A Brief History of Medical Cannabis and Cannabinoids in the U.S.

The Ayurvedic Medicine Materia Medica

Since the late 1940s and early 1950s, both state and federal entities have assiduously avoided treating cannabis as the medicine it has been for over 4,000 years. Cannabis has been recognized as a medicine since at least 2637 B.C.E. when it was included in the first known pharmacopoeia, the Ping Ts’ao Ching, alleged to be written by the second Emperor of China, Shen Neng. Cannabis has appeared in all subsequent major pharmacopoeias including an Ayurvedic Medicine Materia Medica, dated from between 1100 B.C.E. and 1700 B.C.E., as well as the Ebers Papyrus (1500 B.C.E.) and the works of Discordes (70 C.E.). 

Cannabis was in the United States Pharmacopoeia (USP), a quasi-governmental produced compendium of commonly used therapeutic agents, from the 1850s until 1942. During that time cannabis was widely available in prescriptions as well as in over-the-counter preparations and dispensed from prescription pharmacies.

As far back as 1906 the percent of cannabis is to be found on patent medicine packaging. Many, if not all, of the available post Pure Food and Drug Act of 1906 nostrums had label verbiage that the product was FDA approved.  All had the cannabis ingredient listed. These nostrums were available in pharmacies, which were and are medically supervised by pharmacists.

At the turn of the 20th century, cannabis was the third most common ingredient in prescription and over the counter medicine. Cannabis was available in leaf, powder and tincture sold by Squibb, Eli Lily, Sharp and Dohme, Merck and other well-known pharmaceutical companies. In the 1920s American physicians wrote 3 million cannabis containing prescriptions per year.

Cannabis has been demonized as "marijuana" since the 1890s. Prior to that time, hemp was the most profitable agricultural crop in the world for a thousand years. In the early part of the 20th century we had the incongruous situation where marijuana was illegal in more than half the U.S. states while over 25 cannabis-containing over-the-counter products could be found on the shelves of every pharmacy in America. Cannabis continued to be a common ingredient in prescription and patent medicine until well into the 1930s. So what happened?

Cult of Modernism

Like every generation before and since, citizens in the early 20th century felt they knew more than their parents. They were well aware that they lived in an era of amazing progress, what with the telegraph, telephone, phonograph, automobiles, movies, electric lights, and manufactured pharmaceuticals.

The Flexner Report, a study of the quality of medical education funded by the Carnegie Foundation was released in 1910. Its findings elevated the status of allopathic medicine while marginalizing other kinds of medicine such as osteopathic, naturopathic, and homeopathic medicine. All of the latter were more supportive of plant based medicines than allopaths and MDs. After 1910 there was a decrease in physicians prescribing plant based medicine. Over the next 20 to 30 years most plant based medicine was replaced by synthetic and semi-synthetic single molecule manufactured medication.

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Marihuana Tax Act of 1937 (MTA)

As late as 1937, cannabis was available in over 25 over-the-counter patent medicines, which could be obtained without a prescription. American doctors were still writing several hundred thousand cannabis-containing prescriptions per year. There was a great deal of familiarity with cannabis as medicine by physicians, pharmacists, and the lay public. 

George Schlichten spent $400,000 and twenty years to develop a labor-saving hemp harvesting machine which he patented in 1916.  With the 1933 expiration of Schlichten’s patent on his hemp decorticator, the technology was now widely available to be used and improved upon to cut the cost of harvesting and preparing hemp for industrial use in half.

In the mid 1930s, hemp was on its way to posing economic competition to many powerful industries – textiles (nylon, cotton, rayon), sulfites for papermaking, (four times as many sulfites are needed to make paper from wood pulp as from hemp); tetra-ethyl lead, a gas additive, gasoline power engines from hemp ethanol, synthetics like cellophane, and other commodities. In addition, the plant was a pawn for bureaucratic forces at play in the 1930s in Washington DC. There was a personal competition for top federal lawmen between J. Edgar Hoover of the FBI and Harry Anslinger of the Bureau of Narcotics and Dangerous Drugs (BNDD), the predecessor to the modern-day Drug Enforcement Administration (DEA).

