Thursday August 20, 2015
At the turn of the 20th Century, cannabis was widely used for a variety of ailments and more than 2,000 preparations of the plant were available and prescribed to users. The Marijuana Tax Act of 1937, enacted for racial and economic purposes, began the demise of medical cannabis use but it was hastened by the advent of many new pharmaceutical drugs such as penicillin and digitalis, each derived from natural products but suddenly available in “pure” and “modern” dosing. Cannabis might have survived this dawning of the new age of pharmaceuticals but the U.S. federal government had branded marijuana a “dangerous drug” and was engaged in a systematic destruction of the plant’s long and distinguished use as a medication. The drug was removed from the U.S. Pharmacopeia in 1942.
Medical use of cannabis never fully disappeared but it was relegated to the category of “folk medicine” which, in the 1940s and 50s, had a disparaging connotation. And obtaining the plant became more and more difficult.
In the 1960s and 70s there was a reawakening of interest in the medical use of cannabis. This was generated primarily by “anecdotal” reports from marijuana users but also from researchers of the federal government who were charged with finding the “harms” of marijuana but very often stumbled upon potential benefits. Some researchers reported these benefits publicly. Glaucoma is a good example of this. Researchers were seeking a way to detect illegal marijuana use and a popular myth had been that smoking marijuana causes bloodshot eyes. That theory was debunked but researchers did note that smoking marijuana caused a lowering of inner eye pressure and Dr. Robert Hepler of UCLA wrote a letter to the Journal of the American Medical Association (JAMA) in September, 1971 stating that:
The purpose of this letter is to present preliminary data concerning the most impressive change observed thus far, namely a substantial decrease in the intraocular pressure observed in a large percentage of subject….The possible implications, including the mechanism of action, and even possible therapeutic action in the treatment of glaucoma, are obvious.
Five years later a young professor in Washington, D.C., who was diagnosed with glaucoma at the age of 24, made medical and legal history when he proved in criminal and civil proceedings that marijuana was a “medical necessity.” He capitalized on Hepler’s findings and was tested by the UCLA doctor for ten days. The results were incontrovertible: without the addition of marijuana conventional medications were ineffective for Robert C. Randall, who then successfully petitioned the federal government for access to U.S. supplies of marijuana and became “America’s Only Legal Pot Smoker.” Randall would lead the fight for medical access to cannabis for the next 25 years and is the acknowledged father of the medical marijuana movement.
But even Randall’s legal access demonstrates the rudimentary state of cannabis research as well as the intense level of prohibition in the later part of the 20th Century. There was one source for medical marijuana, the federal government, and the product was grown solely with a view towards the psychoactive properties of the plant. Even though numerous constituents of the plant were already known, it was only delta-9 THC that interested the government. The plant was grown in Mississippi and then shipped to North Carolina where it was processed and rolled into cigarettes. The government claimed that all other ingredients were “removed” at this point and the cigarettes were purely delta-9 THC, dose-quantified in the 1.5 to 1.8% range. The government also created a delta-9 THC pill that delivered 10mg of THC. The pill was not intended for human consumption, but did facilitate animal experiments.
In the early 1990s, a series of research discoveries ensued which led to the discovery of the endocannabinoid system (ECS). At about the same time the legal situation in the U.S. changed dramatically as states began enacting medical cannabis laws in direct response to the federal government’s closure of the Compassionate IND program, the only means of legal access to medical marijuana. The first, of course, was in 1996 in California. Not surprisingly, Californians embraced medical cannabis wholeheartedly and the loose structure of Proposition 215 allowed a free-wheeling industry to develop in the Gold Rush state. California’s state program remains one of the least restrictive in the country. It is also not surprising that the early years of the program drew upon the thriving, albeit still illegal, recreational market for product supplies and marketing. Thus cannabis medications took on a decidedly non-medical veneer. Patients ordered medicines by their street names---e.g. OG Kush and Purple Urkle---and “medical dispensaries” looked much more like “head shops” than pharmacies. For the marijuana-naïve patient, it was a foreign and frightening world.
As we entered the 21st Century, however, things began to change, somewhat. Clinical research outside of the U.S. began looking at the various cannabinoids, especially the now-famous CBD, and their effect on the ECS. As it became clear that the ECS was a pivotal component of human biology and is a key player in the important process of homeostasis, the research accelerated. New applications of the cannabis plant emerged fulfilling the prescient testimony of the AMA lobbyist Dr. William Woodward, who in 1937, spoke against the Marijuana Tax. Acknowledging that the plant was falling into disuse he also wisely noted that “future investigation may show that there are substantial medical uses for Cannabis.”
The good doctor would be amazed.