Cannabis: a lost history
Cannabis, better known as marijuana, has been used for its medicinal properties for thousands of years. It's been heralded as a "cure-all," revered for its healing properties, particularly for pain but also as a potential anticancer treatment. Marijuana was a popular botanical medicine in the 19th and 20th centuries, common in U.S. pharmacies of the time.
It wasn't until 1970 that the herb was declared a Schedule 1 controlled substance in the U.S., a classification reserved for drugs with "high potential for abuse" and "no accepted medical use." Three years later the Drug Enforcement Agency was formed to enforce the newly created drug schedules, and the fight against marijuana use began. In light of its history as a global panacea for all sorts of ills, it's classification as a controlled substance is particularly unjustified.
As noted in the documentary "Cannabis: A Lost History," written, directed and narrated by Chris Rice, marijuana has been "an integral part of human civilization," featuring in ancient Japanese cave paintings, as well as Chinese and Siberian burial rites dating back to 3000 B.C. Based on the evidence — especially the discovery that the human body is equipped with a cannabinoid system — it appears our relationship with cannabis goes back to the very dawn of the human species.
Historical remnants from all around the world also reveal the importance of cannabis in medicine and spirituality. For example, Taoist monks in ancient China burned cannabis as incense, and consumed it with ginseng — a combination thought to open your psychic centers, allowing you to see the future. Cannabis was also revered as sacred in Hinduism, Zoroastrianism and Buddhism.
Cannabinoids and the Cannabinoid Receptor System
The marijuana plant contains more than 60 different cannabinoids; chemical compounds the human body is uniquely equipped to respond to. The two primary ones are cannabidiol (CBD) and tetrahydrocannabinol (THC), the latter of which is the psychoactive component. Cannabinoids interact with your body by way of naturally occurring cannabinoid receptors embedded in cell membranes throughout your body.
There are cannabinoid receptors in your brain, lungs, liver, kidneys, immune system and more; the therapeutic (and psychoactive) properties of marijuana occur when a cannabinoid activates a cannabinoid receptor. Your body also has naturally occurring endocannabinoids similar to THC that stimulate your cannabinoid receptors and produce a variety of important physiologic processes.
So, your body is actually hard-wired to respond to cannabinoids through this unique cannabinoid receptor system. We still don't know exactly how far its impact on your health reaches, but to date it's known that cannabinoid receptors play an important role in many body processes, including metabolic regulation, pain, anxiety, bone growth and immune function.1
The Earliest History of Cannabis
According to the featured video, the earliest written references to cannabis are found in the Chinese Materia Medica, said to be written by Shen Nung around 2800 B.C. The oldest known copy of this book dates back to 50 B.C. Nung is one of three "celestial emperors" revered in the Chinese culture. "Half emperor, half deity, he is said to have ruled over China long before written history," Rice says.
Nung is credited with inventing agriculture — including the hoe, plow and irrigation — as well as acupuncture and Traditional Chinese Medicine (TCM). Often depicted draped in leaves and chewing on various plants, Nung was the first pharmacologist, experimenting with and recording the health effects of plants. Nung documented around 100 different conditions that responded well to cannabis, including gout, rheumatism, malaria and absentmindedness.
Before Nung declared its medicinal attributes, the cannabis plant, called "ma" in Chinese, had been used for centuries in the production of textiles, paper, rope and pottery. Around 200 A.D., a Chinese physician named Hua Tuo performed the first surgery using an anesthetic — a formula called Ma Fei San, which translates to "cannabis boiling powder."
For thousands of years, cannabis remained one of the 50 essential plants used in TCM. It was only removed from widespread use in recent times due to its controversial legal status. The film also reviews the history of cannabis in Indian culture. In the Vedas, the sacred text of India, cannabis (bhang) is listed as one of five sacred plants, and the Hindu god Shiva is referred to as "Lord of the bhang," meaning the Lord of cannabis.
