Indian J. Psychiat. (1984), 26(1), 55--66
DRUG ABUSE IN INDIA : AN OVERVIEW WITH SPECIAL REFERENCE T O
CANNABIS
3. !!. SZTrll.1
MB, MSc. ' Psyc'a ., D. Sc. iPsychi, Diplomat, Am. Board Neurol. &
Psychiat.. F. R. C. Psych., F. A. P. A.,F. I. M. S. A.
S. C. TIVV.VRl,2
M. D. (Psychiat.,
PRADEEP KUMAR,a
M. O. (Pharmaco /,
J. K.TRIVEOI,* M. D. (Psychiat/
SUMMARY
The Indian literature related to drug abuse in general and Cannabis in particular has been reviewed
and possible implications discussed. In this regard to solve the existing controversy, 50 pure chronic can-
nabis users were evaluated for their physical, mental, cogiiitive and socio economic functions and the results
were compared with a matched control group. Results of this study did not reveal any impairment in thesf
areas It is concluded that cannabis, in India, may not be as much injurious to health as has often been
raeitioned in Western Gouitries. Future areas of research have been suggested.
Drug abuse has been showing a rising
trend all over the world including India,
perhaps as a result of newer and greater
stresses related to rapid changes in life
styles. Man is increasingly feeling lonely
and is getting isolated from kith and kin.
Contemporary life is highly competetive
which creates a far severe challenge to-
wards survival than at any time in the
past. The form and manner of commu-
nicating at a socio-familial level is much
too ungratifying and there is just no
desire to await gratification-one must have
what one wants and that too quickly.
There may well be other contributory
phenomena but it all leads one to be-
lieve that the traditional methods of mee-
ting the stress are far too inadequate. As
a consequence prevalence of drug abuse
is on the increase. Elnager et al. (1971)
reported a prevalence rate of 13 per 1000
in the State of West Benagal, while Nandi
et al. (1975) gave a figure of 0.94 per
1000 of the total population for the same
state. Similarly in Uttar Pradesh, Dube
and Han da (1971) from Agra reported
22.8per 1000as suffering from the problem
of drug abuse while Thacorc (1972) from
Lucknow gave a figure of 18.55 per
1000. In all these studies alcohol was
by far the commonest drug abused, acco-
unting for 60-98% of the subjects inves-
tigated. It was followed by cannabis in
4-20% and opium in only 0-15%.
An attempt was made to study the
frequency of drug abuse in different strata
of our society such as (3) students (2)
general population (rural) and (3) psy-
chiatric patients. For these studies Sethi
and Manchanda (1977, 1978a and 1978b)
defined drug abuse as "indulgence in a
drug with a frequency of at least once a
month without medical prescription ex-
cluding intake during festivals or on
ceremonial occasions". This was nece-
ssary since no definition or criteria existed
that would permit a meaningful compa-
rison by different investigators. To find
out the pattern of drug abuse among
students-medical, non-medical and post-
graduate medical students were surveyed.
It was observed that 2 5 . 1 % undergra-
1 Professor and Head
-. Senior Research Officer
*1. Research Officer
I. Lecturer.
Department of Psychiatry, K. G.'s. Medical College, Lucknow.
56 B.B.SETHI etal.
duate medical students, 11.5% college
students and 30.4% post-graduate medi-
cos were drug abusers. Alcohol was
found 1O be maximally abused (51.1%)
followed by Cannabis (40.8%); similar to
observations of Mohan and Arora (1976)
from Delhi and Dube et al. (1977) from
Agra. College students maximally abused
minor tranquillizers but the occurrence
was much less as compared to medical
undergraduates and post-graduates. Mu-
ttangi (1981) from Bombay and Parame-
shwaran and Mashiuddin (1981) from
Hyderabad noted that the prevalence
rate of drug abuse was 4 2 % and 27.5%
among college and university students
respectively. Singh (1979) reported
82.4% boys and 29.6% girls to be abusing
various drugs in colleges of Punjab.
In a study of rural population incor-
porating 8 villages Sethi & Trivedi
(1979) found alcohol to be thecommmon-
est (82.5%) drug abused followed by ca-
nnabis (16.1%). None of the subjects re-
ported abuse of psychotropic drugs where-
as they were found to be occupying third
place after alcohol and cannabis as tar as
their abuse is concerned among urban
student population. Dube & Handa
'1969") reported that 1.24% of the popu-
lation in and around Agra abused alcohol
and cannabis. Deb & Jindal (1974) in a
survey of 4 villages in Punjab found that
78.28% of the population used alcohol
whereas Lai and Singh's (1979) figures
were 9.13%.
The third population studied was the
pattern of drug abuse in psychiatric pa-
tients that has generated interest in recent
years. In a study (Trivedi and Sethi,
1978) on 1000 male psychiatric outpa-
tients, 16.4% were found to be drug
abusers. The extent in affective disor-
ders was 22.8% and in schizophrenics and
neurotics 19.6% and la.4% respectively.
Alcohol was found to be maximally abu-
sed followed by cannabis and minor
tranquillizers in a descending order.
