Cannabis is cultivated in this tropical country. A concentrated product, charas, the resin obtained from the flowering tops of the female plant, is the preparation generally used. The most common method of smoking charas is in a clay water pipe called a Chelum. Next most commonly used is a pipe or needle and straw. Infrequently, charas is smoked in tobacco cigars or cigarettes. Chewing the leaves or drinking a charas mixture as a confection is quite rare.

Although charas smokers are found throughout society, they are predominantly found in certain groups. The ages of the subjects studied ranged from 13 to 70 years old. More than 75% were, married. Almost all were males.

Socioeconomic status was as follows: 70%, lower, 28% middle and 2% upper. 82% are illiterate, 27% had a primary school education and less than 1% had any higher education.

Most smoking occurs in groups of two to 20 friends in quiet out of the way places. Most users smoke several times a day. The longer one has smoked charas, the shorter the duration of the high and the more often the individual can smoke each day.

Weakness, sexual difficulties and physical impotence are commonly reported by smokers. Most report they have a good appetite and eat more than normal, but malnutrition is common.

One hundred chronic smokers were selected at random and examined medically: 93 were malnourished; no evidence of illness was found in 79 subjects; 13 showed signs of respiratory illness (bronchitis) ; 7 showed sleep disturbances and one had pulmonary tuberculosis. No deaths have been reported from charas overdose. One subject out of the 1,011 was known to be chronically psychotic.

A review of over 150,000 outpatient and inpatient psychiatric visits per year over the past 10 years revealed 20 short-term psychotic episodes yearly involving charas alone and 16, short-term psychotic episodes yearly involving both charas and other drugs. An absence of chronic mental illness related to charas use was noteworthy.

Most charas smokers commence use during their teens, gradually increasing their use about five or six times until they reach their highest dose between the ages of 20 to 40 years.

At the extreme, smokers have raised their daily dosage up to 10 times their starting dose within the first two years. They then gradually decrease their daily requirement by about 50% upon reaching their 60's. Generally, most smokers cease charas use after their 60's, but some. use extremely low doses for the rest of their lives.

I These patterns of use are consistent with the development of tolerance. Additionally, chronic smokers note they are able to use larger doses than they did when they began use without any significant signs of intoxication. Also after stopping charas use for a few days or months, the users report they restart use at smaller doses to achieve the desired effect.

No physical dependence was noted. Marked psychological dependence was present which makes it difficult to stop their habitual use. Discontinuation of charas use produced mild psychologic abstinence signs. These signs, generally include restlessness loss of appetite, sleeplessness, nervousness, headache, and gastrointestinal upset.

Most smokers after discontinuation of use are quite able to live with their families and perform their jobs without discomfort. Most chronic smokers return to charas use within days or months. Out of a group of 100 randomly selected ex-smokers who had used for eight to 22 years, 42 have not returned to charas use, 16 use occasionally and 42 have returned to daily use within one to 13 months.

Most common explanation given by the subjects for restarting use were to continue close relationships with charas using friends and lack of a busy job.

A group of 100 opium addicts were selected at random from the community; 51 of these started their drug use with charas and later substituted opium for charas.

Generally, charas smokers report that they become faster in their daily jobs, but observation reveals a slowness in these activities. The ability to perform a non-complicated job is comparable to non-charas smokers. They tend to be cooperative but lazy persons. They tend to be more theoretical than practical and avoid making decisions. They do not demonstrate creativity or contribute significantly to the improvement of their community.