History of the Medicinal Use of Marijuana

strong>History of the Medicinal Use of Marijuana From the National Commission of Marijuana and Drug Abuse The term "marijuana" is a word with indistinct origins. Some believe it is derived from the Mexican words for "Mary Jane"; others hold that "marijuana" comes from. the Portuguese word marigu-ano which means "intoxicant" (Geller and Boas, 1969: 14). This section outlines the many and varied uses of marihuana through history, and deals with its use in medicine and its use as an intoxicant. The experience of the 1960's might lead one to surmise that marihuana use spreads explosively. The chronicle of its 3,000 year history, however, shows that this "explosion" has been characteristic only of the contemporary scene. The plant has been grown for fiber and as a source of medicine for several thousand years, but until 500 A.D. its use as a mind-altering drug was almost solely confined in India. The drug and its uses reached the Middle and Near East during the next several centuries, and then moved across North Africa, appeared in Latin America and the Caribbean, and finally entered the United States in the early decades of this century (Snyder, 1970: 129). Meanwhile it had been introduced into European medicine shortly after the invasion of Egypt by Napoleon and had a minor vogue as an intoxicant for a time in France. Regardless of which parts of the world are discussed, many of the same problems and concerns about cannabis are common to all, including the United States. Understanding its various uses during many centuries in diverse countries and continents can perhaps lead to a better understanding of marihuana in general. History of the Medical Use The history of cannabis products and their use has been long, colorful and varied. "To the agriculturist, cannabis is a fiber crop; to the physician, it is an enigma; to the user, a euphoriant; to the police, a menace; to the trafficker, a source of profitable danger; to the convict or parolee and his family, a source of sorrow" (Mikuriya, 1969: 34). The fact is that cannabis has been held simultaneously in high and low esteem at various times throughout recorded history, particularly in our own times. The volume of information available on the medical application of cannabis is considerable. Occasionally certain references have been condensed or deleted, but this should not detract from the completeness of the report. This historical survey of the medical uses of marihuana is introduced by abroad overview of its use, including brief notes on current and projected research, and then considers specific historical settings and circumstances in ancient China, moving on to Egypt, India, Greece, Africa, and the Western World. Cannabis sativa has been used therapeutically from the earliest records, nearly 5,000 years ago, to the present day (Mikuriya, 1969: 34) and its products have been widely noted for their effects, both physiological and psychological, throughout the world. Although the Chinese and Indian cultures knew about the properties of this drug from very early times, this information did not become general in the Near and Middle East until after the fifth century A.D., when travelers, traders and adventurers began to carry knowledge of the drug westward to Persia and Arabia. Historians claim that cannabis was first employed in these countries as an antiseptic and analgesic. Other medical uses were later developed and spread throughout the Middle East, Africa, and Eastern Europe. Several years after the return of Napoleon's army from Egypt, cannabis became widely accepted by Western medical practitioners. Previously, it had had limited use for such purposes as the treatment of burns. The scientific members of Napoleon's forces were interested in the drug's pain relieving and sedative effects. It was used during, and to a greater extent, following his rule in France, especially after 1840 when the work of such physicians as O'Shaughnessy, Aubert-Roche, and Moreau de Tours drew wide attention to this drug. With the rise of the literary movement of the 1840-1860 period in France (Gautier, Baudelaire, Dumas, etc.), cannabis became somewhat popular as an intoxicant of the intellectual classes. In the United States, medical interest in cannabis use was evidenced in 1860 by the convening of a Committee on Cannabis Indica of the Ohio State Medical Society, which reported on its therapeutic applications (McMeens, 1860: 1). Between the period 1840-1890, Walton states that more than 100 articles were published recommending cannabis for one disorder or another. Concern about cannabis as an intoxicant led the government of India to establish the India Hemp Commission of 1893-94 to examine the entire question of cannabis use in India. Paralleling