U. S. Public Health Service Hospital, Lexington, Kentucky. Mr. A. Cecil Snyder, United States Attorney, San Juan, Puerto Rico. } ; Dear Mr. Snyder: I have your letter of March 14, 1938, in which you state that the Honorable Robert A. Cooper, Judge of the United States District Court for Puerto Rico is interested in acquiring information to guide him in imposing sentences in marihueane eases. I regret thet I could not get around to this before but I have been away from the station. Marihuana addiction has come to the attention of the authorities in the United States and more particulerly to the attention of laymen during the last ten or fifteen years. There hes been an actual increase in addiction but e lerge part of the literature on the subject, especially the ley litemture, owes its inception to propaganda of persons bent on saving the world from something, and of course writers who get paid for their writing have to make their articles interesting. It has been said with some probability of truth that there are about 200 ,000 ,000 marihuana users in the world. ‘These are mostly in Eastern countries such as Egypt, Asia Ninor, Indie, etc., where the drug has been used for ages. Addiction is more prevalent in the southern part of the United States, especially along the Mexican border. It is also said to be fairly prevalent in Puerto Rico, but I have no definite knowl edice about thet. Merihuans in various countries may be smoked, chewed, or taken as an infusion, but in the United States the drug is taken mostly by amoking. The wri “marihuane” »«s originated in Mexico. The real name for the drug is “cannabis éativa® and it is commonly known in the litere- ture as cannabis indica. Marihuena does not cause the same kind of addiction as does opium and its preparations in that a person does not become physically addicted to it so that he must have the drug to maintain comfort. It is taken for ite intoxicating effeet#iand for the thrill that it is supposed to give. Possibly the advertisement in the newspapers ceuses many young people to give it at least one trisl. I am quite sure that most of the marihuena that is taken in the United States is teken somewhat as alcohol is by persons who go out on a party, for instence, Saturday night sprees, etc., although there are doubtless a number of persons who have got into the habit of smoking the cigarettes daily. « Bo Marihuene continuously taken in large quantities does more harm to the physical constitution than any preperation of opium. It is said that in Eeypt it causes perhape 25 or 30 per cent of the insanity, although I doubt whether ech a large proportion is caused by it. Insanity, due to merihuena, ie practically unknown in the United States and in so far as reports go the seme may be said for Mexico where the drug is widely used, I should mention for compariaon here thet opium does not cause people to become ineane as does aeleohol end marihuana. Marihuana causes a very definite intoxication in which the patient has peculiar sensations and perceptions. For instance, he may feel that his arms are twice as long ea they actually are; thet his head is much larger than it is; end it may sean to him that four or five minutes has actually been mhour. It does not follow from this thet every person who tekes marihuane would heve these sensations and feelings every time he takes it; in fact the drug may be | taken in moderation es may eleohol without producing aymptome noticeable to others. Psychopathic and criminally inclinefii people may under the influence | of merihbuene commit crimes. In this respect it resembles aleohol end differs from opium. The opium addict who commits a crime is umally a thief who steals in order to set the wherewithal to buy the opium necessary to sat~ isfy hie physical needs and of course the opium addict is usually ean un- eteble individual. The few really desperate criminele among thes are crim ineale regardless of the opium. The same would apply to desperate mari-~ huane eriminals but with this difference «+ some unstable border-line per~ . sone who would not commit a crime normally may be led to commit « crime | under the influence of marihuana. Mo one need fear that « normal individual who happens to smoke a few marihuane cigarettes is going to coumit a crime because of the intoxication produced. It is said thet merihuene stimulates the sex impulee and thet persons under ite influence are likely to commit sex crimes. ‘The reports in the lay press about this ere of course greatly exaggerated, but the same applies to eex that I have said about other types of crimes. I would my in relation te erime that the number of crimes produced by persons under the influence of marihuane is infinitesimal as compared with those produced by persons intoxicated with alcohol. This is not because elcchol hes greater crime- producing qualities but because its use is so much more wide epread. As to treatment of marihuana addiction, the only immediate treatment necessary is te take the drug ewny from the patient. There is no suffering. The other treatment is the same as the trestment for opium eddicts « nemely, the treatment of the psychopathic tendencies that some of these people have, but opium addicts are likely to be more psychopathic, inct because opium makes them so but because the penalties for hendling opium have been so great thet practically all the normal people have been cured. Therefore, we may expect fewer relapses.in the cases of srihuene addicte than in opium eddicts because more normal people