Socio-psychiatric problems of cannabis in Nigeria

Sections

Introduction
CLIMATE
POPULATION
RELIGION
DEVELOPMENTS
SOCIOLOGICAL PROBLEMS
Cannabis in Nigeria
Clinical observation
Other sociological effects of cannabis

Details

Author: T. ASUNI
Pages: 17 to 28
Creation Date: 1964/01/01

Socio-psychiatric problems of cannabis in Nigeria

M.A., M.D., D.P.M. T. ASUNI Specialist Psychiatrist and Medical Superintendent, Aro Hospital for Nervous Diseases, Abeokuta, Nigeria; Associate Lecturer in the Department of Psychiatry, University of Ibadan, Nigeria

Introduction

The extent, range and quality of the socio-psychiatric problems of cannabis in Nigeria can only be evaluated against the geographical, demographical and socioeconomic background of that country.

The Federation of Nigeria has an area of 356,669 square miles (923,772.71 square kilometres). Its greatest length from east to west is over 700 miles (1,126.54 kilometres), and from north to south 650 miles (1,046.07 kilometres). The total area is made up as follows:

 
Square miles
Square kilometres
Northern Nigeria
281,782 729,815.35
Eastern Nigeria
29,484 76,363.56
Western Nigeria
45,376 117,523.84
Federal Territory of Lagos
27 69.93

The most southerly point is about 4° north of the Equator, while the northern boundary reaches nearly 19° north. The western frontier runs nearly north and south along the 3° east meridian. The eastern frontier reaches nearly to the 15° east meridian South of Lake Chad, then runs in a south-westward direction to the Atlantic coast.

The coastline - intersected by an intricate network of creeks and rivers - consists, for most of its length, of a sandy beach backed by a belt of mangrove swamp which, in places, is up to 60 miles (96.56 kilometres) in depth. Beyond this there is a zone of tropical forest in undulating country with scattered hills, then the country becomes more open and park-like, with some hilly ranges. Farther inland still, it develops into an undulating plateau with hills of granite and sandstone at a general elevation of 2,000 feet (609.6 metres) but rising on the central plateau and along parts of the eastern frontier to over 6,000 feet (1,828.8 metres). The northern extremities stretch out towards the Sahara desert, but the northern frontier lies within the limits of the summer rains.

CLIMATE

The climate of Nigeria is affected by two main wind currents. One, north-easterly, or Harmattan, is very dry, and normally gives cloudless weather with low humidity, cold nights and mornings, and frequently dusty haze. The other, south-westerly current, is very moist; and when it prevails in sufficient depth, the weather is cloudy, with frequent afternoon or evening thunderstorms, line-squalls and periods of monsoon rain near the coast, and mist in the early mornings.

Nigeria may be divided into four main climatic regions.

Coastal Belt

The coastal belt, extending some 50 miles (80.47 kilometres) inland from the coast, is hot and humid with a high rainfall. Temperatures range between 70°F and 75°F (21°C and 24°C) in the early morning throughout the year, and between 80°F and 90°F (27°C and 32°C) in the afternoon except for a comparatively cool season from June to September. Relative humidity is normally 100 % in the early morning falling to between 60 % and 80 % in the afternoon.

Rainfall varies from 60 inches (152.40 centimetres) a year in the west, to 130 inches (330.20 centimetres) in the east. In the west, there is a principal wet season from May to July with a secondary wet season in October, but towards the east, these seasons gradually merge into a single wet season from May to October. Sometimes during December, January and February, the dry north-easterly wind current reaches the coastal area.

Hinterland

In the hinterland comprising the remainder of eastern and western Nigeria, the climate is drier, with more seasonal variations and a smaller rainfall. Temperatures average 70°F (21°C) in the early morning, afternoon temperatures vary from 90°F to 95°F (32°C to 35°C) between February and April, from 80°F to 85°F (27°C to 29°C) in July and August. Relative humidity is mainly between 90% and 100% in the early morning, falling in the afternoon to about 50 % in January and February, and to 75% in July and August. Rainfall, which is generally less in the north of the area, varies from 35 inches (88.96 centimetres) in the west to 100 inches (254 centimetres) in the east. In the west the wettest months are May, June, July, September and October, but towards the east, August is also wet and the rainy season is continuous from May to October. For varying periods between December and March the north-easterly wind current penetrates to this region giving drier conditions, colder nights and haziness.

Northern Nigeria

In northern Nigeria there is a marked seasonal variation in the climate. In December and January early morning temperatures range from 70°F (21°C) in the south to below 55°F (13°C) in the north-east; in May and June they rise to 75°F (24°C) over most of the territory. Afternoon temperatures are highest in April and May when they reach 95°F (35°C) in the south, and 100°F to 105°F (38°C to 41°C) in the north; they fall to about 85°F (29°C) in July and they rise to a secondary peak of 95°F to 100°F (35°C to 38°C) in the north in October and November. Relative humidity decreases as one travels north. Rainfall varies from 50 inches (127 centimetres) a year in the south to 25 inches (63.5 centimetres) in the north, during a season which lasts from May to October in the south, from June to September in the north.