the question over cannabis use in the latter half of the 19th century was the growing medical use of other medications superior to cannabis in their effects and more easily controlled as to dose. Consequently, medical use of cannabis declined and cannabis began to lose support of the medical profession. During the years between 1856-1937, cannabis lost its image as a medicine and was left with a disreputable image as an intoxicant. Strong public reaction coupled with a campaign in the public press led to a federal anti-marihuana law in 1937. (The drug was illegal in many states before 1937.) The issue of medical use remained active, however, and Dr. William C. Woodward, Legislative Counsel to the AMA, an opponent of cannabis use and the only physician to be a witness at the Taxation of Marihuana hearings, stated: "There are exceptions in treatment in which cannabis cannot apparently be successfully subsituted for. The work of Pascal seems to show that Indian Hemp has remarkable properties in revealing the subconscious; hence, it can be used for psychological, psychoanalytic and psychotherapeutic research". (Hearings, House of Representatives, 1937: 91). Although cannabis drugs are generally regarded as obsolete and rarely used in "western" medicine today, cannabis is "still used extensively in the Ayruvedic, Unani and Tibbi systems of medicine of the Indian-Pakastani subcontinent" ("The Cannabis Problem, 1962: 27). The Pharmacopoeias of India mention cannabis use in the recent past. Two preparations of cannabis, a liquid extract and a tincture, are listed in the 1954 and 1966 Pharmacopoeias of India which contain descriptions of cannabis and its extract and how it is made (Chopra & Chopra, 1957: 9). A more recent source makes reference to the fact that "in contemporary India and Pakistan, there continues to be widespread indigenous medical, 'quasi-medical,' and illicit use of both opium and cannabis" (Chopra & Chopra, 1957: 12-13). Bouquet notes that hemp resin is occasionally used in the native medicines of the countries where it is collected. He points especially to India where, "the medical systems . . . make much use of cannabis as a sedative, hypnotic, analgesic, anti-spasmodic and anti-hemorrhoidal" (Bulletin on Narcotics, 1962:27). According to the Canadian Commission of Inquiry into the Non-Medical Use of Drugs: "There is no currently accepted medical use of cannabis in North America outside of an experimental context. Although cannabis has been reported to produce an array of possibly useful medical effects, these have either not been adequately investigated, or can be replaced by using other more readily available and convenient drugs. The natural product's variability in potency and instability over time are among the factors which have led to its disfavor in Western 20th century medicine.... cannabis has often been employed in the past, and is currently used illicitly in North America, to reduce the secondary symptoms and suffering caused by the flue and the common cold. These . . . alleged therapeutic properties of cannabis have not been adequately studied in a scientific context, and their general medical potential remains a matter of conjecture". (1970: 74). Similar statements regarding cannabis are to be found in Marijuana, edited by Erich Goode, and in the textbook Pharmacological Basis of Therapeutics by Goodman and Gilman (1970: 300). Concerning therapeutic uses, the latter states: "Although cannabis was once used for a wide variety of clinical disorders and has even been demonstrated to have antibacterial activity, there are at present no well substantiated indications for its use. It is no longer an official drug. Preparations are rarely available (cannabis preparation and synthetic THC are obtainable only for research purposes), and prescriptions are regulated by special tax laws". Hollister (1971: 27) lists a few difficulties of the therapeutic use of cannabis: "The onset of the action of oral doses of THC is often rather slow, contrary to that of conventional sedative-hypnotics. Doses high enough to produce a marked hypnotic effect are almost always accompanied by some degree of psychotomimetic-like perceptual disorders, which many patients might find disagreeable. The fine titration of dose required to provide sedative effects is likely to be difficult. The drug does not have novel effects compared with other sedative-hypnotics". The Department of Health, Education, and We] fare report to Congress in 1971, Marihuana and Health, repeats the statement of the Canadian Interim Report of Inquiry into the Non-Medical Use of Drugs, and states: "There is no currently accepted medical use of cannabis in the United States outside of an experimental context". (DHEW: 1971: 27). Allen Geller and Maxwell Boas (1969: 