According to the Mahanirvana, "bhang is consumed in order to liberate oneself," and liberation is the path to immortality. The ancient Egyptians, Persians and Greeks also used cannabis in a variety of ways, including medicinally and for spiritual upliftment. References to cannabis are even found in Islamic, Judaic and Christian texts, although an error in translation appears to have crept into the Bible along the way. The original Hebrew term "kaneh bosm," or cannabis, is found several times in the Old Testament.
In Exodus, chapter 30, God instructs Moses on how to make a holy anointing oil: "Take for yourself choice spices: 500 shekels of pure myrrh, half as much fragrant cinnamon, 250 shekels of kaneh bosm and 500 shekels of cassia and mix these with olive oil." In more modern Bibles, kaneh bosm has been translated as sweet calamus. The problem is this plant does not have the properties that the Bible ascribes to kaneh bosm.
According to the film, a 12th century painting found in a Sicilian basilica also "appears to show Jesus near a pot leaf." The painting is titled "Jesus healing the blind." Interestingly enough, "modern scientific studies have since proven that cannabis delays retinal degeneration," Rice says.
The American History of Cannabis
In the U.S., the prohibition of marijuana began to turn in 1996 when California became the first state to legalize medical cannabis. Since then, many others have followed. In 2012, Colorado and Washington state became the first states to legalize its recreational use. Today, the majority of Americans support cannabis either as a medicine, for recreational use, or both. Surveys show at least 4 in 10 Americans have tried marijuana, while nearly 60 percent support full legalization.
A 2013 survey found a majority of physicians — 76 percent — also approve of the use of medical marijuana.2 CNN's chief medical correspondent and neurosurgeon Sanjay Gupta also made a highly publicized reversal on his marijuana stance after the production of his two-part series "Weed," which aired in 2014.3
The American history of cannabis goes back to our Founding Fathers, who cultivated the plant for industrial purposes. George Washington, for example, is said to have grown more than 100 hemp plants at his home in Mount Vernon, Virginia.4 Cannabis is called hemp when being used for its fibers, which are extracted from the stem and constructed into rope, clothing and paper.
Hemp plants are low in tetrahydrocannabinols (THC) levels and therefore do not get you high. During the 17th century, hemp was viewed as an important cash crop. It was used for rope by navies around the world, and as a thick durable linen ideal for clothing and packaging heavy materials. Hemp seed oil was used in soaps, paints and varnishes.
The battle that has raged over marijuana is a long and arduous one. You can read a brief history of marijuana prohibition in the Huffington Post.5 Still, movements to legalize marijuana have persisted throughout, starting as early as 1973, when Oregon became the first state to decriminalize cannabis. The most successful movement to date, and the one that produced the first legal marijuana market in decades, is the medical marijuana movement.
Medical cannabis is now legal in 30 U.S. states,6,7 the majority of which allow limited use of medical marijuana under certain medical circumstances, although some limit medical cannabis to oils or pills only. Eight states have legalized it for recreational use.
A number of municipalities have also created their own marijuana rules, either decriminalizing it, legalizing it, enacting rules that direct city law enforcement to cease arresting individuals for marijuana possession, or making cannabis offenses the lowest priority for law enforcement.
What Can Cannabis Treat?
