History of the Therapeutic Uses of Cannabis

Cannabis is a genus of herbaceous flowering plants in the family Cannabinaceae. There is some dispute whether the three main types of Cannabis – C. sativa, C. indica and C. ruderalis – are three separate species or different strains or varieties of the same species. In the United States today, the term hemp is used to refer to varieties of cannabis1 that contain 0.3 per cent or less of tetrahydrocannabinol (THC), the plant’s main psychoactive constituent, whereas the common term marijuana refers to cannabis that has more than 0.3 per cent of THC and can induce euphoric effects in users. In most European countries, the threshold is 0.2 per cent, and in Switzerland it is 0.1 per cent. However, both plants are classified as Cannabis sativa L.

The dried leaves and flowering tips of the plant, high in THC, and the resin extracted from the plant have gone by many names over the millennia. In Spanish, cannabis is commonly called hierba or María; names coming from various other cultures for cannabis preparations are bhang, charas, dagga, khif, ganja, diamba, maconha, canapa, and chamvre. In English, common slang terms are grass, weed, shit and pot.

Today, we believe that the cultivation of cannabis in Asia goes back many thousands of years. Before the Common Era, western Asia was the departure point for the diffusion of cannabis to Europe and the African continent and then, in the 16th and 17th centuries, to North, Central, and South America.
For a very long time, people have been using both the non-psychoactive and psychoactive varieties of cannabis. Hemp has been used for its fibres and for its seeds. Hempseeds, which have great nutritional value, are used in the preparation of many dishes. Since long ago, hemp fibre, well known for its great versatility, has been used to make paper, fabric and rope. The Phoenicians who traversed the Mediterranean three thousand years ago, as well as the Egyptians in the time of the pharaohs, used this very tough material to construct their sails and fishing nets. In China, the first paper products (an invention that was kept secret for a long time) were made with hemp several centuries before the beginning of the Common Era. But it was only in the ninth century that the Arabs introduced it to the west, where it replaced papyrus and clay tablets. Gutenberg’s first Bible, like all the other books of that time, was printed on paper made from a mixture of hemp and flax.
The psychoactive components of the plant were also known before the Common Era and were already used in healing rites and ceremonies in numerous cultures. Cannabis was identified as a sacred plant in the Vedas, religious Hindu texts that date back to about 1500 to 1300 BCE. The earliest written reference to the healing properties of cannabis is found in the Rh Ya, a Chinese pharmacopeia of about 1500 BCE. As for its numerous therapeutic properties, now rediscovered today, such properties were certainly known in the Middle East, from whence the traditional applications used in treating certain neurological disorders were transmitted to us. Today, we can still profit from this experience that is hundreds, if not thousands, of years old.

In the eighteenth century, Europeans travelling in Arab countries and in Asia discovered cannabis containing high levels of THC. The term Indian hemp was introduced for the first time by the German naturalist Georg Eberhard Rumpf (1627–1702). However, before the 19th century, Indian hemp was not much used in medicine in either Europe or America and, most often, it was met with a certain scepticism.
In 1823, an article on the successful use of Indian hemp in the treatment of whooping cough appeared in the Hufeland Journal: “The extract of cannabis was used at the Polyclinic in Berlin in the emergency treatment of a patient suffering from a convulsive cough. The same extract in powder form, mixed with sugar, in a dose of 4 grams was prescribed daily” (Dierbach 1828, 420). In 1830, the therapeutic application of Indian hemp was described in detail, for the first time in Europe, by Theodor Friedrich Ludwig Nees von Esenbeck (1787–1837), Professor of Pharmacology and Botany at the University of Bonn, Germany. Certain doctors, notably Samuel Hahnemann (1755–1843), prescribed cannabis extract for treating numerous cases of nervous disorders where medical practitioners would more usually have used opium or Hyoscyamus niger (henbane). He found that cannabis had fewer side effects than the two alternatives.