The problem of drug abuse whether
it exists in India or not has been a subject
of great concern. In order to seek an
answer a National Committee on drug
abuse was appointed by the Government
of India in 1976 and the Committee in its
report (NCDAI, 1977) concluded that
"there is a hard core of drug addicts in
general population and the drugs most
frequently abused are alcohol, tobacco,
cannabis and opium. Further, the prob-
lem among the students is more com-
plex and difficult and drugs most
commonly used are alcohol and tobacco.
The students used psychotropics to a
greater extent than general population but
the use of opium and cannabis is mar-
kedly limited. On the whole, the pre-
valence was more among boys and men
than amongst girls and women. There
are, however, disturbing signs that the
drug abuse may be on the increase.
There is no reason for panic but no room
for complacency either".
CANNABIS
Until the year 1980 (Turner et
al, 1980) 421 compounds were identified
from the cannabis plant of which appro-
ximately 61 are with cannabinoid struc-
ture. Of these cannabinoids,--/^9
--Tetra-
hydrocannabinol (THC) is of greatest
interest because of its characteristic men-
tal effects that constitutes the main reason
for use of cannabis by humans. Several
other cannabinoids including cannabi-
diol (CBD) and Cannabinol (CBN), as
well as various non-cannabinoid consti-
tuents of supyrolized cannabis may also
have biological activities of other types.
Dependent on the geographical origin of
the plant, relative and absolute contents
of individual cannabinoids vary widely
(Turner el al., 1980).
Various preparations derived from
cannabis plant have a wide lange of po-
tencies. Marihuana or Bhang consists
mainly of dried leaves and stems and can
DRUG ABUSE IN INDIA : AN OVERVIEW 0 /
range in content from less than 1%
to greater than 8% T H G . Other prepa-
rations (Hashish; Ganja, Charas) made
from the resin and flowering tops of
the plant can contain upto 15% of THC.
Recently, in western world solvent ex-
tracts of lead material, flowers or resin
have appeared on the illicit market.
The potency of this so called '"Hashish
oil", "honey oil" or "weed oil" is extre-
mely variable; the T H C content can-
range upto 60%. The toxicity of these
preparations appears to be related to
their T H G content, although other can-
nabinoids or non-cannabinoids may
contribute significantly.
The pyrolysis of cannabis products
produce hundreds of compounds that
make up the vapour and particulate pha-
ses of the smoke which consist of toxic
chemicals and carcinogens. The tetra-
hydrocannabinolic acid is activated by
conversion to T H C at usual burning
temperatures during smoking and about
50% of the total available is delivered in
the mainstream smoke from a marihuana
cigarette (Rosenkrantz, 1982).
EPIDEMIOLOGY AND ETIOLOGICAL FAC-
TORS
1 he abuse of cannabis ranks number
two after alcohol in its rate of prevalence
in urban and rural population in India.
Among all the psycho-active drugs of
abuse cannabis abuse has exhibited a
steep rise particularly in western coun-
tries where it is becoming more popular.
This growing trend of cannabis abuse has
drawn considerable attention and has
resulted in its recognition by the social
scientists, health workers and planners.
A flood of investigations have appeared in
ihe literature in recent years as regards
various aspects of cannabis abuse but the
controversy remains. The factors respon-
sible for its initiation, perpetuation and
consequences continue to haunt us. No
unitary theory explains the true aetiolo-
gical factors responsible for cannabis
abuse. Personal, inter-personal, familial,
developmental, psychodynamic environ-
mental and biological factors might con-
tribute individually or collectively. So-
cio-demographic studies (Sethi et ol., 1981 ;
Dube, 1972; Verma, 1972) reveal that
indulgence in cannabis was initiated aro-
und adolescence and early adulthood a r d
curiosity, companionship and need for
pleasure in descending order were factors
for such behaviour. Further, cultural
sanction and easy availability of the drug
appear to be important determinants.
Several studies have suggested that
drug dependent gioups are characterised
by high levels of neuroticism and psycho-
ticism and by low level of extroversion
(Gossop, 1978; Teasdale and Hinkson,
1971). However, investigations of non-
psychiatric, chronic cannabis abusers
(Sethi el al, 1981, 1983) did not reveal any
particular identifiable trait in their per-
sonality. Psychiatric and psychometric
evaluations of cannabis abusers did not
reveal any significant impairment. These
observations suggest that social, cultural
and occupational or environmental facets
are more important than the personality
constellation.
ADVERSE REACTIONS OF CANNABIS
The ill-effects of cannabis are much
highlighted in the literature but the issue
remains unresolved. The lethality of can-
nabis in humans remains questionable.
