset when the drug is smoked, experienced smokers can adjust their dosage to achieve the effect that they seek. When the drug is taken by mouth this adjustment is less easy to achieve. Apart from these considerations there does not appear to be any significant difference in effect between the many different forms of cannabis that are used throughout the world.
 
The taking of cannabis does not normally result in any characteristic physical effects except that of redness of the eyes. When the drug is smoked there may be some initial rawness and burning in the throat, and tightness in the chest. Upon occasions, particularly when the subject is initially anxious, headache may result. There may be nausea and vomiting. Once the effect of the drug has worn off there may be an increase in appetite, even ravenous hunger. There have been isolated reports in which death has been attributed to cannabis, but these are very rare and their validity cannot be confirmed.
 
The effects of cannabis in moderate amounts are predominantly psychological. They begin with a sense of excitement or tension, sometimes with apprehension or hilarity, followed as a rule by a sense of heightened awareness: colours, sounds and social intercourse appear more intense and meaningful. A sense of well-being is then usual. After this a phase of tranquility and of passive enjoyment of the environment normally follows until, after a few hours, fatigue sets in and the subject sleeps. Although a "hangover" may follow this is not a common occurrence.
 
When the amount consumed is more considerable, or the subject is of a nervous disposition, or in an uncongenial social setting, symptoms of anxiety may be the first effects. These may be expected to settle, and the subject enters the euphoric or the passive state described above. On occasions, however, the anxiety may mount and symptoms suggestive of a deluded state ensue. As a rule these effects are not overwhelmingly intense. In most cases the subject retains his sense of contact with reality and remains aware of the fact that he is under the influence of a drug whose effects will pass off. On rarer occasions, usually with a heavy oral administration, the disturbance may be more profound.
 
The untoward effects of over-dosage as described above appear, in the great majority of cases, to pass off uneventfully as the drug clears from the system. They would be described in medical language as a toxic psychosis; There have been reports of a psychotic state persisting longer, even in rare cases giving place to what appears to be a prolonged schizophrenic illness, but it is difficult from these reports to assess the exact role of the cannabis in these circumstances.
 
Having reviewed all the material available to us we find ourselves in agreement with the conclusion reached by the Indian Hemp Drugs Commission appointed by the Government of India (1893-1894) and the New York Mayor's Committee on Marihuana (1944), that the longterm consumption of cannabis in moderate doses has no harmful effects.'
 
There have been reports, particularly from experienced observers in the Middle and Far East, which suggest that very heavy long-term consumption may produce a syndrome of increasing mental and physical deterioration to the point where the subject is tremulous, ailing and socially incompetent. This syndrome may be punctuated on occasions with outbursts of violent behaviour. It is fair to say, however, that no reliable observations of such a syndrome have been made in the Western World, and that from the Eastern reports available to us it is not possible to form a judgment on whether such behaviour is directly attributable to cannabis-taking.
 
In Western society cannabis is sometimes taken with other drugs. There is no evidence to suggest that cannabis in man in customary doses enhances the effect of other drugs. When combined with another drug, cannabis in man does not cause this to exert an effect quantitatively greater than that which would result from the use of that drug alone in the same dosage; when cannabis is used with other drugs such as L.S.D., or occasionally alcohol, it is their effects, rather than those of cannabis, which predominate. Some persons who have taken L.S.D. frequently are apt to get a recrudescence of the hallucinogenic experience as a consequence sometimes of quite small doses of cannabis.
 
Those who believe that there is a syndrome of chronic excessive cannabis-taking describe symptoms of physical deterioration such as yellowing of the skin, tremor, wasting and unsteadiness of gait. Here again it is very difficult to make a confident judgment as to the role played by the drug and the changes brought about by other factors such as malnutrition. There is no evidence that in Western society serious physical dangers are directly associated with the smoking of cannabis.
 