Plateau

The plateau, an area near the middle of northern Nigeria, which lies about 2,500 feet (762 metres), shows significant variations in climate, being generally cooler and less humid, with a rather higher rainfall. Morning temperatures in the middle of the area are 57°F (14°C) in December and January rising to 66°F (19°C) in April and May; afternoon temperatures vary from 88°F (31°C) in April to 75°F (24°C) in August.

POPULATION

The total population of Nigeria for mid- 1961, estimated from the first complete census of 1952/53, was 35,752,000: 19,877,000 in the north; 8,377,000 in the east; 7,119,000 in the west; and 379,000 in Lagos.

In northern Nigeria there are few large towns, and the people live mainly in villages. This applies also to eastern Nigeria, except that the general density of population is much higher and the villages are bigger and closer together. The people of western Nigeria tend to congregate in large units.

RELIGION

Islam is the predominant religion of northern Nigeria, and also has a considerable following among the Yorubas of western Nigeria. Christian missions have made considerable progress among the Ibos in eastern Nigeria and the Yorubas in the west. According to the census of 1952/53 some 44% of the population of Nigeria is Moslem, 22% Christian, and the remainder hold fast to their ancient cults and faiths.

DEVELOPMENTS

In recent years the pace of industrialization and mechanized agriculture, urbanization, and communications has increased at a phenomenal rate. Communication within the country by rail, road, air, and water has opened up practically every part of the country. International communication, especially by air and sea, has brought the country closer to the rest of the world. Movements of people within the country and abroad have consequently increased.

While each of the governments of the federation lays great emphasis on the development of industrial enterprises, it is fundamentally recognized that agriculture is the basis of the country's wealth and the basis for all development plans. It is estimated that almost 80% of the total working male population is engaged in agriculture and hunting.

SOCIOLOGICAL PROBLEMS

Hardly any week goes by now without reports appearing in the newspapers about arrests, court charges or imprisonment of traffickers in cannabis. This traffic has been so extensive that it has reached international level. This more frequent report of arrests of traffickers may be a reflection of the growing vigilance of the police; but it is also certain that it is an indication of the increasing traffic in the drug.

Cannabis in Nigeria

Cannabis sativa is not indigenous to Nigeria, and evidence indicates that it was introduced to the country, and most likely to other parts of West Africa, during and after the second world war by soldiers returning from the Middle East and Far East, and North Africa, and also by sailors. There is less reliable indication that it was first introduced to the country during the first world war, but it did not gain a foothold, nor did it spread afterwards. It grows profusely in this tropical climate with little or no care. Farms of the plant, scattered over southern Nigeria, have been reported by the police.

MAP OF NIGERIA SHOWING PLANTATIONS AND SEIZURES OF INDIAN HEMP FOR 1962

Full size image: 52 kB, MAP OF NIGERIA SHOWING PLANTATIONS AND SEIZURES OF INDIAN HEMP FOR 1962

The only purpose for which it is grown in Nigeria is for smoking, and it is not used for fibre. It is neither chewed nor brewed. It is not used in the herbal concoctions of the traditional healers or in home remedies, as confirmed by Oliver (1960). Since it is foreign to Nigeria, there is no traditional name for it, and what names that have been coined for it are used to cover its identity. It is known by its common name, "Indian hemp", but names such as Igbo (Yoruba), Nwonkaka (Ibo), and Gum are also used, Igbo being the most popular. There are various other names. It is significant that in his exhaustive collection, Useful Plants of West Tropical Africa, Dalziel (1936) did not mention cannabis.

Smartt (1956) made a general statement that psychoses due to drugs are fairly common in Africa, and that cannabis - which is usually smoked as bhang - is used frequently as an intoxicant. This might be true of Tanganyika, where he made his observation, and other parts of east, north and south Africa, but it was certainly not true of West Africa in our experience in the past, and it is only recently that cannabis intoxication has been gaining ground. The fact that it was not mentioned by Tooth (1950) in the then Gold Coast, and Lambo (1956, 1960) in Nigeria, is an indication of its previous rarity. Extensive inquiries made from traditional healers in western Nigeria have also confirmed this. It is beyond doubt that this is also an indication of the increasing traffic and consumption of the plant in this country.

Home Consumption

How much of the total production is consumed locally is impossible to say. It is worthwhile to point out that while Benabud (1957) stated that the view may be held without exaggeration that the people of every country have a pronounced weakness for one type of addiction, Lambo (1957) stated: "... drug addiction strictly speaking is uncommon among primitive Africans, and where it is found [in the primitive setting] it is usually associated with ritualistic orgies." Cannabis is not used in this connexion.

