History of Cannabis
||First of use of industrial hemp in China.
||First use of medical cannabis in China.
||First use of medical cannabis in the Chinese Pharmacopeia.
||Cannabis is used in Egypt to treat glaucoma and inflammation.
||Bhang, a combination of milk and cannabis, is used in India as an anesthetic.
||First reported use of medical cannabis in Ancient Greece.
|Chinese texts recommend cannabis use to treat over 100 ailments.
||Industrial hemp is brought to North America by Jamestown Settlers for farming and manufacturing.
||George Washington grows medical cannabis and industrial hemp.
||Napoleonic forces bring cannabis to France and Egypt.
||Cannabis becomes recognized as medicine in western society.
||Cannabis added to U.S. Pharmacopeia.
||Henry Ford’s Model T is made from hemp plastic and powered by hemp ethanol.
||Massachusetts becomes first state to outlaw cannabis.
||Marihuana Tax Act passed.
American Medical Association opposes Marijuana Tax Act.
First Federal arrest for the sale of marijuana.
||Cannabis is removed from US Pharmacopeia.
||United Nations Single Convention on Narcotic Drugs includes Cannabis/Marijuana.
||Controlled Substance Act Classifies Marijuana as a Schedule I drug with no accepted medical use.
NORML (National Organization for the Reform of Marijuana Laws) founded.
||Marinol (a synthetic cannabinoid) approved by U.S. Food and Drug Administration.
||California becomes the first State to legalize medical cannabis with proposition 215.
|The District of Columbia and 15 more states legalize medical cannabis:
AK, AZ, CO, DE, HI, ME, MI, MT, NJ, NM, NV, OR, RI, VT, WA
||CT and MA legalize medical cannabis.
CO and WA are the first states to legalize recreational marijuana to be regulated/taxed.
||NH and IL legalize medical cannabis.
Uruguay becomes the first country to legalize recreational marijuana to be regulated/taxed.
||First time legal sales of recreational cannabis take place in the U.S. since prohibition (Colorado).
MD and MN legalize medical cannabis. Medical cannabis is now legal in 22 states and DC.
What is Cannabis?
Cannabis, also known as marijuana, is a plant that originated in Central Asia and is now grown in many parts of the world. The cannabis plant contains compounds called cannabinoids. This guide will cover the most common types of cannabis and cannabinoids, as well as the effects each have on the human body.
What is Industrial Hemp?
Industrial hemp is also derived from the cannabis plant family, though it lacks the high levels of THC (the cannabinoid attributed to the psychoactive effects of cannabis). Therefore, it does not cause intoxication.
State Laws versus Federal Law
In the United States, the Controlled Substance Act lists “marijuana” as a controlled substance. By federal law, the use, sale, and possession of “marijuana” are illegal. Until recently, there was no separate definition for industrial hemp. Twenty-two states and the District of Columbia have enacted laws to legalize medical cannabis. Two states, Colorado and Washington, have also made it legal to use cannabis recreationally. Additionally, fifteen states have passed industrial hemp farming laws. Many more states are considering cannabis and/or industrial hemp laws.
The Controlled Substances Act (CSA) was enacted into law by the Congress of the United States in 1970. The CSA regulates the manufacture, importation, possession, use and distribution of certain substances.43 The legislation created five Schedules (classifications), with varying qualifications for a substance to be included in each. Although Congress created the initial listing, the CSA authorizes the Drug Enforcement Administration and the Food and Drug Administration (FDA) to determine which substances are added to or removed from the various schedules. Congress also has the ability to add or remove substances through legislation.
The CSA does not recognize the difference between medical and recreational use of marijuana. It is treated like every other controlled substance, such as cocaine and heroin. Under the CSA, marijuana is classified as a Schedule I drug. Schedule I drugs may not be prescribed. However, controlled substances that are still considered dangerous, but not a Schedule I drug may be prescribed. To be listed as a Schedule I drug, the CSA states that the drug meets the following findings:
- The drug or other substance has a high potential for abuse.
- The drug or other substance has no currently accepted medical use in treatment in the United States.
- There is a lack of accepted safety for use of the drug or other substance under medical supervision.
Although doctors may not “prescribe” cannabis for medical use under federal law, they can “recommend” its use under the First Amendment.