However, it has been reported to be
toxic for the respiratory bronchitis, obs-
tructive pulmonary disease, cancer), car-
dio-vascular (tachycardia, hypotension an-
gina in vulnerable subjects^ and gastro-
intestinal (decrease in gastric secretion,
hepatotoxici ty, en hancemen t of alcohol in -
duced hepatotoxici ty) systems. Other toxic
effects (aspergillosis, anaphylactic shock in
sensitive subjects, aggravation of some der-
58 B.B.SETHI etal.
matological conditions,, inalnourishment
etc.) are also reported. Besides, cannabis
is reported to be causing chromo-
somal aberrations and mutagenicity
carcinogenecity, impairment of immune
system ana endocrinal disturbances affec-
ting both male and female reproductive
hormones. It is also reported to be cau-
sing sterility, teratogen esis, decrease in
sexual activity and impairment of post-
natal development of offspring of canna-
bis abusers. As regards acute effects of
cannabis on behaviour, it has been repor-
ted to impair intellectual functions and
driving skills. Chronic abuse of cannabis
may lead to various psychiatric syndro-
mes viz. flash back, psychosis,, amotiva-
tional syndrome, cerebral atrophy and im-
pairment in sexual ar.d social adjustment
etc.
The reports of these toxic effects of
cannabis chiefly hail from Western litera-
ture and remain a controversial issue since
contradictory reports too are available in
the literature.
Alarmed by rising trend of cannabis
abuse. W H O in 1981 invited leading scien-
tists of collaborative centres to resolve
some of these issues. Realizing the impor-
portance of the entire reports a study
has been conducted to explore the possible
consequences of cannabis intake in
human subjects. The study entitled
" ong Term Effects of Cannabis Use" was
also conducted in this department.
METHODOLOGY
hi this project 50 male pure chomic
cannabis abusers (abuse for a minimum
period of 5 years) were identified and
these subjects were evaluated for their
physical, mental, cognitive and socio-
economic status. The subjects were inves-
tigated using a semistructured proforma
which included variables for socio-demo-
graphic characterties and several factors
for initiation, maintenance and also the
pattern of cannabis abuse. After a tho-
rough physical and psychiatric assessment,
studies such as. haemogram, liver func-
tions, total serum protein, renal functions-
including urine analysis, serum creatinine
and blood urea; electrocardiography,
electro-encephalography, nerve conduc-
tion te^t and tonometry have been done.
Detailed psychiatric and cognitive assess-
ment was tone usuv, Weschsler Memory
Scale., Bhatia Battery ot Intelligence Test.
Bender Gestalt Test, Cornell Medical In-
dex, Taylor's Manifest Anxiety Scale and
Hamilton Rating Scale for Depression.
Further, to investigate any possible
association between levels of A*-T. H . C.
and physical and mental status of cannabis
abusers, cannabis samples from 20 ran
domly selected patients were obtained.
These crude cannabis samples were ana-
lysed for their A"-T. H. C. content by the
method of Singh et al. (1981) using thin
layer gas chromatographic techniques.
The results were compared with an
equal number of control subjects matched
for age, sex and economic status.
OBSERVATIONS AND RESULTS :
Socio-Demographic Characteristics:
Most of the chronic cannabis abusers
were found to be between 23 to 40 years
of age, married (76%), Hindus (70%)
either illiterate (36%) or educated upto
high school (32%)., hailed nearly equally
from unitary (48%) and joint (52%)
families, belonged to lower middle 48%)
o/ middle ^36%) segment of socio-econo-
mic class (Table-1 and Table-2).
Pattern of abuse:
In majority of the subjects cannabis
intake was initiated between 19-25 years
(52%), or between 12 and 18 years(36%),
for seeking of company (56%), pleasure
(24%) and curiosity (8%). These sub-
jects maintained hi take of cannabis for
reasons such as pleasure (42%), impro-
DRUG ABUSE IN INDIA : AN OVERVIEW 59
TABLE 1. Socio-Demographic Characteristics
of Cannabis
(JV-50).
Age (inyears) :
17--22
23--28
29--34
33--40
U--46
X"=
Marital Status :
Unmarried
Married
Widower
Separated
Divorce
X =
Religion :
Hindu
Muslim
Christian
Sikh
Users
Experimental
N
3
13
15
11
8
=2.55; N. S
10
38
2
=0.45; N. S
35
11
1
2
Xs
=0.95, N. S
Education :
Illiterate
Just literate
Primary
18
2
y
Upto High School 16
Intermediate
Graduate
Post-Graduate
X =
Type of Family :
Unitary
Joint
X 8
-
3
1
1
*9.90, N.S.
24
26
-0.16, N. S
Social Status ( income in Rs. per
Upper middle
1.1001-1500)
Middle (501-10001 18
Lower middle
(201-500)
Very low (upto
i00)
x=
24
8
=0.77, N . S .
%
6
26
30
22
16
20
76
4
70
22
2
4
36
4
18
32
6
2
2
48
52
month) :
36
48
16
and
.._ _.-
Control
Control
N*
--
5
17
9
10
9
14
35
1
_
40
7
2
1
10
11
12
11
5
I
--
22
28
TM ~
22
22
6
%
10
34
18
20
18
28
70
--
80
14
4
2
20
22
24
22
10
*)
44
56
44
44
12
Table 1 (Contd.)
