Cannabis (concluded)

Title

Cannabis (concluded )

Sections

III. Cannabis Intoxication
IV. Problems of Hashish Intoxication
V. SUPPLY
BIBLIOGRAPHIC NOTES

Details

Author: J. Bouquet
Pages: 22 to 45
Creation Date: 1951/01/01

TECHNICAL

Cannabis (concluded * )

Dr. J. Bouquet

III. Cannabis Intoxication

A. ACUTE INTOXICATION

Since about 1840 the nature of temporary acute intoxication caused by cannabis has been examined in many publications. Unfortunately many of these publications merely reproduce earlier studies.

Though these studies are conscientious and fairly comprehensive, they are open to criticism in various respects:

  1. First, the experiments deal only with a few subjects of a high intellectual level who are members of advanced civilizations (this also applies to the brilliant but over-literary account of hashish intoxication given by eminent authors such as Baudelaire[42] and Theophile Gautier).[43] Thus, the conditions described are not those usually found among the mass of low-class addicts having little or no education, and the psychological reactions cannot be the same.

  2. Most of the investigators analyse hashish intoxication caused by the absorption of products with a cannabis base through the mouth. They hardly deal at all with hemp smokers. It would appear, however, that the symptoms caused by smoking and swallowing hemp are not quite the same.

  3. Experiments have nearly always been performed with pharmaceutical products (cannabins, fat or soft extracts of Indian hemp), or with complex preparations of the illicit trade (such as dawamesk). In these cases it is difficult to ascertain that they do not contain other active substances besides hemp. The natural drugs, such as tops, charas, hashish, etc., cause partly different and less-marked symptoms.

* For the Introduction and parts I and II of this article, see Bulletin on Narcotics, vol. II, No. 4, October 1950.

Superior figures in the text indicate reference to the "Bibliographic Notes" on pages 44 and 45.

We live in the present through the action of out will, which draws our attention to objects of immediate interest. Through memory we live in the past. A perfect memory would enable us to live our whole life over again, starting from the moment when we became aware of ourselves. Imagination enables us to live in the future. With this faculty we are easily able to create an entirely new world, patterned upon our own desires.

The effect of absorbing the substances which Charles Richet[44] has so appropriately called the "poisons of the intellect" is to weaken the individual's will, the faculty which controls, sorts out, groups and correlates ideas according to logical laws. Thus in the case of the intoxicated subject, memory and imagination predominate, he becomes entirely absorbed in the past and the future, and loses sight of the realities of the moment.

Cannabis is a drug which affects the mind most powerfully. Besides producing a delirious excitement of the imagination and stimulating the memory to an extraordinary degree, it engenders a state of exhilaration, well-being and bliss which forms one of the greatest attractions to addicts.

The first effects of an adequate dose of a drug with a cannabis base are felt not more than two hours after ingestion. "You experience a feeling of physical and moral well-being", says Moreau de Tours, "of inner contentment and intimate joy. You cannot understand or analyse or explain these indefinable sensations. You feel happy, you say so, you proclaim it with exaltation, you endeavour to give vent to your joy by every means in your power, you repeat over and over again that you are happy, but you cannot find words to explain to yourself how or why you are so happy."

Motor excitation. The subject feels himself to be strong, agile, elegant, and capable of extraordinary feats of prowess. He experiences an intense desire to move about. Walking, jumping, dancing seem desirable things, and yet the sensation of ineffable tranquillity and perfect happiness which dominate are so strong that he usually abstains lest it should leave him.

Weakening of the power of control. During this period, his intellect is calm, and he retains the full strength of his will. Gradually, however, his mind becomes filled with ideas foreign to the subject on which he is endeavouring to fix his attention. All of a sudden he is overcome by absurd but irresistible laughter, caused by any trifling incident, which very often is not in the least funny. A commonplace sentence, a very ordinary act, the sight of some person, may be sufficient to provoke the subject to mirth. At this stage the most usual objects appear strange, new, and extremely amusing.

Dissociation of ideas. The phase at which ideas become dissociated coincides with a need for conversation and effusiveness. Extraordinary conversations take place, giving rise to the most extravagant misunderstandings, which are greeted with new bursts of wild laughter. The subject talks excitedly, argues heatedly about trifles, and is astonished to see that persons around him do not appear to share the excitement he feels. The conversation becomes more and more fantastic and incoherent as the will, yielding to the action of the drug, loses its power to direct thought where and how it wants.

An increasingly rapid train of ideas surges through the mind; they follow one another with bewildering speed and are immediately expressed, regardless of their nature, "so that the rush of words and nonsense is due not only to the exaggeration of ideas, but also and chiefly to the fact that every idea is expressed" (R. Meunier).[11]

The symptoms at this stage of intoxication sufficiently explain why hashish addicts like to consort together when consuming the drug. The opium addict, on the contrary, prefers to indulge alone, as he does not pass through this stage of voluble excitement and effusiveness.

During this phase of cannabis intoxication the subject tries to express a multitude of thoughts simultaneously and feels that this is impossible because speech is too gross to express such beautiful thoughts and not fast enough to reproduce the swiftness of his thoughts. Ideas well up incessantly ( this, however, only applies to addicts who are to some extent educated); they whirl through his brain, becoming ever more lively and striking and are associated together in the most unexpected ways. The addict feels it in his power to solve the most abstruse philosophical and scientific problems; he could have the most brilliant ideas,*perform the most heroic deeds, and experience the most wonderful, emotions... if only he deigned to do so.

Hypertrophy of the ego. He considers himself superior to all other human beings. "When the wretch has taken but one drachma he lifts his head higher than the Emirs", says a Persian poem. "I am become God", proclaims Baudelaire. The hashish addict looks on his fellows with very great, but friendly, contempt. He considers them as much inferior to himself in every way but feels a deep affection for them, and is grateful to them for existing as by their own unworthiness they enhance his sense of his own importance.

Recent American documents have referred to the case of a young student who, while under the action of marihuana, was convinced she had found the solution to a certain problem connected with her work, and jumped out of the window of her room in order to reach more rapidly the place where she worked.

Delirium. This stage in cannabis intoxication is marked by an extraordinary intensification of the feelings as well as by a hypertrophy of ideas, to use Charles Richet's[44] expression. "The emotions are extremely exaggerated and paradoxical. The simplest acts become theatrical, and the person announces in a tragic voice or with peals of laughter that it is raining or that midnight has just struck" (Moreau de Tours). The exact notion of persons and neighbouring objects is also lost. "At times I could see my friends", writes Theophile Gautier, "but they were deformed, half man and half plants, with the pensive look of an ibis, perched on the leg of an ostrich and looking so strange that I doubled up with laughter in my corner, and in order to join in the absurdity of this scene, began throwing cushions into the air".

Horror of noise. This mental confusion gradually increases. The moments of lucidity become shorter and shorter and the addict gradually surrenders entirely to his subjective impressions. The loud and boisterous gaiety marking the first stages is succeeded by a pleasant sensation of moral and physical lassitude. He no longer wishes to speak or hear others speak, but wants complete silence. Tunisian hashish addicts have told Dr. J. Bouquet that at this stage of intoxication they were painfully affected by the ticking of a watch and even by the slight buzzing sound made by mosquitoes.

The least effort becomes an almost impossible exertion and the mind allows itself to be deliciously lulled into a state of apathy, indifference and complete calm. Life seems easy, pleasant and devoid of material cares.

Notion of time. This stage is also marked by a complete change in the notion of time. The progress of time appears infinitely slow, because between two clearly received impressions a multitude of others well up which are hazy and often incomplete, but which delight the subject by their number and variety and by the interest he attaches to them, as the critical sense no longer functions. These ideas, particularly those only half-formed, seem innumerable, and as time is only measured by the memory of them, it appears infinitely long.

Notion of space. The notion of space is also wholly impaired. It is difficult, however, to obtain an exact conception of this phenomenon without having personally experienced it. The distance between the subject and a person standing quite near him appears enormous. The hand seems to be separated by an enormous space from the glass it attempts to seize. If stairs have to be mounted, the steps appear to extend to the sky. Dr. J. Bouquet explains this phenomenon by the fact that in hashish intoxication all objects are seen by the addict through a mist (this may simply be the result of the dilation of the pupil caused by the drug). A thick and sometimes multicoloured mist seems to envelop everything, making the horizons recede, rendering out-lines indistinct and blurring and idealizing shapes. This is so marked that such faulty perception sometimes interests the intoxicated person himself. "Look how my arms have lengthened; my hands are already right over there and my fingers change their shapes when I move them as if they were made of soft clay", said one addict.

Deformation of perceptions. At this stage of intoxication, therefore, the senses, particularly sight and hearing, are extremely acute; but the perceptions are all distorted, and the distortions are constantly varying and altering. The shape and colour of objects are often changed. A picture, flowers or an ordinary tapestry becomes a wonderful landscape, a place of enchantment. A bare wall becomes covered with brilliant and fantastic foliage of extraordinary plants and with strange animals and gorgeous patterns. Everything becomes animated and swarms, dazzles and changes, obeying the whims of the excited imagination; then pales, blurs and dies away, to be replaced by new and equally seductive visions.

Dual personality. A peculiar sensation of dual personality is sometimes observed. The addict is conscious of his real ego, which functions normally, while another fantastic and capricious personality exists side by side with it and gives rise to innumerable phantasies.

A Tunisian hashish addict told Dr. Bouquet that his other personality, which he contrasted by calling "his friend Hachoum", appeared to him every time he took hashish, in the form of an old, ironical and ill-tempered dwarf, who mercilessly criticized all his thoughts and deeds and never wearied of gibing at the plans and resolutions which the drug suggested to his real personality.*

Suggestibility. This is the stage of great suggestibility. A bystander need only tell the intoxicated person that a thing exists for it immediately to appear before his eyes. Any impressions made on the senses immediately give rise to imaginary perceptions, that is, illusions and hallucinations. R. Meunier[11] was able, with the aid of hemp, to influence subjects who were completely unamenable to hypnotism or to suggestion in the waking state. Any orders given during delirium are carried out even if their execution is fixed for the following day. It is easy to realize the dangerous consequences of such acute suggestibility from a social point of view, and that hashish addicts have been made to commit crimes under the influence of the drug (e.g. the history of the Old Man of the Mountain, the assassination of General Kleber in Cairo, etc.). **

The visual hallucinations caused by hashish intoxication among North Africans frequently consist of gay, lively and vividly coloured Lilliputian elves (Dr. Perrussel)[22] . This is very rarely mentioned in records of hashish intoxication among Europeans. Dr. J. Bouquet considers that this is merely due to the fact that one of the popular traditions of the natives of North Africa is a firm belief in the existence of people known as "Hijouj and Majouj", tiny beings living far away at the end of the world, behind a large wall built to keep them out, as the world would come to an end if they succeeded in knocking it down.

E. Pascal[39] attributes this acute suggestibility of the hashish addict to the persistence of relationship with the outside world. Whereas in certain forms of intoxication (e.g. opium and morphine) the senses are lulled and it is difficult to communicate with the subject, the senses of the cannabis subject are sharpened, so that the most varied ideas can successfully be conjured up in his mind.

Hallucinations. The extreme suggestibility of the hashish addict is useful, however, in certain cases such as those of experimental intoxication. It sometimes happens that certain subjects are the victims of painful hallucinations. They believe they are being pursued by wild beasts or threatened by assassins. As they are extremely emotional, this causes them acute suffering, and it is important that some agreeable idea should be suggested to them so that their minds are diverted to pleasant thoughts, as they would not hesitate to jump out of a window to escape the imaginary dangers which terrify them. The number of reported attempts at suicide is remarkable. Fortunately their motor incapacity is usually such that they are quite unable to move. Thus, R. Meunier mentions the case of a woman who, when intoxicated by hashish, found life so futile that she wished to kill herself, but had not the strength to seize a revolver placed within her reach.

Acute sensitiveness to sound. It is at this stage, too, that auditory sensations become extraordinarily keen. The slightest musical sound, the peal of a bell, the vibration of a string, a gramophone record, produce the effect of inexpressibly beautiful harmony. Charles Richet observed people who were ordinarily not very sensitive to music plunged by a few musical sounds into a state of indescribable ecstasy and bliss. Dr. Gobert[22] mentions the case of an addict who used to dip the strings of his mandolin, which hung on the wall, in sugar-water before smoking his hemp. When the appropriate stage of intoxication was reached, the flies, alighting on the strings, cause vibrations which sounded exquisite to his ear.

