History of Cannabis

in Medication

Early history

The world’s oldest pharmacopeia & 6000+ years of use

For more than 6000 years humanity has actively documented their use of Cannabis for medical purposes1.
In fact, the earliest evidence of cannabis cultivation dates back to 4000 B.C in China where cannabis was an important part of the diet, as it was included in “the 5 grains” together with rice, barley, millet, and soy beans2.

During the Han Dynasty in China (206 B.C. – 220 A.D.) the world’s oldest pharmacopeia, Pen-ts’ao ching, was written based on oral traditions passed down to generations since 2.700 B.C. The pharmacopeia indicates that cannabis is useful for a range of diseases, here among, rheumatic pain, intestinal constipation, disorders of the female reproductive system, malaria as well as being used to anesthetize patients during surgery3.

Cultivation & Use Of Cannabis

Cropped Cannabis Map

In India, cannabis’ useful properties were utilized even further, both for medicine and recreational purposes, as cannabis was religiously associated. It belonged to one of five sacred plants referred to as the source of happiness, donator of joy, and bringer of freedom.3

At 1000 years B.C. cannabis was used in the treatment of numerous diseases as the distinction and knowledge of both the psychoactive and medical effects were immense in India at the time. The categories of treatment were many here among: analgesic (headache), anticonvulsant (epilepsy, rabies), hypnotic, tranquilizer (anxiety), anesthetic, anti-inflammatory (rheumatism), antibiotic (infections), antiparasitic (worms), antispasmodic (diarrhea), digestive- and appetite stimulant as well as being used as an aphrodisiac and expectorant (asthma).3

The knowledge and use of the sacred herb spread to Arabia as found in Muslim texts (the year 1000 A.D) and it is presumably Arab traders who brought cannabis to the African continent. Cannabis reached Brazil in the 16th hundred when African slaves brought the plant to the area. Meanwhile in southern Europe, cannabis was a scarce resource solely used for cultivating fibers taught by the Arabs, and knowledge about cannabis’ medical benefits was close to non-existing as it was confused with opium. Therefore, the long-documented history of cannabis’ medical benefits did not reach western Europe before the 19th century.3

Modern History

Cannabis as an over-the-counter medication

Cropped Pisos RemedyThe therapeutic use of cannabis was introduced to western medicine in 1839 by the Irish physician William O’Shaughnessy when he published “On the preparations of Indian hemp or gunjah’’ based on his work experience in India. In India, he worked for the British East India Company and reviewed existing literature about cannabis as well as conferred with elders and healers to understand the recreational and medical use of cannabis.
However, it was not before O’Shayghnessy’s own successful attempt in proving cannabis’s safety and its analgesic and sedative properties that the plant rapidly earned a central role in western medicine throughout Europe and North America.
The rapid adoption of cannabis’ benefits, resulted in the Committee on Cannabis Indica, of the Ohio State Medical Society, in 1860 to report cannabis as a successful treatment against gonorrhea, asthma, rheumatism, and intense stomach pain. Furthermore, the increasing popularity led to the Cannabis status of an over-the-counter pharmaceutical known as “Piso’s cure” and the “one-day cough cure”. In 1924, with more than half a century’s use of cannabis, the Sajous’s Analytic Cyclopedia of Practical Medicine concluded that the plant was useful in the treatment of migraines, coughing and inflammation along with diseases such as tetanus, rabies, and gonorrhea.1

Cannabis facing both political fire and scientific evidence

Despite decades of safely using cannabis in medication, the western world adopted hostile legislation against cannabis up to 1937, when “The marijuana Tax Act” was enacted in the U.S. due to a shift in the political environment4 and in 1942, cannabis was removed from United States Pharmacopoeia5.

The hostile legislation was purely political, as the findings from the Indian Hemp Drugs Commission demanded by the British House of Commons prove the following:

“In respect to the alleged mental effects of the drugs, the commission has come to the conclusion that the moderate use of hemp drugs produces no injurious effects on the mind. […] As a rule, these drugs do not tend to crime and violence.” In addition to:  “Moderate use of these drugs is the rule, and that the excessive use is comparatively exceptional. The moderate use produces practically no ill effects.” 4

Cropped Cannabis MedicationNevertheless, by 1961 United Nations pronounced a global collaboration to prohibit and monitor illegal drugs, hence including cannabis, known as the Single Convention on Narcotics Drugs5.