Occupation :
Unemployed 6
Studen t --
Farmer 7
Service 1
Businessman 8
Skilled worker 10
Unskilled worker 18
X = 3.40,X.S
ving concentration
(18%) iO allay anxiety
12
--
14
5
16
20
36
(22%: ),
*1
2
8
4
8
14
10
a
4
16
*'
16
28
20
company
(16%) and for re-
laxation (14%) (Table-2).
TABLE 2. Pattern of
(a) Age of initiation (in yrs)
12--18
19--25
26--32
33--39
40--46
Mean =19
(b) Reasons for initiation :
Company
Curiosity
Pleasure
Psychosocial stress
Cannabis
.22.4
To increase work capacity
To increase appetite
Tradition
(c) Reasonsfor Maintaining ,
Curiosity
Company
Pleasure
Relaxation
Better performance
To allay anxiety
For digestion purpose
To avoid loneliness
To allay trie depression
and frustration
For improving concentration
Religion cult
To avoid withdrawal
symptoms
N
18
26
j
1
--
28
4
12
2
0
2
2
2
9
21
7
4
8
1
1
3
11
2
--
Use
%
36
52
10
2
--
56
8
24
4
U
4
4
4
18
42
14
8
16
2
2
6
22
4
--
60 H.B.SETHI etat.
The total duration of cannabis abuse
ranged from 5-10 years (62%), 11-12
years (24%) and 23-34 years (14%)
(Table 3). Most of the subjects consu-
TABLE 3. Duration of Use
Pattern of cannabis
consumption
--Irregular 16%
--Gradual increase 20%
--Stationary 26%
4%
6%
4%
6%
2%
2%
Durations of Cannabis use
(years)
3-10 11-16 17-22 23-28 29-34
6% 4%
2% 2%
med cannabis in the form of Bhang and
Ganja together (58%) followed by only
Bhang (34%). T h e dose ranged between
1-5 gm/day in majority (36%) and A 9
-
THG content was found to be 5.6% and
10.4% in Bhang and Ganja, respectively.
(Table 4).
TABLE 4. A " ' THC Content in Crude Ca-
nnabis
Bhang (gm/day;
0
1--5
6- -10
11--15
16 & above
A--9 THC%-
Ganja (gm/day)
0 1-5 6--10 11-15
Number of subjects
1 1 --
4 18
7 -- 4
4 --. -- _
2
-Bhang--5.64^1.2
Ganja--10.4-1-2.6
(MJ;S. E.;
16 &
above
3
2
5
As depicted in Table-5 5 2 % of the
abusers reported not having experienced
any stressful event prior to initiation of
cannabis intake while 4 8 % reported one
or the other psycho-social stresses. Majo-
rity of the abusers (64%) were noi found
to possess any abnormal personality traits.
TABLE 5. History of stresses within a year
prior to onset of cannabis use
No stress
Stress within one year (N =
I. Loss of (a) love object
(b) prestige
(c) Economic
II. Frustration
N
26
=24) 24
14
5
6
3
-Scholastic failure 5
--Lack of heterosexual
attachment --
--Lack of promot
or job
III. Others
Premorbidpersonality of subjects :
Personality Traits
ion
9
3
Experi-
mental
N %
/o
52
48
31.1
11.1
13.3
6.6
11.1
20
6.6
Control
N %
--Average personality 32 64 36 72
(No abnormal psychiatric traits)
--Schizoid traits
--Paranoid traits
---Obsessive traits
--Hysterical traits
--Antisocial traits
--Asthenic/dependent traits
--Cyclothymic traits
5
1
2
4
3
1
2
10
2
4

(i
2
4
4
X
3
2
1
1
3
a
--
i>
4
2
2
i i
36% of the abusers never disconti-
nued the cannabis abuse while 64% occa-
sionally discontinued. Out of those who
discontinued the cannabis at t'mes, 32%
DRUG ABUSE IN INDIA: AN OVERVIEW 61
did not experience any withdrawal symp-
toms. In rest of the subjects, mild-cra-
ving, psychological upset, tiredness and
fatigue, anxiety, bodyache, listlessness,
irritability, decrt ased performance, poor
concentration and sleep disturbance were
the reported withdrawal symptoms in des-
cending order. However, these symp-
toms neither required active medical
intervention nor were the subjects com-
pelled to resume cannabis intake imme-
diately (Table 6).
TABLE 6. Withdrawal Symptoms
Subject (N=50) N %
1. Never stopped
2. Stopped occasionally
18
32
36
64
(b) Symptoms (N=32)
A. No symptoms 10 31
B. Mild craving 19 38
2. Psychological upset 6 12
3. Tiredness & Fatigue 8 16
3. Anxiety 5 10
5. Headache, bodyache 6 12
6. Listlessness 8 16
7. Decreased performance 5 10
8. Poor concentration 6 12
9. Sleep disturbances 2 4
10. Irritability 7 14
11. Palpitation 1 2
PHYSICAL AND PSYCfflATRIC EVALUATION
On clinical psychiatric evaluation
most of the subjects (64%) were found to
have no psychiatric problem. The re-
maining were, however, found to mani-
fest mild features of depression (16%) and
anxiety (10%) (Table 7). There was no
abnormality on physical examination ex-
cept chronic bronchitis in a few.