As the hashish subject feels all the nuances of the music with such extraordinary intensity, he may, on hearing certain passages, burst into tears, or be overwhelmed with grief or terror.*

** See report O. C. Cannabis 8 by Professor Mazhar Osman Uzman[52bis] . He mentions various cases of suggestibility.

These phenomena are easy to explain. Sounds have the power of awakening memories and evoking certain associations of ideas which, in turn, bring the emotions into play (Moreau de Tours).[18] They therefore affect the understanding, imagination and sensibility. Ideas are associated with each sound, or at any rate with the various reasoned combinations into which these sounds enter. As imagination and the memory, that is, the evocative faculties, are in a condition of acute sensibility under the influence of hemp, memories of dangers, losses of friends and sad thoughts, are at once connected with sad tunes, and happy and joyful thoughts with lively tunes. Such thoughts and memories have an almost boundless influence on the understanding at this stage.

Disturbances of the affections. Memory and affection are, like the imagination, over-excited at this stage. Scenes long forgotten reappear before the addict's eyes and are re-enacted in their smallest details. The memory of beings dear to him comes back with intensity and persistence; he would like to have all his friends with him and to overwhelm them with attention and marks of the greatest affection, and regards them all as ideally faithful, sincere and devoted.

On the other hand, if he has an aversion to anyone, his antipathy is transformed into a fierce hatred. He is convinced that he has now everything to fear from his enemies and that they are hatching some odious plot against him. There is only one step from this point to the belief that danger is imminent. The addict often reaches this stage and becomes a prey to sudden fits of terror and irresistible criminal impulses. This accounts for certain violent reactions, sometimes murders of relatives and friends, committed under the influence of the drug. Jealousy intensified by hashish intoxication has, in North Africa, been the cause of many criminal attempts on women, wives, and mistresses. (See O. C. Cannabis 12 by Professor A. Porot (of Algiers), and [56] .)

Oneiric ecstasy. If this irritability does not come to a head-and fortunately this is usually the case-the over-stimulation of the imaginative faculties gradually decreases. The mist which blurs every object and person present or conjured-up gradually thickens. The bright colours disappear and a grey tone predominates. Even objects close at hand become indistinct, as in twilight. The tired brain no longer seems to have the strength to follow the memory and the imagination in their wanderings. The addict gives himself up to a sort of calm and tranquil ecstasy, at times still occasionally interrupted by a ew fitful dreams. This is the stage called "kif" by the Mohammedans, that is, blissful rest.

A Tunisian hashish addict told Dr. J. Bouquet that when under the influence of takruri he could not listen to a gramophone record of Om Kalsoum, the Egyptian singer then in vogue, without being plunged into a poignant fit of grief, which spoiled all the pleasure he derived from the drug, the songs of this artist being usually imbued with sadness.

The duration of the above stage may vary according to the personal reactions of the individual to cannabis. It is gradually succeeded by a deep and heavy sleep. Sometimes, though rarely, the addict may awaken after a short interval to experience a new attack of delirium.

The addict usually wakes up in good spirits. His physical depression is not very marked and in general he remembers what he experienced during his intoxication unless the dose was a large one. In the latter case, the delirium is not so intense and may even be no more than deep slumber accompanied by dreams.

E. Pascal[39] explains this persistence of the memory by assuming that hashish intoxication does not completely inhibit normal consciousness; the subconscious divagations are registered, and can be remembered after the crisis. The addict's suggestibility and his delirium and hallucinations prove that he is in a subconscious condition, but the persistence of the memory indicates that consciousness still subsists.

Summary. To sum up, hashish intoxication may be divided into four main and distinct phases:

  1. A condition of excited mental well-being accompanied by motor excitation.

  2. Mental confusion accompanied by illusions and hallucinations (the stage described by North Africans as "fantasia").

  3. Oneiric ecstasy (called "kif" by North Africans).

  4. Depression and sleep.

The picture just given of hashish intoxication is, of course, somewhat schematized.

The phenomena do not always occur in the same order, and some of them may be constant in one individual and altogether absent in another. In Some cases, visual or auditory illusions predominate, in others painful hallucinations or cerebral erotic dreams, or, again, fits of poignant melancholia. These depend, as Professor Pouchet has said, on the country, race, culture and, above all, on suggestion, the latter word being used to apply to the influence of outward circumstances at any given moment. As Dr. Blonde1[45] has said, "each hashish addict has the dream he deserves".

Revelation of the subconscious mind. In all cases, however, an exaltation (in varying degrees) of the individual's most common thoughts may be noted, that is, his subconscious leanings are revealed.

This phenomenon is the result of the weakening of the will under the influence of the drug, which, in the circumstances, acts like most cerebral stimulants, including alcohol ( in vino veritas, says the proverb). The drunkard likes talking; he is communicative and reveals the inmost depths of his character. The hashish addict's intimate and secret thoughts are not only revealed by certain unconscious movements, but also by his words, acts, illusions and hallucinations.

E. Pascal39bis concludes from this special action of cannabis that it would be useful in psycho-analysis. Dr. Lage70 is of the same opinion.

Effect on the genital system. When erotic excitement occurs during the crisis of intoxication, it is purely cerebral. No physical changes occur, so that it is wrong to ascribe aphrodisiac properties to Indian hemp. Certain oriental preparations with a hemp base (such as majoun, dawamesk, etc.) undoubtedly have this property. (See documents O.C.1542(d) and O.C.1542(o).) This is, however, due to the fact that in these preparations cannabis is combined with other substances which act on the genital system. Hemp by itself has no such properties. "A hashish addict would not lift a finger for the most beautiful maiden in Verona", says Théophile Gautier.

* * * * *

The observations of cannabis intoxication which have brought to light the nature and order of the phenomena just discussed were based on generally educated European subjects who had ingested preparations with hemp extract base through the mouth.

The question arises whether the phenomena are the same in the case of smoked hemp, when the persons drugged are people of little education and intoxication becomes chronic owing to frequent consumption. Investigations of such cases can only be carried out in regions where the use of the drug is common.

Many difficulties are encountered in North Africa in the endeavour to study hashish intoxication from the information provided by native addicts. They are suspicious, and dislike confiding in an investigator. Most of them, too, are incapable of analysing what they experience. As a rule, they simply say that they consume hemp "because it makes them happy". That is about as much as can be elicited from them.

Mental disturbances

Certain conclusions may be drawn from the investigations carried out by Dr. J. Bouquet:

  1. If the resin content is approximately the same, the effects are more rapid (manifesting themselves after about a quarter of an hour) when hemp is smoked than when it is swallowed. They are, however, less violent, except when a few rapid pulls are taken at a pipe of chira. In the case of takrouri (chopped tops) eight or ten pipes must be smoked over a period of one or two hours before the period of euphoria sets in.

  2. No rapid sequence of amusing and witty ideas can be observed during the period of euphoria, of the kind noted in cases of experimental intoxication among edu-cated Europeans. There is only a flow of absurdities, coarse jokes and obscenities, often on homosexual topics.

  3. The phase of motor excitation is usually little marked. This may be due to the fact that the native who desires complete intoxication always smokes reclining on cushions or mats.

  4. This phase of motor excitation appears to be frequently replaced by a period of extreme volubility of fairly short duration, interrupted by characteristic fits of high-pitched, spasmodic and uncontrollable laughter.

  5. Acute sensitiveness to sound, changed notions of time and space, and coloured visions always occur.

  6. Emotional disturbances are generally fairly marked. Besides the affectionate form, which is the most frequent, there is also that in which the exaggeration of the natural sadness of the subject promotes the irascibility and impulsiveness already marked among these populations in their normal state.* The tendency to suicide has not been observed.

  7. The period of oneiric ecstasy ("kif") is more liable to be caused by smoking than by ingestion, and lasts longer; for North Africans are more prone to contemplation than to activity.

  8. Intoxication is followed by deep sleep. On awakening, the addict shows marked symptoms of mental and physical debility. Chronic addicts who consume large doses daily hardly ever awake from a state of manifest torpor.

Hence the phenomena observed during hashish intoxication vary according to whether cannabis is smoked or cannabis preparations are ingested.

The effects of the drug appear to be stronger when it is absorbed through the digestive tract.

The symptoms also differ according to the subjects' education and social level.

Additional investigation is essential and must be undertaken in the countries where cannabis is consumed.

Physical disturbances

S. Dontas and P. Zis ( Archives internationales de Pharmacodynamique et de Therapeutique, 1928, p. 30) also consider that the effects of hemp are less violent when smoked than when ingested. Their opinion is based largely on the study of observations of physical disturbances.

It should not be imagined that acute cannabis intoxication (even the simple crisis in experimental intoxication) has no subsequent effects on the organism.**

* Professor A. Porot and J. Sutter.[47 ]

** See, as regards America, Dr. G. Lage[70] and Dr. L. Angulo.[71] The observations of these authors as a matter of fact differ very little from those made in Asia and Africa.

The physical symptoms generally observed are the following:

1. During intoxication caused by ingestion through the mouth of cannabin preparations
  1. First period: Generally corresponding to the phase of mental excitement accompanied with motor excitation. The following may be observed: Pressure on the temples, profuse perspiration, changes in the respiratory reflexes, tachycardia, numbed or cold extremities, muscular hyperesthesia (the subject when seated has the sensation of falling; when walking he tends to collapse), tactile hyperesthesia, nausea and occasional vomiting (interrupting the effect of the drug);

  2. Second period: Generally corresponding to the phases of mental confusion and, occasionally, oneiric ecstasy; a sensation of blasts of hot or cold air on the face, a whirling sensation in the head, dilated pupils, buzzing noise in the ears, constriction of the epigastrium.

    The symptoms mentioned in (a) and (b) are not always present simultaneously among all subjects. Some of them may be altogether absent.

    If the dose is a large one, the symptoms of both periods may occur simultaneously.

  3. Symptoms after the crisis of acute intoxication. Certain sensitive subjects show symptoms of oneiric delirium for several nights on end, interrupted by sudden awakenings accompanied by a sensation of anguish.

2. Intoxication caused by smoking

The symptoms observed are as severe as in cases of intoxication caused by charas (hashish, chira). They are less marked, and some of them, (e.g. profuse perspiration, vomiting, constriction of the epigastrium, cold extremities) rarely occur when intoxication is due to smoking of the actual plant (ganja, takrouri).

In all cases where intoxication is due to smoking preparations, however, the following symptoms are also observed: dryness of the mouth and pharynx, thick and sparse saliva, irritation of the throat causing coughing, intense thirst.

These symptoms are particularly marked among beginners, who say that hemp smoke pricks and reddens the eyes. Before the smoker can derive agreeable sensations from cannabis he must go through the discomforts of habituation. It is this indispensable "apprenticeship" that has in part repelled Europeans living in the regions of the Old World where hemp is consumed; hence the extremely small number of addicts among them.

After intoxication, hemp smokers nearly always show symptoms of a saburral condition of the digestive tract accompanied by dryness of the mouth and irritation of the upper respiratory tracts. A dry cough, loss of appetite and a marked fall in the blood pressure are observed among inveterate smokers.

Cases of acute intoxication due to hemp are rarely fatal. Medical literature at present contains only one fatal case reported by Prentiss (1885).[46] Furthermore, the annual reports issued by the Egyptian Central Narcotics Intelligence Bureau report one death due to cannabis intoxication in 1928 and two (in 1930 and 1932 respectively), attributed to manzoul (a mixture with a base of hashish and aromatics). In 1934, A. Dreyfus[50] reported the fatal intoxication of a man who had absorbed a large quantity of bread stuffed with kif.

B. CHRONIC INTOXICATION

Save in very rare cases acute experimental hemp intoxication has no serious consequences. Though its mental and neuro-muscular effects are acute, they are also ephemeral, and the healthy body quickly recovers from its physical disorder, provided of course that the subject abstains from fresh recourse to the drug within a very short space of time.

