Welcome to the world wide web page of Tod H. Mikuriya, M.D.
The International Journal of the Addictions, Vol. 3. No. 2. Fall 1968 p 397-398
PSYCHO-PATHOLOGICAL ASPECTS OF THE CANNABIS SITUATION
IN MOROCCO: STATISTICAL DATA FOR 1956” REVISITED
Adverse psychiatric reactions requiring hospitalization in chronic marihuana users were reported by Benabud (1) in a study of patients confined at the Berrechid Mental Hospital in Morocco. Through examination of hospital records he noted that 68% or 824 of the 1,252 patients admitted to Berrechid for the calendar year 1956 had used marihuana either regularly or occasionally. This study went on to list demographic and clinical features of the patients. 328 patients of this population were described as "genuine cannabis psychosis cases.”
In appraising diagnosis and statistics, consideration must be given to the setting and situation of this study. The writer had occasion to visit Berrechid Mental Hospital in August 1966. The following statistics were supplied by the superintendent. This 2.000 bed institution. serving the greater part of Morocco, handles an averaee of 125 admissions—discharges
per month. The professional staff strength is allocated to be seven physicians. The hospital had one psychiatrist and four physicians. Berrechid’s quota of psychiatric social workers is two, but at the I line of the visit they had none. Although they were budgeted for 55 nurses. they had 39.
Authorized non-professional nursing staff was 400. but only 133 were at hand. The overrall patient per diem expenditure was 6 Dirham, or $1.20. Reliable information and accurate diagnoses with these conditions could hardly he expected.
Only a few of the patients at Berrechid were voluntary, the population being almost exclusively referred by the courts.
In Morocco there are few psychiatrists. Most of the ‘certified,’’ or committed, patients are referred to the courts by general practitioners. The busy physicians in the community must rely on data supplied by relatives or the police. Ascription of “cannabism,’’ as cause for hospitalization, then, is further open to question because of the absence of comparison of incidence of kif use occurring in the hospitalized patients and the general community. Given such data, the situation would be like examining the incidence of tobacco use in a mental hospital and concluding that it was a significant factor in causing hospitalization.
Beside. the problems in making accurate diagnoses caused by the paucity of professional staff, certain other difficulties were encountered. Usual laboratory studies beyond routine blood count, urinalysis, and chest X—ray were unavailable. An EEG machine was acquired only last year. Post—mortem examinations were and are rarely performed because of adverse attitudes within the Moslem community.
In the absence of usual and accepted medical data it is necessary to rely on accounts given by a physician at the hospital. Clinical impressions obtained from the Superintendent were that acute “psychoses” caused by cannabis overdose cleared within 3—5 days without sequelae. Chronic use by those of marginal means encouraged emergence of avitaminoses and infections through lessened food—gathering efforts. These symptoms would become evident upon a few days’ abstinence from cannabis. As to whether or not permanent central or peripheral nervous system changes occur with chronic cannabis use, they probably do not.
Studies concerning adverse psychiatric reactions with cannabis use in any significant number of subjects are ahsent in the United States. this may he due to several factors, such as: (1) low incidence of adverse reactions; (2) failure to recognize or report such reactions; or (3) weak strength of cannabis preparations available in this country. It is thus necessary to rely on studies in countries where indigenous use is significant. One must he wary in evaluating reports from such countries because of differences in culture, facilities, and processes of definition of disease entities.
To date no studies of possible toxic effects of chronic cannabis use have been undertaken utilizing acceptable medical research procedures. In light of reports of increasing marihuana use, especially in young men and women, such studies are clearly indicated.
Tod H. Mikuriya, M.D.
San Francisco, California
(1) Benabud, A.. ‘‘Psycho-pathological Aspects of he Cannabis Situation in Morocco Statistical Data for 1956.’’ Bulletin on Narcotics, IX 4. pp. 1 - 16. Republished and enhanced http://www.undcp.org/bulletin/bulletin_1957-01-01_4_page002.html
Cannabis continues to be cultivated in Morocco. The California state mental hospital compared with Berrechid Hospital in Morocco closed many years ago with the property and buildings sold to a Buddhist church. Former patients, many homeless now, may be seen on the streets of San Francisco.