FIGURE 1 A habitual cannabis smoker

Full size image: 26 kB, FIGURE 1 A habitual cannabis smoker

The local users of cannabis are usually found amongst the lower class-mostly in towns. It is believed that some" dives ", shady night clubs, and long-distance-lorry parks and taxi ranks are where they congregate. There is no evidence that there is a positive correlation between poverty and cannabis smoking. In any case, the cost of one wrap of cigarette, 6 d. (7 U.S. cents), will buy a square meal (see table 1).

On the other hand, there is indication that users belong mostly to those of the fringe of society, who have drifted away from the restraining influence of their families into the urban community. They are usually unemployed - and there is a lot of unemployment - or they are employed in situations with no permanence, security or prospects.

It is also suspected that with the loneliness of urban life, and the absence of tribal ties and healthy recreational activities, these young men gravitate to the seamy side of urban life.

(1 wrap weighs about 0.004 oz.)
 
0.004 oz costs
6 pence (7 cents)
1 lb costs
?60 ($168)
2.205 lb. equal
1 kg.
1 kg. costs
?120 5s. 1d. ($336.71)
Selling price of cannabis abroad
 
1 lb. costs
?1,000 ($2,800)
1 kg. costs
?2,205 ($6,174)
TABLE 1 Selling price of cannabis in Nigeria

It is also known that some prostitutes use cannabis. This may be another symptom of their defective personalities; the police have mentioned in some of their publications that cannabis is believed by some of its users to be an aphrodisiac.

A local weekly magazine said, "Indian hemp became notorious with the introduction of thuggery in Nigerian politics. The thugs stand side by side with the politicians during campaign meetings. It is believed that in order to produce the indefatigable type of men required these thugs are fed with the Indian hemp...."

The same paper also said, "In Lagos, it was formerly confined to the ' guides ', ex-prisoners, thugs and female club-goers; but now one will be surprised to find respectable people indulging in smoking the 'wrap' privately Now Indian hemp is being given to animals, especially racehorses. The owners of the horses are supposed to be very respectable people."

Transportation

Cannabis is usually transported within Nigeria in the boots of motor-cars. To conceal the characteristic odour, it is carried in cement bags, which are made of several layers of paper. It has also been reported that it is sometimes transported in open lorries at night, packed under bags of cocoa, corn, etc.

One of the reasons for the increase in the traffic can be found in the recently acquired knowledge of the fantastic price paid abroad for a commodity which requires little effort to produce, and the ignorance of the harm that can be done. Added to this are the increased international communication and transport.

A police report states: "Recently we have discovered that Indian hemp is being exported from Nigeria in large quantity to the United Kingdom by sea through passengers. A case was detected where a wealthy trader in Lagos attempted to smuggle 15 lb. Indian hemp through an innocent student to her son who has been in London for 17 years. Other cases of less significant quantity were also detected."

This report illustrates one method of smuggling through innocent passengers, who do not know the contents of parcels to be delivered to friends or relatives of the sender. It is suspected that sailors also participate in the smuggling, but it is more difficult to detect those, as they (knowing what they are carrying) can easily drop the parcel into the sea immediately they suspect that the ship is being searched.

From table 2 it will be seen that western Nigeria tops the list not only in the number of seizures, but also in the number of plantations. It has been suggested that one of the reasons for this is the suitability of the soil and geographical conditions for easy growth of cannabis, and that the quality in terms of potency is much higher than that of cannabis produced in the eastern region with heavier rainfall, and the northern region with its comparative extremes of temperature. It has not been possible to test this hypothesis.

 
West
Lagos
North
East
Number of seizures
154 67 37 73
Number of plantations
22
-
4 2
Weight seized (kg.)
6, 154.893 716.435 224.925 55.688
Total for 1962, 7,151.941 kg        
Total for 1961, 823 kg:
       
TABLE 2 Seizures of cannabis in Nigeria - 1962

There is no doubt that other reasons contribute to this apparent frequency of seizures in the western region. As it has been pointed out above, the western region has more towns than any of the other regions, and the use and abuse of cannabis are predominantly urban practices. Another reason is that the western region is the gateway to the rest of the country from the principal port of Lagos, both by rail and road. Not only then is it more possible to detect the traffic across the narrow bottleneck of western Nigeria (which incidentally is the smallest of the three regions), but also the filtration of export cannabis en route to the port, for local consumption, will be more widespread.

One other reason is that the shorter the distance between the place of production to the port of disposal, the lower the chances of detection. The producer in western Nigeria may therefore feel safer in dealing in this prohibited commodity, as he has the shortest distance to travel to the port of Lagos.