Contradictory to marijuana being listed as a Schedule I substance and the federal government’s claim that there are no medical uses of cannabis, the U.S. government filed a patent for cannabis cannabinoids in 2001: US Patent 6630507.44
Additionally, the federal government ran a program from 1978 to 1992 that allowed select patients to receive medical cannabis. Only four of the original patients are still alive and receiving cannabis through what was known as the Compassionate Investigational New Drug Program.45, 46
Two historic developments occurred in March 2014: 1) the FDA gave approval for studies to begin on a medicinal form of cannabis for the treatment of intractable epilepsy in children47 and 2) the U.S. Department of Health and Human Services approved a study on medical cannabis for military Veterans with Post-Traumatic Stress Disorder.48Conflict between State and Federal Law.
The supremacy clause, part of article VI of the Constitution, contains a “doctrine of pre-emption.” This clause states that the federal government wins in the case of conflicting legislation. In the case of medical cannabis, although a state regulation allows it, the federal law prevails.
However, the Congressional Research Service’s January 13, 2014 report, State Legalization of Recreational Marijuana: Selected Legal Issues, states the “federal government is limited in its ability to directly influence state policy by the Tenth Amendment, which prevents the federal government from directing states to enact specific legislation, or requiring state officials to enforce federal law.”49
On August 29, 2013, the U.S. Department of Justice (DOJ) announced an update to their cannabis enforcement policy.50 In a memorandum, it outlines the policy making it clear that cannabis remains an illegal substance and it will be aggressively enforced under the CSA. However, it outlines eight enforcement areas that will be the federal prosecutors’ priority. Outside these enforcement priorities, the DOJ relies on state and local authorities to address cannabis activity through enforcement of their state laws.
The DOJ memorandum states, “The Department’s guidance in this memorandum rests on its expectation that state and local governments that have enacted laws authorizing cannabis-related conduct will implement strong and effective regulatory and enforcement systems that will address the threat those state laws could pose to public safety, public health, and other law enforcement interests.” With this memorandum, the DOJ indicates that it will defer the right to challenge states’ legalization laws at this time, but reserves the right to challenge them if there is “evidence that particular conduct threatens federal priorities.” The eight priorities that guide the DOJ’s enforcement of the CSA include:
- Preventing the distribution of cannabis to minors.
- Preventing revenue from the sale of cannabis from going to criminal enterprises, gangs, or Cartels.
- Preventing the diversion of cannabis from states where it is legal under state law in some form from going to other states.
- Preventing state-authorized cannabis activity from being used as a cover or pretext for the trafficking of other illegal drugs or other illegal activity.
- Preventing violence and the use of firearms in the cultivation and use of cannabis.
- Preventing drugged driving and the exacerbation of other adverse public health consequences associated with cannabis use.
- Preventing the growing of cannabis on public lands and the attendant public safety and environmental dangers posed by cannabis production on public lands.
- Preventing cannabis possession or use on federal property.
Federal law governs the Veterans Health Administration and Veterans Affairs (VA) healthcare facilities. There are VA hospitals and/or clinics in every state. Veterans who live in states where medical cannabis is legal and who qualify for his or her state medical cannabis program cannot get a written certification or recommendation for medical cannabis from VA physicians. In fact, until recently, a Veteran could be denied treatment at a VA facility if he or she tested positive for cannabis.
In January 2011, the VA issued a new directive paving the way for Veterans to play a larger role in their healthcare, including the use of medical cannabis.51 VHA Directive 2011-004 provides the following guidelines:
- VA practitioners may not complete forms or provide written statements recommending a Veteran’s participation in a state medical cannabis program.
- Veterans may request copies of their personal medical records using the appropriate forms.
- Decisions to modify treatment plans of patients who participate in a state medical cannabis program need to be made by individual providers in partnership with their patients.
- Veterans who participate in a state medical cannabis program cannot be denied VHA services, including any clinical programs where the use of cannabis may be considered inconsistent with treatment goals.
- Chronic pain must be treated in accordance with VHA step-care model, and any prescriptions for chronic pain must be in accordance with VHA Pain Management Strategy.
- A Veterans participation in a state medical cannabis program will be entered in the non-VA medication section of the patient’s electronic medical record.
- VA practitioners will not pay for or provide cannabis authorized by a non-VA entity.
- Possession of cannabis, even for authorized medical reasons, by Veterans while on VA property is in violation of VA regulation 1.218(a)(7) and places them at risk for prosecution under the Controlled Substances Act.
Because there are many states with medical cannabis programs that do not have a system in place to assist Veterans in obtaining medical cannabis without a physician’s recommendation, Veterans are forced to receive medical care outside the VA in order to access medical cannabis. A few states do include a method for Veterans to obtain medical cannabis without a written recommendation. For more information about Veterans’ access to medical cannabis see Appendix C.
What are Cannabinoids?
