MODULE 1: The history of cannabis as medicine

1.1 Learning objectives

After studying this module, you will have learned about the following:

The global timeline of cannabis use as a medical practice
The evolution of the modern regulation of medical cannabis
The history of prohibition and the legacy of criminalization
Shifting attitudes towards cannabis for medical purposes

1.2 An ancient medicine

Although medical cannabis use remains somewhat controversial, the therapeutic usage of this plant actually has a documented history dating back to 2737 BC. The cannabis plant has been used to treat numerous ailments for centuries in many areas around the world.

1.3 The rise of modern regulation

The regulation of medical cannabis in North America has been evolving rapidly, and it has resulted in over 70 years of prohibition of the cultivation, use, sale and research into cannabis as medicine.

1.4 Cannabis prohibition

How did we get here?

Cannabis is the most-frequently used illicit psychoactive substance in the world. While used for centuries legally, things changed dramatically for cannabis in the 1930s and 40s. Unlike other botanical medicines whose use has faded out naturally, cannabis was cut down in its heyday as a result of political and social pressures. Cannabis use was restricted first in the United States and then the laws of other countries followed suit.

In the 1930s, US federal narcotics and government officials orchestrated a ruthless media campaign against marijuana use that has been called a “hysteria campaign”. The powers that be did not explain that “marijuana” was the same plant as cannabis, which had been used for decades. By the mid-1930s, magazines and newspapers were full of reports of awful crimes being committed while under the influence of marijuana and warnings about the “burning weed with its roots in hell”. This trend is typified by the well-known 1936 propaganda film Reefer Madness, which depicts innocent high school students lured into marijuana use that results in manslaughter, suicide, attempted rape and, ultimately, irreversible madness.

Factors contributing to the anti-marijuana trend

Particularly in the US, complex social and political factors contributed to cannabis prohibition, including:

Anti-immigrant sentiment
Economic insecurity
Personal ambition
Political/religious landscape

Mexican immigration and the Great Depression

A wave of Mexican immigrants settled in the southwestern US after the Mexican revolution of 1910, popularizing the recreational use of “marihuana” in a smoked form. As the drug’s popularity grew, it was negatively associated with the immigrant community. Anti-cannabis factions deliberately referred to it as “marijuana” (the Anglicization of the original Spanish term) to emphasize the drug’s foreignness and play into anti-immigrant sentiment. Rumours spread of Mexicans bringing their “demon weed” or “locoweed” to unsuspecting American schoolchildren. In many cases it was not clear that marijuana was, in fact, the same cannabis plant used for years by local apothecaries.

Along the Gulf Coast, the plant also became associated with West Indian immigrants, and this connection was broadly extended to African-Americans, jazz musicians, prostitutes and lower-class whites. Anti-drug campaigners often depicted marijuana as associated with the criminal immigrant class.

During the Great Depression of the 1930s, widespread poverty and unemployment further deepened resentment of immigrants and minorities.

In Canada, drug prohibition began with the Opium Act in 1908. The drug prohibition movement in Canada was largely based on anti-Chinese sentiment and the agitation of moral reformers. Cannabis was swept up in the anti-drug reforms of the 1920s and added to the Confidential Restricted List in 1923 under the Narcotics Drug Act Amendment Bill. It is likely it was added based on Canadian participation at international conferences where marijuana was discussed.

One man’s crusade

Considered the father of the war on drugs, Harry Anslinger was the first man appointed as Commissioner of the US Federal Bureau of Narcotics in 1930, after working as the assistant commissioner of the Bureau of Prohibition. Prior to the repeal of alcohol prohibition in 1933, Anslinger claimed that cannabis was not a problem and did not lead to violence or harm. After alcohol prohibition was repealed, however, it is believed that he radically changed his position out of self-interest. He ran the Department of Prohibition, which would shrink considerably without a new mass scourge to fight. In a bid for power and a larger department budget, he began to build on the very fears he had previously dismissed, casting marijuana as an addictive narcotic favoured by undesirables that would lead to violent behaviour.

Anslinger and his department elevated and promoted dubious anecdotal evidence of marijuana’s link to violence and ignored contradictory evidence of its usefulness as a therapeutic (he disregarded a statement from the American Medical Association in which 29 of 30 pharmacists and drug industry representatives objected to his proposals to ban it). Despite the fact that marijuana use was not widespread at the time, Anslinger depicted it as an epidemic scourge and spearheaded the hyperbolic mass media campaign against the drug, creating a deeply rooted stigma that lingers to this day. Anslinger held his position until 1962.