In view of the small size of Lagos and its small population, it is obvious that the country has far more than its share of seizures. This fact can be explained by the cosmopolitan nature of the town, which is also the capital and the main port of Nigeria. It is the mecca of a large number of young people all over the country. Furthermore, police activities in Lagos are more intense than elsewhere in the country.

It is impossible to have a plantation of any appreciable size in Lagos, which is very urban with very little land available for cultivation. Since the plantation of cannabis is usually situated in the middle of a farm with the usual crops planted around to form a thick-periphery to conceal the plantation, one is hardly likely to find a tract of land big enough for this operation in Lagos.

It is important, however, to point out that this difference in the number of seizures and disclosure of plantations may be more apparent than real. The main reason for this may well be the difference in orientation of police activities throughout the country, the accessibility of different parts of the country to police activities, the participation of reliable informants, and so on.

On the other hand, it is not too far fetched to invoke the conservative Islamic culture of the northern region to explain the comparative rarity of seizures there, apart from the large expanse of sparsely populated area. The Islamic religion is not as tolerant of smoking as some other religions. The vegetation in the north is not as thick as in the south to hide cannabis plantation. Furthermore, it is striking that there is no evidence of traffic of cannabis across the desert in spite of the age-long and frequent communication between northern Nigeria and some north African countries.

Seasonal Variation

The highest seizures and discovery of plantations of cannabis in 1962 were recorded between July and October as follows (in kilogrammes):

 
West
Lagos area
North
East
July 1962
2532.75
-
140
-
August 1962 .
2643.5 28.4
-
-
September 1962
648
-
11 26
October 1962
120 642
-
7
Total
5944.25 670.4 151 33

Percentage compared with Year's Total

It will be seen from the above figures compared with the total figure for 1962 that the seizures for the four-month rainy season are proportionately greater than the seizures for the rest of the year, especially for Lagos area (93 %) and the western region (96 %).

Comparative figures for the relevant period in 1961 are not available. In spite of this it has been suggested by the police that the rainy season favours the growth of cannabis.

Police Activities

The Criminal Investigation Department, Narcotic Section, intensified their activities in the search for cannabis in 1962, and their records for this year, from which some of the facts in this paper have been extracted, are more detailed than in previous years. They are aware of the gigantic nature of the problem.

The problem, is so great that it does not appear to be worthwhile chasing the individual smokers or small pedlars, as these are numerous and their apprehension may not necessarily lead to the sources of the supply. It is presumably for this reason that most of the detections and discovery are of considerable size and quantity.

FIGURE 2 This picture shows the ingenious way cannabis is hidden in a tin, the lid of which is soldered on to a smaller tin containing oil for the oil lamp. Cannabis is kept in the bigger tin. The whole outfit looks like an ordinary oil lamp.

Full size image: 21 kB, FIGURE 2 This picture shows the ingenious way cannabis is hidden in a tin, the lid of which is soldered on to a smaller tin containing oil for the oil lamp

Several means are used to deceive the police. The clandestine plantation situated in the middle of the normal cash crops has been mentioned. The picture (figure 2) illustrates the cunning way cannabis is hidden. Without reliable informants and clever police work, some detections would have been impossible. Police work in this connexion can also be hazardous, as figure 3 shows. The culprit sitting in front of the police officer fired the gun at the officer when he was ferreting out the plantation. This desperate move of the culprit could have been made under the influence of cannabis.

The policy of the police is to give as wide publicity as possible to cases associated with cannabis, in the hope that the heavy punishment usually meted out to culprits will deter others. They have also given radio talks from time to time to acquaint the public of the dangers of the weed.

FIGURE 3 The result of a police raid on a plantation. On the right is a pile of cannabis. The man sitting in front of the policeman holding a gun is the culprit. He had fired the gun at the policeman.

Full size image: 48 kB, FIGURE 3 The result of a police raid on a plantation

The story was told of the wife of a judge who returned from leave some months after her husband. She was pottering round the garden, which was beautifully kept by prison labour, when she came across an unusual weed. She called out to her husband, presumably a knowledgeable gardener, to come and identify the weed. It turned out to be cannabis, which was being cultivated in his garden by a prisoner who was described, perhaps to add more spice to the story, as one who had been sentenced by the same judge for being in illegal possession of cannabis.

Inducement

It takes very little pressure to induce a novice to smoke cannabis, especially when the, party feeling of communal enjoyment is high, or in some other pleasure seeking environment. A number of cases have reported their introduction to cannabis to have been in this manner. The following report, shorn of its journalistic colouring, gives a true picture of an inducement process.

"Eight of us occupied a table at one corner of the premises. There was a lady in our company.

"I hadn't met my table mates before, but we got along fine conversing on irrelevant subjects, commenting on the music and the dresses worn by the beautiful women in attendance.

