Keep off the Grass A Scientific Enquiry Into the Biological

Effects of Marijuana

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This book is dedicated
to the memory of my father Bishara Nahas
and of my mother née Gabrielle Wolff
 Preface

Some ants are among the few social animals known to use
"drugs." Their custom is to drag live plant lice deep into their
nests, to ingest some of the juice excreted by their captives,
and thus, apparently, to find in the resulting intoxication re-
lief from the pressure of their working day. But these ants
pay a price for their intoxication because the "drug" also re-
duces their awareness and their aggressiveness. They are
then unable to compose an adequate defense should their
colony be attacked by another "nation" of ants.
Marijuana, like most drugs ingested by man, gives the user
the impression t h a t his senses are enhanced, when in fact
they have been distorted and impaired. Those who explore
beneath the surface of the sea know this problem. Diving on
air, deeper t h a n one hundred feet, they are subjected to what
is often called "rapture of the deep" or "nitrogen narcosis,"
which I understand, is subjectively very similar to the feeling
experienced when smoking a "joint." "Stoned" by "rapture of
the deep," a diver is seriously endangered because he loses
his instinct for self-preservation. But on land, car drivers
"stoned" by marijuana become a hazard not only to them-
selves but also to all the other users of the road!
One of the oldest intoxicants known to humankind, mari-
juana is now widely spread throughout the Western world,
where two decades ago it was practically unused. But little
ix
X Preface
has been known about the scientific effects of the drug. In
this timely and important book, Dr. Gabriel Nahas describes,
as a result of careful scientific studies, the damaging bio-
logical effects associated with the marijuana habit. They are
of the most serious nature. They impair the formation of
basic chemicals essential for the orderly division of our cells,
for the normal transmission of heredity, and for the preserva-
tion of memory. If we remain ignorant of these effects, we too
may lose our instinct for self-preservation!
If we are concerned about the external pollutants t h a t
threaten our environment, we should be equally concerned
about internal pollutants—like marijuana products. For
sheer survival, we must defend ourselves against both kinds
of pollution. Furthermore, I believe that we need to keep all
our senses constantly at their maximum keenness if we are to
enjoy and to take full advantage of our short participation in
the miracle of life. ^*

Jacques Yves Cousteau

 Foreword

It is with both pleasure and a sense of the need to urge caution

that I introduce this crusading effort of my friend and col-
league Dr. Gabriel Nahas. The pleasure derives from Dr.
Nahas' accomplishment in this book. To it he has brought the
same enthusiasm and zeal t h a t have marked everything he
has done throughout an extraordinarily active life. During
World War II, Dr. Nahas, then an adolescent, helped many
downed British and American airmen to pass through occu-
pied France to the safety of Switzerland or Spain. His effi-
ciency and courage in the face of the risks involved in run-
ning this underground operation became legendary. In his
subsequent career as a scientist, Dr. Nahas has not been
one to shirk the unpopular problem, nor to do it less t h a n
full scientific justice, as his efforts in relation to the subject
of this book testify.
He is one among a growing number of physicians who be-
lieve that, besides providing for the physical, as well as the
mental, well-being of the individual, medicine must become
increasingly aware of, and responsive to, the demands of the
community. This attitude necessarily leads to compromise
between the goal of accommodating the desires and welfare
of the person and the aim of seeking and putting into prac-
tice ways of protecting the h u m a n species. Compromise, of
course, means concessions, a thought implied in the words of
XI
XU Foreword
Jean Hamburger, a physician concerned with the future of
medicine and the future of man: "If man wishes to retain all
the original marvels t h a t separate him from the mutton-
birds and the termites, his anguish will simply have to be
preserved . . . [and] all these marvels will vanish if he over-
uses tranquilizing drugs." Indeed, since anguish is so often
at the root of creative power, one must heed the caution of a
concerned artist, the great French poet Charles Baudelaire,
who discovered after experimenting with hashish that "this
[poison] never reveals to the individual more than he is
himself."
Thanks to the work of Dr. Nahas and others who have con-
ducted well-controlled investigations, some of the physio-
logical effects of chronic exposure to marijuana of known
potency are now being defined. There is no question in my
mind that chronic use of marijuana in these concentrations is
hazardous, both to the user and also to the society t h a t is
exposed to the consequences of the user's judgment during his
"high."
One must ask, however, how many marijuana users de-
velop the physiological and psychological effects of chronic
intoxication? Anecdotal information suggests t h a t there may
be a large number of "casual" users who apparently suffer
no permanent harm as a result of their experiences with this
drug. Furthermore, many of them whom I have interviewed
dispense with its use when they reach adulthood and its
responsibilities. What, in fact, are the consequences of casual
marijuana use for this group? Is it appropriate to apply crimi-
nal penalties to marijuana use, with its apparently very
broad spectrum of possible effects, and not to tobacco cig-
arettes and alcohol? What are the fundamental causes of
self-prescribed administration of psychoactive substances in
our culture? It is, of course, possible to point to peer pressure,
a certain "passivity" and readiness to "escape reality,"
characteristics one attributes to the young. But I believe
that one must go beyond the superficial and obvious to ask:
What is the relationship between drug use, pandemic in
many sectors of American society, and socioeconomic status?
Foreword Xlll

