The Cannabis Apothecary

Cannabis has a long and interesting past. The earliest record of the plant comes from roughly twelve thousand years ago. A Neolithic cave painting found in Kyushu, Japan, depicts tall stalks with hemp-shaped leaves featured alongside impressively dressed people, horses, and crashing waves. Dried cannabis seeds have also reportedly been found in excavations of ancient ruins on the tiny island of Okinoshima, off the coast of Kyushu.¹

More recently, archeologists found proof of the use of the cannabis flower in China’s Gobi Desert. Excavations done in the 1990s turned up evidence of an ancient mass burial site from roughly 2,700 years ago. This discovery of two thousand ancient tombs also memorably turned up a large leather basket full of ancient weed.² That these ancient peoples were willing to drop a pound of pot into a grave serves as a pretty strong indicator that cannabis must’ve been plentiful and important in their primitive society, which Dr. David Casarett notes in his book Stoned: A Doctor’s Case for Medical Marijuana.³ Tests done by neurologist and cannabis researcher Dr. Ethan Russo and his team revealed that this musty stash contained high levels of cannabinol (CBN),⁴ a cannabinoid that is produced over time as THC breaks down. This new information led archeologists to determine that the ancient weed was extremely high in THC. In all likelihood, our ancestors indeed used cannabis for medical and/or spiritual purposes. Cannabis seeds (achenes) have been documented in Chinese medicine for around 1,800 years. To this day, seeds are listed in the Chinese Pharmacopoeia for use as a laxative.⁵ Cannabis seeds have also been found inside Siberian burial mounds that date back to 3000 BC.⁶

The two men who are given credit for introducing cannabis to the West are Portuguese botanist and physician Garcia da Orta and Irish doctor William Brooke O’Shaughnessy. Da Orta sailed to Goa in the 1530s to serve as the physician to the Portuguese viceroy to the Indies. While in India, he came into contact with the cannabis drink known as bhang. In a book published in 1563, da Orta described his experiences with this strange new elixir: “The Indians get no usefulness from this [bhang], unless it is in the fact that they become ravished by ecstasy, and delivered from all worries and cares, and laugh at the least little thing.”⁷

O’Shaughnessy discovered cannabis while in India as well. But in his case, he saw that it was extensively used in medicine, particularly for combating seizures, rheumatism, and spasms caused by tetanus. On his return to England, he published a paper in the Provincial Medical Journal and Retrospect of the Medical Sciences attesting to the plant’s efficacy for tetanus and “other convulsive diseases,” including rabies and cholera.⁸ By the late nineteenth century, thanks in part to the work of these doctors, cannabis was part of both the British and American pharmacopoeias.

Medical and Recreational Use in America

Before cannabis was adopted for medical use in the United States, hemp production was actually encouraged by the government. Hemp is a type of cannabis bred for fiber. It does not produce much THC, the main psychoactive element in cannabis. In the seventeenth century, hemp was used as a fiber for rope, sails, and clothing.⁹ In the eighteenth century, George Washington famously grew hemp at Mount Vernon and used its fibers to repair the nets he employed on his fleet of fishing boats that trawled along the Potomac.¹⁰

In the late nineteenth century, cannabis became a popular ingredient in many medicinal products and was openly sold in pharmacies, either in liquid form or as a refined product called hashish.¹¹ Even back then, the line between medical and recreational use was blurred. A “hasheesh” candy advertised in an 1862 issue of Vanity Fair, for example, was billed as a treatment for nervousness and melancholy but was also called a “pleasurable and harmless stimulant.” The ad was surprisingly open-minded for its time, encouraging all to partake: “Under its influence all classes seem to gather new inspiration and energy.”¹²

The practice of smoking cannabis was largely unknown in the United States until it was introduced by Mexican immigrants, who arrived in droves after the Mexican Revolution of 1910.¹³ As a result, the recreational use of the drug became associated with immigrants even though US citizens had been happily consuming years before their arrival. This incorrect association engendered fear and prejudice not only of cannabis but of the Mexican immigrants themselves. Antidrug campaigners of the day took advantage of the moment and began to campaign against the so-called Marijuana Menace.¹⁴ Between 1914 and 1925, twenty-six states passed laws prohibiting the plant.¹⁵

By the Great Depression, fear of marijuana was further inflamed by a flurry of research that linked the use of cannabis with violence, crime, and other socially deviant behaviors. By 1931, three more states had outlawed cannabis, bringing the total to twenty-nine.¹⁶ Just five years later, the propaganda film Reefer Madness debuted in theaters and further cemented marijuana’s poor reputation via a morality tale of “youthful victims” who were lured into trying the drug, only to face terrible consequences.