CANNABIS IN THE UNITED KINGDOM
 
Prevalence
 
In 1956 the United Nations Commission on Narcotic Drugs observed that it was clear that consumers of cannabis, as of opium, numbered millions in the world, and that geographically it was the most widespread drug of addiction.2 Few countries have published numerical estimates of consumers or consumption, preferring to rely on such data as the quantities of drug seized and the number of convictions, for demonstrating the nature of their cannabis "problem." These details often reflect altered emphasis in enforcement and are not a reliable guide to scale or trends, without supplementary evidence about what is not being detected.
 
Our witnesses considered that there had been a gradual growth in cannabis use in the United Kingdom over the past 20 years, and the relevant statistics so far as they go are consistent with this. The following table shows the numbers of convictions for cannabis offences and of seizures by H.M. Customs and Excise, and the amounts seized, in each year since the end of the Second World War:
* Before 1967 amounts seized by the police were not comprehensively recorded and do not figure in the table. In 1967 the total amount of cannabis involved in 2,734 prosecutions was 102-681 Kg. and 457 cannabis plants. The weights shown are simple aggregations of reported quantities of herb and resin.
 
In the early part of the period, most seizures were of green plant tops, found in ships from Indian and African ports and thought to be destined for petty traffickers in touch with coloured seamen and entertainers in London docks and clubs. By 1950 illicit traffic in cannabis had been observed in other parts of the country where there was a coloured population. In 1950, however, police raids on certain London jazz clubs produced clear evidence that cannabis was being used by the indigenous population; by 1954 the tendency for the proportion of white to coloured offenders to increase was well marked, and in 1964 white persons constituted the majority of cannabis offenders for the first time. The recent trend can be seen from the following figures:
 
Several witnesses discounted the significance of immigrant influence on cannabis-use, and asserted that international movement of young people and new attitudes to experimentation with mood-altering drugs were the main explanation of increased cannabis use by white persons in the United Kingdom since 1945.
 
The Times advertisement on 24th July 1967 claimed that
"The use of cannabis is increasing, and the rate of increase is accelerating. Cannabis smoking is widespread in the universities, and the custom has been taken up by writers, teachers, doctors, businessmen, musicians, artists and priests.... Smoking the herb also forms a traditional part of the social and religious life of hundreds and thousands of immigrants to Britain.... Uncounted thousands of frightened persons have been arbitrarily classified as criminals...."
 
We invited witnesses to estimate the numbers of people who had tried cannabis and of those who used it regularly. Only guesses were forthcoming and these ranged between 30,000 and 300,000. We could find no basis for constructing estimates of our own. It is clear from the Convictions recorded that such use of cannabis as there is, is widely spread throughout the country. Most witnesses felt that cannabis-use would continue to be popular and to spread for some time yet. As to speed of growth, we doubt whether the annual doubling of convictions in 1966 and 1967 reflects a corresponding growth in the use of cannabis in that period. One explanation might be that the formation of drug squads in many police areas in the past three years has been responsible for more successful police action against cannabis offenders than previously.
 
Supply
 
The annual volume of seizures by the Customs has been fairly steady over the past decade or so. Individual cases have shown that large supplies have been brought in by highly organised smuggling. According to witnesses, however, there is also a substantial traffic in small amounts carried by persons returning from holidays abroad, or sent—mainly to immigrants—by post from their home countries. Several witnesses felt that "amateur" smuggling was now becoming more organised, with a more standardized drug in the illicit market. Lebanon, Pakistan and Cyprus were mentioned as major sources. It was suggested that hashish now formed some eighty per cent of the traffic.
 
Within the United Kingdom, we were told, the competition of the "amateur" smuggler has made the illicit traffic a very loosely organised and often casual activity not exploited to any significant extent by professional criminals. We were informed that the price of cannabis on the illicit market has shown little fluctuation in recent years beyond what might be expected for varying quality, and that there has been no shortage of supplies.
 