4) think that cannabis' "unsavory reputation has largely stymied further research." Despite the many statements discounting cannabis' therapeutic usefulness, some authorities maintain that its medical value might be reborn through further research and/or use. David Solomon, in his foreword to The Marihuana Papers (1968: xxi) argues that: "Marihuana should be accorded the medical status it once had in this country as a legitimate prescription item. After 1937, with the passage of the Marihuana Tax Act and subsequent federal and state legislation, it became virtually impossible for physicians to obtain or prescribe marihuana preparations for their patients. Thus, the medical profession was denied access to a versatile pharmaceutical tool with a history of therapeutic utility going back thousands of years". In a 1970 article, "Pot Facing Stringent Scientific Examination ," reference is made to Dr. Par who states that there are three areas in which "chemical and animal experiments are under way:" (1) Analgesia-mood elevation plus analgesic power may make useful drug. (2) Blood pressure reduction-hypertension may be helped by new drugs which lower the blood pressure by what seems to be action on the central nervous system. (3) Psychotherapeutic-new compounds are antidepressants and antianxiety drugs (Culliton: 1970). Mikuriya cites it studies concerning cannabis funded by the National Institute of Mental Health in 1961. The studies were "either specialized animal experiments, part of an observational sociologic study of a number of drugs, or explorations of chemical detection methods" (Mikuriya, 1969: 38). Feinglass has pointed to four general categories into which the clinical studies of marihuana could be divided (1968: 206-208). They are: Anticonvulsant effects-treatment of tetanus, convulsions of rabies, epilepsy, infant convulsions, Psychotherapeutic actions - appetite-stimulation, treatment of depression, sedative and hypnotic in reducing anxiety, treatment of addiction, Antibiotic properties, Pain-affecting power. Grinspoon suggests: Very little research attention has been given to the possibility that marihuana might protect some people from psychosis. Among users of the drug, the proportion of people with neuroses or personality disorders is usually higher than in the general population; one might therefore expect the incidence of psychoses also to be higher in this group. The fact that it is not suggests that for some mentally disturbed people, the escape provided by the drug may serve to prevent a psychotic breakdown. (1969: 24). Mikuriya lists many possible therapeutic uses of THC and similar products in his paper "Marihuana in Medicine: Past, Present and Future." He includes: Analgesic-hypnotic, appetite stimulant, antiepileptic, antispasmodic, prophylactic and treatment of the neuralgias, including migraine and tic douloureaux, antidepressant-tranquillizer, anti-asthmatic, oxytocic, anti-tussive, topical anesthetic, withdrawal agent for opiate and alcohol addiction, child birth analgesic, and antibiotic (1968: 39). China The oldest known therapeutic description Of cannabis was by the Emperor Shen-Nung in the 28th century B.C. in China, where the plant had long been grown for fiber. He prescribed cannabis for beri-beri, constipation, "female weakness," gout, malaria, rheumatism and absentmindedness (Bloomquist, 1968: 19). Egypt In Egypt, in the 20th century B.C., cannabis was used to treat sore eyes. Additional medical usage was not reported until much later. India Prior to the 10th century B.C., bhang, a cannabis preparation, was used as an anesthetic and antiphlegmatic in India. In the second century A.D., a Chinese physician, Hoa-Tho, prescribed it as an analgesic in surgical procedures (Mikuriya, 1969: 34). From the 10th century B.C. up to 1945 (and even to the present time), cannabis has been used in India to treat a wide variety of human maladies. The drug is highly regarded by some medical practitioners in that country. The religious use of cannabis in India is thought to have preceded its medical use (Blum and Associates, II, 1969: 73; Snyder, 1970: 125). The religious use of cannabis is to help "the user to free his mind from worldly distractions and to concentrate on the Supreme Being" (Barber, 1970: 80). Cannabis is used in Hindu and Sikh temples and at Mohammedan shrines. Besides using the drug as an aid to meditation, it is also used to overcome hunger and thirst by the religious mendicants. In Nepal, it is distributed on certain feast days at the temples of all Shiva followers (Blum & Associates, 1969, 11: 63). The Hindus spoke of the drug as the "heavenly guide," "the soother of grief." Considered holy, it was described as a sacred grass during the Vedic period (Fort, 1969: 15). A reference to cannabis