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The History of Medical Cannabis
This syllabus topic chronicles the use of medicinal cannabis during ancient civilizations through present day. Multiple major milestones of the medical cannabis timeline will be described in detail.
Cannabis is an ancient plant, with evolution traced back some 36 million years to the Central Asian/Himalayan foothills region. Similar to the opium poppy (Papaver somniferum), cannabis (Cannabis sativa) has been medicinally used since antiquity, spanning throughout human history and across civilizations (1). Its very name reflects the long-standing relationship with humanity; in 1542, the German physician-botanist Leonhart Fuchs pragmatically assigned the species name Sativa, which means "cultivated" or "useful" in Latin (2).
The earliest cultivation and use of cannabis is difficult to trace because it pre-dates recorded history. However, archeological evidence confirms the use of cannabis fiber for hemp and seeds as a foodstuff around 4000 BC in China, during the Neolithic period (3).
Emperor Shen-Nung, credited with discovering tea and ephedrine, is considered to be the first to describe the medicinal uses of cannabis. In his 2737 BC compendium of Chinese medicinal herbs, cannabis was recommended to treat malaria, constipation, rheumatic pains and childbirth, and was mixed with wine for use as a surgical analgesic (4). Cannabis achieved nowhere near the significance in Ancient China that it later attained in India.
By 1000 BC, medicinal, recreational, and spiritual/religious use of cannabis had widely disseminated throughout India. Cannabis use was closely interrelated to the Hindu religion. The Atharva Veda, a collection of scriptures dating from 1400-2000 BC, ascribed sacred virtues to cannabis as one of five sacred plants, a bringer and source of happiness, joy and freedom. Cannabis was used medically as an analgesic, anticonvulsant, hypnotic and tranquilizer, anesthetic, anti-inflammatory, topical and systemic antibiotic, anti-parasitic, antispasmodic, digestive aid and appetite stimulant, diuretic, aphrodisiac or anaphrodisiac, antitussive and expectorant. Knowledge of cultivation and differential psychoactive potency of the plant was evident in several cannabis preparations. The weakest, bhang, consisted of dried leaves with the flowers removed, and was referenced in the Atharva Veda as a treatment for anxiety. More potent was Ganja, prepared from flowers of the female plant. The strongest, Charas, was prepared entirely from the resin that covered female flowers (1,4).
Cannabis was considered sacred in Tibet during the same period, and was used to facilitate meditation in Tantric Buddhism. Its use in medicine is thought to be extensive, as concepts of Tibetan medicine borrowed heavily from Hindi medicine, and strong emphasis in its pharmacopoeia on Ayurvedic botanical preparations (1,4). From India, medical cannabis use spread to Assyria and Persia around the 9th century B.C., and then throughout the Middle East, the Arabian Peninsula and Africa. It entered into the medical compendiums in every region and civilization (4).
The medicinal and intoxicant properties of cannabis had been known and documented throughout Europe since the 1200s, largely from physician exposure during travel to India and Arab regions. However, it was two publications in the early 1840s that triggered massive cannabis medicine penetrance and widespread use in Western Medicine (3).
The Irish scientist and physician William O’Shaughnessy practiced in Calcutta during the 1830s. After studying the literature, he performed toxicity experiments on goats and dogs; satisfied with the apparent safety, he began treating patients. He found that cannabis had analgesic, sedative and anti-seizure properties, and was most impressed by its efficacy in ameliorating severe muscle spasms in patients with tetanus and rabies (5). His 1839 paper extolling the analgesic, appetite stimulant, antiemetic, muscle relaxant, and anticonvulsant effects of cannabis treatment had far-reaching impact on medical practice, and medicinal use of cannabis rapidly expanded throughout England, the rest of Europe, and across the Atlantic to the U.S. (3,6).
The psychiatrist Moreau observed the common use of hashish among Arabs, and around 1840 began to systematically investigate the effects of different cannabis preparations on himself, and later his students. His 1845 publication described the outcomes of these experiments, and is considered one of the most complete descriptions of acute effects from cannabis (4).
One reason for the rapid spread of cannabis medicine was the lack of therapeutic options for symptoms related to infectious diseases such as rabies, cholera, and tetanus. In 1854, cannabis became listed in the US Dispensatory, officially legitimizing its medical use (7). The Ohio State Medical Society held the first clinical conference on cannabis in 1860. In their published conference proceedings the same year, a Dr. Fronmueller described his clinical use of cannabis as analgesic treatment for inflammatory and neuralgic pain in hundreds of patients. Comparing analgesic therapy with cannabis versus opium, he concluded: 1) Cannabis was comparable in therapeutic utility; 2) while less potent and less reliable, it lacked opium-related gastro-intestinal (GI) and CNS side effects; 3) unlike opium, cannabis stimulated patient appetite; 4) cannabis was a more benign drug, with greater efficacy than opium as anti-inflammatory treatment; 5) cannabis was also recommended in patients whose pain was poorly controlled with opium (5).
During the second half of the 19th century, over 100 scientific articles were published in Europe and the US on cannabis medicine efficacy. Throughout this period, cannabis extract was dissolved in alcohol for ingestion as a tincture and extracts; smoking pre-rolled cigarettes became a route of administration around the turn of the 20th century (4).
JR Reynolds, Queen Victoria's personal physician, published in the Lancet in 1880 a summary of his 30 years of medical experience with cannabis. He found it highly effective as a nocturnal sedative in senile insomnia and as treatment for dysmenorrhea, neuralgias, migraine headache, and epileptoid or choreoid muscle spasms; of uncertain utility in asthma, alcoholic delirium and depressions; ineffective in joint pains aggravated by motion, and chronic epilepsy; and "worse than useless" in mania. He stressed the importance of individualized dose titration, with gradual increase to avoid "toxic" effects (6).