TABLE 7. Clinical Evaluation.
No Psychiatric Problcmc
Psychiatric problem
--Depressive feature
--Anxious Preoccupation into:
(a) Family problems
(b) Economic problems
(c) Future
--Suspiciousness
--Anxiety
32
18
8
64
36
16
4
4
10
Similarly, laboratory examination for
haemogram, liver and renal function tests,
cardiogram and nerve conduction test did
not reveal any abnormality. However,
in two subjects electroencephalogram was
found to be abnormal. In one, it was non-
specific borderline defect and in the other
slow activity with superimposed beta
activity was detected. Tonometry was
found to reveal normal ocular tension in
84% cases and lower tension in 16%
cases (Table-8).
Psychometric evaluation did not re-
veal any significant abnormality in compa-
rison to control subjects on Bhatia Battery
of Intelligence Test, G. M. I. and HRS-D.
28% subjects were found to have low
memory score on W. M. S. indicating
mild memory impairment and 6% had
low scores on B. G. T. indicating orga-
nicity. One surprising observation was
made on Taylor's Manifest Anxiety Scale,
where experimental patients were found to
have statistically significant low anxiety
scores as compared to control subjects.
(Table-9).
62
(a;. Biochemical
Investigation
B.B. SETHI ital.
TABLE 8. Laboratory investigations
Mean ^ SE Remark
- H b %
L. F. T. (Liver Function [est
Serum bilrubiu
Van den-berg
Alkaline Phosphatase
Total serum protein
--K. F. T. (Reaal Function Test,
Blood urea
Serum Creatinine
blood sugar (Fj
- Urine analysis
Albumin
Sugar
Microscopic
120.2 gm% X. A. D.
0.22 mg% X . A . D .
--ve X . A . D .
8 . 2  0 . 0 2 K . A . U n i t X . A . D .
"..60.26gm% X . A . D .
242.2rog%
0.80.002mg%
984.6mg,J
--ve
--ve
Xorma!
X . A . D .
X . A . D .
X. A. D.
X . A . D .
X . A . D .
X . A . D .
(b) Other Investigations
Tests
E.C:.G.(N = 50)
E. E. G. (X=48
Mtrve conduction
Metre/Sec.
Mean^S. E.
Xormal
30
46
Abnormal
1 --Nonspecific borderline
1 --Slow activity superimposed with fast Beta
activity
Rt. Ulnar Lat. Popliteal (Rt.)
344.2
(Normal)
Lt. Ulnar Lat. Popliteal (Lt.
40-1-4.6
(Normal)
323.8
(Normal)
Tonometry
Tension of both eye* (m. m. Hg)
7-12
13--18
8
42
16
84
DRUG ABUSE IN INDIA: AN OVERVIEW 63
TABLE 9. Psychometric Evaluation
Scores ' Experimental Control
N % N %
(a) Taylor's Manifest Anxiety Scale :
lielow 17 46 92 50 100
17--22 4 8 -- --
23--28 -- -- -- --
MS.E.=6.92.2 MS.E. = 13.82.6
(P<0.05)
(b) Cornell Medical Index (A-R score)
Below 30 46 92 48 96
31--40 3 6 2 4
41--51 1 2 -- --
52--62 -- -- -- --
M  S . E. = 142.4 M  S . E . = 11 + 1.2
X' = 1.2;N.S.
(o) Hamilton Rating Scale
lielow 17 46 92 48 96
17--23 4 8 2 4
24--29 -- -- -- --
MfcS. E . = 8 + 0 8 + M  S . E.=6.21.8
X  = 0 . 7 ; N . S .
(d) Bender.Gestalt Test (Z-score)
0--5 34 68 38 76
6--12 13 26 10 20
13-24 3 6 2 4
M  S . E . = 5  1 . 2 M  S .  = 4 ^ 1 . 6
X =0.81, N.S.
(e) Weethsler Memory Scale CMP
HI--90 28 56 22 44
91--100 16 32 20 40
101--110 3 6 6 12
111--120 3 6 2 4
MS.E.=94.6;t8.6 X-1.4, N . S .
X=2.3,N.S.
(0 Bhalia
7i--ao
a i--9o
91--100
101-110
111-120
Battery ofIntelligence
2
M  S . E.
11
23
11
3
- 9 6 . 3  7 . 2
4
22
46
22
6
X-
2
10
17
175
6
*1.4 N . S .
4
20
34
30
12
X=2.3, N. S.
DISCUSSION
Cannabis having been used since time
immemorial in several cultures and for
variety of effects, has been an issue ol
heated debate with regard to its possible ill
effects on physical, psychological and
social aspects of an individual. Alan .on
the street has read a number ol documen-
ted reports by one or more investigators
that seem to contradict and refute each
other resulting in confusion.