in Hindu scriptures is the following:To the Hindu the hemp plant is holy. A guardian lives in bhang ... Bhang is the joy giver, the sky filer, the heavenly guide, the poor man's heaven, the soother of grief ... No god or man is as good as the religious drinker of Mang. The students of the scriptures of Benares are given bhang before they sit to study. At Benares, Ujjain and other holy places, yogis take deep draughts of Mang that they may center their thoughts on the Eternal . . . By the help of Mang ascetics pass days without food or drink. The supporting power of Mang has brought many a Hindu family safe through the miseries of famine (Snyder, 1970: 125). Greece In ancient Greece, cannabis was used as a remedy for earache, edema, and inflammation (Robinson, 1946: 382-383). Africa Cannabis was used in Africa to restore appetite and to relieve pain of hemorrhoids, its antiseptic uses were also known to certain African native tribes (O'Shaughnessy, 1842: 431). Various other uses, in a number of countries, included the treatment of tetanus, hydrophobia, delirium tremens, infantile convulsions, neuralgia and other nervous disorders, cholera, menorrhagia, rheumatism, hay fever, asthma, skin diseases, and protracted labor during childbirth. The 19th Century Documents of the 19th century report on the use of cannabis to control diarrhea in cholera and to stimulate appetite. In his reports of the late 1830's and early 1840's, O'Shaughnessy (1842: 431) stated that tetanus could be arrested and cured when treated with extra large doses of cannabis. John Bell, M.D., Boston, reported enthusiastically in 1857, about the effects of cannabis in the control of mental and emotional disorders as opposed to the use of "moral discipline" to restrain the mentally ill. Similarly, in 1858, Moureau. de Tours reported several case histories of manic and depressive disorders treated with hashish (Walton, 1938: 3). The Ohio State Medical Society's Committee on Cannabis Indica, convened in 1860, reported that their respondents claimed cannabis successfully treated neuralgic pain, dysmenorhea, uterine hemorrhage, hysteria, delirium tremens, mania, palsy, whooping cough, infantile convulsions, asthma, gonorrhea, nervous rheumatism, chronic bronchitis, muscular spasms, tetanus, epilepsy and appetite stimulation (McMeens, 1860: 1). The India Hemp Commission (1894: 174) likewise was informed of similar medicinal uses for cannabis. Specific reports included the use of cannabis as an analgesic, a restorer of energy, a hemostat, an ecbolic, and an antidiaretic. Cannabis was also mentioned as an aid in treating hay fever, cholera, dysentery, gonorrhea, diabetes, impotence, urinary incontinence, swelling of the testicles, granulation of open sores, and chronic ulcers. Other beneficial effects attributed to cannabis were prevention of insomnia, relief of anxiety, protection against cholera, alleviation of hunger and as an aid to concentration of attention. Medical uses in the 20th Century Despite the fact that marihuana was made illegal in the United States in 1937, research has continued on the medical uses of marihuana. The findings include various possible medical applications of cannabis and its chemical derivatives. One of the most recent and interesting findings (Frank, 1972) concerns the effect of cannabis in reducing intraocular pressure. It was found that as the dose of marihuana increased, the pressure within the eye decreased by up to 30%. This occurred in normal persons as well as in those with glaucoma, a disease of the eye in which increased intraocular pressure may cause blindness. Much more research is necessary in connection with this experimental clinical finding before final judgment can be passed on such a possible therapeutic value. During the past 20 years in western medicine, marihuana has been assigned antibiotic activity; as a result, several studies relating to this possibility have been undertaken. H. B. M. Murphy (1963: 20) reported investigations in Eastern Europe. He stated that "it is alleged to be active against gram positive organisms at 1/100,000 dilution, but to be largely inactivated by plasma, so that prospects for its use appear to be, confined to E. N. T. (ear, nose and throat) and skin infections." Dr. J. Kabelikovi (1952: 500-503) and his coworkers carried out tests on rats, which were similar to tests carried out with penicillin in vitro. The alcohol extract of cannabis was bacterially effective against many gram-positive and one gram-negative microorganisms. It was also found that a paste form of external application was successful. According to Kabelikovi, "from a study of 2,000 herbs by Czechoslovakian scientists it was found that cannabis indica (the Indian Hemp) was the most promising in the realm of antibiotics." In