The therapeutic compounds, active ingredients, in cannabis are known as cannabinoids.12 Not only are cannabinoids found in cannabis, but also naturally occur in the nervous and immune system of humans and other animals. Cannabinoids can be categorized into three general types:
- Phytocannabinoids (cannabinoids)— produced in the cannabis plant
- Endogenous Cannabinoids (endocannabinoid system)—produced in the bodies of humans and other animals
- Synthetic Cannabinoids—produced in a laboratory
Over 70 unique cannabinoids have been identified in the cannabis plant. The most studied cannabinoid is tetrahydrocannabinol (THC), followed by cannabidiol (CBD). In addition to these two cannabinoids, there are many others that have been identified to interact with the cannabinoid receptors found in the human body. Two cannabinoid receptors have been identified in the endocannabinoid system of humans. These receptors have been named CB1 and CB2. Each cannabinoid has specific properties that correlate with the endocannabinoid system to treat specific medical conditions and relieve specific symptoms. 13
What are Terpenoids and Terpenes?
In addition to the cannabinoids found in cannabis, there are a few other compounds known to have some health effects, including terpenoids and terpenes.15 Cannabis, as well as other plants, fruits, spices and herbs, derive its unique aromas and tastes from terpenoids and terpenes.16
Research indicates that terpenoids and terpenes interacting with phytocannabinoids may produce meaningful therapeutic benefits.17 It’s believed that there are over 200 different terpenes and terpenoids in cannabis.18 The primary terpenes and terpenoids identified in cannabis include limonene, myrcene, linalool, pinene, beta-caryophyllene, nerolidol, caryophyllene oxide, phytol, eucalyptol, and γ-terpinene.19
Cannabinoid and Terpene Profiling
In general, sativa, indica, and hybrid subspecies of Cannabis sativa L. are distinguished by their cannabinoid profiles and effects on the human body.24 Terpene profiling is in the infancy stage. However, terpene profiling is believed to be the most accurate method for classifying cannabis strains and the medicinal effects.
Because cannabis has been crossbred so much over time, it is very hard to find medical cannabis that is truly pure sativa or indica. It is likely that most of the cannabis now grown or sold in the U.S. is a hybrid with varying percentages of sativa and indica.
Because there are currently no comprehensive federal or state standards for strain qualities, standards are voluntary. Some states do have standards and restrictions for pesticides, microbial contaminants (fungi, bacteria, etc.), and other contaminants. Because there is no agreed upon method of naming strains based on cannabinoid profiles, it is very possible to have identical strain names with different cannabinoid profiles depending on the region, state, or dispensary.
Many cannabis testing labs do a good job of calculating medicinal compounds in each strain and providing reports. Most labs base the reports on scientific data and patient review data in an attempt to give a clear picture for the dispensary and ultimately for the consumer. Some labs have also begun terpene profiling and labels will reflect such information.
Although the U.S. Centers for Disease Control and Prevention have listed alcohol and other drugs as a cause of death, it has never listed cannabis. Several studies have shown that cannabis has relatively low toxicity and lethal doses are impossible to reach.33, 34
Prescription drugs have become one of the leading causes of accidental death in the U.S. When comparing the potential for overdose of prescription drugs to cannabis, it is clear cannabis is the safer drug. Drug overdose death rates in the United States have more than tripled since 1990 and have never been higher. In 2010, the number of drug overdose deaths in the U.S. reached 38,329, with prescription painkillers being responsible for 16,651 of those overdose deaths.35
In toxicology, several terms are used to describe drugs and other substances. These terms include:
- Median Lethal Dose or LD50 – refers to the point where 50% of test subjects exposed to a substance would die. This is a general indicator of a substance’s acute toxicity.
- Median Effective Dose or ED50 – refers to the effective dose for 50% of people receiving the drug. This is a general indicator of reasonable expectancy of a drug’s effect.
- Therapeutic Ratio or Safety Ratio – refers to the ratio of the effective dose (ED50) to the lethal dose (LD50). A high safety ratio is an indicator of a substance’s relative safety.
Thousands of studies have shown that cannabis is a valuable aid in the treatment of a wide range of medical conditions and symptoms. Most notably, cannabis relieves pain and inflammation, nausea, glaucoma, muscle spasticity and other movement disorders. It is also a powerful appetite stimulant, which can be successfully used to treat those suffering from AIDS wasting syndrome or dementia. Additionally, research shows that the medicinal benefits of cannabis may also include protecting the body against certain types of malignant tumors and halt the spread of numerous cancer cells. See Appendix B for links to current research.
source : cannabismedicina.org