"We were drinking and smoking cigarettes, but I observed that my friends didn't appear satisfied. Something was missing. Suddenly one of them whom I would rather call Samuel Iye got up, went to a nearby house and returned after a few minutes.

"He handed a small envelope to the man sitting next to him. This man started wrapping something in the form of a cigarette. [Now I know why they call it wrap.] I was completely ignored.

"After wrapping the thing, he lit it, took a long draw, tightened his teeth, puffed his jaws, swallowed the smoke and passed the cigarette to the man next to him. He, too, did the same thing and passed it over to the girl, who took her turn. It dawned on me that they were not smoking the usual cigarette but Indian hemp. The odour was hideous, but I dared not show concern.

"It next came to my turn and I politely refused since I had a cigarette in my mouth.

"'Come on, have a go, boy !' One of the chaps loudly pressed me.

"I always try novelties, at least once, so I took a 'pull' and handed it over to the next fellow. Two minutes later, I started coughing violently. Tears ran down my eyes; I longed for water to drink, and felt choked. After five minutes of persistent coughing, I cooled down a little bit, opened my eyes and saw my newly-made friends laughing at me.

" 'How you feeling, boy ?'

" 'Fine,' I spluttered between coughs.

"That was Indian hemp, and the 'smoke' my first experience. I came to myself only after taking a lot of cold water, and washing my face; even then, I continued to cough at intervals.

"I noticed thereafter that conversation on our table became more lively and my friends more jovial. The lady forgot convention and became more familiar with everyone, using obscene words. They all had bloodshot eyes after having four rounds each of the stuff."

Public Attitude to Cannabis

This varies from one subculture to another. The thug and criminal subculture believe that it increases their prowess and courage. Under the influence of cannabis, they become dare-devils. Prostitutes and their clientele believe that it has a powerful aphrodisiac effect. Long-distance truck and lorry drivers and taxi drivers attribute to cannabis long staying power and sustained alertness, which they need to do very long hours. Dance-band musicians feel they can excel themselves under the influence of cannabis. Students and older schoolboys have smoked cannabis on festive occasions with the hope of achieving more mirth and enjoyment.

The majority of the community do not know about it and cannot recognize it. Those who know of its dangerous effects on the mental state have either read of these in magazines or newspapers or have direct or indirect contact with patients whose illness has been precipitated by cannabis.

Few people know of the fantastic price paid for it in Europe and America; and fewer people still have the contact or knowledge of how to set about exporting it.

Those who know about cannabis - either its pedlars or users - also know that it is a prohibited substance, so every effort is made to hide it not only from the police, but also from anyone who is in any form of authority and does not belong to their subculture. Even where they have been taken ill after smoking cannabis, or their psychiatric illness is associated with cannabis, some of the patients deny not only that they are smoking, but also any knowledge or recognition of the weed. A few of them maintain this denial even when their mental state has improved.

FIGURE 4 This is a typical plantation situated in a thick forest. The intense and large vegetation forming the background completely surrounds the plantation, making detection impossible except on information. Note the height of the plantation relative to that of the man in the picture.

Full size image: 77 kB, FIGURE 4 This is a typical plantation situated in a thick forest

Clinical observation

This is based on the material of two psychiatric hospitals; one is situated in Lagos, the Federal capital and principal port and the other in Abeokuta, in western Nigeria.

Lagos (Yaba) mental hospital is mainly a statutory institution into which only compulsory admissions are made, and it has a crowded accommodation of 470 patients. It is the only psychiatric hospital in Lagos. I am grateful to the two psychiatrists working in this hospital for supplying me with the clinical material of cases associated with cannabis and discharged in 1962.

The other hospital, which is 60 miles from Lagos, is Aro Neuropsychiatric Centre in Abeokuta, western region of Nigeria. It is an open hospital with accommodation capacity for 200 beds, only 100 of which are being used at present for reasons of staff shortage and the advantage of keeping a large number of patients within the community in neighbouring villages. Associated with this hospital both administratively and clinically is Lantoro Institution, overcrowded with 300 beds, and 6 miles away from Aro. It is a closed hospital, and similar to the Lagos hospital.

Since Aro is the most modern psychiatric hospital in the country and indeed in West Africa, and it takes voluntary patients, it admits patients from all over the country and occasionally from neighbouring countries.

Before going into details of the clinical material, and to give a balanced picture of the situation, it is justifiable to point out that there are numerous traditional healers, specializing in mental illness, scattered all over the country. They are widely patronized by practically all sections of the community from the most literate and westernized to the least affected by western influence and most traditional. The result, therefore, is that the number of cases we see in hospitals are certainly not the total incidents of psychiatric disorders. What proportion of these cases is seen in hospitals is difficult to say.