Users
 
All our witnesses were agreed that cannabis-smoking in the United Kingdom was a social rather than a solitary activity, casual and permissive like the taking of alcohol. Friend introduced friend; the drug was readily enough available; if it did not suit the initiate, no one was the loser. The collective impression was that cannabis "society" was predominantly young and without class barriers. It resented middle-aged society's judgment on alcohol and cannabis. It was not politically inclined and our witnesses saw no special significance in the popularity of cannabis among members of radical movements.
 
Some witnesses thought that it was possible to distinguish particular social groups within cannabis "society" and mentioned staff and students in universities and art schools, jazz and pop musicians and entertainers, film makers and artists, and others engaged in mass media of publicity. They explained this part of the pattern by the particular appeal of the drug to those interested in creative work and self-expression. But they also mentioned that there were growing numbers of workers in unskilled occupations who smoked cannabis for pleasure at week-ends as their equivalent to other people's alcohol. The aspect that some of our witnesses thought most worthy of note was the broad similarity of attitude to cannabis and its dangers amongst all these groups.
 
The "professional" group, for example, was described to us as fundamentally law-abiding; discriminating in the use of cannabis for introspection and elation as well as for social relaxation; "involved in life," often to the point of social protest; not much interested in experiments with L.S.D.; generally disinclined to take amphetamines or alcohol (which was regarded as much more damaging than cannabis); and tending to stop the use of cannabis on marriage, or when the risk of prosecution was felt to be inimical to career prospects. The "unskilled" group was said to be similarly industrious and law-abiding and to see nothing wrong or harmful in its use of cannabis.3
 
Outside these groups the picture was much more confused and in flux. There were young people who had failed to adjust to university life or professional training or regular work, and who had "dropped out"; actively discontented and rebellious teenagers, looking for "kicks," who were prepared to take any drug offered to them; their weaker associates who took cannabis to avoid rejection by the group; and a few who were severely unstable and sought escape from their problems in a multiple drug use that included cannabis.
 
None of our witnesses felt able to estimate the relative sizes of the groups that they identified. We judged that they considered the responsible law-abiding regular users to be in the majority. They could tell us little about the use of cannabis by immigrants and we did not find any clear links between this and cannabis-smoking by other groups. Proportionately to their numbers there have been more convictions recorded against immigrants than indigenous United Kingdom nationals and we have no doubt that a number of those who have recently come to this country from areas where cannabis-smoking has been traditional have not given up their habit. We made special enquiry without success in an attempt to discover whether the smoking habits of immigrants made them particularly vulnerable to enforcement or caused unusual problems of social adjustment with local communities.
 
Use and effects
 
Witnesses knowledgeable about patterns of use told us that although some people smoked every day without interference to work or social life, the typical user probably took the drug once or twice a week, aiming at a "high" of 2 or 3 hours. More intensive daily smoking tended to make the user withdraw from other activity, particularly if he was not in a full-time occupation. Some people responded badly to the drug and a small number of initiates gave up smoking quickly because they disliked feelings of nausea or burning in the chest. There was little bias as between leaves or resin, but most smokers were interested in distinctive effects and there were individual preferences for material from particular sources. Experience and the heightened suggestibility due to the drug allowed the regular smoker to achieve the elation he sought with successively smaller doses. There was no physical tolerance; and "hangovers," although occasionally severe, were extremely rare.
 
We found a large measure of agreement among witnesses about the principal subjective effects of the drug. Most gave chief emphasis to its relaxing and calming effect. Several medical witnesses speculated that it had appeared to be beneficial for young patients during depression and also to have helped ex-addicts to abstain from heroin. Others contested this. Some suggested that cannabis tended to concentrate the user's attention on his anxieties, aches and pains, without helping him to resolve them, and to induce passivity without removing suffering. Apart from relaxation, the main sensations looked for were euphoria, tolerance of environment, and--at a more intellectual level—heightened awareness of self. Much reference was made to the varying influence of the circumstances in which the drug was used, little to altered visual or sensory perception. It was generally agreed that it was dangerous to drive a motor vehicle under the influence of cannabis not so much because driving ability was over-estimated (as with alcohol) as because of possible distortion of perception of depth and perspective.
 