GREAT BRITAIN

The Scotsman Sir William Brooke O’Shaughnessy, doctor, scientist and engineer, was a veritable pioneer in the therapeutic use of cannabis in western Europe – and specifically in the use of its psychotropic properties. In 1833, as an employee of the British East India Company, he travelled for the first time to India. He was 33 years old. Very quickly he became interested in the therapeutic potential of cannabis and, in 1839 he published a synthesis of his experiments, which aroused considerable interest in Great Britain. First of all, he became aware of the various traditional therapeutic uses of the plant in India and he then conducted studies on animals and humans to fully understand its action and to better evaluate its side effects.
Following his initial investigations, he came to the conclusion that, because of the “completely harmless nature of cannabis resin,” a complete study ought to be conducted of clinical cases in which “its obvious qualities indicated greater therapeutic benefit” (O’Shaughnessy 1973). Consequently, tinctures of cannabis (extracts of cannabis resin dissolved in ethyl alcohol), in doses of between 65 and 130 mg, were prescribed for patients suffering from rheumatism, tetanus, rabies, epileptic spasms, cholera and delirium tremens. Of three cases treated for rheumatism, two were “almost healed in three days,” although the administration of these high doses induced considerable side effects, such as total paralysis and uncontrollable behaviour. In the third case, no reaction to the treatment was observed; it was only later that the patient confessed that he regularly took cannabis. This led to the first indications of the development of a tolerance.
Other studies conducted with weaker doses led to similar conclusions: “Reduction of pain levels in most patients, notable appetite stimulation with all patients, undeniable aphrodisiac effects and feelings of great spiritual happiness. Everyone followed the same progressive development and none of the cases presented headaches or nausea as a response” (O’Shaughnessy 1973).
Convulsions and spasms induced by rabies or tetanus were controlled with the administration of high dosages of cannabis. In the case of tetanus, the cannabis acted positively on the progress of the disease and was administered in doses in the range of 650 mg for cases judged to be “hopeless.” O’Shaughnessy observed muscle relaxation as well as a cessation of “convulsive tendencies.” Similarly, the observations conducted on epileptic spasms were encouraging. As for the treatment of cholera, excellent results were obtained, although more often with Europeans than with Indians, who were regular consumers of bhang, an edible paste made from the leaves and flowering tops of cannabis. O’Shaughnessy also identified the antiemetic effects of cannabis.

As a result of reports published by this illustrious pioneer, the use of cannabis expanded in Europe and in America, where it quickly turned into a widely accepted medication. Numerous new doctors then spread the news of their experiments.
In 1845, Michael Donavan (1790–1876), an Irish apothecarist and chemist, described the effectiveness of cannabis in the treatment of intense neuralgic pain in the arms and fingers, inflammation of the knee joint, facial neuralgia and sciatic nerve pain in the pelvis, the knees and down to the feet. In addition, he observed cannabis’s stimulating effects on appetite. The same year, Dominic Corrigan, an Irish physician, described several cases of Huntington’s chorea (Sydenham’s chorea) and of neuralgia that could be treated successfully with a cannabis tincture. As found by other doctors, he took note of the substantial variability in the effectiveness of the active element, which today can be attributed to the varying concentrations of THC in the plants. In one single case, the administration of 20 drops of this tincture led to a “transitory loss of almost all muscle tone followed by sleep whereas in another case a patient received three times a day for a week a similar dosage without any significant problem and with successful results.”
The British doctor John Clendinning reported in 1843 on trials conducted on several clinical cases: “I have no hesitation in confirming that prescribing cannabis, with the exception of notably rare cases, has been shown to have very precise effects as a somniferous or hypnotic agent producing sleep; as an analgesic…; as an antispasmodic for the relief of cough and cramps; as a central nervous system stimulant to relieve sluggishness and anxiety; as a cardio tonic; and as a stimulant of good humour. All these effects were observed in both acute and chronic disorders, in both young and old and in both men and women.”
Other British doctors, such as Fleetwood Churchill (1849), Alexander Christison (1851), John Grigor (1852), Horace Dobell (1863), A. Silver (1870), John Brown (1883), Robert Batho (1883) and R. H. Fox (1897), also reported on the analgesic properties of cannabis in the treatment of rheumatism, sciatica, migraines, pain of various origins, muscular cramps, asthma attacks, insomnia, uterine contractions in childbirth, heavy menstrual bleeding (menorrhagia) as well as treating dependency on opiates or chloral hydrate.2 According to Dr. Edward A. Birch, in a seminal article published in The Lancet in 1889, Indian hemp immediately reduces “the desire for chloral or opium” and stimulates the appetite.
In his time, Sir John Russell Reynolds (1828–1896), a well-known professor of medicine in London and personal physician of Queen Victoria, for whom he prescribed cannabis every month to treat menstrual disorders, summarised his experiments in 1890, collected over a period of 30 years, relating to medicinal compounds based on cannabis: “Indian hemp, as long as it is administered with caution, is one of the most precious medicines that we have available” (Reynolds 1890). He specified that cannabis could be used successfully to treat the insomnia of old age and that this could be done “for months if not years without needing to increase the dosage.” On the other hand, in the treatment of insanity it is “worse than useless.” He added that cannabis is “by far the most useful medicine in the treatment of almost all illnesses that are accompanied with pain. The professor encouraged the use of cannabis in the treatment of trigeminal neuralgia as well as other neuralgic pain; however, in cases of sciatic pain based on movement, the treatment was ineffective. Many patients suffering from migraines were able to overcome the effects of the crisis using cannabis “from the appearance of the first signs or the very beginning of the condition.” As well, cannabis was equally very beneficial in the treatment of “nocturnal cramps in the elderly or in those with gout” and in the treatment of painful menstrual cramps. Some asthmatics suffering from spasticity also found benefit in this treatment.