What factors decide attendance at the hospital have not been ascertained, and it will not be reliable to include distance, for instance, without some qualification, as it has been observed that a number of patients attend the hospital from a long distance for the same type of abnormal behaviour, for which patients nearer the hospital have not been brought.

One would be on surer ground if one considered aggressive, destructive and homicidal behaviour. This presumably is the type of behaviour that leads patients admitted to Lagos hospital to be certified. On the other hand, the admission of such patients to Aro may be related to the rural/urban location of the patient, the availability of immediate help from traditional healers and distance to the hospital.

LAGOS (YABA) MENTAL HOSPITAL

Of the 380 cases discharged during. 1962 (the only ones available for statistical evaluation at present) 16 had a history, of cannabis smoking. Of these 16 cases, 3 were re-admissions during the period under review. Therefore the material consists of 13 different patients only.

The significant items extracted from the records are as follows:

Sex: They were all males

Age:
 
10 to 19 years
1 patient
20 to 24 years
7 patients a
25 to 34 years
5 patients
35 years and over
none

Occupation:

Motor drivers/mechanic.
3
Labourer
1
Domestic servants
2
Fisherman
1
Electrician
1
Trader
1
Seaman
1
Prison warder
1
Tailor
1
"Prophet"
1
a

All in this age-group are re-admissions.

This distribution considered along with residence, and amount of education has been used to categorise the patients into social classes:

Class I
(People on top of social scale)
     
None
Class II
(Upper middle class-professional managerial senior officers)
     
None
Class III
(Lower middle class-junior officers, clerks, small-business owners, foremen, skilled workers, etc.)
      5
Class IV
(Semi-skilled workers, office workers, messengers, etc.)
      4
Class V
(Unskilled workers)
      4
Origin:
Rural
      9
 
Urban
      4
Educational background:
     
Literate
12
       
literate
1
Religion:
 
Christians
    10
   
Moslems
    3
Parents' education:
   
At least one parent literate
  4
     
Both parents illiterate
  9
Comments

The one factor which appears to be common in all the above items is that most of the patients belong to the transitional group of the general population. Only 3 (labour, fisherman and trader) are engaged in traditional occupations. Only 4 have urban origins. All but one are literate.

This suggests strongly that the young men who drift into the towns, in this case, the capital, in the hope of finding employment or losing their anonymity because of their schizophrenic propensity, and getting away from the controlling influence of their small circumscribed communities are those that have broken down with psychiatric illness associated with the smoking of cannabis.

Diagnosis

All 13 cases were psychotic. In two cases of schizophrenia it was considered that cannabis smoking was secondary to their mental illness, and the other 11 were described as toxic psychosis with cannabis as the precipitating cause of the psychosis, and the re-admissions belong to the latter group. Most of these toxic psychoses presented like acute schizophrenia with auditory hallucinations (9 cases), delusion of persecution (7 cases) and thought disorder (8 cases).

Length of Hospital Stay

All but 3 were discharged from hospital within three months. These 3 were discharged at six, seven and twelve months respectively.

ARO NEURO-PSYCHIATRIC CENTRE

The clinical observation in this hospital is based on 26 consecutive cases whose illness has been definitely related to cannabis over a period of 18 months.

Age and Sex

As in Lagos, all the cases seen were males. Ordinary smoking is generally a male habit in this country, except among the more sophisticated women, night hostesses and old women in some rural areas. The latter smoke clay pipes and not cigarettes. The most important explanation of the absence of women in both hospitals is the smaller proportion of women exposed to the use of cannabis. Apart from prostitutes and night hostesses, no other female subculture lives on the fringe of society. Females tend to marry at a much younger age than males, and they do not drift into towns looking for employment as much as men do, because few of them possess the minimum educational qualifications and for other sociological reasons.

Also, like in Lagos, the cases are young. The average age of the patients is 21.7, ranging from 16 to 37. Apart from 3 who are 29 all the others are 25 and under.

Occupation
8 students 3 clerks
8 drivers (lorry and taxi)
1 petty trader
1 farmer 1 watchman
1 minor chief
1 electrician
1 dance band musician
1 carpenter

The most striking fact that has emerged is the high proportion of students in this case. The intelligence of these boys based on their performance in school was within average and some of them are on the higher side of average range. There was nothing striking in their previous personalities to have marked them out. Most of them smoked Indian hemp with the false belief that it would sharpen their mental ability, or to make them enjoy a party better, or simply out of curiosity.

It is a popular belief that Indian hemp smoking is so common among lorry and taxi drivers that it is almost an occupational hazard and a number of grievous and fantastic accidents in which they are often involved are attributed to the cannabis effect. Enquiries also reveal that a number of patients belonging to different occupational groups were introduced to cannabis by drivers. It is now the practice here to ask specifically if patients, especially taxi and lorry drivers, are Indian hemp smokers. The possible explanation one can give for this prevalence among drivers is that the occupation, for its itinerant nature and the great opportunity it affords for emotional detachment, attracts the particular type of personality prone to cannabis smoking.'

