Back in 2727 B.C. the Chinese Emperor Shen Nung sang the praises of his favorite plant used as a medicine. Throughout the centuries, the medicinal use of the plant spread through ancient Asian and European Cultures. In 1500 BC, it was added to the Chinese pharmacopoeia and it was thought to be good for spirit and mind, said to contain both yin and yang. Fast forward to the United States, as early colonists, they grew the plant to use in manufacturing rope and cloth. By the 1600s and beyond, farmers—including the likes of George Washington and Thomas Jefferson—were growing this plant on their plantations. The plant, Cannabis sativa, is known widely today as marijuana.
The Origins of Medicinal Marijuana
For centuries, humans have used marijuana—or cannabis—for its psychoactive properties recreationally, and its therapeutic properties medically. In Chinese culture, the seeds were used as a laxative, the oil for hair loss, the flowers for menstruation, and the leaves were juiced for use as an anti-worm treatment. “It was also advocated for gout, constipation, and absent-mindedness.” Dr. Sydnee McElroy, host of the podcast “Sawbones: A Marital Tour of Misguided Medicine” says. “Now I’m thinking maybe that last one didn’t work.”
Sawbones is a medical history podcast, and on the episode about marijuana, Sydnee lists numerous things marijuana was used for. Ancient Egyptians used it for glaucoma, enemas, and generalized inflammation. Indians touted the use of marijuana for lowering fevers, curing dysentery, and prolonging life in general. “Cannabis very much was a cure-all. Anything you could name, somebody used marijuana to fix it. So earaches, edema, any kind of inflammation…” Sydnee says.
From Pliny the Elder, who recommended it for cramped joints, gout, and generalized pain to Queen Victoria who popularized marijuana for menstrual cramps, influential people through the ages were proponents of the drug. In the early United States, cannabis was used in a lot of patent medicines—medicines made and sold under a patent and available without prescriptions—until the 1906 pure food and drug act changed the way patent medicines were made and regulated. Today in the United States, marijuana is criminalized, classified as a Schedule I drug, on the same level as heroin, LSD, and ecstasy. In recent years, there has been a push to bring this plant back to its roots as a medical option.
One of the people fighting for the use of marijuana as medicine is a researcher at Boston’s McLean Hospital, Sager Ann Sager. When she was a psychology major at Boston College, Sager wanted to get involved in research and met with people in a few different labs after graduation in her pursuit of finding where she fit. She decided she wanted to work in the laboratory of Dr. Stacy Gruber—affectionately known as the ‘Pot Doc” by her patients—because of all of the different ways she studies the brain.
Medical Marijuana, Today
Over the past few years, through observational studies, marijuana has been shown to have a positive effect on some medical issues. In 2006 Cannabidiol—a non-psychoactive molecule found in marijuana, also known as CBD—helped limit seizures in a little girl in Colorado. Tetrahydrocannabinol—the compound in marijuana that gives the ‘high,’ also known as THC—has been used by cancer patients to help nausea caused by chemotherapy. Dr. Gruber’s laboratory has some data that CBD can be advantageous for sufferers of bipolar disorder and they want to do a full clinical trial.
The lab already performed an observational study in which they looked at several groups of people: those who had been diagnosed with bipolar disorder and those who had not, and those who smoked marijuana and who didn’t smoke marijuana. “Interestingly, the people with bipolar disorder who smoked marijuana, within four hours of smoking, seemed to report some improvements in their mood,” Sager said. Experts in the medical marijuana research field believe that CBD is the part of the plant that has the mood-stabilizing effects as some studies show too much THC can make you more anxious and have negative effects. Yet people still show stabilization in their mood while using recreational marijuana with THC in it.
With all the reported improvements coming from observational studies, why is there still a problem getting research done? “We’re in a really interesting space right now because there’s a lot of studies that we want to do but the way that marijuana and which includes cannabidiol is scheduled right now we’re not able to research all these things in the way that we want to research them,” Sager says.