UNITED STATES

In the United States the use of cannabis for therapeutic purposes was also widespread during the 1800s and early 1900s. In the American pharmacopeia of 1854, its therapeutic properties were described as follows:
Cannabis extract is a powerful narcotic that gives rise to sensations of gaiety, intoxication, hallucinations accompanied by delirium, drowsiness and mental numbness, with only weak effects on the blood circulation. It also has aphrodisiac properties, stimulates the appetite and, in certain cases, induces a cataleptic state. During organic disorders, it can cause drowsiness, attenuate spasms, relieve nervousness and reduce the intensity of pain. From the point of view of its effects, cannabis is a little like opium with the difference that it does not suppress the appetite, does not reduce secretions and does not cause constipation. Its effects are less predictable than those of opium; but in cases where opium is contraindicated because it induces constipation and nausea, then it is better to administer cannabis. It is used specifically to treat neuralgia, gout, tetanus, rabies, epidemic cholera, Huntington’s chorea, hysteria, depression, delirium and uterine haemorrhaging. Dr. Alexander Christison of Edinburgh attributes to it the effect of accelerating and intensifying contractions during childbirth and has successfully used it for this purpose. The therapeutic properties of cannabis act rapidly and without any anesthetising action, even though it seems that this effect is produced in certain cases. (Mikuriya 1973)
It is clear that variations in the chemical composition of the plant contributed to the observation of multiple cases of overdose but without ever producing serious consequences. In his 1912 ‘An Essay on Hasheesh’, Victor Robinson wrote, “A strange thing about hasheesh is that an overdose has never produced death in man or the lower animals. Not one authentic case is on record in which cannabis or any of its preparations destroyed life” (Robinson, 1912, p. 35). In that era, just as today, such a level of therapeutic innocuousness was definitely not the case for other available medications.
In 1938, Robert P. Walton, professor at the medical university in South Carolina, published a treatise titled “Description of the Hashish Experience” (Walton 1938). In it, he provided an account of cannabis intoxication, reported by a young doctor who had intentionally consumed a very strong dose of cannabis.

[After one hour,] quite suddenly there is developed an indescribable feeling of exaltation and of grandeur. The words “fine,” “superfine” and “grand” come to my mind as being applicable to this feeling. This indescribable feeling is purely subjective… The idea of oneness with all nature and with the entire universe seems to take hold. There is no material body or personality… There is marvellous colour imagery, blue, purples and old gold predominating with most delicate shading effects… Evidently sleep gradually set in and continued undisturbed until the usual rising time. No special sensation on rising. Feeling, if anything, more than usually refreshed. All of the sensations recorded above have completely vanished. The recollections of the experiences are however very clear and vivid.