As mentioned, your body makes its own cannabinoids, similar to those found in marijuana, but in much smaller amounts. These endocannabinoids appear to perform signaling operations similar to your body's neurotransmitters, such as dopamine and serotonin. Cannabinoid receptors can be found on cell membranes throughout your body. In fact, scientists now believe they may represent the most widespread receptor system.8
The fact that your body is replete with cannabinoid receptors, key to so many biological functions, is why there's such enormous medical potential for cannabis. Even though research has been limited by its classification as a Schedule 1 controlled substance, its list of medicinal benefits is still quite long. For example, cannabis has been found useful in the treatment of:9,10,11,12,13
Among the most exciting research is that on cancer. Not only does cannabis help with the unpleasant side effects of traditional chemotherapy (including pain, nausea and insomnia), but the cannabis itself appears to be a natural chemotherapy agent.17
Researchers have found cannabis is pro-apoptotic, meaning it triggers cellular suicide of cancer cells while leaving healthy cells untouched, and anti-angiogenic, meaning it cuts off a tumor's blood supply. Dozens of studies point to marijuana's effectiveness against many different types of cancer. For example, Harvard researchers found THC cuts tumor growth in lung cancer while significantly reducing its ability to spread.18
Medicinal Marijuana Can Help Stem Death Toll From Narcotic Pain Killers
Another area where cannabis offers great hope is in the treatment of pain. Overdoses from narcotic pain killers are now the leading cause of death among Americans under the age of 50, and pharmaceuticals in general have for decades been among the leading causes of death in the U.S. According to Dr. Margaret Gedde, owner and founder of Gedde Whole Health and the Clinicians' Institute of Cannabis Medicine, research clearly confirms that cannabis is safer and less toxic than many prescription drugs.
This includes liver and kidney toxicity, gastrointestinal damage, nerve damage and death. Moreover, cannabinoids often work when pharmaceutical drugs fail, so not only is cannabis safer but it's typically more effective. Besides treating intractable seizures, one of the strongest areas of research regarding marijuana's health benefits is pain control.
In 2010, the Center for Medical Cannabis Research released a report19 on 14 clinical studies about the use of marijuana for pain, most of which were FDA-approved, double-blind and placebo-controlled. The report revealed that marijuana not only controls pain but in many cases, it does so better than pharmaceutical alternatives.
If you compare opioids to marijuana, marijuana is unquestionably safer. Contrary to opioids, a cannabis overdose cannot kill you because there are no cannabinoid receptors in your brain stem, the region of your brain that controls your heartbeat and respiration.
What's more, marijuana has been shown to ease withdrawal symptoms in those trying to wean off opioids, which are extremely addictive. In states where medical marijuana is legal, overdose deaths from opioids decreased by an average of 20 percent after one year, 25 percent after two years and up to 33 percent by years five and six.
Big Pharma Takes Aim at CBD
Unfortunately, but not surprisingly, the drug industry is now trying to turn CBD oil into a drug, and hence illegal for sale as a supplement.20 Showing promise for a wide range of ailments, the drug industry sees cannabis as major competition, and rightfully so. June 25, 2018, GW Pharmaceuticals became the first company to gain FDA approval for a CBD-based drug.21,22
The drug in question, Epidiolex, was approved for the treatment of intractable childhood epilepsy in children aged 2 and older. Another product called Sativex is also awaiting FDA approval. Sativex has already been approved in a number of other countries for the treatment of spasticity in multiple sclerosis patients. In a June 25 statement,23 FDA Commissioner Dr. Scott Gottlieb stated:
“This product approval demonstrates that advancing sound scientific research to investigate ingredients derived from marijuana can lead to important therapies … This is an important medical advance. But it’s also important to note that this is not an approval of marijuana or all of its components. This is the approval of one specific CBD medication for a specific use. And it was based on well-controlled clinical trials evaluating the use of this compound in the treatment of a specific condition.
Moreover, this is a purified form of CBD. It’s being delivered to patients in a reliable dosage form and through a reproducible route of delivery to ensure that patients derive the anticipated benefits. This is how sound medical science is advanced. So today, in addition to celebrating this scientific achievement and the medical advance that it represents … we should also reflect on the path that made this possible.
It’s a path that’s available to other product developers who want to bring forth marijuana-derived products through appropriate drug development programs. That pathway includes a robust clinical development program, along with careful review through the FDA’s drug approval process. This is the most appropriate way to bring these treatments to patients. This process also includes a review of the purity of a new drug and manufacturing controls.”