If, on the other hand, he has not the strength to resist the drug's attraction, a state of chronic intoxication soon sets in and the outlook is serious. The transition to the chronic state takes place imperceptibly, as with all forms of drug addiction; despite occasional struggles against it, the drug addict finds it very difficult to escape from its grip and the use of hemp quickly becomes an imperious necessity.

But whereas the study of acute intoxication shows that the phenomena are more marked with ingested hemp preparation than with smoking hemp, the study of chronic intoxication shows that the most rapid and serious forms, and those involving the most disastrous consequences, are due to hashish (chira, charas) smoking. Only exceptionally, (in the East at any rate), does the smoking of chopped hemp (ganja, takrouri, kif, etc.) make the addict a complete mental and physical wreck. That is the explanation of the fact that very few cases of insanity from cannabis addiction are found nowadays in North African mental asylums, whereas some forty years ago the figure was very high. That was because in those days hashish (chira) could be obtained with the greatest ease in North Africa; but since about 1910 the drug has become almost unobtainable and smokers have to be satisfied with raw cannabis ends.

1. Chronic intoxication through raw hemp smoking

Mental troubles. The subject becomes less and less inclined to work, is indifferent to everything and finds the least effort burdensome. As Dr. Gobert says:[22] "The daily use of hemp affects the inclinations, feelings and intelligence of its devotees to such an extent as to unfit them for normal human intercourse and remove them to the edge or fringe of society." When he is not smoking, the drug addict, generally jovial, voluble, amiable, and often over-attentive, sometimes passes abruptly from good-naturedness to unsociability and irritability. Moreover, he always suffers from lapses of memory and his actions and conversation become disconnected.

When these unfortunates are under the influence of the drug they appear to be stupefied and their walk is as uncertain as that of a drunken man. At a later stage of intoxication, except in the case of old addicts, the most striking symptom is the condition of euphoric and excited delirium followed by a period of dreamy ecstasy and then by sleep, though this is never of very long duration in such cases.

Physical troubles. In the early stages of chronic intoxication there is scarcely any trace of somatic disorders. The subject continues in good health but his fitness for work and resistance to fatigue diminish. At a later stage he frequently suffers from headaches, and to get relief, he has himself cupped and scarified at the nape of the neck; in his own words: "he has his blood drawn". Recourse to this remedy at frequent intervals increases the subject's weakness. The next development is often a progressive anorexia. The addict eats only one very frugal meal per day, even if he does not go without it altogether, and instead just eats a few sweet pastries or chews dry seeds (peanuts, almonds, toasted marrow-seeds). At this stage anaphrodisia and partial impotence are frequently noted, often ending in sexual inversion. The addict also very frequently becomes emaciated and his capacity for work falls to zero. Unless he is fortunate enough to have parents in a position to assist in providing for his needs he sinks to the lowest depths. These unfortunates, morally degraded and incapable of any continuous physical effort, supply a high proportion of the criminal element, incorrigible thieves and sexual offenders.

Such victims scarcely ever attain a condition of dementia: it is not in mental asylums that they are to be found, but in the riff-raff of professional beggars, vagabonds and thieves.

If, however, the addict begins to consume hemp again at very short intervals, his life becomes a sort of stupor interspersed with increasingly frequent fits of ecstasy, alternating with crises of melancholic depression and hallucinations. These hallucinations often assume a terrifying form, and by strengthening the more or less delirious convictions of the addict, sometimes lead him to commit dangerous acts.* He has to be confined. When it reaches this stage, chronic intoxication from hemp is one of the aetiological factors of mental epilepsy. (Professor A. Porot): "It presents the same characteristics as intoxication from the abusive use of hashish (charas, chira). The same applies to addicts who, in an endeavour to prolong the period of intoxication and increase its intensity, mix the hemp with henbane (sikran), datura or opium". (See document O.C. 1724---X.)

It should not be forgotten that apart from any question of mental debility, the North African native has a marked propensity to violent psychopathic outbursts and crises of self-excitement brought on by the most trivial, or at any rate, disproportionate causes. Professor A. Porot has drawn attention to these curious natural disorders for which he has suggested the descriptive term "excito-motor crises of the native".

How many years are needed to transform a normal being into a wreck of this kind ? That cannot be determined. To begin with, there is the factor of individual resistance, but the rapidity of degeneration depends above all on the quantity of drug habitually consumed. On the other hand, hemp smokers are to be found who have been addicted to this vice for many years (thirty, forty or fifty) and who, apart from a certain obvious mental instability, show no signs of physical troubles, seem to have preserved normal health, and continue to follow their occupations. But in all these cases the individuals had managed to regulate and restrict their drug consumption. A few daily pipes of kif are merely an agreeable weakness, enough to induce the condition of euphoria and well-being which they desire. They can rest content with that. Needless to say, rational addicts like these do not constitute the majority. The same observations have been made in India.[66]

2. Chronic intoxication from hashish (chira, charas) smoking

Mental troubles. These are similar to those noted in eaters of illicit preparations having a hemp resin base (dawamesk or majoun type, etc.)

This form of chronic intoxication is much more serious and brings on infinitely more harmful disorders than the smoking of raw hemp.

Several special studies of it have been made; as regards Turkey by Dr. Hassan Racine ( "Notes sur le Hachich", Montpellier Medical, 1876); as regards Egypt by Dr. A. Marie, assisted by Dr. Warlock, then Director of the Abbassieh asylum ( Notes sur la Folie hachichique"-Nouvelle Iconographie de la Salpêtrière, No. 3, 1907); as regards Tunis by Dr. Perrussel[22] . (See document 1542 O., p. 27, and the annual reports of the Central Narcotics Intelligence Bureau).** The most striking symptom in victims of this drug is the intensity of the delirium and the hallucinations-of sight, hearing, taste and smell. The idea that the victim is possessed by a demon or spirit and persecution mania are common. In their delirious imagination, some addicts believe themselves to be sultans, prophets or famous conquerors.

At a later stage of chronic intoxication, the most striking phenomenon is a characteristic state of mental confusion; the two predominating symptoms are intellectual torpor and continuous dreaminess.

An addict will remain for hours in a state of the most complete mental inertia, indifferent to everything and verging on stupidity. His mental unawareness is absolute: he is as unconscious of his surroundings as of his position. All general activity vanishes and facial movements cease. The powers of perception are dulled. The victim hides himself away like a wild animal, apart from human society, unconscious of all that is happening around him.

** See also Prof. Mazhar Osman Uzman,[52bis] Prof. A. Porot,[56] Dr. P. O. Wolff [62 bis] and Dr. C?aux.[61]

As a general rule, this state of confusion ceases abruptly with a sort of brutal awakening, leaving in its wake delirious sequelae, a sort of agitated condition of anxiety and uneasiness. That is the time when addicts of this kind are most dangerous; their susceptibility is intense: a simple affirmation, or the slightest contradiction, may rouse them to fury, jealousy or threats of violence. Nor need a third party be present to bring on a fit of aggressiveness. The hashish addict is subject to auto-suggestion and after some careless remark is apt to commit acts of violence without any apparent reason. It is also obvious that at this stage his suggestibility is very intense and he may then, at the instigation of others, become an extremely dangerous-even though irresponsible-instrument.

Physical effects. The somatic disorders found in hashish-smoking addicts are similar to those noted in raw hemp smokers; but their development is more rapid, and often leads to generalized tremor with difficulties of locomotion and cachectic emaciation.

It is hashish addicts of this type who usually end in mental asylums, as maniacs or cases of dementia praecox or schizophrenia.

In the former case a few weeks or months of calming treatment, accompanied by extra feeding and withdrawal of the drug, will improve their condition. Generally, however, they slip back into their vicious habits as soon as they have left the hospital.

With hashish dementia or schizophrenia the outlook is more sombre: mental and physical disintegration go hand in hand. This rapid sequence terminates, after a few months, in death in a state of dotage and marasma.

It has been explained above that eaters of mixtures compounded of hemp resin and aphrodisiacs (of the dawamesk, garawich or majoun type, etc.) are subject to crises of an erotic character: their state of sexual excitement may reveal itself in the various forms of offences against morals, such as exhibitionism, rape, etc. The same erotic tendencies have been noted in smokers of raw hemp and hashish- but particularly in cases where addiction is quite recent-for custom brings on anaphrodisia and sexual impotence. This undoubted eroticism of hashish-smoking beginners may possibly be the explanation of the numerous attempts at rape reported from the United States as attributable to marihuana smokers.

Note. In connexion with cannabis intoxication, attention should be drawn to a very controversial work: The Marihuana Myth by Dr. Leopold Salazar Viniegra, of the Mexican Public Health Service (October, 1938).

This writer maintains that cannabis has no dangerous effects from the mental standpoint. Subjects displaying some signs of mental disturbance under the action of the drug are either cases of dementia praecox or mentally deficient, or general paralytics. Cannabis causes no mental disorder in healthy and normal subjects: experience reveals only slight physical disturbances. Cannabis has no influence on the development of criminal tendencies.

The appearance (and assessment) of mental effects attributed to marihuana are the result of auto-suggestion, and that is why they are only found in educated persons steeped in the literature on the effects of hemp. Ordinary people, on the other hand, in their simplicity, regard cannabis merely as a harmless substitute for tobacco: they are satisfied with two or three cigarettes or cigars a day, made of tobacco mixed with marihuana; from the social point of view, therefore, the offence of hemp addiction is a myth which should be struck out from the penal codes. All the writers who have dealt with cannabis are the victims of collective suggestion of literary origin, for which Moreau of Tours, Baudelaire, Richet, etc., are responsible. The phenomena described by them exist only in their imaginations.

Drs. S. Allentuck and K. M. Bowmann ( American Journal of Psychiatry: 99, p. 248, 1942) also say that no permanent harmful result is observed after the administration of cannabis. They propose its utilization to alleviate the effects of weaning opium and morphine addicts.

It seems desirable, however, to avoid trying to cure a drug addict with another habit-forming drug.

Allentuck and Bowmann’s view has been strenuously opposed by J. Bouquet ( Journal of the American Medical Association, 1 April 1944) and P. O. Wolff (The treatment of drug addictions). Neither is in favour of the use of marihuana in the treatment of other drug addictions. (See also Kolb, American Journal of Psychiatry: No. 99, 1942.)

IV. Problems of Hashish Intoxication

A. EXTENT OF HASHISH ADDICTION

It has been established beyond dispute that the use of cannabis to induce a special form of intoxication is of Asian origin. Europe and the Far East have as yet been but slightly contaminated. This practice has, however, gradually spread all around the eastern end of the Mediterranean and the areas along the southern coast as far as the Atlantic.

The east coast of Africa has not escaped, and the drug has penetrated progressively from the coast to the centre of the continent, where it at present constitutes a danger29 which is difficult to check. It has also reached America (Jamaica, Brazil, Mexico, and, more recently, the United States and Canada), where its abuse is causing considerable alarm to the various Governments.

The problem of cannabis is not at present of outstanding importance for Europe. Although in the past the plant was grown openly or secretly for the production of narcotic resin in the Balkan countries (Bulgaria, Greece, Romania, Turkey and Yugoslavia), the Governments concerned have since passed measures of prohibition and are making commendable efforts to trace and destroy whatever secret plantations may exist. This does not mean that consumers of the drug have completely disappeared from those countries. Clandestine consumption still exists among certain sections of the population in Turkey, Bulgaria, and Greece. In recent years, clandestine cultivation of hashish has been discovered in the neighbourhood of Paris (Orly, Aubervilliers, Le Bourget). See [63] .

In Asia, the cradle of hashish intoxication, the question is more complicated. For one thing, there are vast regions which are still beyond the reach of investigation (Sinkiang and Tibet, for instance). Other countries have not yet adopted measures of supervision or prohibition (e.g. Iran).* In other districts cannabis grows wild, and this circumstance might well defeat all attempts at control (this is the case in Siam, Burma, etc.). In India, which is largely contaminated, there is strict control, but the plant easily grows wild and clandestine crops are not rare. The same doubtless applies to Syria, Lebanon, Asiatic Turkey, and the Asiatic territories of the Union of Soviet Socialist Republics.

As for the existence of cannabis addicts, it appears that, with the possible exception of Japan, China, and the Siberian territories which cover all the north of the Asiatic continent, there is no country in Asia without devotees of the drug.