What is there in American education t h a t might facilitate

habituation/addiction to the use of psychoactive materials?
It has been suggested t h a t not only in this, but in other
postindustrial societies, the conception of the future as differ-
ent from the present, and alive with potentialities for im-
proving the lot of man, has been lost. Is this so? How does the
problem of drug use relate to the all-important question of
ethics in the developing society, to decency, and to the
dignity of man? I believe this constellation of questions, how-
ever imperfectly I have formulated them, is linked with the
marijuana problem. Let the reader bear them in mind while
going through Dr. Nahas' fascinating account, in the hope
that this part of the issue t h a t Dr. Nahas sets forth—ele-
gantly, and yet with a crusading spirit—will not be mistaken
for the real problem in its entirety.

Andre F. Cournand, M.D.

1956 Nobel Prize in Medicine and Physiology
New York, New York
J a n u a r y , 1976
 Acknowledgements

I wish to acknowledge with t h a n k s the most helpful assis-

tance of Mr. Stanley Englebardt in the early drafting and
composition of this book, and Mrs. Cecil Oberbeck, who re-
viewed and revised the manuscript. I also wish to acknow-
ledge with thanks the contributions of the following col-
leagues:
Professor Charles I. Abou Chaar, School of Pharmacy,
American University of Beirut, Lebanon; Professor Stig
Agurell, Astra Lakemedel AB, Sodertalje, Sweden: Dr. J e a n
Pierre Armand, Cancer Institute, University of Toulouse,
France; Professor Julius Axelrod, Chief, Section Pharmacol-
ogy Laboratory of Clinical Science, National Institute of
Mental Health, Bethesda, Maryland; Professor Nils Bejerot,
Department of Social Medicine, Karolinska Institute, Stock-
holm, Sweden; Professor Marcel Bessis, Director, Institute
of Cellular Pathology, Paris, France; Dr. Pierre Bonte, Labo-
ratory of Social Anthropology, College de France, Paris,
France; Dr. Olav J. Braenden, Chief, Scientific and Technical
Sections of the Division of Narcotic Drugs, United Nations,
Geneva, Switzerland; Dr. Monique Braude, Chief, Preclinical
Pharmacology, National Institute on Drug Abuse, Rockville,
Maryland; Dr. Henry Brill, Director, Pilgrim State Hospital,
West Brentwood, New York; Member, National Commission
on Marijuana; Professor Aviva Chari-Bitron, Israel Institute
XV
xvi Acknowledgements
for Biological Research, Tel Aviv University Medical School,
Israel; Professor de Granier Doyeux, Vice Chairman of the
International Narcotics Control Board of the United Nations,
Geneva, Switzerland; Dr. Bernard Desoize, Institute of Tox-
icology, INSERM, Paris, France; Professor Etienne Four-
nier, Director, Institute of ' Toxicology, INSERM, Paris,
France; Dr. John A. S. Hall, Chairman, Department of
Medicine, Kingston Public Hospital, Jamaica; Professor
Louis Harris, Chairman, Department of Pharmacology, Med-
ical College of Virginia, Richmond, Virginia; Professor
Robert Heath, Chairman, Department of Psychiatry and
Neurology, Tulane University School of Medicine, New Or-
leans, Louisiana; Dr. Leo Hollister, Chief, Clinical Phar-
macology, Veterans Administration, Palo Alto, California;
Professor Jacques Huot, Department of Pharmacology Fac-
ulty of Medicine, Laval University, Quebec, Canada; Profes-
sor J u h a n a Idanpaan-Heikkila, National Board of Health
Helsinki, Finland; Professor S. Kaymakcalan, Head, De-
partment of Pharmacology, Ankara Medical School, Turkey;
Professor Nairn Khalyl, School of Pharmacie, Université de
Beyrouth, Lebanon; Dr. Claude Lefebure, Laboratory of So-
cial Anthropology, College de France, Paris, France; Dr.
Louis Lemberger, Chief, Clinical Pharmacology, Lilly Labo-
ratory for Clinical Research, Indianapolis, Indiana; Profes-
sors Cecile and Rudolf Leuchtenberger, Head, Department of
