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What is Cannabis?

The herbaceous flowering plant Cannabis sativa is from the family Cannabaceae, which is native to Central Asia and India. It is known by many names-marijuana, pot, grass, weed-and can be smoked, vaporized, and consumed orally through edible products. Cannabis contains both medicinal and psychoactive properties and in its nontoxic form, hemp, can be used to make rope, textiles, clothing, paper, and biofuel. Cannabis contains more than 100 chemical compounds, called cannabinoids; the two most commonly known are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is highly potent and primarily accounts for the psychoactive response from cannabis (e.g., euphoria, heightened sensory awareness, creativity, altered sense of time and space, enhanced appetite, increased sexual desire, drowsiness), whereas CBD is generally not psychoactive and instead is often used as an anti-inflammatory agent and analgesia.

Cannabis has a long and circuitous history of sanctioned and unsanctioned use by civilizations and societies dating back to ancient times. Understanding this history can help shed light on current attitudes toward and perspectives on cannabis use in the United States, which directly impact cannabis use behaviors. This chapter will briefly discuss the geographic and historical origins of cannabis, the recent history of its use in the United States, and ideological/sociocultural factors that account for the growing increase in its acceptance and availability in the United States (For a brief summary of the chemical and botanical properties of cannabis, see Chapter 3.)

The Geographical and Historical Origins of Cannabis

Cannabis has been used in one form or another since the prehistoric ages and is widely believed to have originated in the steppes of Central Asia in approximately 12,000 BCE. In early human societies, it played a role in textile manufacturing (e.g., basketry, fishing nets), medicine, food (i.e., the seeds), and as a part of shamanic rites and religious rituals [10].

Its cultivation for fibers is estimated to have started around 4000 B.C. [11]. Some of the oldest evidence of its use for psychoactive purposes comes from the excavation of a shamanic tomb in China in 2700 B.C. [12]. Ancient Chinese texts also make reference to and praise the cultivation and use of cannabis and its byproduct, hemp.

Cannabis use migrated from China to Korea and Japan around 200 B.C., largely in the form of hemp (e.g., used for rope, clothing), and into the South Asian subcontinent around 2000 B.C. to 1000 B.C. [13]. Its use flourished in India, where it was often taken for psychoactive and medicinal purposes, such as during weddings and religious celebrations (e.g., Holi). Cannabis is mentioned in the Hindu scripture the Bhagavad-Gita and is associated with the Hindu god Ganga (giving rise to the term ganja). From India, the plant migrated to Tibet and Nepal in the 7th Century, where it was used as part of Tantric practices.

Cannabis appeared in the Middle East likely between 2000 B.C. and 1400 B.C. via nomadic Indo-European traders and warriors. It then moved into Russia and Ukraine, eventually spreading into Eastern Europe around 3000 B.C. to 2000 B.C. Throughout the 5th Century, cannabis was used across Germany, Britain, Scotland, and France, generally for sails, rope, paper, clothing, and nets. From the Middle East or Europe, cannabis then diffused into Greece and Rome, where it was used medicinally, as a psychotropic, and as a source of fiber. In at least the 15th Century, it likely made its way into Eastern Africa via trade routes from Egypt and Ethiopia and spread throughout Africa largely through coastal migrant settlements. There, it was often used to treat snake bites, malaria, fever, blood poisoning, anthrax, asthma, and dysentery [11]. Cannabis later arrived in South America in the 16th Century, where it became a part of religious rituals and was provided for physical ailments like toothaches and menstrual cramps [11]. Its recreational use in South and Central America did not appear until the 19th Century and during construction of the Panama Canal in the 20th Century [13].

The popularity of cannabis fibers among the British extended to the United States via British colonization [13]. Hemp was grown on the estates of George Washington and Thomas Jefferson, and the US Constitution was written on paper made from hemp. In 1619, the Virginia Assembly passed a law requiring all farmers to grow hemp, which was considered legal tender in Pennsylvania, Virginia, and Maryland. Domestic production decreased after the Civil War, with the advent of the cotton gin offering a cheaper alternative to hemp. Strictly recreational use likely was not introduced until much later, during the early 20th Century, as a product of Mexican immigration [14].