A consistent problem with reported
studies has been ihe definition of a true
cannabis abuser for its use differs from
culture to culture. The operational defi-
nition oi chronic use, therefore, in terms of
duration, regularity, frequency, dose etc.
varies from investigato. to investigator,
making it difficult to compare various stu-
dies. In the present work, the term 'ch-
ronic use' has been operationally deiined
as to regular usage of cannabis for 5 or
more years and all its effects have been
studied in the light ol this definition.
Our experience with the presen t work,
involving 50 chronic cannabis users
and 50 matched controls for age, sex and
economic status, has been that chronic
use of cannabis does not cause impairment
of physical, psychological and socio-eco-
nomic aspects of users.
It was noticed that indulgence in
cannabis use is initiated around adoles-
cence and early adulthood in the majority
of our subjects. These observations are
similar to earlier ones in India ^Dube,
1972; Varma, 1972; Sethi et al. 1981)
and West (Beedle, 1971; Mabilean,
1972; Baselqu, 1972). We could not
delineate a particular factor among our
subjects responsible for early initiation of
cannabis use. Stress was not an impor-
tant factor for such an initiation, however,
curiosity, company, need for pleasure
appear to be important factors for such a
behaviour. Further, cannabis is often
used in the Indian cultural setting for a
64 B.B.SETHI el A/.
variety of reasons, thus cultural sanction
may be an important phenomenon. A
similar observation was made in an ear-
lier study (Sethi et al., 1981).
In terms of psychiatric status of these
subjects, no definite trait could be identi-
fied from a study of their premorbid per-
sonality. Further, psychiatric and psy-
chometric evaluation of these subjects did
not reveal any significant impairment.
However, the abnormality observed on
Bender Gestah Test and Weschler Memo-
mory Scale for Z scores and low M. Q,.
respectively could be due to poor educa-
tional background in these subjects. The
observations made on Hamilton Rating
Scale for Depression, Cornell Medical
Index and Bhatia Battery of Intelligence
Test did not, however, differ from that
made in control subjects. One signifi-
cant observation on Taylor's manifest An-
xiety Scale in which cannabis users were
found to have low anxiety scores, appears
to be due to soothing effect produced by
cannabis or some other yet to be identi-
fied phenomenon.
In our study we did not observe any
impairment of functioning, observations
somewhat similar to that of Gomitas
(1976) but certainly contrary to the works
of Kolansky and Moore (1971) and West
(1970). It appears that use of cannabis in
our society has a traditional and cultural
sanction as a result of which majority of
the subjects do not take an excessive quan-
tity which may otherwise be detrimental
to psychosocial aspects of life. It was
noticed in our work that majority of the
subjects used cannabis ranging from 1-5
gm/day which is a low quantity, . Further,
Halikas et al. (1971) emphasized that anti-
social behaviour more often preceeded
cannabis use than followed it.
Similarly, physical status was found
unaltered, as assessed by physical exami-
nation and laboratory investigations which
are furthei supported by earlier observa-
tion (Hartley etal., 1978; Tennant, 1982).
Normal immune status and lack of in-
crease in the susceptibility to infection
were also reported by Silverstein and
Lessin (1976). Normal nerve conduction
and E. E. G. reported in our study, as did
earlier studies (Dibenedetto et al., 1977;
Stefanis et al. 1976) further confirm that
cannabis does not produce any impairment
of central or peripheral nervous system.
We did not observe any evidence of epilep-
togenesis in E.E.G. even after photostimu-
lation and cerebral atrophy as reported by
Nahas (1979) and Gompbell et al. (1971).
However, Nahas (1979) used pure
\*T. H. G. in his study instead of crude
cannabis. Recently Rotenbergh (1982)
described 'Cannabidiole' as a potent anti-
epileptic agent. It is possible that 'canna-
bis' used by our subjects may be rich in
cannabidiole' and thus exhibited no epi-
leptic discharges during E.E.G. Cannabis
is known to reduce intraoccular tension
both in normal as well as in patients su-
ffering from glaucoma (Cohen, 1976;
Crawford and Meritt, 1978; Meritt et
al, 1981). It is probable that lack of such
observation in the majority of the subjects
might be due to development of tole-
rance following chronic cannabis use.
The Indian Hemp Drug Commis-
sion reported that large number of pra-
ctioners of long experience have seen no
evidence of any connection between the
moderate use of hemp drug and disease
(Grinspoon, 1971) and this conclusion
has never been seriously challenged and
is similar to observation of La Gurdiu
Committee. Studies in Jamaica (Rubin
and Comitas, 1975) and Costa Rica
(Coggins et al, 1977) confirm these obser-
vations and those of our study.
The question as to whether cannabis
produces dependence remains controver-
sial (Goth, 1970; Keilholz and Ladwing,
1970; Stefanis et al, 1976). In this study
it was found that cannabis does pro-
duce mild withdrawal symptoms in some
DRUG ABUSE IN INDIA: AN OVERVIEW 65
subjects but appear to be of no signifi-
cance;, because neither these subjects were
compelled to consume cannabis nor did
it require therapeutic intervention. It
is possible that cannabis does not pro-
duce 'Dependence' because of its very
long half life.