As for North Africa, in Tunisia and French Morocco, the system of controlled sales has been adopted. In Algeria and Egypt there is prohibition. The authorities of these various countries are nevertheless obliged to search for clandestine crops and to keep a close watch on contraband. Libya seems to be practically free from cannabis addiction.

All the other parts of Africa are more or less contaminated,** although in most of them the use of the drug is prohibited (cultivation is controlled in the Union of South Africa); but cannabis grows wild in many areas, and there are numerous illicit crops which are difficult to discover and destroy, because they are deliberately scattered about in districts to which access is almost impossible. The Egyptian Government has been obliged to use air patrols to spot clandestine crops.

* According to reports of the Iranian Government in 1932 (see O.C. 1542, p. 39), the hemp cultivated in most parts of the country does not grow very high, has many branches, and cannot be used for fibre. These are the characteristics of resinproducing hemp. Tall cannabis plants producing textile fibre are obtained only in certain districts of the Caspian Sea and at Kerman.

** See Dr. A. O. Cureau, Les sociétés primitives de l'Afrique équatoriale, Paris, A. Colin, 1912, pp. 268 and 281.

In Oceania, cannabis does not appear to be used as a drug of addiction.

In America, hemp grows wild in the United States, Mexico and the Panama Canal Zone; illicit crops have been reported in the United States, Mexico, Brazil, the northern part of South America, Honduras, Jamaica and the Panama Canal Zone. All the American States prohibit the keeping and consumption of hemp. Addicts are to be found, however, in Canada, the United States, Mexico, Brazil, Cuba, the northern part of South America, Honduras, Jamaica, Dutch Guiana, Trinidad and Tobago, the Panama Canal Zone and Argentina.

According to P. O. Wolff[62] bis, there was already an old focus of cannabis consumption in the north and north-east of Brazil, where there are many negroes of African origin (states of Para, Maranhao, Piani, Rio Grande del Norte, Pernambuco).

Hemp grows there in the wild state. Hemp smokers belong to the lower classes of the population, especially negroes and half-castes. The custom of smoking in groups is said to be in obedience to the religious rites of secret societies.

Marihuana is smoked in common in pipes similar to the hookah or in cigars made of maize straw. In general individual cigarettes are preferred.

In Brazil, certain beverages (infusion, decoction of cannabis) are absorbed at various religious ceremonies which seem to be connected with magic practices.

In Mexico, clandestine cultivation is flourishing, and there is a big illicit export to the United States and Cuba. Mexican cannabis is said to be more active and richer in resin than that grown in Cuba.

It was reported at the first Pan-American Congress of Legal Medicine and Criminology (Havana, September 1946) that 70 to 80 per cent of Cuban addicts were marihuana addicts.

In Cuba smokers use the chichara (from the Arabic chicha, a pipe); they hold the stem between two fingers, which become impregnated with resin and thus produce a brown colour which can be detected by chemical examination. The habitual use of the hemp cigarette ( pito) also produces the tell-tale stains (Dr. Luis Angulo)[71] .

In Argentina and Colombia drug addiction through hemp has been reported chiefly since 1946.

In Ecuador, Nicaragua, Honduras and El Salvador this vice appears to have been introduced since the war.30

B. CAUSES OF CANNABIS ADDICTION

From this enumeration, it may be concluded that a considerable fraction of the world’s population (the figure of 200 million persons has been mentioned) indulges in the consumption of hemp as an inebriant. An attempt may now be made to describe the type of men more particularly attracted by the mirages of these artificial paradises, and the motives which drive them to seek joy and happiness in this drug.

1. India

The practice of taking hemp to induce a special form of intoxication appears to have originated in India. It is therefore normal to start with that part of the world when studying such practices. A note addressed to Dr. J. Bouquet in 1912 by Mr. D. Prain[28] , Superintendent of the Royal Botanical Garden of Calcutta, gives a clear résumé of the question:

HEMP IS USED IN INDIA:

For smoking (ganja and charas)

As a supplement to food (like tea, cola, etc.):

By poor people who find it a salutary means of resisting fatigue or the effects of lack of food. Its use in this case does not cause any physical or moral disorder.

As an inebriant and substance-like opium provoking cerebral hyperesthesia:

By idle persons in order to intoxicate themselves; by vicious persons to enable them to concentrate their minds on unhealthy thoughts; and by fanatics to intensify their mysticism.

Its use in this case becomes pernicious through excess. The symptoms develop rapidly and in their most serious form if opium and datura are added to the drug, as is frequently the case.

For drinking (bhang) and for eating (majun)

As an intoxicant like alcoholic drinks:

By idle persons in order to intoxicate themselves; by depraved persons as a stimulant (in this case nux vomica and cantharides are added to the drug); by criminals to obtain the courage to execute the designs they have conceived in cold blood.

Such use does no injury to the individual if not too frequent. In cases of excess, serious dyspepsia and decrease in vitality follow quickly.

By fanatics in general, without ulterior motives if they are Hindus, in order to commit acts of violence if they are Moslems.

As a stimulant of a particular kind:

Very frequently by people who, without being real hemp addicts, indulge in this debauchery under the influence of an abnormal moral state, hatred or lust.

Many persons take hemp in all three forms.

R. N. Chopra and Cr. S. Chopra[66] give as the principal causes of the habit of consuming cannabis: ( a) instruction by other addicts; ( b) religious factors; ( c) the seeking of aphrodisiac and euphoric properties; ( d) to replace opium, alcohol or other drugs which have become unobtainable; ( e) illnesses or indispositions; (f) arduous work, worry, over-work; ( g) mis- cellaneous causes: curiosity, search for emotion, stimulation to courage and often rashness. Drug addicts generally start between twenty and thirty years of age; it is extremely rare to contract the habit before fifteen and after sixty years of age.

This short survey of the role of hemp in India is enough to show the dangerous and anti-social character of the drug.

2. Moslem countries

The use of hemp in religious rites in India finds no counterpart in the Islamic world. R. N. Chopra[66] points out, however, that in certain Moslem sects in India, cannabis is considered as the incarnation of the prophet Khizir Elijah, the patron saint of water. Its use is even supposed to be condemned by the precepts of Koranic law. Yet hashish is the oldest known drug in Turkey. Until recent years it was the only substance smoked. (In Moslem countries opium is eaten and not smoked). That is why its use is so widespread, especially among the poorer classes. (See O.C. 1542, p. 26.) In French North Africa and Egypt, the practice of consuming hemp has been current for many hundreds of years. * What motives impel the Moslem natives of those regions to indulge in this practice?

The motives are practically the same as in India, except for the desire to intensify religious mysticism.** Their primary object was originally to stimulate their sexual faculties, weakened by excess.

It must be remembered that these are tradition- and routine-bound populations, and that the mental outlook of at least 80 per cent of them is five or six centuries behind that of Europeans. They still believe in a healing lore similar to that which existed in Europe in the Middle Ages. Drugs like cannabis and opium are popularly reputed among such peoples to be powerful aphrodisiacs. Oral tradition has repeated and spread these errors, which also appear in most of the popular medical treatises, thereby acquiring the prestige of the written word. That is quite enough to render useless the exhortations and advice which these unfortunate people may receive from Europeans or educated and enlightened fellow-citizens.

*It is a curious thing that Tripolitania and Cyrenaica, although long occupied by Turkish garrisons, and situated between two countries (Egypt and Tunisia) which are badly contaminated, appear to be practically free from cannabism. An inquiry carried out by Dr. Bouquet on this subject among a number of natives of Tripolitanian origin showed that there was very little hemp consumption in their native country. Dr. Bouquet recently obtained confirmation of this statement from M. Buffaiterille, acting French Vice-Consul in Tripoli, and from Prof. N. Tripodi, the doctor in charge of the Colonial Hospital at Tripoli.

**According to J. Deniker ( "Les races et les peuples de la terre", p. 573), a kind of hemp-worship (Riamba-worship) exists among the African Ba-Louba. They regard hemp as a divinity; all hemp-smokers call themselves brothers, owe each other hospitality, agree not to sell their daughters to each other, etc. Similar conceptions in South America. (See P. O. Wolff[62bis] .)31

If the annual reports of the Central Narcotics Intelligence Bureau of the Egyptian Government are consulted, it will be found that the doctors who have attempted to analyse the causes of the various forms of drug addiction in Egypt are unanimous in recognizing that the natives take drugs in the hope that they will enable them to increase, maintain, or regenerate their sexual powers. For examples see the following remarks in the 1929 report: Dr. H. W. Dudgeon, page 57, "Actually the great majority of cases especially in this country start taking drugs for sexual stimulation . . ."; Dr. Whitcomb, page 73: "the Causes given for addiction are to be a ‘good fellow’ and as an aphrodisiac . . ."; Dr. Ackren, page 73: "The most common cause is the aphrodisiac effects of these drugs"-a statement which is repeated by the same doctor in the 1930 report on page 59. On page 60 of the same report Dr. Takla states: "The commonest cause of drug addiction is the belief that drugs prolong the sexual powers in sexual intercourse". Similar statements are made in the 1931 report, pages 106, 114, 116, 117 and 118, and in the 1934 report, page 55’. Similarly, in the 1933 report, page 69, it is stated that "In Egypt it can be said that 90 per cent of addicts have been intentional addicts but that the reason that these thousands of people took to drugs was that they believed them to be a potent sexstimulant". In League of Nations document O.C.1542 (d), it is stated (page 6) that hashish is most always used as an aphrodisiac in Egypt.*

Sir Thomas Russell, then Director of the Egyptian Narcotics Bureau, was of the opinion that the recrudescence of addiction should be ascribed to the increase in the Nile Valley of certain parasitical diseases (such as malaria, bilharziasis, and ancylostomiasis)-an increase due to modern changes in the system of irrigating cultivable land. These diseases apparently reduce the fellahin to a condition in which they have less capacity for work and less endurance. The agricultural workers, finding their physical strength and virility decreasing, in their ignorance sought a stimulant in order to recover their lost vigour "which forms part of their code of honour". That is why, according to Sir Thomas, the practice of taking hashish, and subsequently manufactured drugs, spread.

The above view is not shared by Dr. J. Bouquet (see League of Nations document O.C. 1724, Add., p. 25 and the Minutes of the 1938 meetings of the Sub-Committee on Cannabis), who considers that there is no connexion between the health and epidemiological conditions of a district and the spread of various forms of drug addiction, and that in the Islamic world the passion for drugs has been a deep-rooted vice for many centuries.

In North Africa, at any rate, the investigations carried out have shown that the natives do not take to drugs in order to invigorate their systems when weakened by overwork and disease. It is primarily in the hope of restoring their virility, which has become impaired by sexual excesses, and secondly, in order to be able to lead in imagination the life which they would like to live, but which their indolence and love of ease in most cases prevents them from attaining by work, forethought and persevering effort.

* Same note for India in R. N. Chopra and Cr. S. Chopra[66] .

It is obvious that many more inquiries must be carried out if conclusions are to be reached which will be valid for all the populations of the Old World contaminated by cannabis.

3. America

In America the use of cannabis seems to have been introduced much more recently.** It appears, however, that hemp was known in Mexico before the Conquest, and that intoxication by that plant formed part of certain religious rites and ceremonies practised by the aborigines. Dr. Livet ( Les Fumeurs de Marihuana-Annales médico-psychologiques, Paris 1920, p. 257) describes certain ceremonies of a religious character among the Indian tribes. Hemp is smoked mixed with tobacco in the form of cigars. A cigar is passed from smoker to smoker until the characteristic symptoms of intoxication appear. He refers to the curious practice of putting in the middle of the place where the meeting is held a small saurian (an iguana) who serves as a control animal. When the animal collapses, overcome by the smoke in the atmosphere, those present must stop smoking, for fear of an intoxication which is reputed to be fatal

In Mexico-apart from these tribes among which cannabis seems to form part of ancient religious rites-the drug (although prohibited) is grown secretly and consumed by the lowest class of the population. The United States Government ascribes the introduction of marihuana into the United States to Mexican workmen employed as seasonal labour in certain states of the Union.***

Public opinion and the authorities have become alarmed at the spread of this form of addiction, which increased enormously after the prohibition of alcohol, and spread especially among the younger generation of the Latin-American population, Mexican, Philippine, Greek and Spanish immigrant circles, and negroes. Habitual hemp smokers in the United States (no case of addiction through oral ingestion has yet been reported) constitute a most serious problem for the police authorities, for it has been found that among the contaminated elements of the population the abuse of the drug produces an unfortunate propensity to violence, and even to crime.*

** Introduced into New Orleans towards 1910[30] .

***According to "How mild is Marihuana" by A. Essati ( Magazine Digest, Toronto, Ontario, 1944) the chief names designating marihuana among traffickers and drug addicts in America are: muggles, mooters, reefers, greefe, griffs, Mary Warner, Mary Weaver, Mary Jeanne, Indian Hay, Loco weed, Love weed, Jay smoke, giggle smoke, Bambalacha, Mohasty, Mu, Moocah, grass, tea. In Mexico the slang words are: Juanita, Dona Juanita, Maria Johanna, Rose Maria. In Cuba: la Hierba, la Mota, la Bareta.