a 1959 publication of Pharmacie, Krejci stated: "From the flowering tips and leaves of hemp, cannabis sativa var indica bred in Middle Europe, were extracted a phenol and an acid fraction. From the acid fraction, two acids were obtained, of which one preserved its antibiotic properties" (p. 349). In another Czechoslovakian publication, Krejci (1961: 1351-1353) referred to two additional samples with antibiotic activity. Sample I in Fig. 1 has been sufficiently identified as cannabidiolic acid and sample 9 as cannabidiol. Both fractions show antibiotic activity. The results of tests lead us to conclude that the antibacterial action of cannabis sativa is not identical to the hashish effect found, for example, in tetrahydrocannabinol. However, it was established that cannabis sativa is effective as an antibiotic for local infections. Kabelik, Krejci, and Santavy (1960: 13) include in "Cannabis as a Medicant" the various microorganisms against which cannabis is effective. Proof could be furnished that the cannabis extracts produce a very satisfactory antibacterial effect upon the following microbes: staphylococcus pyogenes aureus, steptococcus alpha haemolyticus, streptococcus beta haemolyticus, enterococcus, diplococcus pneumonia, B. anthracis, and corynebacterium diptheriae i.e., all of them gram-positive microorganisms. Noteworthy is the effect upon staphylococcus aureaus strains, which are resistant to penicillin and to other antibiotics. These authors also mentioned that E. coli (gramnegative bacteria) were tested and found to be resistant to the cannabis extract. One of the conclusions was "the possibility of utilizing the antibiotics locally without any danger of producing resistant strains to other antibiotics administered at the same time throughout treatment" (Kabelik, et al., 1960: 13). Veliky and Genest in "Suspension Culture of Cannabis Sativa," (1970) reported that "the ethanol extract of cultured cells exhibited antibiotic activity against Bacillus megatherium, staphlococcus aureaus and escherichia coli" (p. 493). Other reports said that "a pronounced antibiotic effect has been observed in South America, where fresh leaves, after being ground, are used as a poultice for furuncles, and in folk medicine in Europe for treatment of erysipelas" (Kabelik, et al., 1960: 8). This section on the -antibiotic uses of cannabis concludes with a summary of several reports from various countries. In Pharmacopee Arabe: "The ground-up seeds are mixed with bread for people with tuberculosis" (Andrews and Vinkenoog, 1967: 145). In Czechoslovakia: "A preparation from seed pulp was . . . introduced by Sirek to act as a roborant diet in treatment of tuberculosis" (Kabelik, 1960: 8). "In Southern Rhodesia the plant is used as an African remedy for malaria, anthrax, sepsis, black water fever, dysentery, blood-poisoning, tropical quinine-malarial haemoglobinuria, and a wart medicine" (Watt, 1961: 13). In Argentina: Cannabis is considered a real panacea for tetanus, colic, gastralgia, swelling of the liver, gonorrhoea, sterility, impotency, abortion, tuberculosis of the lungs and asthma ... even the root-bark has been collected in spring, and employed as a febrifuge, tonic, for treatment of dysentery and gastralgia, either pulverized or in form of decoctions. The root when ground and applied to burns is said to relieve pain. Oil from the seeds has been frequently used even in treatment of cancer . . . (Kabelik, 1960: 8). In 1949, Davis and Ramsey reported a study of the effect of THC on epileptic children. "The demonstration of anticonvulsant activity of the tetrahydrocannabinol (THC) congeners by laboratory tests (Loewe and Goodman, Federation Proc., 6: 3521 1947) prompted clinical trial in five institutionalized epileptic children" (David and Ramsey, 1949: 284-285). Of these five children, all had severe symptomatic grand mal epilepsy with mental retardation; three also had cerebral palsy; and three had focal seizure activity. The EEG tracings were reported to be grossly abnormal in all five children. The results after treatment with homologues of THC, were reported as follows: Three children-responded at least as well as to previous therapy. Fourth child-almost completely seizure free. Fifth child-entirely seizure free. As a result of their study, David and Ramsey (1949: 284-285) felt that "the cannabinols herein reported deserve further trial in non-institutionalized epileptics." Dr. Vansim of Edgewood Arsenal has written in a recently published book "Psychotomimetic Drugs," that the synthetic preparations of cannabis are of interest. There are three areas where they may be of definite use in medicine (Efron, 1969: 333-334). One concerns the use of a cannabis analogue which Dr. Walter S. Loewe reported very effective in preventing