It may thus be categorically stated
that cannabis is not associated with phy-
sical, psychological and socioeconomic
impairment of an individual. However,
National and International discussion on
health and social consequences of can-
nabis use and the relevance of these iss-
ues to development of public policy con-
tinues unabated. Therefore, well designed
large scale, long term, prospective studies
assisted with biochemical investigations
are required to delineate the various eff-
ects of cannabis so as to resolve the con-
troversies.
ACKNOWLEDGEMENT :
The authors are thankful to Indian
Council af Medical Research, New Delhi
for sponsoring the project 'Cannabis and
Health'.
REFERENCES :
BXSELQ,U, E. (1972). United Nations Information
letter division of Narcotic drugs, N. 5, May,
1972.
BEEOLE, P. (1971). Drug abuse: Non-Medical Use
of Dependence Producing Drugs (Ed.) Simon
iitesh, 116, Plenum Press, N. Y., London.
CAMPBELL, A. M. G., EVAN, M., THOMSON, J. L. G.
AND WILLIAMS, M . J . (1971). Cerebral atrophy
in young cannabis smokers. Lancet,
1219.
COGOJNS, W. S., SWENSON, E. W., ET. AL. (1977).
Quoted from: Grinspoon, L. and Bakalar,
J. 11. (1978): Marihuana: Health hazards and
medical benefits. In: Controversy In Psy-
chiatry. Brady, J. P. and Brodie, H . K. H.
(eds.): W. B. Saunders Co. London, pp.
881.
COHEN, S. (1976;. The 94-days cannabis study.
Ann. N. Y. Acad. Sci. 282, 211-220.
COMITAS, L. (1976). Cannabis and work in Jama-
ica. A refutation of the amotivational synd-
r o m . Anna. N. Y. Acad. Sci. 282, 24.
CRAWFORD, W. J . , MERITT, J . C . (1978). Int. Clin.
Pharmac. Biopharm. 17 : 191-196, Quoted
from Meritt et a/., 1981.
DEB, P. C., AND JINDAL, R. B. (1974). Drinking in
rural areas : A study of selected villages of
Punjab. Ludhiana : Punjab Agricultural
University.
DlBENEDETTO, M . , M c NANCE, H . B., KUEHULE,
Y. C A N D MENDELSON, J . H . (1977). Cannabis
and the peripheral nervous system. Brit. J.
Psychiat., 131, 361.
DUBE, K. C. (1972). Drug abuse in Northern
India : Observation concerning Delhi, Agra
Region. Bulletin on Narcotics, 24, 2.
D U B E , K . C . AND HANDA, S.K. (1969). Drughabit
in health and mental disorder. Indian J. Psy-
chiat., 118, 345.
DUBE, K. C. AND HANDA, S. K. (1971). Drug use
in health and mental illness in an Indian Popu-
lation. Brit. J . Psychiat., 118, 345.
DUBE, K. C , KUMAR, A., KUMAR, N . A N D GUPTA,
S. P. (1977). Drug abuse among common
students : An interim report. Bulletin on Narco-
tics, 29 (1), 47.
ELNAGAR, M. N . , MAITRA, P. AND R A O , M . N.
(1971). Mental health in an Indian rural
community. Brit. J. Psychiat. 118, 499.
GOTH, A. (1970). Marihuana in Medical Pharma-
cology. 5th Ed. St. Louis C. V. Mcsby & Co.
282.
Gossop, M . R. (1978). . A comparative study cf
oral and intravenous drug dependent patients
on three dimensions of personality. Interna-
tional J . Addictions, 13, 135.
GRINBPOON, L. (1971). Marihuana reconsidered
Cambridge, Mass. Harvard University Press.
HALIKAS,J. A., GOODWIN, D. W. AND GUZE, S. B.
(1971). Marihuana effects. Asurvey ofregular
users J. A . M . A. 217 : 6 9 2 .
HARTLEY, J. P. R., NOORADY, S. G. SEAFON, A.
AND GRAHAM, J. D. P. (1978). Bronchodilator
effect of A'-THC. Br. J. Clin. Pharmc. 5,
523.
KEILHOLZ, P. AND LADWING, D. (1970). Drogcna-
bhangigkeitbei Dtsch. Med. Wschr. 95, 105.
KOLANSKY, M. AN.> MOORE, W. T. (1971). Effects
of mirihuina on adolescence and young adults.
J. A. M. A. 216 (3). 486.
LAL, B. AND SINGH, G. (1979). Drug abuse in
Punjab. Brit. J. Addiction. 74, 411.
MABILEAN,J. F. (1972). Drug abuse, Non medical
use ofdependence producing drugs (Ed.) Simon
Stesh, Phlenum Press, New York, London,
p. 107.
MOHAN,D. AND ARORA, A. (1976). Prevalence and
pattern of drug abuse among Delhi University
College students. Ind, Med. Assoc, 66, 28.
66 B. B. SETHI it al.
MERRIT, J. C ; OLSEN, J. L., ARMSTRONG, J. R. AND
MCKINSON, S. M. (1981). Topical A-Tetra-
hydrocannabinol in hypertensive glaucomas.