Similar facts have been observed in Jamaica, where the practice of smoking hemp, introduced by immigrant Hindus, has spread among the population and has been the underlying cause of a large number of cases of assault and even murders. The same applies to Cuba (see Dr. Luis Angulo[71] and Dr. G. Lage[70] .).

Similarly, the Government of Canada (see O.C. 1542) has stressed the fact that the introduction of cannabis addiction is of recent date, towards 1930, and that its principal victims are young people; as in the United States, the hemp appears to render those under its influence violent and brutal.

This effect of cannabis is different from that generally found among oriental addicts.

This is perhaps a question of racial susceptibility. The investigations of Stringaris[33] and Sinkarenko[36] showed that the consumption of drugs derived from cannabis had spread in Asiatic Russia in the territories north of the Caucasus and certain districts of the Volga Basin. According to these authors, there, as in North America, a large proportion of criminals (60 per cent) were addicts.

On the other hand, among Europeans living in North Africa, and belonging for the most part to the Latin Mediterranean group (Spaniards, Italians, Maltese, Greeks and French) there is little or no cannabis addiction, although the drug is easy to obtain. It does not appeal to them. In fact, the few Europeans who have had a fancy to try hemp do not appear to have been driven to commit violent anti-social acts whilst under the influence of the drug.

Another hypothesis suggests itself, namely that the resin produced by the cannabis growing in America may have a different composition, and hence different physiological properties, from that coming from the East or from North Africa; but this supposition can scarcely be entertained, for the American resin reacts to identification tests in exactly the same way as that from other producing countries. Nevertheless, research is necessary, to elucidate the problem completely.

* * * * *

Captain Eli Markovitz and Captain H. J. Myers have studied (The Marihuana addicts in the army, War Medicine, December 1944, pp. 382-394) a certain number of soldiers in the American army, especially coloured men, who were addicted to the use of marihuana.

Efforts to treat them were vain, and despite long stretches in the guard room, these men, as soon as they were released, immediately relapsed into their vice, and finally had to be dismissed from the army. This is not a solution, since the addict is simply transferred to civilian life where his vice will determine criminal and anti-social behaviour. (See P. O. Wolff [62 ter] .)

C. SOCIAL ASPECTS OF HASHISH ADDICTION

In the present state of the somewhat disconnected body of evidence which has been collected, it is not yet possible to draw up a table applicable to chronic hashish addicts as a whole. For the time being, all that can be done is to give a brief description of drug addicts in the Levant and North Africa, these being the addicts of whom we know most, although there are still a number of obscure points.

Is it, for instance, true that only the lower classes of the population are contaminated by this vice? That appears to be the opinion of most writers who have dealt with the question. Dr. J. Bouquet, however, thinks that such an assertion is the result of inevitably superficial observation, and that as far as North Africa is concerned leaving aside the question of proportion the middle classes and native bourgeoisie cannot be said to be free from the vice. The same doubtless applies to Egypt and Turkey. An Afghan or Mexican travelling in certain European countries and judging by the drunkards whom he meets staggering along the public highway, would feel justified in asserting that drunkenness is prevalent only in the poorer classes; but he would be wrong. In the East, the foreigner readily notices poor people, a kif pipe between their lips, squatting or lying down on mats in some corner of a souk, at the entrance of a small shop, or in the shade of a Moorish cafe. The more prosperous hashish addict has no need to exhibit his vice in public. It is in his own house, sheltered from prying eyes and from any possible police supervision, that he gathers his friends around him to indulge in the drug.

It is perhaps true that there are fewer hemp smokers in the well-to-do classes than among the lowest strata of the population. But the former certainly contain a much higher proportion of persons consuming preparations made from cannabis (dawamesk, garaouich, majun, etc.). These mixtures sold in the illicit traffic are luxury articles, and always expensive; they are in most cases beyond the means of the poorer addicts. Who then consumes them, if not the well-to-do? Dr. Gobert[22] reports, moreover, that many Tunisian bourgeois are not averse to indulging in hemp, at any rate during the month of the Fast of Ramadan; and Dr. Gueche[51] notes that in Algeria the great majority of hemp consumers are illiterate, but that quite a number of educated people also consume the drug.

In any case, as these circles are reserved and resentful of intrusion, and hence very difficult to approach, present indications are no more than conjectures, to be confirmed or disproved by subsequent investigation.

The cannabis smoking populace, on the other hand, is easier to study. Throughout the whole of the Moslem East it forms a kind of cheerful irresponsible rabble which makes no secret of its vice, particularly in countries such as Tunisia and Morocco, where the use of hemp in its natural state is not forbidden.*

1. Class from which addicts are recruited

In North Africa, hemp smokers are not recruited from the tent-dwelling nomadic Arabs who live in the steppes and fringes of the desert. The vice is rare among the farming population, who live grouped in "douars" in the cultivated or stock-raising districts. Tea addiction finds greater favour with them.**

It is among the sedentary dwellers in the oases and the lower classes in the towns (artisans, labourers, coachmen, small shopkeepers, boatmen, porters, dockers, etc.) that the largest number of hemp consumers are found. Many of such people (except perhaps the artisans and small shopkeepers) indulge, even to excess, in alcoholic liquor. There is no doubt that drunkenness has spread-at the expense of hemp-to the majority of those whose occupations bring them into continuous contact with working companions of European origin, of the lower class. In the port of Tunis, some dock workers, earning 350 francs daily, drink 4 to 5 litres of wine a day, apart from numerous "aperitifs", and smoke takrouri in the evening. They scarcely have enough left for meagre meals and do not even manage to dress decently.

A Moroccan proverb says "Kif is like fire; a little warms, a great deal burns". Many consumers are therefore content to smoke a few pipes every evening while sipping coffee or a cup of tea, before going to bed. It can be said that cannabism has no serious effects on this type of person. Their health will not suffer and they will be able to carry on their work without difficulty. The number of these "careful" smokers is fairly high in the towns among the artisans and small shopkeepers.

Those over whom the drug has a greater hold meet in the evening in groups of five or six in their favourite cafes or in a shop belonging to one of their number.*** Sometimes, if they can afford it, they hire premises, generally a single room, in a side street or quiet dead-end. The furniture is scanty: mats or cushions on the ground or on benches, a few coloured prints on the walls, and a low table with a jar of basil ( Ocimum basilicum), the perfume of which is much appreciated by the natives; they always bring with them either candied fruit or some pastries and sweets, including sometimes a kind of "majun" which they prepare by merely mixing powdered hemp with hot thick syrup. The mixture is poured out on to a marble slab, where it solidifies. It is then cut into pieces. A clay stove (canoun) is used for preparing coffee or tea: fresh mint leaves (nana) are often added to the latter.

*Prof. A. Porot[56bis] and Prof. Mazhar Osman Uzman[56bis] , stress the frequent association between cannabism and alcoholism; and also the retreat of hashish addiction before the invasion of manufactured drugs, especially heroin.

** See.J. Bouquet: Le Theisme en Afrique du Nord, 1948[21g] .

*** Same observation as regards Cuba and groups of smokers ( bonches) of marihuana cigarettes. See Dr. Luis Angulo[71] .

The meetings generally last a long time, as it is customary to attain complete intoxication. The smoking den is therefore left very late in the night, if indeed the stage of sleep which closes the cycle of the phenomena of intoxication does not compel the smoker to stay all night. It is easy to imagine that nights thus passed do not predispose to work on the morrow.

2. Consequences

The drug habit develops in its devotees various tendencies, some innocent, others definitely anti-social, which distinguish them from their fellow citizens. Finding no satisfactory outlet for such tendencies in normal society, they band together to form a somewhat disquieting fraternity.

Those in whom addiction has not yet reached an advanced stage are observed to have a pronounced taste for flowers, perfumes, sweets and singing birds-in fact, feminine tastes, which accord fairly well with their temperament of inverts. They still dress with a certain amount of taste, and are fond of clothes with loud colours.

Inveterate addicts, however, generally not only pay no attention to their persons, but neglect the elementary rules of cleanliness. Their appearance is disorderly and dirty, they are content with a filthy hovel as a lodging, or may even sleep in the open or in some mucky stable corner. Frequently, they no longer trouble to prepare food, but beg at the doors of barracks or charitable institutions (popular soup kitchens, etc.). The little money they have is spent in buying the drug. Impervious to any sense of shame or dishonour, they do not shrink from the most unprincipled and degrading acts to procure funds. They have no feelings left except to be sorry for themselves and invariably throw the blame on others.

The majority of hemp smokers are bad Moslems. They are much more superstitious than pious. They neglect the observance of prayers, and yet a certain number carry out pilgrimages to the tombs of various marabouts. They claim, moreover, that many of the most popular saints of Islam indulged in kif.

Such people are an unproductive burden on society. What little property they have is soon disposed of to provide them with means of buying the drug. If they practise a trade they neglect their professional duties, and poverty soon follows. They do not care, however, and have indeed no hesitation in selling what little furniture or clothing they possess. If they are married, if they have children, they soon become incapable of providing for their families, and abandon them without a qualm to the direst poverty. If single, they refuse to marry and are content to live wretchedly as old bach- elors between their pipe and their stewpot,* spending every penny on the drug. And who benefits by the money thus spent? The State gets nothing from it (except where it has a monopoly of the sale of the drug). It goes to fill the pockets of the crowd of illicit traffickers and smugglers. It is a mistake to imagine that the amounts involved are small. The 1929 report of the Central Narcotics Intelligence Bureau of Egypt estimated an addict's daily average expenditure on hashish at five Egyptian piastres. As the number of smokers in the country at that time was calculated to be approximately 250,000, that expenditure represents E.4,562,500 a year, which not only contributes nothing to the prosperity of the community, but impoverishes it, as the money goes into the pockets of traffickers who are mostly not citizens of the country where they carry on their nefarious traffic.

Nor is this all. A large proportion of the addicts who do little or no work, take insufficient nourishment, and live in deplorable hygienic conditions, account for a considerable proportion of the patients admitted to the hospitals from time to time. Whilst a burden on the public relief institutions when ill, they are also often a charge on the penitentiary institutions, for stealing to obtain funds and their other offences frequently take them to gaol. The healthy industrious sections of the population are obliged to defray the additional expense of supporting this scum of humanity.

It is impossible at present to calculate the extent of such expense in most of the countries where there are cannabis addicts. There are no statistics for Turkey, Tunisia or Morocco.** The only available details are provided in the annual reports of the Egyptian Central Narcotics Intelligence Bureau. The 1937 report states that for a population of 3,110,694 males between twenty and fifty-nine years of age the hashish consumers can be estimated at 11,552 for 1934, 10,503 for 1935, 6,075 for 1936 and 6,524 for 1937. These figures are impressive and give cause for anxiety. If it were possible to estimate exactly what the maintenance of such addicts cost in the State budget (assistance given by charitable societies, hospital expenses, and terms of imprisonment) and to add like expenses connected with addicts taking other drugs (opium, heroin, cocaine, etc.), the total would be startling.

