The Ancient Roots of Cannabis Medicine
One could be forgiven, having lived through the era of cannabis prohibition, for thinking medical cannabis is a modern discovery. However, the truth is that the medicinal properties of cannabis have been known to human civilization for thousands of years. Not only was medicinal cannabis commonplace in America before Prohibition took hold in 1937, but evidence of its efficacy stretches back across millennia.
As society prepares to step out of a shameful era of cannabis prohibition, it is good to know that medical cannabis’ history is millennia old and far from a new discovery.
When did cannabis first appear as medicine?
While the first explicit mention of real-world medical applications did not follow for two centuries, the first mentions of cannabis as a spiritual healer date back to 2900 BCE. Chinese Emperor Fu Hsi acknowledged that cannabis held both the qualities of yin and yang, suggesting it could bring balance and healing to body, mind, and spirit.
Then, in 2700 BCE, Chinese Emperor Shen Nung was credited with the discovery of cannabis's ability to relieve the symptoms of various conditions, including rheumatism, menstrual cramps, gout, and malaria. Shen Nung was considered knowledgeable in the medical field, writing a book called The Great Herbal, which also included information about ginseng and other herbs used in ancient Chinese medicine.
About 700 years later and thousands of miles away, ancient Egyptians would also record the medical applications for cannabis. In 2000 BCE, ancient Egyptians reportedly consumed the plant in Northeast Africa to treat eye soreness, hemorrhoids, and menstrual cramps. Evidence of this use is recorded in a document known as the Ebers Papyrus, which also includes other common treatments used by the ancient Egyptians at the time.
Around the same time, mentions of cannabis were recorded in the Vedas, the sacred text of the Hindu religion originating in India. These references mention that cannabis could be used to relieve pain and insomnia. It also makes mention of treating gastrointestinal disorders by consuming cannabis. It is thought that the Vedas were penned anywhere between 2000 BCE and 1400 BCE, adding yet another ancient mention of medicinal cannabis to the historical record.
Cannabis and the Western World
Before the varieties of cannabis consumed in the East made their way to Europe, Western peoples were largely trading in low-THC hemp for industrial applications like making textiles or rope. As a result, hemp was a cash crop not harvested for its psychoactive characteristics – which were widely applied in the Eastern hemisphere for medicinal purposes – but industries such as shipping and logistics. After all, hemp was a plentiful and durable source for the ropes and masts needed for the Caravels and Galleons that then dominated the seas.
It wasn't until 500 BCE that Cannabis indica, the varietals native to the East, arrived in Europe. It came by way of trade with the nomadic Scythians, and it was then that Europeans really began to realize the medicinal potential of the plant. At that time, prior to selective breeding, Cannabis indica varietals tended to be high in THC and cause euphoria, while Cannabis sativa varietals contained low THC and grew tall and stalky. The thick stalks and bast fibers in sativa varietals proved useful for industrial applications, but cannabis wasn't used for medicinal purposes like it was in the East. Soon after the Scythians brought cannabis to Europe, though, accounts of recreational consumption appeared, including an account by the Greek historian Herodotus that recalls a primitive method of vaporization employed by the Scythians using hot rocks and cannabis.
Cannabis as medicine in the common era
As cannabis remained a medicinal fixture of Eastern cultures, its Westward march did not go unnoticed by physicians in these regions. In the 1st century CE, a Greek doctor named Pedanius Dioscorides wrote about cannabis while studying plants during his time serving in the Roman Army. In his book De Materia Medica, Dioscorides noted that cannabis grew in male and female varieties. He also wrote that cannabis could be juiced to create a remedy for conditions from earaches to "sexual longing."
In 200 CE, Chinese surgeon Hua Tuo reportedly succeeded in using cannabis as an anesthetic. He is credited with being the first person ever to successfully do so. His concoction included powdered cannabis and wine and was administered to patients before surgeries.