Ophthalmology. 33, 40.
MUTTANor, P. K. (1981). Drug abuse among
college students. In : Current Research in
Drug Abuse in India. D. Mohan, H. S. Sethi
and E. Tongue. Hnd (eds.). National and
Regional Conference on Drug Abuse, New
Delhi.
NAKAS, G. G. (1979). Current status of marihuana
research. J. A.M. A.,242,2775.
NANDI, D. N., AJMANV, S., GANGULI, H., BANERJES,
G., BORAL, G. C , GOSH, A. AND SARKAR, S.
(197i). Psychiatric disorders in a rural
community in West Bengal. An epidemiologi-
cal study. Indian. J. Psychiat.. 17, 87.
NATIONAL COMMITTEE ON DRUG ADDICTION IN INDIA
(1977). The prevalence and pattirn of drug
abuse in India. A combined report of seven
centres. Presented to the National Committee
on Drug Addiction.
1<.OSENKRANTZ, H. (1982). Cannabis, marihuana
and cannabinoid toxicological manifestations
in man and animaU. In adverse health and
tieliavioural consequences of cannabis use.
Working papers for the ARF/WHO Scientific
Meeting, Toronto, 1981 K. O. Fehr and
H. Kalaut (eds.) Addiction Research Founda-
tion, Toronto (In Press).
ROTTANBURGH, D., ROBINS, A. H., ARIC, O. B.,
TEGGIN, A. AND GIK, R. (1982). Cannabis
associated psychosis with hypomanic feature.
Lancet, 12, 18, 1364.
RUBIN, V., AND COMITAS, L. (1975). Ganja in
Jamaica. The^Hague, Mouton.
SETHI, B. B. AND MANCHANDA, R. (1977). Drug
abase among medical students. Indian J.
Psychiat., 19, (4), 31.
SETHI, B. B. AND MANCHANDA, R. (1978a). Pattern
of drug abuse among male students. Indian J.
Psychiat., 20(2), 166.
.SETHI, B. B., AND MANGKANDA, R. (1978b). Drug
abuse with special reference to India. Sub-
mitted for publication in Acta. Psychiat.
Scand.
SETHI, B. B. AND TRIVEDI, J. K. (1979). Drug
abuse in a rural population. Indian J. Psy-
chiat., 21 (31), 211.
SETHI, B. B., TRIVEDI, J. K . AND SINGH, H . (1981).
Long term effect of cannabis. Indian J. Psy-
chiat., 23 (3), 224.
SETHI, B. B., TRIVEDI, J. K., KUMAR, P. AND
TIWARI.S. C (1983). Cannabis and health-
study sponsored by ICMR-Unpublished data,
SILVERSTEIN,M.J.ANDLESSIN, P.J. (1976). DNC1!
skin testing in Chronic marihuana users. In
Braude M. C. and Szara S (Eds.) Pharmacology
of Marihuana, New York, Raven Press.
SINGH, G. (1979). Drug use among medical stu-
dents--I : Prevalence and pattern of use.
Indian J. Psychiat., 21 (4), 332.
SINGH, N., AGARWAK, A. K., SHANKER, K. AND
BHARGAVA, K. P. (1981). Evidence of'Abs-
tinence syndrome' in cannabis treated albino
rats. Quart. J Crude Drug Res., 19, No.
2-3, 65.
STEFANIS, C. BOULOUOOURB, V. AND LIAKOS, A.:
(1976). Clinical and Psychological affects ol
Cannabis in long term users. In Braude, M . C.
and Szari, S. (Eds.). Pharmacology of Mari-
huana, New York Raven Press.
TEASDALE,J. D. AND HINKSON, J. (1971). Stimu-
lant drugs : perceived effect on the interper-
sonal behaviour of dependent patients. Inter-
national J. Addictions., 6, 407.
TBNNANT, F. S. J R . (1982) * Clinical Toxicology ol
Cannabis use. In : Adverse health and Beha-
vioural consequences of cannabis use., Fehr.
K. O. and Kalant, H . (Eds.) working papers
for the ARF/WHO Scientific meeting, Toronto,
1981, Addiction, Research Foundation To-
ronto, in Press, 1982.
THACORE, V. R. (1972). Drug abuse in India with
special reference to Lucknow. Indian J. Psy-
chiat., 14, 257.
TRIVEDI ,J. K. AND SETHI , B. B. (1978). Drug abuse
in psychiatric patients. Indian J . Psychiat.,
20(4), 345.
TURNER, C. E.,ELSOHLY, M . A. AND BOEREN, E . G .
(1980). Constituents of Cannabis sativa L.
XVII: A review of the natural constituents.
J. Nat. Prod., 43, 169.
VERMA, L . P . (1972). Cannabis Psychosis. Indian
J. Psychiat., 14, 241.
WEST, K . J . (1970). On the marihuana problems.
In : Psychotomimetic drug. Efron, D. (Ed.)
New York, Raven Press, 327.