1.5 Criminalization and decriminalization

The 60s and 70s

The government anti-marijuana campaign persisted into the 1960s, but in the 60s and 70s, cannabis was widely adopted by the anti-war movement and “hippie” counterculture in both the US and Canada. In response, the Canadian Government formed the Royal Commission of Inquiry in the Non-Medical Use of Drugs in 1969 (known as the Le Dain Commission) to investigate non-medical cannabis use in Canada. The commission’s, 1972 report recommended removing criminal penalties for cannabis possession, but these recommendations were mostly ignored.

In the US, the increased recreational use of cannabis briefly resulted in a relaxation in enforcement and even some government reports that found the drug did not, in fact, cause violence. However, in 1970, the US congress passed the Controlled Substances Act as part of President Richard Nixon’s anti-drug policy. Cannabis was added to the highly restrictive Schedule 1 category, reserved for drugs considered to have a high potential for abuse and no medical benefit. This classification may have been influenced more by Nixon’s hostility towards the counterculture than by science or medical opinion. In fact, in 1972, a bipartisan investigative committee he had appointed to study drug abuse in America (the Shafer Commission) recommended the decriminalization of possession of small amounts of cannabis and concluded that it did not pose any widespread danger to society. Nixon rejected these findings outright, but the report had a significant influence on state governments. From 1973-1978, 11 states passed decriminalization statutes. Nevertheless, at the federal level, the Schedule 1 designation remains to this day, and it has effectively halted medical research into the potential of cannabis as a therapeutic.

The Netherlands decriminalized marijuana in 1976.

1980s and criminalization

As public experience with cannabis grew, general trust in government-led anti-cannabis messages diminished. The 1980s saw President Ronald Reagan’s Just say no campaign reframe cannabis from a violence-inducing substance into a “gateway” that would lead to heavier drug use. In 1986, Reagan signed the Anti-Drug Abuse Act, which instituted mandatory sentencing for drug-related offenses and federal penalties for the sale and possession of many drugs, including cannabis. It was later amended to include a “three strikes” policy, requiring life sentences for repeat offenders.

Drug-related arrests skyrocketed after this law was introduced, and overall prison populations grew from 400,000 in 1986 to almost 1.5 million in 2015. Cannabis arrests (mostly for possession) have accounted for over half of all drug arrests in the US, and African-Americans were, and continue to be, arrested at dramatically higher rates than whites, despite similar rates of use.

By the 1980s, Canadian police forces were also pursuing more cannabis arrests than ever before. In 2016, this resulted in over 75,000 arrests annually.

1.6 Legalization and the modern use of cannabis for medical purposes

Over time, the conclusions of the LeDain and Shafer commissions have been adopted into mainstream public opinion in North America. Today, many Canadians view cannabis as a generally harmless plant with effects that are no worse than those seen with alcohol.

In 1996, a solid majority of Californian voters supported Proposition 215, which allowed California to legalize the sale and use of cannabis for patients with acquired immune deficiency syndrome (AIDS), cancer and other serious diseases. Since that time, 28 other US states have passed laws legalizing the medical use of cannabis.

In 2003, the Canadian government recognized shifting public attitudes and introduced a bill that would decriminalize the possession of a small amount of cannabis, but the Liberals that proposed the bill backed off under pressure from the American Drug Enforcement Agency (DEA). The bill was unsuccessfully introduced again in 2004.

In 2000, the Supreme Court of Canada ruled that Canadians have the constitutional right to use cannabis for medical purposes and noted that the 1923 ban on cannabis was “based largely on misinformation and racism”.

Canada first legalized the medical use of cannabis at the federal level in 2001 with the Medical Marijuana Access Regulations (MMAR). These regulations were updated in 2013 to the Marijuana for Medical Purposes Regulations (MMPR), then in 2016 to the Access to Cannabis for Medical Purposes Regulations (ACMPR) and again in 2018 to the Cannabis Regulations under the Cannabis Act.

1.7 Recap

Cannabis has been used by human beings for medical purposes for thousands of years
Due to complex socio-political factors, over-regulation, criminalization and prohibition have left this plant largely untouched by modern scientific examination and surveillance
This has resulted in persistent stigma
Modern attitudes are shifting, and the current landscape shows strong trends towards decriminalization, public acceptance, and the examination of therapeutic potential

1.8 Learning check

1. True or False: Cannabis was used in ancient

a) True
b) False

2. Complete the following statement: Arabic scholars thought cannabis was effective for________.

a) Headaches
b) Toothaches
c) Epilepsy
d) Gout

3. True or False: Canada has had 4 versions of its medical cannabis legislation.