FRANCE

In France, not only doctors but also artists were interested in the effects of the drug. The poet Théophile Gautier described in detail a long cannabis intoxication in an article in the French magazine Revue des Deux Mondes (Review of the Two Worlds) in February 1846. The article charted his first experience, in 1843, with the group who later became the Club des Hashischins (Club of the Hashish Eaters). Among the members of this club, which was active from 1844 to 1849, were writers and artists such as Alexandre Dumas (who divulged his experiences with cannabis in his novel The Count of Monte Cristo), Charles Baudelaire, the caricature artist Honoré Daumier and the painter Eugène Delacroix. The psychiatrist Jacques Joseph Moreau de Tours, who from 1840 on directed the psychiatric clinic of Ivry, considered hashish to be an important remedy in psychiatry. He treated seven patients suffering from various psychiatric disorders with cannabis: five of them were cured.

GERMANY

In the case of Germany there were, among others, Georg Freudenstein, Basilus Beron, Franz von Kobylanski, Bernhard Fronmüller and Georg Martius, each of whom reported on their experiments with cannabis. Only two years after the revolutionary publication of O’Shaughnessy – that is, in 1841 – there appeared at the University of Marburg, Freudenstein’s thesis ‘De Cannabis sativae usu ac viribus narcoticis’ (The Uses and Narcotic Strength of Cannabis sativa), which dealt with the cultivating and pharmacological aspects of the medicinal plant.
In his thesis, Über den Starrkrampf und den indischen Hanf als wirksames Heilmittel gegen denselben (Concerning Tetanus and Indian Hemp as a Remedy against Tetanus), published at the University of Marburg in 1852, the Bulgarian doctor Basilus Beron studied the application of cannabis in the treatment of tetanus: “Having tried without success almost all the known anti-tetanus agents, I was really happy to see my patient heal thanks to the administration of cannabis… Cannabis, therefore, is strongly recommended in the treatment of tetanus.” In the same year and at the same university there appeared the thesis of Kobylanski, titled Über den indischen Hanf mit besonderer Rücksicht auf seine wehenbefördernde Wirkung (About Indian Hemp and in Particular Its Stimulating Effect on Contractions During Childbirth).
Fronmüller, doctor at the hospital of Fürth, doctor to royalty and doctor in the district of Bavaria, published in 1869 a body of work that induced a great deal of interest: Klinische Studien über die -schlafmachende Wirkung der narkotischen Arzneimittel (Clinical Studies on the Soporific Effects of Narcotics). This publication assembled his experiments with one thousand patients who, for various reasons, suffered from significant sleeping disorders. Initially, Fronmüller administered various medications to all these patients. The results showed that cannabis was very effective in 53 per cent of the cases, partially effective in 21.5 per cent of the cases and minimally or not at all effective in 25.5 per cent of the cases. At the same time, Fronmüller also studied the analgesic properties of cannabis and noted, as well, an anti-inflammatory effect and an appetite stimulating effect.
In the German medical weekly Deutsche Medizinische Wochenschrift, Dr. See from Paris reported in 1890 his observations concerning the cannabis-based treatment for digestive disorders and loss of appetite (See 1890): “Weak doses did not lead to any disagreeable side effects, but did lead to reduced intensity of pain, appetite stimulation and relieving of vomiting as well as stomach cramps; as well, it acted on related symptoms…, vertigo, migraine, hypersomnia or insomnia.” Further on he wrote:
I have seen patients in whom the digestive sensitivity was so great that they no longer even dared to eat and were satisfied by a few mouthfuls of milk. Immediately after having taken the first doses of the medication, they experienced such relief that they began once again without the least discomfort, to eat among other things, meat that was raw, cooked or chopped, purees of dried vegetables, eggs… The effects of cannabis do not vary – they apply to the relief of pain or to the recovery of appetite, regardless of the origin of the disorder… Digestion is stimulated by the cannabis when it has been slowed by a state of neuralgic paralysis or rendered painful by gastric hyperacidity… Intestinal absorption also benefits from the soothing properties of cannabis… In short, cannabis is the real stomach sedative without any of the undesirable effects attributed to narcotics such as opium and chloral.
Toward the end of the 19th century, the recognition of cannabis-based products as medicine was widespread in Europe and America. The German firm Merck, from Darmstadt, was the first producer of cannabis compounds in Europe: cannabinum tannicum marketed in 1882, cannabinon in 1884, and cannabin in 1889. These medicines were administered as soporifics, analgesics, aphrodisiacs, antineuralgics, antirheumatics and antidepressants but were administered also in the treatment of hysteria, delirium tremens and psychosis. In Great Britain, there appeared ready-to-use products from Burroughs, Wellcome & Co.; in the United States, there were products from Squibb (New York), Parke, Davis & Co. (Detroit) and Eli Lilly & Co. Among all these cannabis-based medications available on the market at the turn of the century, the majority were administered orally, about one-third were compounds for external use and some had to be inhaled (like the cigarettes used to treat asthma).
During this period, the recreational ingestion of cannabis was little known in Europe. Thus, in 1899, A. J. Kunkel, professor at the University of Würzburg, Germany, in his manual of toxicology, especially noted that “the chronic abuse of cannabis-based compounds or cannabism seems to be widespread in Asia and Africa… It has not been observed in Europe. In contrast, in India doctors often recognise such cases” (Kunkel 1899).