It must not be thought that the many addicts who attend the hospital out-patient departments are actuated by a desire to reform. The kind of life they lead and the undernourishment they endure, together with the physiological debilitation caused by abuse of the drug, bring on many diseases: broncho-pulmonary afflictions in winter and entero-gastric ailments in summer, not to mention syphilitic lesions, which are fairly common.

In October 1938 in the Nefzaou (Tozeur, Nefta), where the numerous smokers of takrouri are so little ashamed of their addiction that they go about with their kif pipe stuck in the folds of their turbans, one of them confessed to Dr. J. Bouquet to smoking 80 to 100 pipes a day, and so exhausting his resources in purchasing the drug that he was frequently left without money to buy food. Although a young man, he declared that he did not want to marry (which is ignominious for a Moslem) so as to be able to devote all his daily earnings to the purchase of hemp and tea.

Sir R. N. Chopra estimates the number of hashish addicts at about 1,500,000 in India; but this estimate does not include illicit consumption, which is impossible to ascertain.

In the majority of cases, if it is possible to cure the ailment for which they were admitted to hospital, regular and plentiful food and temporary abstention from the drug result in rapid recovery.

Unfortunately, it is exceptional for them not to relapse into their vice as soon as they leave hospital. During their time in hospital nothing is learned, as a rule, of their addiction; firstly because they themselves do not reveal it, and secondly because the subordinate nursing staff, although in permanent contact with them, consists of natives, who attach no importance to the vice and do not report it. Moreover, the laboratory tests so far carried out do not reveal any special signs pointing to cannabis addiction. Lowered blood pressure, the presence in the urine of glucose (frequently), or of glycuronic acid (two cases) are such common symptoms that they are of no value for the purpose of diagnosing addiction (Dr. J. Bouquet)***: there has not yet been any systematic research on the blood. Another reason why the detection of this class of addict is difficult is that they do not show any of those withdrawal symptoms which are so characteristic in the case of opium addicts and consumers of manufactured drugs that they cannot pass unnoticed. According to Chopra[66] , deprivation of bhang does not seem to cause any ill effects. Forced deprivation of ganja or charas sometimes causes disagreeable symptoms, but nothing like those caused by the lack of manufactured drugs.

Thus it is extremely difficult to discover such addicts, unless they give themselves away by some reprehensible act during, or as a result of, a bout of cannabis intoxication, or are caught red-handed holding or consuming a prohibited drug (e.g. chira in North Africa).

The result is that chronic intoxication may follow its course, grow worse with time, and reduce the sufferer to mental epilepsy, hashish mania, or schizophrenia which calls for internment in a lunatic asylum.

There are unfortunately few statistics available concerning the number of interned hashish addicts.

Some figures furnished by Dr. Warnock[53] may give an idea-though only a very rough idea-of the proportion of cases of hashish insanity occurring in Cairo from 1895 to 1901. The number for that period was 689 out of 2,564 insane persons of the male sex, or 27 per cent. In 1902, at the Abbasieh asylum (Egypt), 22.5 per cent of the inmates were hashish consumers; in 1903, 18 per cent, in 1904, 15 per cent, in 1905, 14.5 per cent and in 1906, 12 per cent.

*** See Dr. G. Lage[70] . He mentions certain laboratory research on hashish addicts.

It should be noted that in Egypt insanity is three times more common among men, for they consume opium or hashish, than among women, who are but rarely addicted to these two drugs. That proportion is very significant, when it is remembered that in Europe insanity is more frequent among women than among men.

Some old statistics of persons interned in the asylums of Bengal on account of hemp addiction give the figure of 53 per cent for 1891-92. In 1901, according to Lewin[54] , of 232 cases admitted, seventy-six, or roughly 33 per cent, were cases of insanity due to cannabis. In the Punjab asylum, in 1905, of 567 persons interned, ninety-eight were hashish addicts and nineteen both hashish and opium addicts. Of that number, seventy-five (three of whom were interned in the asylum after committing a crime) were victims of charas (hashish, chira), two of ganja, and twenty-one of preparations for eating. (Official Statistics of Asylums in India). Cases of insanity have also been reported in Siam. In addition, in many cases, the narcotic is added to alcohol.*

In Tunisia, during the year 1925, Dr. Perrussel[22] removed to hospital 119 insane persons (ninety-two men and twenty-seven women). There was no drug addict among the women. The number of hashish addicts among the ninety-two men was thirty-two (i.e., more than a third); it included sixteen smokers of takrouri (chopped hemp), and sixteen smokers of chira, all seriously affected. At present the number of persons interned for hashish addiction in Tunisia is very small (one, in 1937). Unfortunately victims of manufactured drugs have taken their place.

D. CANNABISM IN RELATION TO OTHER ADDICTIONS

If studied superficially, these various statistics, although very fragmentary, would lead one to suppose that the number Of consumers of cannabis, or at any rate of those consuming it in excess, is decreasing; but the real question is whether in most places, save India, hemp addiction has not been supplanted by addiction to manufactured drugs.

In 1932, Sir Thomas Russell[48] write in the Annual Report of the Narcotics Intelligence Bureau: "True, hashish is not the same menace as heroin, but hashish addiction leads to heroin addiction."

The same view is held by Stringaris[33] , Meyerhof[34] , and J. Bouquet. While in Egypt the number of hashish addicts fell from 11,552 in 1934 to 6,524 in 1937, the same statistics show that the number of persons found guilty of consuming heroin rose from 1,605 in 1934 to 2,602 in 1937. The same warning note is sounded by Dr. J. Bouquet with regard to Tunisia. There are fewer hemp addicts there than formerly, chiefly because the number of new recruits to the ranks of cannabis addicts has been declining regularly, partly owing to the increase in alcoholism, and partly because the younger element of the population is attracted by heroin rather than hemp.

* See report by Prof. A. Porot[52 bis] , report by Prof. Mazhar Osman Uzman56bls and work by Dr. Luis Angulo

How is the popularity of manufactured drugs to be explained?

Dr. J. Bouquet considers that one of the main reasons is the abundant supply. Contraband in hemp and hashish (chira, charas) is less paying and more difficult than illicit traffic in chemical drugs. The big traffickers therefore devote all their efforts to trading in the latter substances, and their numerous retailing agents, deriving greater profit from the transactions (a profit which is notably increased by the facility with which the drug can be adulterated) do all they can to recruit and enlarge the circle of their customers. Their solicitations are so numerous and persistent that the victims have little chance of escape. -

1. Substitute drugs

In North Africa, persons accustomed to hemp who have allowed themselves to be persuaded to take manufactured drugs, sometimes return to cannabis, either because the habit is deep-rooted or because they cannot procure supplies of the new drug. In most cases they alternate between one and the other according to the possibilities of supply.

On the other hand, people who start by taking chemical drugs do not turn to cannabis when they have run out of their favourite drug. They find that hemp is not sufficiently swift or powerful in its effects to satisfy their vice. The chief substitute which they try to get is opium (which they chew and do not smoke).

The same no doubt applies to Egypt; in fact the seizure statistics given in the 1937 report of the Cairo Central Narcotics Intelligence Bureau are as follows:

Hashish: 1934:800 kg. 842 g.; 1936:448 kg. 955 g.

Heroin: 1934: 14 kg. 739 g.; 1936: 26 kg. 737 g.

Opium: 1934:314 kg. 265 g.; 1936:500 kg. 951 g.

The decline in hashish seizures corresponds to an increase in heroin and opium seizures. The Egyptian Government also stressed the fact that there had been an increase in clandestine cultivation of the opium poppy in Upper Egypt. While, owing to the efforts of the League of Nations and the United Nations, hashish has become definitely scarcer in Mediterranean districts, heroin has competed with it and, in part, supplanted it. The high price of the white drug and the intensification of the campaign against traffickers compel addicts to look for a substitute. If heroin remains scarce and its price is prohibitive for most of them, they will try to get opium rather than hashish.

2. Cannabism and crime

The problem is certainly not the same in North America. There cannabis addiction is a "new vice", which has a special attraction for young people, particularly in the large cities. It also appears that marihuana smokers are recruited from people who formerly did not indulge either in heroin, morphine or cocaine. What is particularly alarming is the fact that the investigations of the Governments of the United States and Canada show cannabis to have a marked influence on criminality among such addicts.[68]

The same cannot be said about North Africa or the Levant.

There, at present at any rate, a large number of petty offenders (pilferers and thieves), some more serious offenders (assault and battery, minor acts of violence, and indecent assault), but very rarely persons guilty of more serious crimes, even attempted murder, are to be found among hemp consumers. It cannot therefore be said that cannabis addiction has an influence on criminality in the Moslem world at the present time; in North Africa nowadays there are perhaps more brawls, acts of violence, blows and wounds attributable to alcoholic liquor than to cannabis.

In any case, it would be premature to draw conclusions, and further investigations must be pursued in the various countries where there are hashish addicts. There may, moreover, be no direct connexion between drug addiction and criminality: each may arise from, and be explained by, a mental deficiency in the individual. (See O.C. 1542 (c) p. 10).

V. SUPPLY

A. VOLUME AND EXTENSION

The clandestine trade in cannabis, its resin (charas, chira and hashish) and their preparations, is not nearly so widespread as the illicit traffic in manufactured drugs.

It has always been localized chiefly in the eastern Mediterranean basin, stretching out tentacles to the west towards Tunisia, Algeria and Morocco, to the south towards Egypt and the Sudan, and to the north towards certain parts of the USSR. In the last few years a clandestine trade, unconnected with that just mentioned, has been discovered in the United States.

On rare occasions large seizures have been reported in various western European countries; but they concerned consignments in transit to other parts of the world. The only consumers of the drug mentioned in the reports of the Governments of Great Britain, France and the Netherlands, are occasional groups of sailors or traders from India or Moslem countries, settled, for the most part only temporarily, in certain parts of western Europe. Such groups are not sufficiently numerous or large to interest traffickers.

Cannabis traffickers therefore direct their efforts primarily to other regions. Further, such countries must be sufficiently rich; that explains why traffickers pay special attention to Egypt, and that is what the United States has to fear.

It would be superfluous to study the traffickers' organizations, methods and ruses in detail. To acquire a perfect knowledge of them one merely has to refer to the excellent annual reports of the Narcotics Intelligence Bureau of Cairo, which have been published since 1929 by the Egyptian Government, and to the annual reports of the United States Bureau of Narcotics.

Sources

It will moreover be seen; if those reports and League documents O.C. 1542 and O.C. 1542 (k) are examined, that the efforts of the League of Nations had already given encouraging results. It is owing to them that the production of cannabis in the countries of the Balkan Peninsula has been practically stopped. Perhaps some illicit cultivation still goes on there, but not enough to constitute a serious danger. In Yugoslavia, in spite of the fact that they are forbidden by law, there appear still to be illicit crops in districts where opium is cultivated, particularly in the districts of Uskub, Guevgueli, Doiran, etc.* The Yugoslav Government probably put a stop to the cultivation in question as soon as it learned of it.

In Turkey the question is more complicated. In spite of laws and in spite of the sincere efforts of the Government, it cannot be denied that contraband, if not illicit cultivation, still exists. The "hashish of Brusa" has always enjoyed an excellent reputation in the world of hemp consumers. The preparation of, and trade in, this product, together with opium, were a source of considerable profit for part of the rural population of certain vilayets of Asia Minor. It is therefore probable that the peasants in question have not given up such a paying crop, and that illicit plantations, although more carefully concealed, still exist.

Secondly, owing to its geographical position, the Turkish Republic is the highway to the eastern Mediterranean for supplies of the drug which traffickers have been able to obtain in Iran (whether it originally comes from Afghanistan, Sinkiang or Iran itself). Therefore, in Turkey there are two currents of active contraband: one from the interior of the country towards, more particularly, the Moslem Mediterranean countries; the other from certain hemp-producing countries towards Turkey, which is able to consume a certain amount itself and to launch the rest into the illicit traffic.

In 1917-1918 Dr. Bouquet had an opportunity of seeing fairly large stocks of hashish in the hands of the peasants in the villages of Bohemitza, Karasouli, Mayadag and Gorgop (in the district south of Guevgueli). He was told that these stocks were generally sold in Salonica; but at that time the war was interrupting the trade.