ere likely to have been taking the drug. Now that the lew regerding merihuene is becoming severe thie difference will dis- appear end e confirmed relapsing mearihuane addict will also be difficult to eure pemanently because of his innate psychopathic disposition. It is probable that if marihuane addiction became wide spread that meny peychope thie and unstable marihuane addicts would become opium ad- dicte just as many alcohol addicts and cocaine addicts become opium addicts. Aleohol, cocaine and mrihuana give what is felt by the petient es stimula- tion, and especinlly marihuane gives bizarre sensations which are at least momentarily interesting. But people who use these drugs exeessively are really seeking peace and calm end opium is the drug that gives this. This if why so many of them go over to opium, end this is probably why opium ad- dicta will always be somewhat more difficult to cure. In the American Journal 6f Peychiatry for September, 1934, Dr. Valter Bromberg, Senior Psychiatrist, Belleview Hospital, end Peychiatrist to the Court of General Sessions, New York, hes an article on marihuana intoxication — that is without propaganda and wh ich in my opinion is the best article on the subject thet has been written in recent years. Je studied the criminal aspects of it end found that of 2,216 criminals convicted of felonies in New York from 1932 to 1933, not one of confirmed merihuane addiction was noted. This article would well repay reading but if you reed it believe what Dr. Bromberg says and be careful not to confound what he says with what he reports from other people; for instance, he reports that the Publie Prosecutor in New Orleans in 1930 found that of 450 prisoners during 1930, 135 were marihuana addicts, and thet slightly less than half of the murderers and about 20 per cent of the larceny cases, and about 18 per cent of the assault and robbery cases were addicts. The inference is that the ?rose~ eutor thinks these people committed crimes because of their addiction but from my general knowledge of the subject end of the way people have of get- ting one thing on theiriminds end ignoring everything else, I greatly doubt whether more than two or three per cent of the crimes were committed be- cause of the addiction. Although I do not doubt that the New Yrleans cases had taken merihuene off and on, I do doubt the relation of the merihuaene to the _— . I am ssiatel here of G@ic book I recently perianal. ‘Tt was written by a former morphine addict who was ciired of his morphine a@dicticm ané felt the urce to do some crusading ebout the evil Of addiction. He decided be-~ cause of the publicity given about marihuana to try cut the effects of this drug. He got together six other men who, like himself, were heavy drinkers, and went out on a party. They provided thengselves with eight quarts of gin, four bottles of absinthe, and eight marihuana cigarettes. They drank up the gin and absinthe and each of them moked a marihuana cigarette. of course a number of things happened and it was ell attributed to the mrihuane. In conclusion, merihuenea is a harmful drug thet would do much harm if its use became wide spread but there is no denger that its use will become very wide spread among normal people end it will not grip the psychopaths as opium does because it does not ereate the physical craving characteristic in opium _sidieta. The abuse of the drug should be prevented but in preventing its gbuse I think we should be careful not to ruin the lives of persons who happen to have taken it for a short time. I am thinking of the six cases that were a ~recently sent here from Puerto Rico. ‘Three of them had no criminal records whatever. One of these was given four years and the other two were given five years. Such sentences can do no good and they ere bound to do ham. If patients like this were given s year and a day the punishment would act oe as ea deterrent, they would be completely cured during the nine months thet they would stay here, and unless they happen to be very unstable and pay cho- pathic individuals it is extremely unlikely that they would revert to the use of merihuens or eny other narcotic. I also think that the five years given to the other three petients who came here in the seme group is too much in so fer as the cure of their eddiction is concerned. However, each of these petients had hed jail sentences before and presumably are somewhat unetable. Forced confinement for a long period will not do them the same harm that it will do the cther three patients simply beesuse they are prob- ably alreedy rather too hardened and experienced in anti~soeiel methods or practices to suffer to the same degree as the others. I as bringing this up merely te give you our idea about the rehabilitation ef addicts and especially to emphasize thet some may be harmed by harsh trea t- ment and too long confinement. We feel here, and our ideas are based on ex- perience with eddicts, that the cureble addiet can be cured in a year and that many peychopethic eddicts will not be permanently eured with longer treatment. This is not because of anything thet the drug has done to them but beeguse being psychopethic and wmeteble they ere looking fofrelief or the thrill that they get beyond the relief or thrill thet the drug produces in any normal person. Because of this they, regardless of consequences, often go back to the drug thet will produce the relief or thrill that they are looking for. Very truly yours, Lawrence Kolb, Kedical Director, Medical Officer in Charge.