LETTERS

From Dr Elizabeth Tylden, Dr Peter I. Smith, L. E. Weidberg, Nicholas Davenport, Maurice Ashley, I. R. Archer, F. W. Cole- man, N. M. Spyrou, George Reichardt, R. E. Williams, Mrs. Rita M. Cross, Peter Lilley.

Soft option

Sir: Leslie Adrian (1 August) raises a number of points about cannabis whose clarification might be helpful. The apparent anomalies in official statements about cannabis are not in the least surprising. Its unpredictability was one reason why it was withdrawn from vari- ous pharmacopoeias. Doctors abandon the use of a drug which may make a subject dreamy, or giggly, or sleepy, or violent. Cannabis may elicit any of these responses or none of them. In addition, there are enormous variations in strength. Marihuana is only one-fifth the strength of kif, and one-eighth the strength of hashish. Back-garden British- grown pot contains very little active prin- ciple, and various herbal remedies, sold as cannabis, contain none at all.

The apparent diversity of opinions lies in a diversity of facts. The strength and com- position of cannabis vary from type to type and sample to sample. Different people react differently to this, as to other drugs, and the amount smoked can vary from resin to marihuana in a ratio of eight to one. Some- body who claims to 'smoke cannabis regu- larly' may do so once an hour, or once a day, or once a month.

At the time the Wootton Committee col- lected its evidence, moreover, the pooled evidence on escalation to heroin, quoted by Mr Maudling, was not available. Nor was our mounting recent evidence of psychotic reactions to cannabis. Dr Baker's article, showing an increase in admissions to mental hospitals ascribed to cannabis from eighty in 1966 to 140 in 1967, appeared in the same issue of Lancet as the Wootton report itself (18 January 1969). There have been many American reports since—including over 1,000 acute reactions to marihuana necessi-

tating medical help discovered in one year in San Francisco. Reports of thalidomide

like deformities in the babies of cannabis smokers, a confirmation of results in experi- mental animals, have also occurred since the Wootton Committee.

When your article says of cannabis, 'friends demonstrate its use to be uncom- plicated, frequently pleasant, and apparently

harmless', they could say the same about opium or thalidomide. Though cannabis is

less pleasant at first, and more unpredictable

than either, the innocent bystander who emu- lates his friends in smoking it may vomit,

have a fit, or become acutely paranoid the first time he smokes. Reports of admission to mental hospitals for several days after a sudden heavy intake appeared regularly in the literature in the 'thirties. They have been more frequent of late. These acute reactions have been well documented. The subject becomes hallucinated, acutely paranoid, and violently hyperactive.

One man ran the streets seeing enemies behind each lamp-post. Another broke off the neck of a bottle and charged out to look for police, who he believed were hiding to catch him in the garden. The term used by cannabis smokers to describe these episodes is 'freaking out'; 38 per cent of marihuana smokers answering a questionnaire in America had experienced this. These epi- sodes can be short-lived, but in a patient who is predisposed, a schizophrenia-like ill- ness can persist for several weeks. Unlike schizophrenia, it clears up completely when the drug is not taken.

The 'worrying discrepancies about basic facts', mentioned in your article arise also

out of the fact that cannabis contains a

mixture of many different active principles, whose effects are not fully known. So does tobacco, as we now know at the cost of a

mounting national expense account for lung cancer and chronic bronchitis, complications

of smoking which were not even looked at until recently. These are probably the com- plications of smoking anything at all, and cannabis produces an irritant cough far more rapidly than tobacco.

I entirely agree about the need for educa- tion in schools. The trouble is that many of

those who enter the field believe in permis-

siveness in allowing experimentation with drugs. Two school children have died in my area as a result of experiments, and many more have entered the caverns of despair opened by LSD or have become dropouts.

In a survey of cannabis smokers which I undertook this year, 36 per cent were un- employed. In a similar survey in 1965, 30

per cent were unemployed. Unemployment

was more probable with an intake of regu- larly more than three times a week. Your correspondent quotes 4,705 cannabis con- victions. I would give a conservative estimate of four dropouts to each conviction, giving 18,820 of these. Though they deny the im- portance of this, every cannabis smoker knows them, so does every branch of the Ministry of Social Security. Only drugs can dull their sufferings, and blind the eyes of the wealthy occasional smoker to the realities of their life.

Cannabis produces a pharmacological alienation from homes and jobs which has resulted in the formation of a sub-culture. Parents who subsidise their children when they are ill from drug effects find that they are subsidising drug habits and withdraw financial support. Hospitals are intolerant of the attitudes and behaviour of youngsters on drugs. The burden at the moment is fall-

jag on social security and the penal system. Money for research, prevention, and treat- ment can avert mistakes which have been made in America.

Elizabeth Tylden 51 Westboume Terrace, London Nw6