In 1972, this UN treaty was amended resulting in an increasing effort to prevent the cultivation and abuse of opium and cannabis, enlarging the International Narcotics Control Board. Thereby, countries with existing legislation prohibiting cannabis were reaffirmed by the global community, whilst countries without regulations about cannabis adopted the UN treaty in compliance.5 As a result, cannabis medication prescribed by physicians for many years was banned and more than 2000 cannabis medicines, was taken off the shelfs6. Pre 1937 at least 280 Pharmaceutical companies7, including all major pharmaceutical companies present today, produced cannabis medicine.

To understand the significance of cannabis medicine in the years before 1937, there were around 9.4208 medicines present in 1937, which makes the cannabis medicines percentage significant –  a full 20%.

Nevertheless, cannabis remained illegal until the 1972 amendment where a movement towards decriminalization occurred and the attitude shifted from greater prohibition towards growing tolerance and acceptance of cannabis’ medical benefits. A change in sentiment that became the foundation of today’s medical cannabis.5

The Discovery of The Endocannabinoid System

endocannabinoid-systemIn the time between the prohibition of cannabis and the growing tolerance towards the plant’s medical benefits, a revolutionary study conducted on why the cannabis plant possesses medical properties and how the plant interacts with human biology.
The study was conducted in 1964 by professor Raphael Mechoulam together with professor Yechiel Gaoni from The Hebrew University of Jerusalem in Israel. They found the active component of cannabis molecules named cannabinoids. These can act in the human brain by interfering with the intrinsic neuronal signaling system through imitating key natural players, the endocannabinoids.
The professors soon after discovered what exactly an endocannabinoid was, namely a humanely produced cannabinoid that belonged to a – until then – unknown complex system in the human body.
The unknown system was named the ECS, the Endocannabinoid System, and now functions as the foundation for the understanding of cannabis interaction with human biology and chemistry.9

Cannabis Today

WHO concluded in 2018 that CBD, hence medical cannabis, is safe and well-tolerated in humans (and animals) as it is not associated with any known negative public health effects and neither has any abuse potential. Furthermore, WHO reported that CBD has been found as an effective treatment for epilepsy as demonstrated in several clinical trials, whilst  preliminary evidence suggests that CBD may be beneficial in the treatment of Alzheimer’s disease, cancer, psychosis, Parkinson’s disease, and other severe conditions.10

Change in legislation and growing awareness

WHO’s action may be seen as a symbol of the rapid growth globally within legalization- and decriminalization of cannabis the last decades and especially in recent years, as society has become well aware of cannabis’ healing properties and the many thousand years of documented use.

In 2018, 46 countries out of 195 globally have decriminalized the plant for medical purposes to various degrees11, whilst some have opened up for recreational use as well, here among the Netherlands and Canada12. In 2018, the bill Hemp Farming Act legalized industrial hemp (cannabis) with a concentration of no more than 0.3% THC in all of the United States13, allowing medical cannabis to be produced, sold, and used freely under the authorities of the FDA14.  However, the distinct states have individual regulatory systems regarding medical hemp and cannabis15 resulting in various degrees of legalization16.

Medical Cannabis Map

Legal cannabis equals a decline in prescription drugs

In the last decade, many studies have been conducted in order to understand the full potential of cannabis in patients and the health sector17. However, especially one study from the U.S. supported many previous studies by stating very clearly that “That the use of prescription drugs for which cannabis could serve as a clinical alternative fell significantly, once a medical cannabis law was implemented”18. Bradford & Bradford who conducted the study in 2013 found as well that the decline in prescription drugs was estimated to be a $165.2 million per year saving for medicare programs19.

The capitalization of medical cannabis within the pharmaceutical industry

These estimated numbers provided by scientific studies have understandably caught the attention of the pharmaceutical industry.
In 2019, Teva pharmaceuticals, the world’s biggest generic drug manufacturer, are in collaboration with a medical cannabis company 20, whilst GlaxoSmithKline Plc and Pfizer Inc. are looking into how they should utilize medicinal cannabis to serve consumers21. Nevertheless, GlaxoSmithKline Plc and Pfizer Inc. believe that there is lacking evidence of cannabis’ benefits21, despite Pfizer Inc.’s own history of producing and running clinical trials of synthetic cannabinoids in the 1970’ies22. Given WHO’s report from 2018, decades of studies, and Pfizer Inc.’s own history – the claim of “cannabis used in treatment is lacking evidence” – might seem contradictory. The contradiction becomes even more obviously seen in the light of the pharmaceutical industry’s current actions, as the industry inclusive GSK & Pfizer Inc. do not take any chances in losing the opportunity to capitalize on the possible medical cannabis revolution21 as they are applying for 14 Cannabis patents in Canada, in competition with 9 other pharmaceutical companies globally22.