Finally, it must not be forgotten that Istanbul has always been, and still is, the favourite port of hashish (and opium) smugglers. Not only can traffickers place consignments of hashish on steamers calling at Istanbul, but numerous coasting vessels, which are not easy to watch, leave that port to visit various places along the coast of Asia Minor, Palestine, Syria and Egypt.

However, it cannot be denied that the amounts of hashish seized have decreased since 1929, both in Egypt and in French North Africa. Thus, in Egypt hashish seizures in 1929 amounted to over 12,000 kilogrammes; those of manzul (a drug prepared for eating from hashish and spices) were about 240 kilogrammes; in 1937 the hashish seizures were less than 200 kilogrammes and those of manzul less than 20 kilogrammes.

The problem should, nevertheless, be examined more closely; and the trade in cannabis in its natural state, and that in its resin (charas, hashish, chira) should be studied separately.

1. Hemp in its natural state for smoking

(a) Legal supplies. The supply of this product is allowed in three countries only, namely India, Tunis and Morocco.

India*:

It should be noted that the British Government had always considered that it was neither practical nor desirable to depart from the traditional policy of tolerating the moderate use of raw opium and drugs with a hemp basis, while taking every possible step to prevent abuses.

Throughout the whole of India and Pakistan, cannabis in its natural state is consumed in the form of bhang (leaves) and ganja (female tops). The plant both grows wild and is cultivated. There is no government factory for the preparation of bhang and ganja; but cultivation of hemp and collection of the produce from the wild plant were subjected to a system of licences. The produce collected was stored in Government depots. It was issued, as and when requests were received, to licensed retailers under conditions very similar to those governing the sale of opium. Consumers obtained their supplies from shops belonging to these authorized merchants. The Indian Government has just announced (1950) that it proposes to prohibit the cultivation of cannabis for the purpose of obtaining ganja.

Illicit trade doubtless exists, as cannabis grows wild in many parts of India. There may also be clandestine crops which escape the attention of the control authorities. It is said that a considerable contraband trade is carried on with hemp from Assam.

* See work of R. N. Chopra and Cr. S. Chopra [66] and[67] .

There is an illicit export trade to Ceylon and certain parts of Arabia, the east coast of Africa and the Red Sea, where Indian ganja has a great reputation; but this traffic is not so large as that in charas (hashish).

Tunisia:

The sale of chopped hemp ready for smoking (takrouri) is a state monopoly like the sale of tobacco, salt, gunpowder and matches.

The Direction des monopoles every year fixes the area of authorized plantations and issues cultivation permits. It buys the complete crop of whole plants from the producers. The Tunis Tobacco Factory prepares takrouri, by cleaning, chopping and sifting. It divides it up into packets of five grammes which are sold, without any formalities, in all the tobacco shops of the Tunis Regency. In 1937, 6,387 kilogrammes of takrouri were sold, i.e. 1,277,400 packets, at 2 frs. 35 centimes each.**

Illicit trade. This is negligible, so far as illicit crops are concerned. In 1941 small plantations, representing a total of 2,161 plants, were discovered. There is no smuggling by sea, as the produce has not sufficient market value to be worth the sailors' while. Illicit importation is carried out chiefly across the Algerian land frontier (367 kg. were seized in 1937; 958 kg. in 1947). The attempts to introduce contraband hemp from Algeria are sufficiently numerous to justify the suspicion that there are cannabis plantations in Algeria, which are either clandestine or given out to be "for the production of textile fibre" (Dr. J. Bouquet). As the produce is bulky, cumbersome and difficult to conceal, this form of contraband, which is not very remunerative, does not attract the important traffickers' organizations. It is chiefly a matter of isolated attempts by low-class natives.

French Morocco:

In Morocco, the sale of chopped hemp ready for smoking (kif) is the monopoly of the Société internationale pour la Regie cointeressée des Tabacs. As in Tunisia, the hemp is sold in tobacco shops, but mixed with tobacco.

The raw material is bought from the producers in Spanish Morocco. This method makes it possible to provide the consumer with a product to which he is accustomed, and also reduces the stocks which native producers woudd otherwise try to sell secretly in the Protectorate.

Illicit trade. This is purely internal. The mountain tribes which grow hemp certainly sell it secretly. There is no smuggling by sea or across the Algerian frontier. The product is so low-priced that international contraband organizations are not interested in it, for fraudulent importation into Morocco would not yield a profit proportionate to the risks incurred.

The maximum sales were, in 1941: 3,181,782 packets of 5 g. In 1945, sales amounted to 1,448,069 packets. In 1947 they exceeded 2,500,000 packets, despite the increased price: 25 frs. per 5 g. packet. In 1950 the price of 5 g. was raised to 30 frs.

Illicit supplies: it may be taken that in all countries where the consumption of hemp is forbidden the supplies are furnished through the illicit traffic. This traffic is fed from:

  1. Clandestine crops within the country itself: that is the case, for instance, in Malaya, Burma, Ceylon, Iran, Turkey, Syria, Lebanon, the Egyptian Sudan, Tunisia, Algeria, Morocco, Belgian Congo, Bechuanaland, Kenya, Uganda, Sierra Leone, Swaziland, Zanzibar, Mozambique, Brazil, Mexico, the northern part of South America, Honduras, Jamaica, the United States, Cuba, etc.*

  2. The collection of hemp growing wild: that is the case, for instance, in India, Thailand, Nyasaland, the Rhodesias, Bechuanaland, Basutoland, Swaziland, Kenya, Angola, Mexico, the United States, the Panama Canal Zone, etc. The traffic, whether in wild or in secretly-grown cannabis, is never very extensive. If the hemp grows wild, the consumer generally establishes his own reserve supply and sells the remainder in neighbouring districts.

    As for clandestine crops, the necessity for concealment means that they seldom cover a wide area, and therefore cannot provide for a large volume of clandestine trade.

    Matters are otherwise in the United States, where it appears that marihuana growing in a number of states has already given rise to a considerable trade. The hemps growing in the United States cannot all have a sufficient resin content to be used as inebriants, and marihuana traffickers must obtain their supplies of the raw product in certain districts only, and particularly in Mexico.

  3. Contraband coming from other countries. This form of contraband exists in all countries where hemp does not grow wild, is not cultivated, and is consumed although forbidden, e.g. Canada, Dutch Guiana, Trinidad and Tobago, Egypt, etc.

    The negro tribes under French influence in the Chad, Shari and Upper Ubangi regions, who consume large quantities of hemp, are supplied by caravans coming mainly from the southern Sudan. At points where the French authorities can exercise control, these caravans transport only innocent cheap wares, but the forbidden wares (arms, powder, hashish, chopped hemp, etc.) which form the main part of their transactions, are deposited and carefully concealed in various villages in league with the traffickers, to whom the purchaser goes to take delivery of the goods. Suppression of the trade is therefore very difficult.

    There is certainly less illicit traffic in untreated hemp than in any other drug, for the product is bulky and low-priced and consequently of little interest to the traffickers.

Clandestine cultivation was reported (1946-1948) in the neighbourhood of Paris (Charenton, Vincennes, Maison Alfort, Orly Aerodrome) either in the open air or under glass. The seed was derived from the Near East, North Africa and Mexico.[64]

2. Raw cannabis resin (charas, hashish, chira)
(a) Legal supplies. This substance is allowed in only one country, namely India.

Charas is not prepared in India; it comes from Central Asia. It was legally introduced into India by dealers holding a licence from the Government of the Punjab. Importation was strictly controlled. Special depots were established at Leh and Chitral in which charas was stored and from which it was subsequently distributed, but only to resellers in possession of a licence.

Illicit trade. There is a very brisk contraband trade from Sinkiang over the north-west frontier. Further, the prohibition of the consumption of charas in certain parts of India, and the great differences in the duties levied on this product in the various provinces, lead to a considerable amount of inter-provincial smuggling.

Illicit supplies. Apart from India, raw cannabis resin (charas, hashish, chira) is forbidden in all countries. As it has no medical or industrial value, the sole object of illicit traffic in this substance is to supply drug addicts.

Sources. Until some thirty years ago the main sources of supply were Turkey and Greece. Clandestine supplies to Egypt consisted of Turkish and Greek hashish together with a certain amount of Indian charas. In French North Africa, the Indian product was extremely rare; chira came mainly from Greece, though some consignments arrived from Istanbul.

Greece having forbidden the cultivation of cannabis in 1920, Greek hashish became rarer on the market, although it did not entirely disappear as might have been hoped. Large stocks of resin had probably been concealed, and the Greek Government had to promulgate a new law in 1932, more drastic than that of 1920 and providing for the destruction of stocks. But, during this period, from the end of the First World War to about 1932, the traffickers had attempted to introduce the cultivation of cannabis for the production of resin into other countries of Eastern Europe, e.g. Bulgaria (introduction in 1919 to 1920, prohibition in 1925), Romania (prohibition in 1926), Yugoslavia (introduction about 1927, prohibition in 1932), and Albania.

Turkey had always produced a fairly large quantity of hashish, both for internal consumption and for secret exportation, but when Greek production dried up, Turkey intensified its own production until the Government of the Turkish Republic passed the law of 1933 prohibiting the cultivation, holding and use of, and the trade in, hashish. Thus, during that period, seizures effected both in Egypt and in North Africa (the biggest and best customers of Eastern Mediterranean traffickers), were chiefly of Turkish hashish (from Istanbul and Brusa). In Egypt, Indian hashish (charas) though always rated very high, had a rival in the Turkish product, and both had to compete on the market with a less highly valued form of hashish, namely that from Syria and Lebanon. In North Africa the contraband wares consisted chiefly of hashish from Constantinople (in turbans and soles); whilst there was no Indian, and little Syrian, hashish. During that period some consignments of Greek origin were introduced, but coming from old and often adulterated stocks, they disappointed customers who had been attracted by the former reputation of the Greek drug.

At the present time, the chira (hashish) contraband in French North Africa may be said to be dying out; the amounts seized are now negligible. One reason for this is that the illicit trade in manufactured drugs is more tempting for traffickers than that in cannabis and its resin. Moreover, it was mainly from Tunis that the remainder of North Africa procured supplies. Contraband in chira in Tunisia was in the hands of two or three groups of Greek traffickers, who obtained their supplies from Greece. The prohibition of hemp cultivation and of the preparation of hashish in Greece dealt their trade a blow from which it has not been able to recover, in spite of subsequent attempts to substitute Turkish, Syrian and Albanian hemp.

In Egypt, in spite of the Government's efforts, there is still an active contraband trade, although it is on the wane. The annual reports of the Central Narcotics Intelligence Bureau of Egypt are most instructive, and reference should be made to the abundant material they contain about all matters connected with hashish contraband in the Levant.

Contraband in Egypt is carried out: (i) by sea, and (ii) by land.

(i) By sea:

  1. Sometimes the traffickers are members of the crews of steamers coming from India and passing through the Suez Canal (the substance in this case is Indian hashish). The attempts to unload the drugs are made at Suez or Port Said.

  2. Sometimes the steamers come from various ports in the Eastern Mediterranean (in this case, the hashish is Turkish or Syrian). The port of unloading is generally Alexandria.

  3. Sometimes the boats concerned are not steamers, but sailing vessels plying along the coast of Syria and Palestine, and calling at the Egyptian ports. In 1937, 31 kilogrammes 369 grammes of hashish were seized on these small sailing boats, and 23 kilogrammes 577 grammes on steamers. In addition, 141 kilogrammes 760 grammes were fished up from the water or found near the coast. Immersion in shallow parts of the sea of packets of drugs (enclosed in soldered metal containers or rubber bags) is a common practice among the crews of small sailing vessels when they think they are likely to be caught.

  4. Sometimes the drug is unloaded under a false declaration in packing cases for harmless goods. In this case, the Customs clearance agents in the ports are frequently in league with the traffickers. Although that branch contains a fair number of honest members, it also includes a good many persons of more doubtful integrity, for anyone can set up as a transit Customs clearance agent. Drastic action to put an end to this state of affairs has been taken in Egypt and in Tunisia. From now on, it will be impossible for persons who are unable to establish their respectability and solvency to deal with transit and Customs clearance.

(ii) By land:

The traffic is carried on by car or by railway from Palestine (travellers and sometimes railway employees), or by camel drivers crossing the desert between the Palestine frontier and the Suez Canal. The traffic is chiefly in hashish of Turkish or Syrio-Lebanese origin bought in Palestine.