We were told by more than one medical witness that cannabis-users did not seek treatment, and, when seen for other reasons, did not feel that treatment was needed for a cannabis habit. One medical witness mentioned having seen a few cases of acute psychosis following cannabis-use, but did not feel completely satisfied that cannabis had been the cause. The same witness was impressed by evidence of severe disturbance in a sample of chronic cannabis-users, but as this group was self-selected this information seemed to be of doubtful relevance to the generality of experience of cannabis-taking. A review carried out by the Ministry of Health has been reported to us as showing that 82 cases were admitted to hospital in 1966 with the diagnosis of drug addiction where cannabis was mentioned as the only or one of the drugs concerned. Further data were obtained in 79 of these cases. In 29 cases further evidence as to the significance of cannabis in leading to admission to hospital was inconclusive because of inadequate data or the patients' concurrent misuse of other drugs. Of the remaining cases, 8 had psychoses or confusional states, and 9 had other mental symptoms (not psychoses), which appeared to be attributable primarily to using cannabis, although other drugs might have been taken. Twenty cases showed evidence of a way of life in which cannabis had played a significant part in the social deterioration which had led to admission, although acute symptoms had not been the immediate cause. In this group the concurrent misuse of other drugs was a significant consideration. In 13 cases cannabis appeared to be irrelevant as a reason for admission to hospital. Thus in 42 cases the evidence was inconclusive or irrelevant and in the other 37 other drugs might also have been used.
 
SOCIAL ASPECTS OF CANNABIS USE
 
Much of the main controversy about the dangers of cannabis has attached to the claims that its use leads to opiate addiction and to the commission of violent crime. We paid particular attention to these aspects in our review of the salient literature and of evidence as to United Kingdom experience.
 
Progression
 
Hitherto discussion of the question whether there is a progression from cannabis to heroin has relied chiefly upon evidence from retrospective investigations of the previous habits of heroin-users. In the nature of the case such evidence can never be conclusive. On the assumption that the use of cannabis is still confined to a fairly small section of the population, evidence that a high proportion of heroin addicts have previously taken cannabis would only suggest that the marihuana-smoker is more likely than the non-smoker to take to heroin; what it cannot do is to give any clue to the frequency of such a progression among marihuana-smokers generally. For what they are worth, such retrospective investigations (which incidentally more commonly deal with American than with British experience) indicate that many heroin addicts have previously sampled other drugs including cannabis.
 
Most observers discount any pharmacological action disposing the cannabis-smoker to resort to other drugs, and look for other explanations. Some have suggested that in order to obtain their supplies cannabis-users must inevitably resort to the criminal underworld where opiates are also available. According to our witnesses supplies of cannabis in this country are not necessarily obtained in the same places as heroin. However, social mixing of some cannabis and some opiate-users takes place and involvement with opiates could thus occur on a socio-cultural basis.
 
Others suppose that dissatisfaction with the relief or pleasure to be obtained from cannabis leads users on to other drugs, and a minority postulate a predisposition to cannabis which is also a predisposition to heroin. These suggestions arise because most observers obtained their information from drug-users who are patients or offenders. These are often the multiple drug-users who rarely avoid trouble and are frequently to be found in clinics and before the courts. There appears to be a particular group of emotionally deprived, disturbed personalities who have tried most of the illegal drugs (including cannabis) before becoming heroin addicts. In fact most heroin addicts are multiple drug-users and have the emotionally impoverished family background not infrequently found in other delinquent groups, such as high incidence of broken homes, poor school record, police record, unemployment and work-shyness. Cannabis-users with similar personalities and backgrounds may have a predisposition to heroin, amphetamines and other illegal drugs. It is the personality of the user, rather than the properties of the drug, that is likely to cause progression to other drugs.
 
