Tag Archives: Cannabis pharmaceuticals
Cannabis And The Broken US Health Care System
With the ever-present exposure we all get to the modern health care system it’s easy to forget that all this technology is relatively new. Until a few years ago almost all Americans who could do so dealt with disease, illness, injury, impairment and old age in the context of a family and a community of friends and neighbors.
This isn’t a “good old days” fantasy about how things were always better in small-town America where everybody pulled together and cared about each other. In years past there were lots of people without friends or family who suffered and died alone – that’s one of the origins of the centralized health care delivery system, the urgent social need to care for the millions of people, many of them immigrants, who lay sick and dying alone in the city streets of the last centuries. Centralized health care institutions grew out of this core failure of the industrializing American system, when the very closeness of family and community which enfolded those in need was not available so many, for whom there was no alternative but the brutal poorhouse or dying alone in the streets.
But there were also tens of thousands of smaller cities, towns, villages and rural communities where few lay alone, whether sick or injured, where aging people were passed from family member to family member if need be, but were kept, and where the medical profession was an enormously useful adjunct to the family-based health care delivery system but was not the primary caregiver. These days are recalled as quaint by some modern docs who chuckle about the days of house calls, though many doctors still wish that they could make a decent living doing just that.
We live now in an age when care has become interpreted as technical intervention alone. When a person becomes seriously sick or gets badly injured or simply old and frail they are often removed from their family in a manner that brooks no interference. Medical emergencies convey license upon lifesavers who rush you to the central facility where you are handed over to technical specialists, who then take charge as you are transformed into a “case” or “patient”.
Your family or friends, if you have any, are reduced to huddling in a waiting room where they are visited from time to time and provided reassurance that you are in good hands and everything possible is being done.
If and when the emergency subsides you are then passed on to other specialists who apply whatever medical technologies they are familiar with and choose to use in the name of standard medical practice. Their choice of technology and strategy is determined by many considerations, and their motives are usually the highest, but their methods are not to be questioned, and there is literally no room for family or friends to function in the role of caregivers. They can come during visiting hours, and that’s it, because the institution is in total charge of care-taking, and their version of care-taking is how its going to be.
If the institution and the specialists can’t fix the problem you will be designated incurable and sent somewhere called a home, but probably not a home with your family in it, for long-term care. You generally won’t go with your family because they “aren’t able to take care of you”, meaning that there is no system to provide the resources that would enable them to take care of you at home. The systems that exist to provide and allocate society’s health care resources choose to allocate those resources to taking care of you in institutions which they administer and from which they profit, not to home-based alternatives which, while better and more cost effective for you, do not benefit them. They’re not evil, just doing what comes naturally, which means surviving at all cost.
If you recover you are released which means you are free to go, after dealing with the bill of course. You walk out to rejoin your family, if you are very fortunate, and maybe on the ride home in the car someone will ask you – ” So, how do you feel?” Well of course you feel “fine”, and that’s about it. Everybody goes home and goes on with their lives until the next time they crash or drop or break or pass out and then it all begins all over again.
But are you healed by all this? Your disease certainly seems to have passed, your bones mended, your new organ functions perfectly, your heart beats. But what about how vulnerable, how violated, how isolated you feel even behind the pills you are given to “make you feel better”?
Given the institutional cultures of the current health care system, there is no “feeling better”. The isolation and emotional and spiritual deprivation of the severely ill or merely very old person grows until death by loneliness becomes inevitable.
This is the precise point at which families of sick and elderly people ought to begin taking Cannabis seriously, because this marvelous little flower has the capacity, when given with loving hands to a sick or just plain old and worn out person, to not only treat but even to heal, and most certainly to make a difficult life more bearable. There is so much more to say about the Cannabis option, and I will be posting some of my thoughts on this in coming weeks and months.
But for the moment I simply want to say to all those who have already discovered the healing properties of this little flower of the Gods that you are on the right path, and my hope is that if there are others who you care for and love that you will be able to help them walk this same path to a better world. With no fear.