Prohibition: Driving Cannabis Underground

In 1937, the US Congress passed the Marijuana Tax Act, which effectively criminalized marijuana by requiring doctors, pharmacists, and dealers to pay a large tax for prescribing or selling the drug.¹⁷ Notably, the American Medical Association opposed the act. This was the start of cannabis prohibition in the United States.

Fewer than ten years later, in 1944, the New York Academy of Medicine issued an extensively researched report declaring that, contrary to earlier research, use of cannabis did not induce violence, insanity, or sex crimes.¹⁸ However, that report was attacked in The American Journal of Psychiatry, and throughout the 1950s, stricter sentencing laws were passed, making first-offense cannabis possession punishable by a minimum sentence of two to ten years in jail.¹⁹

The changing political and cultural climate of the 1960s saw a growing leniency around drug use, including the use of cannabis. Presidents Kennedy and Johnson each commissioned reports that found that marijuana did not induce violence or lead to heavier drug use.²⁰ Smoking pot seemed harmless and fun, and as journalist Stephen Siff wrote, “In 1967, not only hippie activists but the solidly mainstream voices of Life, Newsweek, and Look magazines questioned why the plant was illegal at all.”²¹

Despite the growing cultural acceptance of cannabis, in 1970, President Nixon signed the Controlled Substances Act, which classified the plant as a Schedule I controlled substance.²² This put cannabis in the same category as heroin—a dangerous substance with no valid medical purpose and a high potential for abuse. Despite the growing call for federal decriminalization, marijuana is still classified as a Schedule I narcotic by the US government. This makes the drug subject to very strict regulations and exceedingly difficult to conduct medical research into the possible medicinal uses of the cannabis plant.

Legalization and Mainstream Consumption

After Nixon’s federal cannabis prohibition, several states decriminalized individual possession of the plant, beginning with Oregon in 1972. Other states began to allow for some types of medical and therapeutic use—in 1978, New Mexico passed the Controlled Substances Therapeutic Research Act, which was the first enacted legislation to acknowledge the medicinal value of cannabis. And finally in 1996, California became the first state to legalize the use of cannabis for medical purposes.²³ In 2012, Colorado and Washington state both legalized recreational use, and Colorado became the first state to open dispensaries for recreational use—a novel concept that was quickly replicated by Washington, Oregon, and then Alaska.²⁴ As of this writing, thirty-three states plus D.C. and Guam have legalized medical use; eleven of those along with D.C. have also legalized recreational adult use.²⁵

Medical Uses Today

Despite the lack of large-scale clinical trials in the United States (due to its aforementioned classification as a Schedule I narcotic), cannabis has become an invaluable aid in the treatment of a wide array of diseases and conditions. Published studies from Brazil, Canada, and Israel, countries where cannabis is federally legalized, have shown that cannabis is useful in helping to treat everything from autoimmune diseases to neuropathic pain. The drug is approved for treating medical conditions ranging from ALS (amyotrophic lateral sclerosis, or Lou Gehrig’s disease) and epilepsy to Crohn’s disease, multiple sclerosis, Parkinson’s, PTSD, and even opioid dependency.²⁶ We’ll read more about cannabis as medicine in Chapter 3.

Recreational Uses Today

Cannabis is the third most popular recreational drug in the United States, just behind alcohol and tobacco.²⁷ According to the latest figures from the Annals of Internal Medicine, more than one in seven adults in the US use cannabis.²⁸ While some of these people are using marijuana for medical purposes, most are recreational users. That means they use cannabis for its psychological and physical effects: relaxation, euphoria, introspection, and even creativity. Today, in states where cannabis is legalized for recreational use, there are yoga and fitness classes as well as spas and beauty studios that promote the careful use of THC and CBD in conjunction with treatments. We’ll touch more on this in Chapter 4.

CBD

Cannabidiol, better known as CBD, is a one of a group of chemical compounds found in cannabis. This group of compounds is commonly referred to as cannabinoids. Some cannabinoids, like THC, can have mind-altering effects on your body, but CBD is a nonintoxicating compound that is a potent anti-inflammatory rich in antioxidants. CBD is said to be good for everything from treating blemishes and eczema to helping alleviate anxiety and general pain.