It can clearly be argued on the world picture that cannabis use does not lead to heroin addiction. So far as the United Kingdom is concerned no comprehensive survey has yet been made, but a number of isolated studies have been published, none of which demonstrate significant lines of progression. Our witnesses had nothing to add to the information already available, and we have concluded that a risk of progression to heroin from cannabis is not a reason for retaining the control over this drug.
 
Crime
 
Published statements on links between cannabis and crime tend to confuse the consequences of enforcing legal restrictions on non-conforming drug users with alleged criminogenic effects of cannabis-smoking itself. Since possession of cannabis is generally prohibited, the user found in possession automatically acquires a criminal record. To obtain his supply, an illicit source must also be involved.
 
A main charge against cannabis overseas, but not in this country, has been that its use makes people commit crimes of violence, because it removes inhibitions. There have been reports of outbursts of wild agitation and unprovoked violence by chronic users. Other observers have denied any direct link with violent crime. The Indian Hemp Drugs Commission concluded that "the connection between hemp drugs and ordinary crime is very slight indeed," but that excessive use did, in some very rare cases, make the consumer violent; 600 witnesses were asked by the Commission whether they knew of cases of homicidal frenzy, and very few did. A considerable majority of these witnesses did not consider that the drug 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 New York Mayor's Committee reported to similar effect: many criminals might use the drug, but it was not the determining factor in the commission of major crimes.
 
Probable reasons for this divergence of views are: criminals in some countries have based their defence on alleged cannabis-intoxication which provoked behaviour which they could not remember and for which they could not be held fully responsible; many of these users had combined cannabis with opium, heroin, amphetamine, barbiturate or alcohol, and it was impossible to identify which of these if any was to blame for an individual's criminal behaviour; samples of persons investigated have mostly been small and the history of drug-taking, its duration and its degree in each individual has been provided exclusively by the man himself, who often believed it to be in his interest to lie about it.
 
The most that emerges from the welter of conflicting statements is that an excessive dose of cannabis may lead to an attack of disturbed consciousness, excitement, agitation, or panic, and reduce self-control. The extent to which the affected person may commit a violent crime in this state of mind depends much more on his personality than on the amount or preparation of cannabis which he has been taking. The evidence of a link with violent crime is far stronger with alcohol than with the smoking of cannabis.
 
In the United Kingdom the taking of cannabis has not so far been regarded, even by the severest critics, as a direct cause of serious crime. It is not, of course, disputed that a number of criminals take cannabis as many do alcohol. We sought further evidence on these matters, but we found that for lack of reliable methods of detecting cannabis in the body the police were not in a position to offer any information.
 
A COMPARISON OF CANNABIS AND OTHER DRUGS
 
Cannabis has intrinsically different effects from most other drugs. As with most other drugs its effects are very variable, and depend not only on the substance consumed but on the person and his social setting. To this extent it is not easy to make any close comparison between cannabis and other drugs in common social use. Nevertheless, science, the law and social attitudes tend to create a common frame of reference for all drugs and, provided the risks of oversimplification are borne in mind, comparison of cannabis with other substances that affect the mind is relevant to our study even though it must necessarily be in broad terms.
 
Unlike the "hard" drugs, such as heroin, cannabis does not produce tolerance. Consuming the same, sometimes even a smaller, amount of cannabis continues to produce the original effect. Unlike heroin, cannabis does not cause physical dependence and withdrawal effects do not occur when its use is discontinued. The majority of users regard cannabis as pleasurable and so continue its use, but if they decide to give it up they do not usually experience difficulty. Here it might be said is a form of psychological dependence, but it is of a different order from the intense psychological dependence which normally follows the use of the "hard" drugs. The "hard" drugs are also physically dangerous: the direct result of over-dosage may be death, and possible indirect results are ill-health and even death, from pneumonia, malnutrition and infection due to dirty syringes. The social effects of taking opiates and cannabis are very different. The opiate-user frequently gets drawn into a "junkie" sub-culture where obtaining the drug and all that goes with it becomes a way of life, and this inexorably leads to gross deterioration. This is not true of cannabis, the use of which by itself does not appear to impair the subject's efficiency. In Western society it is clear that some adolescents form aberrant social groups around cannabis-taking; but where these are personally or socially deleterious it is not clear that the cannabis itself is primarily to blame. The use of other drugs as well as cannabis is often to be found in such groups and the social implications of adolescent alienation are probably of greater significance than the actual drugs.
 