Prior to the 1930s in the United States, marijuana was a legal and legitimate medical option. Americans used to know marijuana by the name “cannabis.” It was sold on shelves in the pharmacy as tinctures and was fairly widely used. But when the Revolution of 1910 brought a wave of Mexican immigrants to the United States, prejudices against them began to take shape. Just as an American man sits down to a beer at the end of the day, a Mexican man would sit down for a smoke of what they called “marihuana.” The United States government began to spread rumors that use of this “marihuana” would cause these men to be violent and approach proper white women for sex. One of the leaders of prohibition, Harry Anslinger, was once famously quoted as saying, “There are 100,000 total marijuana smokers in the U.S., and most are Negroes, Hispanics, Filipinos, and entertainers. Their Satanic music, jazz, and swing result from marijuana use. This marijuana causes white women to seek sexual relations with Negroes, entertainers, and any others.” In 1937 the result of all this fear-mongering was the Marijuana Tax Act, which banned both the use and sale of marijuana. Later, after marijuana was criminalized, it gave the government an excuse to deport immigrants.
In 1942, cannabis was officially removed from the U.S. Pharmacopeia. Then in 1970, as part of the “War on Drugs,” President Nixon placed marijuana on the Schedule I drug list. As a Schedule I drug, marijuana is listed as having no use medically and a high potential to be abused. In recent years, the U.S. government has been petitioned to remove marijuana from the schedule I drug list, and it has denied each request, partially based on the fact that there is no clinical data.
Sager and her colleagues are trying to change this lack of information. “The problem is that we can research [schedule I drugs] in certain ways,” she says, “but the gold standard of doing research is the clinical trial model.” Because marijuana is classified as schedule I, Sager says they aren’t allowed to buy it from a dispensary and administer it to patients. For a clinical trial to work, they need to randomize patients: some taking the product and some taking placebo. To the government, to do this with marijuana from a dispensary would be like buying heroin and experimenting on people with it. “It is a little bit tricky to do the research with the way that marijuana and its constituents are scheduled right now.”
Most studies have been done in rats. “As far as human studies, a lot of what we do is anecdotal,” McElroy says, “we interview people who smoke pot because we can’t give it to them. So, we take a bunch of people that have pain, and we say ‘do you smoke marijuana’ and if they say ‘yes’ we put them in one group and if they say ‘no,’ we put them in another, and then we ask them a bunch of questions.”
The only way that clinical trials can be done on a schedule I drug is to go through the federal government, and Sager says it takes years to get the go-ahead for a clinical trial. In the case of the Gruber lab, the Food and Drug Administration (FDA) and the local Institutional Review Board (IRB) had approved a product the lab-made, a high CBD preparation that was derived from hemp and was ready to go until the Drug Enforcement Administration (DEA) stepped in and told them that anything derived from the marijuana plant is still a Schedule I substance and can’t be given in a clinical trial. The only way to get a product approved to be administered in a clinical trial is if the drugs are obtained from the National Institute for Drug Abuse (NIDA). Of course, there is a lot of red tape to get through first.
“The only one place that it can come from is from NIDA, and there is one place that they grow marijuana, the University of Mississippi,” Sager says. And it’s not easy to get what they need from NIDA. Sager says that NIDA have expanded their options in recent years, but they still don’t have many non-flower products, so researchers have to administer a tincture instead of a smokable. The tincture is specially formulated by the lab to help reduce anxiety. “There are lots of other products out there that we would love to study, but they don’t come from the government,” Sager says. “In the future, we would love to have more ecologically valid studies and actually study products that are out there that people are buying.”
The Future of Medical Marijuana
The status of marijuana has been causing controversy in the U.S. People are now widely beginning to realize that marijuana does indeed have some medical purposes, and even pregnant women have started experimenting with marijuana to ease nausea associated with morning sickness. It can seem scary to have people self-experimenting with this drug, but Sager says its only scary because we don’t have enough information about it. There are other drugs we use that have been studied and approved but have the potential to be more dangerous due to their side effects. When it comes to medication and marijuana Sager’s opinion is, “It’s out there, it’s around, people are using it. We just need to study it more.”