History of the Medicinal Use of Cannabis

As noted here, ancient civilizations, including those in Egypt and China, are known to have medicalized cannabis for disease such as fatigue, rheumatism, and malaria [10]. Numerous other societies, including those in India, the Middle East, Southeast Asia, South Africa, and South America, have documented histories of using cannabis as a medicine for a wide range of maladies, such as pain, malaria, constipation, fever, rheumatism, sleeplessness, dysentery, poor appetite, slow digestion, headache, female reproductive disorders, labor/childbirth pain, skin inflammation, depression, and cough [11, 15].

The medicalization of cannabis was greatly influenced by the work of Irish physician William Brooke O'Shaughnessy [11]. While working in India in the 1840s, O'Shaughnessy wrote prolifically about the medicinal benefits of cannabis (which was commonly used in India) and provided detailed records of his numerous animal and human experiments in treating cholera, rheumatism, hydrophobia, tetanus, rabies, and convulsions. His research, published in The Bengal Dispensatory in 1842 and The Bengal Pharmacopoeia in 1844, led to a surge in the medical field's interest in the potential ameliorative effects of cannabis, and the republication of his findings in British and European medical journals helped pioneer scientific inquiry into the plant. Indeed, more than 100 articles on the medical use of cannabis appeared in medical journals from 1840 and 1900. By then, the British had adopted cannabis as an effective analgesic, anti-inflammatory, antiemetic, and anticonvulsant [10]. Nonetheless, its psychoactive properties led to public fear of misuse and addiction, and cannabis was removed from the British Pharmacopoeia by 1932 [10].

On the heels of O'Shaughnessy's pivotal research, cannabis began to be recognized and used by Western medicine around the mid-19th Century, including its listing in the United States Dispensatory in 1854 [15]. In the US, commercial cannabis was available in drugstores and pharmacies, and doctors often prescribed it for sedative or hypnotic purposes, as an analgesia, and for other miscellaneous uses (e.g., poor appetite, gastric upset, vertigo) [11]. Increasing research in the United States and United Kingdom throughout the late 19th Century shed light on its utility in controlling pain, anxiety, migraines, poor appetite, and restlessness [15]. However, medicinal cannabis use began to decline around 1890, replaced by the advent of synthetic (and more stable and reliable) drugs like aspirin, chloral hydrate, and barbiturates.

At the start of the 20th Century, efforts to regulate cannabis, such as through the Pure Food and Drug Act, underscored a growing concern about the plant's safety. Consequently, from 1914 to 1925, 26 states made cannabis illegal [14]. By the 1930s, public perception in the United States had solidly shifted, mirroring that of Britain and Europe [10] and fed in part by massive economic and job losses during the Great Depression. No longer embraced as a potentially powerful medicinal tool, cannabis was now deemed harmful, addictive, and a moral blight on civilized society. This was reflected in the passage of the Uniform State Narcotic Act in 1932, which gave states the ability to control the sale and use of narcotics (and cannabis). Among its most vocal supporters and lobbyists was Harry Anslinger, Commissioner of the Federal Bureau of Narcotics, who also was a central figure in the adoption of the Marijuana Tax Act of 1937. The first federal government regulation of cannabis, the Marijuana Tax Act provided an additional barrier to the research and use of cannabis for medical purposes by taxing physicians and pharmacists using cannabis medicinally. And although it technically did not criminalize cannabis, it essentially did so by making the sale and possession largely illegal. Its passage was intended to (and indeed did) dissuade the general public from recreational use, as Anslinger was an outspoken critic who claimed cannabis led to addiction, violent crime, psychosis, and mental dysfunction.

Having now effectively made the medical use and study of cannabis not only more difficult but costly and socially taboo, the federal government in 1942 had the plant removed from the United States Pharmacopeia and National Formulary [16], and in 1951 and 1956, enacted legal penalties for the possession of cannabis via the Boggs Act and the Narcotic Control Act, respectively. Cannabis was finally criminalized at the federal level under the Comprehensive Drug Abuse Prevention and Control Act of 1970. It should be noted that that...