CHAPTER 2 HISTORY OF THE USE OF CANNABIS

2.1 The earliest known reference to cannabis is in Assyrian tablets of the
seventh century BC. It has thus been in use for at least 2600 years. Like
very many other herbs, it has been used medically for a wide variety of
ailments, especially throughout Asia and the Middle East. The mild euphoria
that it induces led to its use as an intoxicant, perhaps most notably in
countries where Islam prohibited the use of alcohol.

2.2 In Western medicine, it appeared in the Herbal (i.e. pharmacopoeia) of
Dioscorides of about 60 AD, and in all subsequent herbals. The 16th century
saw a detailed interest in cannabis, with reports of it and its usages
being sent back by many travellers to the East, and the number of possible
uses given in the herbals doubled. In England, the Herbal of John Gerard
(1597) recommended it as it "consumeth wind and drieth up seed [i.e.
semen]", and quoted Dioscorides as recommending it for easing the pain of
earache and for the treatment of jaundice. Nicholas Culpeper, in his Herbal
(1653), gave the same indications for the use of cannabis seeds, and also
recommended the decoction of the roots, as this "allayeth inflammations,
easeth the pain of gout, tumours or knots of joints, pain of hips...".

2.3 In these and other early Herbals, each medicine was said to have
multiple uses, often without justification. More critical views ultimately
prevailed, but only slowly. Thus by 1788 the New Edinburgh Dispensatory
still included three quarters of the entries of Dioscorides, but excluded
most animal products. Such exotic remedies as "scrapings of an elephant's
tooth", "dust from the walls of a wrestling school" and, remarkably, as a
cure for quartan malaria, "seven bed bugs in meat and beans", had been
eliminated. The loss of the animal products and most of the minerals left
the 1788 New Dispensatory consisting mainly of herbal remedies. There was
little change for 150 years, and the British Pharmacopoeia of 1914 included
most of the contents of the volume of 1788. But the situation was about to
change radically, with the rise of synthetic pharmaceutical chemistry.

2.4 Meanwhile, in 1833 Samuel Carey in his Supplement to the Pharmacopoeia
and Treatise on Pharmacology advised that cannabis could be used to make
"an agreeable intoxicating drink". This is the only British reference to
cannabis as an intoxicant known to us from this period.

2.5 Cannabis was reintroduced into British medicine in 1842 by Dr W
O'Shaughnessy, an army surgeon who had served in India. In Victorian times
it was widely used for a variety of ailments, including muscle spasms,
menstrual cramps, rheumatism, and the convulsions of tetanus, rabies and
epilepsy; it was also used to promote uterine contractions in childbirth,
and as a sedative to induce sleep. It is said to have been used by Queen
Victoria against period pains: there is no actual proof of this at all, but
Sir Robert Russell, for many years her personal physician, wrote
extensively on cannabis, recommending it for use in dysmenorrhoea. It was
administered by mouth, not by smoking, but usually in the form of a
tincture (an extract in alcohol). Cannabis extracts were also incorporated
in many different proprietary medicines.

2.6 "People were well aware at that stage that [cannabis] was an
unpredictable drug" (Edwards Q 26). The advent of a host of new and better
synthetic drugs led to the abandonment of many ancient herbal remedies,
including cannabis. Thus in the British Pharmacopoeia of 1932 no fewer than
400 herbal remedies were omitted, among them cannabis, extract of cannabis
and tincture of cannabis -- though all three remained in the British
Pharmaceutical Codex of 1949[4].

2.7 Until 1968, the only control of medicines in the United Kingdom (other
than those regarded as dangerous) was provided by the pharmacopoeias, which
set quality standards for the preparation of drugs. The Medicines Act 1968
was enacted following the thalidomide tragedy: it gave the Government power
to license pharmaceutical companies, and individual products and clinical
trials. It also established the Medicines Commission and the Committee on
the Safety of Medicines, to advise the Government on the exercise of their
new powers. Existing drugs received "licences of right". The licensing
powers are now exercised through the Medicines Control Agency (MCA).
Doctors may prescribe an unlicensed drug, or a licensed drug for an
unlicensed indication ("off-label"); but they do so at their own risk, and
without the benefit of the surveillance for adverse effects which is
conducted in respect of licensed medicines through the "yellow card" system.

2.8 Drug abuse has been the subject of international conventions since
1912. In 1961 these were consolidated and brought up to date by the UN
Single Convention on Narcotic Drugs. Cannabis and cannabis resin were
listed in Schedule IV, which entitled (but did not oblige) parties to adopt
"special measures of control", and to ban them altogether "except for
amounts which may be necessary for medical and scientific research only,
including clinical trials..." (Article 2.5). According to the Home Office
(p 150), this reflected "WHO's view that the drug was widely abused, had no
therapeutic value and was obsolete in medical practice". Under the
Dangerous Drugs Act 1964 (shortly consolidated by the Dangerous Drugs Act
1965), which implemented the Convention in the United Kingdom, cannabis was
still able to be prescribed, though subject to certain controls. The
tincture received a "licence of right" under the Medicines Act 1968;
doctors were therefore still able to prescribe it.

2.9 The scale of drug abuse increased dramatically during the 1960s. In
1971 the UN adopted a further Convention on Psychotropic Substances; and
the United Kingdom enacted the Misuse of Drugs Act 1971, which repealed the
Act of 1965 and other enactments, replacing them with a more comprehensive
and flexible regime. Cannabinol and its derivatives including THC (the
chemical which gives cannabis its psychoactive properties -- see Chapter 3)
appeared in Schedule I to the Convention, and parties were therefore
obliged to ban them "except for scientific and very limited medical
purposes by duly authorized persons" (Article 7(a)). In 1973 the licences
of right granted in 1968 were reviewed, and the original Misuse of Drugs
Regulations (SI 1973 No. 797) were made under the 1971 Act. Cannabis's
licence of right was not renewed, and the Regulations listed cannabis,
cannabis resin and cannabinol and its derivatives in Schedule 4 -- which is
now Schedule 1 to the Misuse of Drugs Regulations 1985 (No. 2066) --
thereby prohibiting medical use altogether.

2.10 According to the MCA, by 1973 there was "insufficient evidence" to
support medical use of the tincture (Q 174), and it was rarely prescribed
except to patients who were already drug misusers. The Parliamentary
Under-Secretary of State for Health told the Commons on 14 January 1998
(col. 320), "It was rarely used and, when it was, it was used mainly for
its sedative qualities. Advice at the time from the World Health
Organization was that cannabis was no more effective than any other
available drug in treating the conditions for which it was used, so its use
was stopped." According to the Department of Health, there was also a
problem of diversion to recreational use through bogus prescriptions (Q 174).

4 The British Pharmaceutical Codex, produced by the Royal Pharmaceutical
Society of Great Britain, was a source of officially recognised standards
for pharmaceutical preparations until 1979. Since then it has been in the
process of being superseded by the British and European Pharmacopoeias. Back

Checked-by: Richard Lake