The history of Medical Cannabis

When the new king of Madagascar, Andrianampoinimerina, assumed the crown in 1787 he objected to people becoming “half-witted” through cannabis. Despite its long history of medical use, consumption became punishable by death. The regressive move came several centuries after consumers in Egypt – where hashish was commonly eaten – were said to have their teeth pulled out on the orders of the Ottoman ruler, in one of the first cannabis bans in history.

But the benefits of cannabis use have meant that draconian clampdowns have generally never worked for long. It is part of ancient Chinese pharmacopoeia – with evidence suggesting cultivation 12,000 years ago. There are records from the Assyrians, Greeks, Indian Hindus and Romans that show cannabis use for pain relief, inflammation reduction, mood enhancement and arthritis treatment. Cannabis has also been used to bring relief from malaria, constipation and rheumatism, and the Vikings used it to relieve toothache pain and provide respite to women during childbirth.

In the UK, cannabis was medically accepted until the 1930s. During the Tudor era, farmers were mandated to grow hemp for naval materials such as rope, and Queen Victoria’s doctor Sir John Russell-Reynolds may have prescribed her cannabis oil for menstrual cramps. But prohibitions began to emerge amid perceived recreational use. In South Africa, in the 1870s, it was banned solely among Indian immigrants, in one of the starkest signs drug laws have been used to target migrants. Mexico followed in 1920, the UK’s 1928 Coca Leaves and Indian Hemp Regulations classified cannabis as a poison and the US made it illegal for all uses in 1937. It started to pressure international organisations to move similarly.

 “By getting the public to associate the hippies with marijuana … and then criminalising both heavily, we could disrupt those communities” Ex-US president Richard Nixon

Then, in 1961, the UN deemed cannabis to possess no medical value and having “particularly dangerous properties”. It became a schedule one drug and research, and medical use was stopped in its tracks (though this was recently reversed). A former aide of “war on drugs” architect, ex US president Richard Nixon, later admitted that “by getting the public to associate the hippies with marijuana … and then criminalising both heavily, we could disrupt those communities” amid a campaign against the antiwar left.

However, reefer madness narratives increasingly crumbled as miraculous tales of the use of cannabis for serious medical conditions which had not otherwise responded to treatment. “In the 1970s, Holland was one of the first countries to diverge from prohibitionist policies and permitted medical use of cannabis,” says Dr Jessica Steinberg, who recently received a PhD from Oxford University on the history of legal cannabis markets.

“There was already relaxed law enforcement, including an adopted harm reduction approach. At the time, youth movements were gaining force. There was a need to acknowledge younger generations and prohibitionist policies did not align with these groups’ interests.”

Then US states, beginning with California in 1996, legalised medical use; amid growing suggestions of its usefulness for epilepsy, multiple sclerosis, chronic pain, anorexia and even cancer. “There have been other state laws labelled as ‘compassionate use’, which highlights the role of advocacy and patient’s lived experiences of struggle in advancing reform,” adds Steinberg.

“Like a lot of politicians do, they didn’t really listen to the scientific evidence,” Prof Mike Barnes

Brazil, Italy, Canada and dozens of other countries soon followed as cannabis prohibitions began to go to pot. In 2018, the UK begrudgingly followed suit under pressure from two high-profile media campaigns featuring children suffering from rare forms of epilepsy that only cannabis could ease.

“Like a lot of politicians do, they didn’t really listen to the scientific evidence,” says Prof Mike Barnes, the director of The Medical Cannabis Clinics, a specialist medicinal cannabis centre. “They listened to the emotion behind the children with epilepsy who the press got behind.”

Four years on, amid serious barriers, access has gradually opened up yet low-cost supplies are not available through public healthcare systems. A month’s legal supply can be obtained privately for those who can prove they have a medical need for up to £300, however large amounts of specialist oils needed by children with epilepsy remain in excess of £1,000. Prescriptions on the NHS remain almost unheard of.

“We need better choice,” says Barnes. “Even the best prices of about £4,000 a year leaves medical cannabis well out of the reach of many families who need it.” And few doctors are prepared to prescribe, with retirements and oversubscription leaving people scrambling or forcing them into the black market.

The backlash also continues, even as 10,000 prescriptions have been issued across the UK since legalisation and some 50 countries have legalised medicinal use. An Australian scientist, Dr Stuart Reece, told a Home Affairs committee meeting on 18 May that there is evidence of DNA mutations from cannabis. He has also published a questionable paper claiming there is a higher risk of cancer in cannabis users.

“We’re talking about high duty recreational use anyway and not medical use,” says Barnes. “So the risks of properly prescribed medicinal cannabis are small. This is scaremongering.”