grand mal seizures if given in small doses. The second use refers to cannabis as an antidepressant. Straub (Walton, 1938: 3), Adams (1942: 726-727), and Stockings (1947, 920-922) point to the possible use of cannabis and cannabis analogues in relieving dysphoria in depressed patients. Other authors (Parker and Wrigley, 1950: 278-279) had lesser success but recommended further research in this field. A report from London in 1968 suggests that cannabis treats the symptoms and not the cause by focusing the user's attention on his anxieties and pains without helping him to resolve them (Report by the Advisory Committee, 1968: 11). The third use is described by Douthwaite, who used hashish in 1947 "for reducing of anxiety and tension in patients with duodenal ulcer" (Pond, 1948: 279). A report in a 1965 issue of Medical News ("Cardiac Glycocides," p. 6) suggests cannabis as treatment for a specific form of malignancy. Cannabis is recognized as an appetite stimulant, which suggests that the drug might be useful in the treatment of pathological loss of appetite known as anorexia nervosa (Grinspoon, 1969: 21). Similar symptoms exist in terminal cancer patients who, when treated with cannabis over a short period of time, demonstrated stimulation of appetite, euphoria, increased sense of well-being, mild analgesia and an indifference to pain which reduced the need for opiates (DHEW, 1971: 11). Cannabis has been recently proposed as an adjunct in the treatment of alcoholics and drug addicts. Roger Adams (1942: 726-727) and Todd Mikuriya (1970a: 187-191) noted that the substitution of smoked cannabis for alcohol may have rehabilitative value for certain alcoholics. Regarding the use of cannabis analogue in the treatment of drug, alcohol and depressive state withdrawal, Thompson and Proctor (1953: 520523) report the following: Depressive States: 20 cases of neurotic depression-4 improved (20%) 6 cases of psychotic depression-none improved (00%) Post-Alcoholic Cases: 70 cases--59 reported clinical alleviation of symptoms (84%) Drug Cases: 6 cases of barbiturate addiction-4 reported amelioration of symptoms (66%) 4 cases of dilaudid addiction-3 reported alleviation (75%) 2 cases of pantopan and one paregoric addiction-all reported smooth withdrawal (100%) 12 cases of Demerol addiction-10 withdrawals in one week (83%) 6 cases of morphine addiction-2 withdrawals without unpleasant symptoms (33%) The doctors concluded that "Pyrahexyl (a synthetic cannabis-like drug) and related compounds are beneficial in the treatment of withdrawal symptoms from the use of alcohol to a marked degree, and in the treatment of withdrawal symptoms from the use of opiates to a less marked, but still significant degree" (Thompson & Proctor, 1953:520-523). Drs. Allentuck and Bowman (1942) undertook a study of the use of marihuana in the morphine abstinence syndrome. They stated: A series of cases were selected from among drug addicts undergoing treatment. . . . Comparative results were chartered for the gradual withdrawal, total withdrawal, and marihuana derivative substitution, as methods of treatment. . . . 49 subjects were studied. The results in general, although still inconclusive, suggest that the marihuana substitution method ameliorated or eliminated (the symptoms) sooner, the patient was in a better frame of mind, his spirits elevated, his physical condition was more rapidly rehabilitated, and he expressed a wish to resume his occupation sooner (p. 250). In his study of the medical application of cannabis for Mayor LaGuardia's committee, Dr. Samuel Allentuck reported "favorable results in treating withdrawal of opiate addicts with tetrahydrocannabinol (THC), a powerful purified product of the hemp plants" (Mikuriya, 1969: 38). Roger Adams' detailed studies, as reported by Dr. C. K. Himmelsbach in his 1944 article "Treatment of the Morphine Abstinence Syndrome with a Synthetic Cannabis-Like Compound" (1944:26), indicated that "withdrawal manifestations were considered to be mild. The reported therapeutic value of marihuana was attributed to improved appetite, greater sleep, euphoria, and a reduction of the intensity or elimination of abstinence phenomena." Himmelsbach, however, had lesser success when he studied the effect of a "pyrahexyl" compound on the morphine abstinence syndrome, as noted by his conclusions that: (1) Pyrahexyl compound appears to possess considerable cannabis-like effect when administered orally, but little or none when given intramuscularly. (2) When given by mouth In definitely effective amounts pyrahexyl compound had no appreciable ameliorative effect on the opiate abstinence syndrome .

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History of the Medicinal Use of Marijuana

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