If you’re wondering why we’ve been experiencing a sudden uptick in CBD interest, here’s a little background for you. In June 2018, the Food and Drug Administration (FDA) approved a CBD-containing medication, Epidiolex, for use in treating two rare forms of epilepsy: Lennox-Gastaut syndrome and Dravet syndrome. Three months after that, the DEA rescheduled Epidiolex—but not CBD itself—to Schedule V, which means it has an accepted medical use and a low potential for abuse.²⁹

Other than the drug trials that were administered in order to get Epidiolex approved, most of the published research on CBD comes from preclinical studies, which are often done on animals or in a petri dish, not on humans. The standard double-blind, placebo-controlled human studies that the Western medical establishment favors are only now being run, after the FDA relaxed restrictions in December 2015.

We still have so much to learn about the efficacy and uses of CBD, but that hasn’t kept it from becoming ubiquitous as the wellness ingredient du jour. CBD can be found in everything from mascara to cocktails. A grocery store in Oregon even sells a CBD-infused bratwurst! According to the Chicago-based Brightfield Group, sales of CBD-based supplements, personal care products, and food grew by 88 percent between 2016 and 2017, earning a total profit of $327.4 million. With the legalization of hemp under the 2018 Farm Bill, the CBD market was projected to skyrocket to $5.7 billion by the end of 2019.

As mentioned earlier, hemp is a variety of cannabis that has traditionally been used to make clothing, rope, textiles, and paper. It has specifically been bred over centuries, possibly millennia, to contain as little THC as possible. In the US, hemp is legal as long as it contains only 0.3 percent or less of THC. Until recently, CBD was also legal only if it came from a state that grew industrial hemp under the provisions of the 2014 Farm Bill. But when Congress passed the 2018 Farm Bill, hemp—and therefore CBD—was declassified at the federal level, making it easier to grow and to ship across state lines. Under the new law, which took effect on January 1, 2019, hemp plants containing no more than 0.3 percent THC are no longer classified as a Schedule I controlled substance. “This is nothing short of seismic for the cannabis industry,” said Kristen Nichols, editor of Hemp Industry Daily, in an interview with Bloomberg.³⁰

This means that farms all across the country can—and are—growing hemp legally. Some craft cannabis farmers, like brothers Aaron and Nathan Howard at East Fork Cultivars in southern Oregon, are breeding new strains of hemp that contain even higher levels of CBD. Traditionally, hemp has had low resin, and so contains only small amounts of CBD—not a medicinally important amount. The Howards also sell plants on their recreational cannabis site that are higher in CBD than most THC-containing strains have been in recent decades. CBD, in addition to its many other benefits, can ameliorate some of the negative side effects of THC.

Anna Symonds, director of education at East Fork Cultivars, teaches a free CBD Certified class for frontline cannabis professionals in which she details the latest research about CBD and how it works in the body. Preclinical research has shown that CBD is analgesic, antianxiety, antiseizure, neuroprotective, anti-inflammatory, antitumor, and even antipsychotic.³¹ It can also help lift mood and depression, probably because it interacts with serotonin receptors. In addition to being nonintoxicating, CBD is also nontoxic and nonaddictive—even at high doses. According to Symonds, the only side effects of CBD are positive: It can lower blood pressure and reduce a type 2 diabetic’s need for insulin (though she counsels people to take CBD at a different time of day than they take other medications, just to discourage potential drug interactions.)³²

Like THC, CBD interacts with your body’s endocannabinoid system (ECS). The ECS, which was only discovered in the 1980s,³³ has receptors all around the body. CB1 receptors are found mostly in the central nervous system (brain, spinal column, and nerves), and CB2 receptors are found mostly in immune system cells and in the gut. Interestingly, scientists have found that CBD activates CB1 receptors only when THC is present. This is probably why small amounts of THC used in conjunction with CBD are better for remedying analgesic and anti-inflammatory conditions. For this reason, Symonds and other cannabis educators refer to CBD and THC as “the power couple.” CBD doesn’t bind directly with CB2 receptors, but there is speculation that there’s some kind of indirect action that helps. We’ll read about the endocannabinoid system in more detail in Chapter 2.

Whether it is smoked, infused into food, or applied topically, the effects of taking Cannabis sativa can vary in ways that are sometimes hard to explain. But I will try my best, with a little help from my friends. The lovely cannabis plant can be used to treat quite a range of issues, from helping to reduce anxiety, inflammation, and pain to promoting appetite, cell regeneration, and immune support. How can one plant do all of this? you (and I) might wonder. To answer this question, we need to step into some science.

The Endocannabinoid System

The chemical compound THC was officially named and labeled in the 1960s by scientists who were studying the effects of cannabis on humans. Over the years, researchers worked to understand how, exactly, THC affected the body, and this led them to discover a network of receptors within the body that sparks a reaction when it comes into contact with THC. These receptors make up what scientists now refer to as the endocannabinoid system, and they are responsible for regulating the homeostasis (balance) of all of our most basic biological functions.