In this country the barbiturates and the so-called minor tranquilizers such as meprobamate and chlordiazepoxide are widely prescribed by doctors and are all capable of producing varying degrees of tolerance and physical and psychological dependence. Over the last ten years the death rate from barbiturate poisoning (both accidental and suicidal) has doubled and cases of self-poisoning necessitating hospital admission have trebled. The amphetamines are also widely prescribed, and tolerance, psychological dependence and psychosis have become increasingly recognised as a consequence of their excessive use. Misuse of intravenous methylamphetamine (Methedrine) and related compounds carries with it the same risks of syringe-transmitted infections as are associated with heroin. No similar hazards have been observed to result from the use of cannabis.
 
We shall in due course be submitting a report on our study of L.S.D. and therefore do not propose to deal with it at length here. Suffice it to say that L.S.D. and other hallucinogens have for some while had a limited role in research and in experimental psychiatry. It is only in the last few years that these drugs have been used illicitly. It is still not easy to reach a clear assessment of their effects and dangers in this context, and it is therefore extremely difficult to make a clear comparison between them and cannabis. The subjective reports of those taking hallucinogens, both in clinical and in illicit conditions, suggest a response that is very much more intense. Under the influence of L.S.D. subjects may be so dangerously deluded that serious, even fatal, accidents occur, but there are no reliable reports of similar episodes among those who have taken cannabis alone.
 
Cannabis is often described as an "intoxicant" and frequently compared with alcohol. Both produce relaxation and euphoria; both, taken in excess, impair judgment, speed of reaction, and co-ordination. Cannabis more readily distorts perception of time and space. Unlike alcohol, cannabis is not known to enhance the effects of certain other drugs, induce a limited degree of tolerance or, over the long term, cause physical damage to body tissues directly or by dietary deficiency. Cannabis may well, however, be at least as dangerous as alcohol as an influence on driving or other responsible activity. This sharpness of similarity and contrast is considerably blurred by the effects of very different social settings. Alcohol in our culture is in general use and not illegal. Cannabis is used by a minority, and mostly against the law. Drinking patterns vary widely by country and by social class. Though many drinkers, particularly those who can be regarded as alcoholics, drink to get drunk, alcohol-users normally take a small amount, seeking only mild effects and a little social relaxation. The patterns of cannabis-smoking are more obscure. Experienced cannabis-users often smoke cannabis for a mild intoxication that they feel will improve their performance in a particular social setting or activity, e.g. playing jazz. Many smokers, howev-er, take the drug in anticipation of a few hours of intense mental elation without the aggressive impulses often associated with taking large amounts of alcohol. All in all, it is impossible to make out a firm case against cannabis as being potentially a greater personal or social danger than alcohol. What can be said is that alcohol, with all its problems, is in some sense the "devil we know"; 4 cannabis, in Western society, is still an unknown quantity.
 
Tobacco-smoking is, of course, the most widespread "drug-addiction" in our society. The immediate effects are well known and substantially harmless. Physical dependence does not appear to occur, but habituation is intense, and people find great difficulty in giving up smoking. The long-term dangers of smoking in inducing cancer of the lung, in exacerbating chronic bronchitis and in contributing to coronary thrombosis are great. Nevertheless the danger that smoking may produce lung cancer was for a long while not apparent. It is not possible to say that long continued consumption, medically or for pleasure, of cannabis, or indeed of any other substance of which we have not yet had long experience, is free from possible danger.
 