But for not cannabis’s substantial economic value, medical utility and a war between two powerful federal criminal justice bureaucrats, cannabis would have continued to remain the purview of physicians and pharmacies. Professional oversight of dispensing medical cannabis would still be by a pharmacist, which is the same situation that existed from 1850 until 1942.

To be clear, even after the MTA was passed, cannabis continued to be supported by the medical establishment. Long time editor of of the Journal of American Medicine (since 1924), Dr. Morris Fishbein, said in 1942 that cannabis was the best treatment for migraines. The New York Academy of Medicine recommended legalizing recreational cannabis (1944) as part of the LaGuardia Crime Commission Report. Colonel James Thalen, editor of Military Surgeon, the semi official armed forces medical journal, wrote a 1943 editorial “The Marijuana Bugaboo” and later in 1954, “The Marijuana Bugaboo Revisited”, in the same publication (now renamed “Military Medicine”). Both of Colonel Thalen’s editorials were highly critical of the MTA.

Cannabis medicine, before the Pure Food and Drug Act of 1906. Source: Cannabis Museum

The Perception of Cannabis Was Changed by the Marihuana Tax Act (MTA)

According to the 1937 Congressional testimony given by the American Medical Association's (AMA) spokesperson and chief legal counsel, Dr. William C. Woodward, the system in place from the 1850s to 1942 worked satisfactorily.   Woodward had a formidable resume. He was an attorney as well as an MD, former federal Commissioner of Health (1893-1913), former Health Commissioner of Boston (1913-1919), past president of American Public Health Association (1914), in addition to being AMA’s chief legal counsel since 1924. He testified for the AMA before the House Ways and Means Committee AGAINST the Marijuana Tax Act.

"The AMA knows of no dangers from the medicinal use of cannabis,” Woodward said.

According to a recent 2018 article in the Atlantic by Dan Baum, based on a 1994 interview with top Nixon aide, John Ehrlichman, the reason cannabis was placed in Schedule I under the Controlled Substances Act of 1970s was to marginalize and demonize anti-Vietnam War activists. They were among Nixon’s chief political critics.

In 1988, after a two year rescheduling hearing, the DEA Chief Administrative Law Judge, Francis Young, recommended rescheduling cannabis to Schedule II. The recommendation was not implemented by George H.W. Bush. Judge Young’s Finding of Fact found that “marijuana” (cannabis in its natural state) is one of the safest therapeutic agents known to man.

Cannabis as a Medicine in the U.S.

We have ample evidence of the fact that cannabis is medicine. Some of the points include but are not limited to:

  • Over 4,000 years of documented historical medical use of cannabis prior to its introduction to the U.S. in the 1840s.
  • Dr. W.B. O’Shaughnessy reintroduces medical cannabis to England in 1839.
  • Cannabis was in the USP from 1850s-1942.
  • Sir William Osler, considered the father of modern medicine, writes cannabis is the most effective treatment for migraines 1892.
  • Sir Joshua Reynolds prescribed tincture of cannabis to Queen Victoria in the 1890s for treatment of menstrual cramps.
  • 1937 the AMA testimony before the House Ways and Means Committee was aggressively AGAINST the Marihuana Tax Act.
  • History of tens of millions of prescriptions written by American physicians prior to 1942.
  • Marinol, synthetic THC, was FDA approved in 1985 and is a Schedule III drug.
  • 1988, DEA Administrative Law Judge recommends moving cannabis to Schedule II.
  • Health Canada approves tincture of cannabis, 2005.
  • The 2009 AMA House of Delegates (HOD) request to reschedule cannabis to Schedule II.
  • 2010 – The European Union legalizes Sativex, a whole plant cannabis alcohol extract.
  • Today, A growing body of clinical experience gained as a result of Proposition 215 in 1996 and eventual legalization of medicinal cannabis in over 30 states and D.C.
  • 2018, Epidiolex, a whole plant alcohol extract, approved by the FDA as schedule V drug.

All the above sources suggest the government should have treated cannabis as medicine.