It is not always possible to determine the origin of contraband drugs. Although Palestine seems at present to be the most important hashish depot in the Levant, it must be remembered that cannabis is not grown there.

The hashish obtained by traffickers comes from various sources:

  1. Asiatic Turkey (illicit crops).

  2. Syria and Lebanon (illicit crops): In June 1946 the Lebanese Government promulgated a law prohibiting the cultivation of cannabis.

    Nevertheless large quantities of hashish of Syrio-Lebanese origin were seized in Egypt in 1947, 1948 and 1949.

    "The Lebanese have this trade and cultivation in their blood", we read in the 1937 report of the Egyptian Narcotics Bureau.

  3. Iraq. The growing and storing of cannabis are forbidden in Iraq; but investigations have shown that there is a considerable traffic in hashish, probably fed in part by Iranian plantations. No special measures have yet been adopted in Iran to control the cultivation of cannabis for the production of hashish, and there are no regulations governing the export of the drug. That no doubt explains why reports of the Government of the Union of Soviet Socialist Republics have mentioned a considerable amount of contraband in charas (hashish) in the frontier districts between the USSR, Iran and Afghanistan, thereby confirming the statements made by Sinkarenko[36] and Dr. Stringaris[33] as to the spread of addiction to cannabis preparations in certain parts of the USSR.

To sum up, the contraband trade for the supply of drug addicts originates in India (in a comparatively small measure), Afghanistan, Iran,* and the various countries between those States and the Mediterranean. The Governments of most of those countries are, it is true, making efforts to paralyse clandestine traffic; but often in vain; for they have to deal sometimes with illicit crops covering a small area and skilfully located far from the routes which are watched, and sometimes with small but numerous consignments coming from different districts, often far away, and distributed in stores situated in out-of-the-way places. The stocks thus brought together are transported when necessary to the seaports, where they can be entrusted to sea-going accomplices, or to places near the frontier where smugglers will get them across when a suitable opportunity occurs.

It must not be thought, however, that the groups engaged in illicit hashish traffic are as large as the remarkably well-organized groups of manufactured drug traffickers with their ramifications in all the chief countries of the world.

The few associations of hashish traffickers, generally directed by Greeks, which gravely disturbed the Egyptian abolition authorities for many years, have now been reduced to impotence. Their ringleaders have been imprisoned or expelled. According to the annual reports of the Central Narcotics Intelligence Bureau of Cairo, most of the traffickers arrested since 1937 were independent individuals acting on their own for profit, or small groups belonging to the type of underworld adventurer class to whom regular work is repugnant and who hope to reap a sufficient profit by introducing and reselling hashish in Egypt, to keep them in funds until the next opportunity of attempting a coupoccurs.

But, although the amount of drugs introduced by any one of these gangs of traffickers is comparatively small, the number of such gangs is large and the aggregate quantity of drugs involved is hence considerable, and a source of permanent concern to the narcotic control services. The same applies to the consignments of hashish unloaded at night on the western shore of the Red Sea, and carried by caravans of nomad Bedouins across the desert to the towns in the Nile Valley. The Egyptian Government is also seriously concerned by the spread of clandestine hemp crops in Upper Egypt. Air patrols are used to spot these crops. The hashish prepared in Upper Egypt sometimes reaches Lower Egypt, passing through the hands of many dealers, themselves often drug addicts.

* See Dr. Dana, "Le Hachich et ses intoxications en Iran", Thesis, Paris, 193859.

B. TRAFFICKERS WHO ARE ADDICTS

It is often very difficult to distinguish between drug addicts and small traffickers. This fact, which has often been noted in the case of dealers in hemp and hashish, is also true of the host of small traffickers in manufactured drugs.

The leaders of the important gangs of traffickers and the directors of the clandestine organizations make money out of the trade but do not take the drugs themselves. On the other hand, numberless small retailers are in many instances recruited - and very easily recruited - from the ranks of drug consumers, for profits on the sale of the drug, possible adulteration, giving short weight, and the like enable them to obtain the wherewithal to satisfy their own vice.

It is such people who are the most dangerous spreaders of addiction. They attempt to market their wares by every possible means. They know that incipient addicts are inexperienced and easily satisfied purchasers, and these they pester with offers and requests, encouraging them to recruit new consumers from among their friends. Their influence on young people is thus nefarious in the extreme.

If they are arrested, they always deny that they are traffickers, confessing on the other hand that they are addicts. Thus they hope to secure leniency from the courts, whereas from the social point of view they are actually the most dangerous offenders. It is criminals of this type who have introduced chemical narcotics among the female population of Tunis, and it is due to them that some young pupils in the Tunisian schools contract the habit of smoking takrouri. It is certainly they who popularized the smoking of marihuana cigarettes among young people in some of the schools in the United States.

C. SUPPRESSION

How should these evil-doers be dealt with? It is difficult to draw up a plan which could be applied to all contaminated districts; the conditions vary too greatly.

In the United States, for instance, addicts appear to be supplied by home production (wild plants or illicit crops) and by smuggling across the Mexican frontier. Attempts to introduce the drug by sea (Pacific and Atlantic) have so far been of small importance. Few consignments of raw cannabis resin (charas, hashish, chira), have so far been reported.

It may therefore be hoped that the "Marihuana Tax Act" of 1937 will suffice to ensure control over cannabis traffic, and to prevent the abuse of the plant and its derivatives. The general measures adopted for controlling and stopping the traffic in narcotic drugs (opium and manufactured drugs) by sea, air and land also make it possible to seize hashish, chira, and charas if attempts to introduce these drugs into the United States are made, as is to be expected and feared.

In Canada, marihuana smokers are certainly supplied by contraband trade, mostly from the United States. It is quite improbable that cannabis growing in the Canadian climate can produce sufficient quantities of inebriating resin to be used by drug addicts. The authorities therefore merely have to watch for traffic from outside, as in the case of other drugs.

In French North Africa, the task is more complicated. The section of the population which indulges in cannabis is exclusively native. It has been consuming the drug for a very long time. It is well aware that hemp cultivated in certain areas of Northern Africa yields a product which is of value to smokers. The authorities must therefore safeguard themselves in the first place against internal illicit traffic. In Morocco, Tunisia, and Algeria clandestine crops are discovered every year, and Dr. J. Bouquet believes there are undoubtedly large crops in Algeria which are represented as crops for the textile fibre.

The authorities must also - and above all - take steps to stop the secret importation of chira (hashish). Compared with the amounts smuggled forty years ago present-day illegal imports are very small indeed. Smuggling still goes on, however; and relations between the Near East and French North Africa are too close for producers of hashish (chira) not to try to sell a consignment from time to time in Tunisia, whence it can easily be sent (via Italy or France) to America.

The same applies a fortiori to Egypt, which is more vulnerable because nearer to the producing countries. There have, moreover, been many attempts at clandestine hemp-growing in Upper Egypt.

In India, the problem is still more complicated, as hemp grows wild, and charas production is carried on, uncontrolled, in neighbouring territories which have no regulations concerning the production of or trade in this drug.

D. PROHIBITION OR CONTROLLED TOLERATION

Since hemp resin has no medical or industrial value and since resin-producing hemp plants give few seeds and only provide textile fibre of a poor quality, it should be very simple to reach an agreement forbidding hemp growing outright in districts where its resin production is high. That is a task for the United Nations.

Unfortunately, the views of various States are opposed to such a radical measure. In India there is the politico-religious problem, and in Tunisia and Morocco the politico-social problem. Rather than institute prohibition, which might, they fear, be badly received by their subjects, who have used hemp for centuries, the Governments of those countries resort to a policy of controlled toleration, restricting contraband and maintaining consumption within moderate limits. The Egyptian Government (see Annual Report of the Narcotics Intelligence Bureau, 1936, p. 172) disputes that this is achieved. It rightly contends that it is delusion to believe that an addiction can be moderated; for populations which crave narcotics the only factor that compels moderation is that of financial inability to buy the drug. Nothing could be truer, and that is why, year by year, the Government of Tunisia raises the selling price of takrouri by several francs a packet.

Dr. J. Bouquet is convinced that if measures of absolute prohibition had been taken twenty-five or thirty years ago excellent results would have been achieved and the problem would no longer be so acute. He thinks, however, that at the present time total suppression (at least in countries where the consumption of hemp is a long-standing habit) would result in an increase of addiction to manufactured drugs, which are much more dangerous and less in keeping with the temperament of the populations in question. What is required, if gradual suppression of the drug is to be achieved, is ceaseless vigilance and a persevering effort to prevent these various populations, receiving any substantial fresh supplies through contraband channels.

In all countries, both those where the use of hemp resin and its preparations is forbidden and those where it is still tolerated, it is essential that there should be a sufficiently strict system of control to cut off clandestine supplies. Further, international and national measures of control should aim both at attaining this end in countries which have long been tainted, and at arresting its development in countries not yet heavily contaminated where the vice is, however, giving cause for alarm.

What measures can be suggested to deal effectively with traffickers?

Dr. J. Bouquet considers that fines have no effect. That is also the opinion of the Director of the Central Narcotics Intelligence Bureau of the Egyptian Government who states in one of his reports that only 1 per cent of the fines imposed is paid into the coffers of the State. The only fines paid are those imposed on the small number of sentenced traffickers who are members of important gangs. Such fines are paid out of the gang pool. The small traffickers, who form the great majority of prosecuted offenders, are either without means, or else, if they happen to own any real property, have taken care to register it in the name of their wives or near relatives.

Therefore, although the system of fines may have some effect in cases where pharmaceutical importers, chemists etc. have diverted drugs from the legal trade into the illicit traffic, it is quite useless in most of the ordinary cases of clandestine traffic. It is not, however, by any means suggested that the system should not be maintained. It constitutes a salutary threat for certain accomplices of the traffickers, such as hotel-keepers, cafe-keepers, warehousemen, carriers, forwarding agents and others.

Imprisonment, followed by deportation from the territory where the offence has been committed and refusal of permission to return, seems to be the measure most feared by traffickers who are foreigners in the country where they operate. But such deportation should be strictly applied in all cases, and would be still more effective if the various States directly concerned in combating addiction agreed that every deportation for traffic in drugs would automatically entail refusal of permission to reside in the other countries, or, at any rate, strict supervision capable of paralysing the trafficker's usual activities.

In the case of people who engage in drug traffic in their own country, the only effective measures (if the countries concerned do not accept the principle of corporal punishment which, however, is very effective) are sentences of imprisonment with hard labour, especially if in addition to imprisonment and fine the offender is placed under administrative or police supervision in some place far away from the district where he practised his trade. A draft decree on these lines has been studied in Tunisia. It provides for the immediate expulsion from the territory of the Regency of Tunis of all foreign traffickers after they have served their term of imprisonment.

As for traffickers of Tunisian nationality, when discharged from prison they will be placed under supervision in the desolate territories to the south of Tunisia, where the poverty of the nomadic tribes will preclude any trafficking in drugs. The Decree of 1 July 1939 also provides that parents whose children are minors and indulge in drugs (though this has reference mainly to heroin and cocaine) shall be able to ask the courts to intern the young offenders for a varying period in special establishments.

Traffickers who deserve no pity are those who, being themselves addicts, try to pay for their daily dose of drugs by selling part of their supplies at a profit. They are the most dangerous propagators of drug addiction. At the present time, this type of person is most frequently encountered in the trade in manufactured drugs, but there are also plenty of them in the illicit traffic in hashish (charas, chira).

BIBLIOGRAPHIC NOTES

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The most complete bibliographical indexes appear in: E. PASCAL, "Contribution à l’étude du chanvre indien", Pharmacy Thesis, Toulouse, 1934 (400 references). R. P. WALTON, "Marihuana, America's New Drug Problem", J. B. Lippincott Co., New York, 1938 (438 references). The most recent index (83 references) appears at the end of Dr. P. O. WOLEF'S: "Marihuana in Latin America: the Threat It Constitutes", The Linacre Press, Washington, 1949.

References to documents of the:

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30

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3l

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32

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38

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52B

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56

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59

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60

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61

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62B

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62C

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71

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72

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