BEGINNING OF THE 20TH CENTURY

The first half of the 20th century was marked by contradictory tendencies. The discredit heaped on the recreational use of cannabis led to a reduction of its use in medicine. In addition, the vigorous development of synthetic medicines, such as aspirin, chloral hydrate, bromisoval, barbiturates and opiate derivatives, contributed to the sidelining of natural products.
The chemical composition of cannabis extracts varied so much that it was difficult to determine a dosage and the intensity of the effects was not always predictable. As well, it was not unusual that very specific differences in a subject’s reactions, that is, how an individual reacted to the medication, varied from one person to the next. In addition, one had to wait up to an hour or more after the oral intake of the extract for the first effects to be felt. Unlike morphine, cannabis was not soluble in water and could not therefore be made into solutions for injection.
In 1925, cannabis was added to the first international drug control treaty, which initially included opium, morphine, heroin and cocaine and which had been signed at The Hague in 1912 at the first International Opium Convention. Thereafter, cannabis was considered legally in the same way as these other substances. In America during the 1930s, the hysteria of the anti-cannabis movement was in full flower. According to this faction, murder could be committed under the influence of cannabis and its use led to madness. Newspapers of the time vied with one another for the most sensational reports of horrific scenarios. Harry J. Anslinger, the first commissioner of the Federal Bureau of Narcotics, who was clearly looking for a new battleground after the prohibition against drinking alcohol had been lifted, contributed greatly to the phenomenon of ‘reefer madness’. In 1937, Anslinger wrote an article for American Magazine titled ‘Marijuana, Assassin of Youth’. From that time on in America, anything connected with uncontrolled passion, fanaticism, anarchy, or violence was associated with cannabis.
However, in parallel with this, clearer heads were to be found. In 1938, the mayor of New York, Fiorello H. LaGuardia, created a scientific commission made up of internists, psychiatrists, pharmacologists and a hygiene and public health specialist, as well as representatives of health organisations, hospitals and the justice system. The goal of this commission, called the Laguardia Committee, was to study the issue of marijuana in New York. It began its work in 1940 and published a very detailed report four years later (Laguardia Committee 1944). Following are some of the main conclusions it made.

 The practice of smoking marijuana does not lead to dependence in the medical sense of the word.

 The sale and distribution of marijuana is not under the control of any single organised group.

 The use of marijuana does not lead to morphine or heroin or cocaine addiction and no effort is made to create a market for these narcotics by stimulating the practice of marijuana smoking.

 Marijuana is not the determining factor in the commission of major crimes.

 Marijuana smoking is not widespread among schoolchildren.

 Juvenile delinquency is not associated with the practice of smoking marijuana.