FDA Cracks Down on CBD Supplements
As expected, with its approval of the first CBD drug, the FDA has increased its scrutiny of companies making CBD extracts. In November 2017, four Colorado businesses received FDA warning letters for making “illegally unsubstantiated health claims” on their CBD products.24 In a November 1 press release, the FDA said:25
“[T]he agency today issued warning letters to four companies illegally selling products online that claim to prevent, diagnose, treat or cure cancer without evidence to support these outcomes … The deceptive marketing of unproven treatments may keep some patients from accessing appropriate, recognized therapies to treat serious and even fatal diseases.
The FDA has grown increasingly concerned at the proliferation of products claiming to treat or cure serious diseases like cancer. In this case, the illegally sold products allegedly contain cannabidiol (CBD), a component of the marijuana plant that is not FDA approved in any drug product for any indication.”
The warning letters26 also rejected claims that CBD oil can be classified as dietary supplements since Investigational New Drug (IND) applications have been submitted for the CBD-containing drugs Sativex and Epidiolex. This suggests the agency is not just aiming to clean up the cannabis industry’s propensity to make illegal claims; it also raises concerns that the legality of all CBD products is in question now that at least one CBD-containing drug has been approved.
Many CBD Products Are Mislabeled
The FDA scrutiny is not entirely unwarranted, however. A November 2017 study27 in JAMA found only 30 percent of CBD extracts sold online accurately list the amounts of cannabinoids on the label. And, while CBD is very safe, accuracy is still of utmost importance.
The FDA and DEA will also use information like this to push CBD into pharma-only territory. The JAMA study used triplicate tests to analyze the cannabinoid content of 84 CBD products purchased online, along with a 10-point method validation procedure. A 10 percent plus or minus allowable variance was used, which is consistent with herbal product labeling in general in the U.S. According to the authors:
“Observed CBD concentration ranged between 0.10 mg/mL and 655.27 mg/mL (median, 9.45 mg/mL). Median labeled concentration was 15.00 mg/mL … With respect to CBD, 42.85 percent of products were underlabeled, 26.19 percent were overlabeled, and 30.95 percent were accurately labeled.
Accuracy of labeling depended on product type, with vaporization liquid most frequently mislabeled … and oil most frequently labeled accurately … Concentration of unlabeled cannabinoids was generally low; however, THC was detected (up to 6.43 mg/mL) in 18 of the 84 samples tested … Of tested products, 26 percent contained less CBD than labeled, which could negate any potential clinical response.
The overlabeling of CBD products in this study is similar in magnitude to levels that triggered warning letters to 14 businesses in 2015-2016 from the U.S. Food and Drug Administration (e.g., actual CBD content was negligible or less than 1 percent of the labeled content), suggesting that there is a continued need for federal and state regulatory agencies to take steps to ensure label accuracy of these consumer products.”
Educate Yourself on the Scientific Evidence Supporting Medical Marijuana
If you're still on the fence when it comes to giving people the right to use medical marijuana, one of the best ways to still your fears is to look at the research, and look at what doctors are doing in clinical practice. To start, I recommend listening to my interviews with Gedde and Dr. Allan Frankel, in which they discuss many of the medical benefits of cannabis. Other helpful resources include:
- The International Association for Cannabis website, which maintains a Clinical Studies and Case Report page.28
- Cancer.gov,29 the U.S. government's cancer website, contains research relating to the use of cannabis
- PubMed30 is a searchable public resource containing a vast amount of medical literature, including studies involving cannabis
- The Journal of Pain31 is a publication by the American Pain Society with a long list of studies on the pain-relieving effects of cannabis
- National Institute on Drug Abuse32 provides information about preclinical and clinical trials underway to test marijuana and various extracts for the treatment of a number of diseases, including autoimmune diseases such as multiple sclerosis and Alzheimer's disease, inflammation, pain and mental disorders
- ProCon.org lists 60 peer-reviewed studies on medical marijuana and cannabis extracts published between 1990 and 2014, listed by the condition treated33
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