The Commission's analysis of frequency, quantity and duration of marihuana use suggest that the United States is at the present time in a fortunate position. All of the studies available to the Commission have indicated that only a minute number of Americans can be designated as very heavy marihuana users. These studies uniformly indicate that chronic, constant intoxication with very potent cannabis preparations is exceedingly rare in this country.

The Commission believes that important distinctions must be made between the daily (moderate and heavy) American marihuana user and the very heavy hashish or charas user in other parts of the world where cannabis is widely cultivated and its use deeply ingrained. Many of the North African and Asian users do not employ the drug only as an intoxicant in the western sense. Instead, it is frequently used in "folk medical practice," in religious rites and as a work adjunct particularly in those occupations which are physically demanding, monotonous, unintellectual, and offer little possibility of advancement.

In these countries, very heavy use is typically associated with young males from a lower socioeconomic background. Nonetheless, use is more widespread among all ages and elderly chronic users are not uncommon.

Generally, these very heavy users consume high amounts of very potent preparations continually throughout the day so that they are rarely drug-free. These individuals evidence strong psychological dependence on the drug, requiring compulsive drug-taking. Clear-cut behavioral changes occur in these extreme cases. The very heavy User tends to lose interest in all activities other than drug use. A common element of the behavioral pattern is lethargy and social deterioration. Not surprisingly, these users have been held in low esteem and very heavy use has been subject to societal disapproval in almost all countries.