 The publicity concerning the catastrophic effects of marijuana smoking in New York City is unfounded.

At the end of the 1940s and the beginning of the 1950s, the work of Roger Adams, Alexander R. Todd, Samuel Allentuck and Siegfried Walter Loewe stimulated a renewal of interest in the medical use of cannabis.
Loewe taught pharmacology at several German universities before immigrating to the United States in 1934, impelled by the rise of Nazism. In 1936, he undertook research into cannabis. In an article that appeared in 1950 titled ‘Cannabiswirkstoffe und Pharmakologie der Cannabinole’ (The Active Elements of Cannabis and the Pharmacology of Cannabinol), Loewe summarised the knowledge of his time on the chemistry of the cannabinoids (Loewe 1950). From 1942 on, it had been proved that the primary active element was a substance that scientists called tetrahydrocannabinol, or THC. However, its exact chemical structure was not yet known. On the other hand, the biological mechanism of the synthesis from cannabidiol to cannabinol through the intermediary of THC had been identified with precision. In his work, Loewe indicates, among other things, that the effects of reducing cramps and lessening pain are attributable to THC.
In the early 1940s, THC was used for the first time in a medicinal treatment, when Allentuck reported the successful THC-based treatment of inflammation caused by opiate dependency. In the same period, the first synthetic cannabinoids were manufactured and tested in clinical trials. In the list of these substances, parahexyl (synhexyl) was the main synthetic derivative of THC.
L. J. Thompson and R. C. Proctor reported in 1953 of successful use of synhexyl and similar substances in the treatment of alcohol withdrawal. They observed a weaker but distinct effect in opiate withdrawal. Among 70 alcoholic patients, 59 benefited from synhexyl in fighting withdrawal symptoms, compared with 11 patients who did not show any improvement in these symptoms. Among 12 patients dependent on Demerol (an opiate), 10 overcame withdrawal symptoms within a week without having recourse to any other medication. In a few cases of dependency on barbiturates, an improvement of the withdrawal symptoms was also observed (Thompson and Proctor 1953).
At the end of the 1940s, G. T. Stockings prescribed synhexyl for fifty depressed patients. In subjects who were in good health, 5 to 15 mg induced states of euphoria, while in depressed subjects, the same state was not achieved until reaching a dose of 60 to 90 mg of synhexyl. He concluded that the euphoric effect “consists of a pleasant feeling of happiness and exhilaration with a marked sense of physical well-being and self-confidence; there is a sense of relief from tension and anxiety and the threshold for unpleasant affect is markedly raised (Stockings 1947).
The interest accorded research on cannabis was reawakened in 1964 with the precise identification, by the Israeli researchers Yehiel Gaoni and Raphael Mechoulam, of the chemical structure of delta-9–tetrahydrocannabinol, or delta-9-THC for short (Δ-9-THC, or just THC). From then on, research in the field of chemistry and metabolic processes and the potential positive or negative effects of cannabis and the numerous cannabinoids entered an intense period of heightened activity. A second great period, even more significant, arrived on the scene at the beginning of the 1990s following the discovery in the human organism of the endogenous cannabinoid system, the cannabinoid receptors, as well as cannabinoids produced naturally by the human body; that is, the endogenous cannabinoids, or endo-cannabinoids.

Transcript of Chapter One – Cannabis Healing – a Guide to the Therapeutic Use of CBD, THC and Other Cannabinoids by Franjo Groetnhermen. M.D. Translated into Englsih from the French Edition by Jack Cain –

Printed with permission from the publisher Inner Traditions International. www.InnerTraditions.com


1  Strictly speaking, Cannabis is the Latin genus name and in scientific nomenclature is capitalised and italicised. Throughout the book, Cannabis Healing – a Guide to the Therapeutic Use of CBD, THC and Other Cannabinoids (from which this article is an extract), the word cannabis (lowercase and in roman) is used in its more generic meaning, referring to all varieties of cannabis (both sativa and indica) with their varying amounts of THC (both hemp and marijuana).

2  Dates refer to when the doctors published reports on their findings about the healing properties of cannabis.

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