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
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