Type of Disorder
4 mania
5 psychoneurosis (all students)
16 schizophrenia
1 character disorder

Among the psychoneurotics was one who also had anaesthesia of his arms and derealization syndrome lasting several months.

It is perhaps not surprising that that schizophrenic psychoses are more common as the basic personalities of these patients are predisposing to the temptation of smoking Indian hemp. The finding is in accord with Bromberg (1939), who found manic depressive reaction to be in the minority compared with schizophrenia.

The psychoneurotic symptoms included feeling of fuzziness in head. "I begin to feel pain in my head the next day. Now I feel heaviness in the head." "There is something moving round my head that does not allow me to read or write. If I am writing I feel more pains in my head. I feel the pains in my head beating "; "heat in the brain "; "a feeling of my head being separated from the rest of the body "; "pain and occasional stiffness of neck." "Occasional blackout";

restlessness, insomnia. Most of these seem to be centred round the head, but they are quite different from the cephalic parasthesiae like crawling and creeping sensations, the feeling of water bubbling in the head and the feeling that there is a hole in the skull which sometimes precede a frank schizophrenic attack in our experience. This difference may be more of degree than of kind of symptomatology.

Mania. - There is nothing typical about this, but some features are more prominent than others. Restlessness, hyperactivity, pressure of talk, and flight of ideas are very marked, but delusions are notably absent and there is no disturbance of sensorium, except in one case which showed signs of delirium.

Schizophrenia. - Most of the schizophrenics are of the simple form. They show no flowery picture of delusions and hallucinations but are withdrawn asocial, indifferent with varying degrees of thought disorder, and it was very difficult if at all possible to establish any rapport with them. Whether these patients could have developed this illness without smoking or whether their smoking is a manifestation of the illness is hard to say.

There were two paranoid schizophrenics - one who attributed his failure to hold down a job for any appreciable length of time to the evil machinations of his envious friends. These paranoid ideas of the unsophisticated usually take the form of attributing their failures and shortcomings to evil "juju" of others.

The other paranoid schizophrenic was acutely disturbed with very intense anxiety and suspicion. He said he felt that some people were going to catch him, and he wanted to run away.

The histories of a majority of these schizophrenics contain elements of aggression, restlessness, insomnia and destructiveness at the early stage of their illness before they were brought to the hospital. This may well be the toxic stage.

The difference in the diagnostic categories between the Aro and Lagos institutions may be found in the nature of the two hospitals and the location and comparative paucity of native therapists in Lagos.

It has been pointed out that Lagos hospital is a statutory institution; therefore only compulsory admissions can be made and the limited out-patient facilities cater for mainly discharged patients. It is not surprising that psychoneurotics are not represented.

The toxic psychotic effects of cannabis (in Lagos) will be reported in the Lagos hospital much earlier than in Aro for the reason of the distance between Aro and urban centres in western Nigeria. This distance will force relatives and friends to administer some first-aid home remedies and consult traditional healers before coming to Aro.

The effect of this is that the initial diagnosis in Lagos has been mostly toxic psychosis, and this is the diagnosis which remains on the records, even though the picture that emerges before final improvement or recovery has been mostly schizophreniform with rather flowery symptoms.

On the other hand, the picture presented by Aro patients are mostly schizophreniform, and the histories indicate that the acute toxic phase has subsided with time, and home or traditional therapist's treatment before arrival in the hospital.

Another apparent difference is that while most of the schizophrenics in Aro are of the simple form, it is not known what form those in Lagos took, as the symptoms recorded are those of the initial stage of the illness precipitated by cannabis, and the intermediate symptoms are not recorded.

Crime

Apart from the patient with the urge to steal, an aggressive schizophrenic sent from the court with the charge of intent to do grievous harm with a machete, and a motor driver who was imprisoned for reckless and dangerous driving, there is no major crime in these series. It is conceivable, however, that a lot of reckless action of a criminal nature could be enacted mostly during the period of acute intoxication and to a minor extent during the residual psychotic state. In any case it is not easy to establish the relationship between crime and cannabis smoking, as the relevant information is usually anecdotal and inquiries into the crime factors overshadow the cannabis factor.

Premorbid Personality

The importance of constitutional predisposition can be illustrated by the case of a young man of 19 years who had attended the hospital two years previously for a psychoneurotic depressive disorder, which cleared up with treatment. He had been performing his duties satisfactorily for two years until he smoked Indian hemp once. His illness not only relapsed, but took a more sinister form and he was indeed psychotic. It is not, however, in most cases that predisposition to psychiatric disorder is so evident; and quite often detailed personal history does not yield any such indication of vulnerability.