By the 9th century CE, cannabis was widely administered throughout the Arabic world, including in territories controlled by the Holy Roman Empire. In these times, it was used to treat a wide range of conditions, particularly to relieve pain.
Medicinal cannabis in the 19th century until today
In Europe and North America, the embrace of cannabis as medicine was relatively slow. For the most part, despite the writings of physicians like Dioscorides, the West viewed cannabis through the lens of industrial hemp.
That changed by the 19th century. In 1839, Irish physician WB O'Shaughnessy conducted the first ever human clinical trials of cannabis products. He prepared multiple formulations, including extracts and tinctures. These cannabis products were used to treat a several conditions and symptoms, many of which are still being researched today. These included rheumatism, cholera, tetanus, and seizures.
Suddenly, cannabis took off in Europe and North America. O'Shaugnessy's writings led to a boom in medical experimentation with cannabis products. By 1850, cannabis was added to the U.S. Pharmacopeia, the federal government's standardized list of all prescription and over-the-counter medications. According to Dr. Lester Grinspoon, author of Marihuana Reconsidered (1971), there were more than 100 articles concerning medicinal cannabis published in Western scientific journals between 1839 and 1900.
Prohibition puts an end to medical cannabis research
It is likely that research into medical cannabis would have continued, but a public campaign to link the consumption of cannabis to laziness and criminality while stoking the embers of anti-immigration xenophobia ultimately led to several states banning cannabis. In 1937, the U.S. Congress followed suit with the Marijuana Tax Act of 1937, which made cannabis federally illegal and ushered in the era of federal prohibition that continues until this day.
Of course, that wasn't the end of the story of cannabis medicine in America. After spending a long time underground and in black markets, California voters opted to legalize cannabis for medicinal purposes in 1996, establishing the first medical cannabis market in the United States. Today, adults in many U.S. states can access legal cannabis in some form, and several countries, including Canada, Uruguay, Germany, and Israel, have adult-use or medical cannabis programs.
While THC remains a Schedule I banned substance under the U.S. Controlled Substances Act (CSA), the legalization movement has gained traction and research into medicinal cannabis has emerged in the U.S. anew. California voters opted to legalize cannabis for medicinal purposes in 1996, establishing the first medical cannabis market in the nation. In the decades that followed, many states plus Washington, D.C. followed suit with medical or adult-use programs.
While what’s allowed varies between states, these laws generally outline which conditions qualify a patient for access to a medical cannabis identification card, purchase limits, and the type of products available, among other guidelines. Once a patient or their caregiver obtains an identification card, they are eligible to enter and purchase cannabis products from a medical dispensary. Anyone without a medical identification card in medical cannabis-only states is not eligible to purchase cannabis products.
Meanwhile, several states and Washington, D.C. have legalized adult-use cannabis consumption for residents aged 21 years or older. This wave began with Colorado and Washington, where voters in each state approved legalized adult-use cannabis in 2012. Similar to medical cannabis, adult use cannabis program laws vary from state to state. Differences between state laws include purchase limits and available products, among other items. However, one thing is guaranteed to stay the same: Nobody under the age of 21 can purchase adult use cannabis.
Scientific insights from international research, particularly in Israel, have given us new understandings about what makes cannabis work. These studies have yielded new approaches optimizing the medicinal potential of cannabis in a targeted, effective way. What we have learned already suggests that cannabis could be an integral part to new approaches toward healthcare treatment for a diverse range of conditions that have proven challenging to address.
What is the future of medical cannabis?
As more states reform their cannabis laws and Congress takes up the debate in Washington D.C., there is reason to believe we are in the final days of cannabis prohibition. Federal descheduling of cannabis would do wonders for medical research, easing access to the cannabis scientists and universities need for their studies. Already, the breathing room liberalizing cannabis laws has provided for the scientific community to advance research into medical cannabis around the world. The future of medical cannabis could be even bolder – time, and the research, will tell.