The great interest in cannabis from the pharmaceutical industry, indicates that much can be learned from history, but even more important, the use of cannabis’ healing proprieties in clinical treatments are not new – as a matter of fact, it is ancient news.

Now the challenge is to educate legislators about medical cannabis’ many benefits, so society’s demand for the plants healing properties can be fulfilled and heard, and cannabis once again can become a part of the clinical methodology.

Click here for References
  1. History of medical cannabis – Nova Science Publishers Inc. https://medreleaf.com/app/uploads/2018/03/1.History-of-medical-cannabis.pdf
  2. The Religious and Medicinal Uses of Cannabis in China, India and Tibet – Journal of Psychoactive drugshttps://www.tandfonline.com/doi/abs/10.1080/02791072.1981.10471447
  3. History of cannabis as a medicine: a review – Brazilian Journal of Psychiatry https://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462006000200015&lng=en&tlng=en
  4. The Rise and Decline of Cannabis Prohibition – Transnational Institute https://www.tni.org/files/download/rise_and_decline_ch1.pdf
  5. Cannabis in the pharmaceutical industry – PwC, Canada’s cannabis series https://www.pwc.com/ca/en/industries/cannabis/pwc-cannabis-series-chapter-9-cannabis-in-the-pharmaceutical-industry.html
  6. History of medical cannabis – Wikipedia ( the antique cannabis book) https://en.wikipedia.org/wiki/History_of_medical_cannabis

  7. Appendix A, Pharmaceutical Cannabis Manufactures – The Antique Cannabis Book http://antiquecannabisbook.com/Appendix/MfgIndex.htm
  8. Background calculation: Today we have globally 13.570 medicines (https://www.drugbank.ca/stats) with a rise of 40-50 each year (https://cen.acs.org/pharmaceuticals/drug-development/new-drugs-2018/97/i3). Calculating these figures backwards, the number of medicines worldwide in 1937 amounts to 9.420. With 2.000 cannabis medicines in 1937 this correspond to a percentage of 20% of all medicines.
  9. Themed issue on cannabinoids in biology and medicine – British Journal of Pharmacology https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3165944/

  10. CANNABIDIOL (CBD) Pre-Review Report – WHO (World Health Organization) https://www.who.int/medicines/access/controlled-substances/5.2_CBD.pdf

  11. Medicinal cannabis policies and practices around the world – International Drug Policy Consortium https://idpc.net/publications/2018/04/medicinal-cannabis-policies-and-practices-around-the-world
  12. Cannabis Regulation Around the World – The Cannigma https://cannigma.com/regulation/cannabis-regulation-around-the-world/
  13. S.2667 – Hemp Farming Act of 2018 – Congress.gov (official website for U.S. federal legislative information)

  14. Hemp Production and the 2018 Farm Bill – U.S. Food and Drug Administration https://www.fda.gov/news-events/congressional-testimony/hemp-production-and-2018-farm-bill-07252019
  15. State Medical Marijuana Laws – National Conference of State Legislatures https://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx
  16. States where marijuana is legal – Business Insider
  17. How Medical Marijuana could litterally save lives – The Washington Post https://www.washingtonpost.com/news/wonk/wp/2015/07/14/how-medical-marijuana-could-literally-save-lives/
  18. Medical Marijuana Laws Reduce Prescription Medication Use In Medicare Part D – Health Affairs (peer-reviewed and leading journal of health policy thought and research)

  19. Medical Marijuana Laws Reduce Prescription Medication – National Library of Medicine https://pubmed.ncbi.nlm.nih.gov/27385238/

  20. Exclusive: One Of The Largest Pharma Companies In The World Has Made A Big Move In Cannabis – Forbes

  21. CBD Piques the Interest of Consumer Health Giants – Bloomberg https://www.bloomberg.com/news/articles/2019-08-01/cbd-piques-consumer-health-giants-interest-as-market-takes-off

  22. Book: Neuropathic Pain – IntechOpen

  23. Big Pharma Collects Most Canadian Cannabis Patents – New Frontier Data https://www.globenewswire.com/news-release/2018/08/15/1552656/0/en/Big-Pharma-Collects-Most-Canadian-Cannabis-Patents.html