Cytochemistry, Swiss Institute for Experimental Cancer Re-
search, Lausanne, Switzerland.
Professor Claude Lévi-Strauss, Director, Laboratory of So-
cial Anthropology, College de France, Paris, France; Mr.
David Martin, Senior Analyst, United States Senate, Wash-
ington, D.C.
Professor Raphael Mechoulam, Head, Laboratory of
Natural Products, The Hebrew University of Jerusalem, Is-
rael; Professor Costas Miras, Head, Department of
Biochemistry, Athens University Medical School, Greece;
Professor William D. M. Paton, Director of the Institute of
Pharmacology, Oxford University, England; Professor Har-
ris Rosenkranz, Head, Department of Biochemistry, Mason
Acknowledgements xvii
Research Institute, Worcester, Massachusetts; Professor
Cornelius Salemink, Head, Organic Chemistry Laboratory,
Utrecht University, The Netherlands; Professor Conrad
Schwartz, University of British Columbia, Vancouver; Dr.
Karl E. Shaefer, Chief, Biomedicai Science Division, Sub-
marine Medical Research Laboratory, Groton, Connecticut;
Professor Mohamed Soueif, Chairman, Department of Psy-
chology, Cairo University, Egypt; Professor Costas N.
Stefanis, Chairman, Department of Psychiatry, Athens Uni-
versity Medical School, Greece; Dr. Maurice Teste, Psychia-
trist in Chief, Ibn Nafis Psychiatric Hospital, Marrakech,
Morocco; Dr. Jared Tinklenberg, Drug Abuse Council, Wash-
ington, D.C.; Professor Guy Vourch, Director, Institute of
Anesthesiology, Paris, France.
Professor Monroe Wall, Director, Chemistry and Life Sci-
ences Division, Research Triangle Institute, North Carolina;
Professor Coy Waller, Director of Research, School of Phar-
macy, University of Mississippi, Oxford, Mississippi; Profes-
sor Etienne Wolff, Head, Department of Embryology, College
de France, Paris, France; Professor Daniel Zagury, Head,
Department of Histology, University of Reims Medical
School, France; Professor Arthur Zimmerman, Department
of Zoology, University of Toronto, Canada.
Dr. Pierre Bonte, Laboratory of Social Anthropology, Col-
lege de France, Paris; Professor Camille Burg, Director Gen-
eral, INSERM; Mr. Marion Gilliam, President, Myrin In-
stitute, New York; Mrs. Olivia Gilliam, Secretary, Myrin
Institute, New York; Dr. Y. Shilov, Laboratory of Narcotics,
United Nations, Geneva; Professor M. Issidorides, Univer-
sity of Athens; Professor Yves Laporte, College de France.
And from Columbia University, College of Physicians and
Surgeons, I also wish to acknowledge: Professor William
Blanc, Department of Pathology; Professor Andre Cournand,
Department of Medicine; Professor Paul Cushman, De-
partment of Medicine; Dr. Robert Esser, Department of
Neurology; Professor Henry Clay Frick, Department of
Obstetrics; Dr. Albert Greenwood, Department of Pathology;
Professor Wylie Hembree, Department of Gynecology and
XV111 Acknowledgements
Obstetrics; Professor George Hyman, Department of
Medicine; Dr. William M. Manger, Department of Medicine;
Professor Fred Mettler, Department of Neurology; Professor
Akira Morishima, Department of Pediatrics; Professor Ralph
W. Richter, Department of Neurology; Professor Nicole Suciu
Foca, Department of Surgery; Professor Philip Zeidenberg,
Department of Psychiatry—and my research assistants in
the laboratory: J a n Adamec; Richard Henrich; Joy Hsu; Iris
Schwartz, Colette Léger.
I also wish to acknowledge the research support provided
by grants from: the National Foundation—March of Dimes;
the National Institute of Mental Health and the National
Institute on Drug Abuse; the Phillipe Foundation; and gifts
from Senator and Mrs. David VanAlstyne and Mr. and Mrs.
Henri Doll.
Finally, I wish to acknowledge the unswerving support of
my sister, Hélène; my cousins, Edmund and Robert; and for
giving me the greatest incentive to carry out my quest—my
wife, Marilyn; and our three children, Michèle, Anthony,
and Christiane.
 5>f^I. Englewood, 1969