To make a comparative evaluation between cannabis and other drugs is to venture on highly subjective territory. The history of the assessments that have been given to different drugs is a warning against any dogmatic judgment.
 
Tobacco was once the object of extreme judgments. In the 17th century a number of countries attempted to restrict or forbid its use, but without success. In 1606 Philip III of Spain issued a decree restricting its cultivation. In 1610 in Japan restrictions were issued against planting and smoking tobacco, and there are records of at least 150 people apprehended in 1614 for buying and selling it contrary to the Emperor's command, who were in jeopardy of their lives. At the same time, in Persia, violators of the laws which prohibited smoking were tortured, and in some cases beheaded. The Mogul Emperor of Hindustan noted "as the smoking of tobacco has taken a very bad effect in health and mind of so many persons I order that no person shall practice the habit." Smokers were to have their lips slit. In 1634 the Czar of Russia forbade smoking, and ordered both smokers and vendors to have their noses slit, and persistent violators to be put to death. Medical reports of the period are full of accounts of its deleterious effects on mental and physical health.
 
Even non-alcoholic beverages that are now in common use have, in their time, been regarded as gravely dangerous. As late as the beginning of this century the Regius Professor of Physic at Cambridge along with the most distinguished pharmacologist of the time described in a standard medical textbook the effects of excessive coffee consumption: "the sufferer is tremulous and loses his self-command; he is subject to fits of agitation and depression. He has a haggard appearance. . . . As with other such agents, a renewed dose of the poison gives temporary relief, but at the cost of future misery." Tea was no better. "Tea has appeared to us to be especially efficient in producing nightmares with . . . hallucinations which may be alarming in their intensity. . . . Another peculiar quality of tea is to produce a strange and extreme degree of physical depression. An hour or two after breakfast at which tea has been taken ... a grievous sinking . . . may seize upon a sufferer, so that to speak is an effort. . . . The speech may become weak and vague. . .. By miseries such as these, the best years of life may be spoilt."
 
With such earlier judgments in mind we do not wish to make any formal or absolute statement on a comparison of cannabis and the other drugs in common social use. All we would wish to say is that the gradations of danger between consuming tea and coffee at one end of the scale and injecting heroin intravenously at the other, may not be permanently those which we now ascribe to particular drugs.
 
1 "The moderate use (of hemp drugs) practically produces no ill effects. In all but the most exceptional cases, injury from habitual moderate use is not appreciable"—Indian Hemp Drugs Commission.
"From the study as a whole, it is concluded that marihuana is not a drug of addiction, comparable to morphine, and that if tolerance is acquired, this is of a very limited degree. Furthermore those who have been smoking marihuana for a period of years showed no mental or physical deterioration which may be attributed to the drug"—New York Mayor's Committee.
2 Official Records of the Economic and Social Council, Twenty-second Session, Supp. No. 8 (E/2891), para. 133.
3 A similar picture of attitudes was found by investigators in Oakland, California, who obtained the confidence of youngsters, mostly Mexicans and Negroes, through providing them with club amenities without strings. The youngsters were firm in their conviction, based on their own experience, that the use of such drugs as marihuana resulted in harmless pleasure and increasing conviviality, did not lead to violence, madness, or addiction, was less harmful than alcohol, and could be regulated. They cited case after case of individuals known to them who had not been harmed in health, school achievement, athletics or career as a result of a habit of smoking marihuana; and they were not themselves interested in being helped to abstain from the drug. Most had taken up marihuana-smoking from a simple desire to emulate older boys, and not by reason of emotional disturbance or social stress. On the contrary the group regarded those who took drugs to excess as having a weak personality, and marihuana-users generally as making a positive effort to be in the main stream of organised society and reality.
4 In 1966, 66,468 males and 4,031 females were convicted of offences of drunkenness.
 

Our valuable member Advisory Committee on Drug Dependence has been with us since Thursday, 28 March 2013.