Association with Other Drugs

Most of the adults who smoke Indian hemp also drink alcohol, but there is no evidence that their use of alcohol is excessive. In fact one patient said he got the same pleasurable feeling, of mild inebriety from smoking Indian hemp as he got from drinking beer, and he took to the former exclusive of the latter because it was cheaper.

It is the association with amphetamine among schoolboys that is most striking. Some of these boys have been taking amphetamine or other "brain pills" quite regularly either to ward off sleep at night to enable them to study till late or to "sharpen their memory and intellect". The psychiatric disorders have, however, been precipitated directly and immediately by Indian hemp. It is not inconceivable, however, that the one might have prepared the soil for the other in the creation of the disorder.

Addiction

In the absence of withdrawal symptoms on admission to hospitals where the use of cannabis is suddenly stopped, in the absence of the phenomenon of increasing dose to produce the desired effect and for other reasons, cannabis has not been found to be a drug of addiction in Nigeria. True enough, a few people appear to be habitual smokers, but the explanation for this can be found in the need for the company of their associates since they find it difficult to rise above this association, having lost face with more healthy company.

Duration and Degree of Disorder

One of the most disturbing observations is the very long period of incapacitation suffered by the patients. Some students have missed a whole school term. Only two cases, both psychoneurotic students, were treated as out-patients; the other psychoneurotics were treated as in-patients not only because of the long distance between their homes and the hospital, but also because of the severity of their illness. Some of the psychotics were so disturbed that they could not be treated in an open unit. The longest period of admission is over twelve months and the shortest is three weeks. One of the outpatients is still attending the clinic after twelve months, as he has not yet fully recovered.

What makes the situation with regard to the psychiatric disorder most dangerous in this country is the very easy accessibility of the drug, and unless something drastic is done to prevent its growth, the incidence of psychiatric disorder directly or indirectly due to cannabis will continue to increase.

Other sociological effects of cannabis

The people involved in cannabis smoking, like others who exhibit behaviour patterns frowned upon by society tend to be driven underground. In this situation their sense of isolation from the main body of society gets intensified. Their sense of value also changes to that of their new sub-culture and this new sense of value may be generally asocial or definitely antisocial.

This drift is accentuated by frequent unemployment. Even those who are employed tend to lose their efficiency, and tend to report late for work as their sense of time is often disturbed. The result is that they lose their jobs and add to the mass of the unemployed. The economic loss to the individual and the nation is bound to be colossal. Apart from this economic loss associated with unemployment, one has to consider the loss in vehicle wreckages and unnecessary loss of lives in road accidents.

The effect of the abuse of cannabis on the family is difficult to isolate, as there are usually some other factors involved. From observation it has been noted, however, that those seriously involved in smoking cannabis are unable to fulfil their role as effective husbands and fathers. The cohesion of the extended family grouping, which can buffer this ill effect, is often undermined by the disruptive and irresponsible behaviour of these smokers. They bring disgrace to the family. The concern of mothers about this practice in their sons is most striking, especially if the sons are only children or only sons among daughters. They often trace them to the dens where they smoke and try by persuasion to extri- cate them from the clutches of the unsavoury company they keep. They solicit the help of older male relatives, neighbours or friends to dissuade the victim from the dangerous practice.

FIGURE 5 The innocent victim. The husband was sentenced for infraction in relation with cannabis. This means, for the wife, a long and solitary period of waiting.

Full size image: 29 kB, FIGURE 5 The innocent victim. The husband was sentenced for infraction in relation with cannabis. This means, for the wife, a long and solitary period of waiting.

Some cases of habitual criminality have been associated with cannabis. It is not that the criminality has been precipitated by cannabis, but rather that both stem from the same source, and perhaps cannabis smoking affords them the assumed unconcern and disregard for society at large.

It is an advantage that the plant is not used for its fibre, and its eradication will not mean any economic loss in this respect.

If occupation may be used as an index of acculturation or departure from the controlling influence of the traditional and indigenous means and ways of life, it becomes quite obvious that most of the people who are smoking Indian hemp are those who have grown away from this influence, provided the sample in Aro hospital is taken as representative of the general population of Indian hemp smokers: only 3 (farmer, minor chief, petty trader) are engaged in traditional occupations and only 2 (farmer and minor chief) have come from a village setting.

Even though Indian hemp is not used by people in the higher economic bracket, it is not associated with extreme poverty. This further emphasizes the importance of socio-cultural changes as a significant factor in the spreading of the use of the drug.

The ultimate problem involved is not only psychiatric and criminological, but cuts across the whole fabric of the socio-cultural situation of this developing country, and it has to be tackled, not sectionally, but with a united front of many disciplines.

References

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