Rush-hour traffic moved slowly as I drove from West Side

Highway north toward the George Washington Bridge. After
weeks of the dreariest kind of cold, rainy weather, New York
was experiencing a springlike day in April.
As I headed toward my home in Englewood, New Jersey, I
turned on the car radio just in time to catch the hourly news.
The announcer made short mention of the fine weather and
then launched into what had become a familiar litany of daily
news events—the continuing war in Southeast Asia; the
mounting wave of demonstrations and protests on college
campuses; a major drug bust in Harlem.
I confess to listening only half-heartedly to the problems
discussed in the news. It wasn't apathy so much as the fact
that my life was taken up with other, more immediate, con-
siderations; my work as a pharmacologist at the Columbia
University Medical Center, where I was then engaged in
research on the way drugs act on the body, and my wife and
three children in our suburban community. That evening we
were scheduled to attend a parents' meeting at the junior
high school where our oldest daughter was enrolled.
When we arrived at the school, there was only a moderate
turnout of parents. "Probably the weather," said my wife.
"Not too many people want to sit in a stuffy school auditorium
on a balmy night like this."
But a friend, sitting just behind us, leaned over with
1
2 Keep Off the Grass
another explanation of the unfilled auditorium. Pointing to
the mimeographed program, she said, "The key speaker to-
night is a sergeant from the Englewood Police Department
Narcotics Bureau. He's going to talk about drug addiction,
and I don't think many parents in this school are worried
about that sort ofthing. After all, most of the youngsters here
are from middle- and upper-middle-class families."
We settled back for what appeared to be another lecture on
the perils of drug abuse. While I did not fully agree with our
friend's view of who used drugs, I did think the lecture might
have been better directed at parents from less affluent
neighborhoods. After all, weren't drugs the traditional outlet
for the poor, the downtrodden, and the disenchanted?
The police officer, in his practiced delivery, covered ground
very familiar to a pharmacologist. He described the vari-
ous drugs favored by the current generation; he told about
their effects on body and mind; and he even demonstrated the
paraphernalia used in their preparation and administration.
"As far as marijuana is concerned," he said, "we don't know
exactly how much is being used in the United States today,
but there's no doubt t h a t it has undergone a sharp increase in
the last few years, particularly among young people. Surveys
conducted on several college campuses indicate that a major-
ity of the students have tried it at least once, and a significant
percentage smoke it once a week or more."
Then came the evening's shocking statement. The sergeant
leaned over the lectern and said, "I think you should know
t h a t the youngsters in this school are not exempt from this
problem. In fact, there's good evidence t h a t some of them are
either experimenting with marijuana or using it regularly."
He went on to say that for some youngsters in our community,
marijuana had become a way of life, a situation comparable to
the use of liquor by the chronic alcoholic.
These remarks caused quite a stir in the audience and the
question-and-answer session that followed the sergeant's
talk was lively. His answers, however, served only to
heighten our concern. For one thing, we learned that this was
not just an educated guess on his part. School authorities had
already caught several children smoking marijuana in the
Englewood, 1969 3
bathrooms and had smelled the weed's distinctive odor on
other occasions. For another, we were told that the drug
probably was being distributed among our thirteen-,
fourteen-, and fifteen-year-olds by their fellow students who,
in turn, got it from older siblings. Then, as a final warning,
the sergeant added:
"As a police officer I make no judgments about the Tight­
ness or wrongness of our present marijuana laws. My job is to
apprehend lawbreakers, no matter what their age or back­
ground. But I must admit I do it with grave misgivings
because I know what a serious effect arrest can have on the
life of young persons. It may interrupt their education and
shadow their future in many ways. In some states, for ex­
ample, a single arrest is enough to prevent a teen-ager from
obtaining a driver's license or working at jobs that are
licensed by the state. Conviction, even without a sentence,
may prevent youngsters from ever being licensed as a physi­
cian or a lawyer; and it can make it difficult for them to get
responsible positions in business or industry. A police record
may eliminate the possibility of ever getting a government
job. And it may spotlight them for a long time as a
troublemaker—even though they are, in fact, no more
troublesome than most teen-agers."
Although no poll was conducted to find out how the other
parents felt after the officer's speech, I'm sure many still
believed that a certain affluence, education, and social posi­
tion could protect their children from such perils. From the
vantage point of the past seven turbulent years, during which
time marijuana use has spread across every social and ec­
onomic barrier and has achieved even some de facto legal
acceptance, the reactions and responses from the adult audi­
ence that evening seemed naïve, even ludicrous. But in the
early spring of 1969, the plague of drug use was not yet widely
recognized, or at least not yet taken seriously by most Ameri­
cans.

My own view of drug use has always been different. I know its
dangers. I saw them first many years ago in Alexandria,