Medical Cannabis & Hashish In Old Europe
The consciousness that Cannabis is a powerful natural medicine was well-developed in Europe of the 1800s. Knowledge of the medical uses of Cannabis, Coca Leaf and Opium came to Europe from the Andes and Asia first through explorers and traders of the 1600s and 1700s, then increasingly through travelers, writers, adventurers, scholars and missionaries in the 1800s.
Of course Cannabis also came to Europe as Hashish at the same time as it arrived as dried, pressed flowers, so Europeans had a Cannabis concentrate to work with from the earliest days. In the beginning there was some confusion over whether Cannabis flowers and Hashish were the same thing – a confusion soon to be mirrored with Coca Leaf transmuted into Cocaine, and Opium Sap transmuted into Morphine and Heroin.
Americans who find the history of Cannabis fascinating will enjoy browsing the following essay, which I discovered in a public domain EU document. The entire document is mostly about drug control in Europe, but this essay which is intended as background for discussions of control happens to be the best concise history of early medical use of Cannabis in Europe that I have read, and so I’m happy to share it with you here on Panacea Chronicles.
Cannabis as medicine in Europe in the 19th century
Manfred Fankhauser
As in the previous centuries, hemp was predominantly used in the 19th century as a fibre material. Herbal cannabis played a marginal role as a medicinal plant, although its seeds were used medicinally, mostly in the form of pressed oils or hemp milk as medicine against gonorrhoea or cystitis. In tandem with prevailing interest in plants, products and culture from the Orient, medicinal use of cannabis arrived in Europe from the East during the 18th century.
Much has been written on the historical knowledge in Europe of the psychoactive properties of hemp prior to the 18th century: among readers of Herodotus’ description of Scythian cannabis-incensed burial rites; by alchemists, in particular the herb Pantagruelion lauded by author François Rabelais; via knowledge of Islamic medicine via al-Andalus, and elsewhere (Bennett et al., 1995; Booth, 2003; Mercuri et al., 2002).
However, widespread scientific writings on its psychoactive properties came later. For example, Gmelin wrote in 1777 of the Eastern use of bhang for stupefying (‘etwas Betaeubendes’), mind-clouding (‘Benebelung des Verstandes’) and intoxicating effects (Fankhauser, 2002); and in 1786 the Comte d’Angiviller thanked a certain Boulogne for his sending of Indian hemp plants with the prophetic words ‘Cette plante sera peut- être un présent intéressant pour l’Europe’.
At the end of the 18th century, the French naturalist Sonnerat informed Lamarck’s 1873 Encyclopédique de botanique of Cannabis indica (Emboden, 1974) and brought Indian hemp home to France after a journey to the Orient. Napoleonic campaigns in Egypt and the Near East introduced colonial troops — notably the scientists Silvestre de Sacy, Rouyer and Desgenettes — to hashish (Abel, 1980; Booth, 2003).
European interest in this ‘new’, or rather rediscovered, plant grew only hesitantly. The first comprehensive description of the medical usefulness of Indian hemp in Europe was written in 1830 by the German pharmacist and botanist Friedrich Ludwig Nees von Esenbeck. Until that point in time, use of hemp for medical purposes had remained at a low level.
This situation changed significantly prior to the middle of the 19th century. William B. O’Shaughnessy (1809–1889/90), an Irish medical doctor stationed in Calcutta, India, published in 1839 a comprehensive study on Indian hemp. Thanks mainly to his On the Preparations of the Indian Hemp or Gunjah, Cannabis indica now also became recognised within European-school medicine. O’Shaugnessy used various hemp compounds in his investigations, partly with great success, against the following indications: rheumatism, rabies, cholera, tetanus, convulsions and delirium tremens.
With hashish he had found a well-suited medicine to give his patients relief, and in the case of cramps, even total disappearance of symptoms. For concluding remarks, he wrote: ‘The presented cases are a summary of my experience with cannabis indica, and I believe that this medicine is an anticonvulsivum of great value’ (O’Shaughnessy, 1839).
Europe reacted promptly to this new knowledge from India. This is not surprising as until then no adequate treatment existed against recognised diseases such as rabies, cholera or tetanus. Great hopes were based on O’Shaughnessy’s results. The French were the first to engage themselves intensively with the plant. As early as 1840, the French medical doctor Louis Aubert-Roche (1809–1874), who resided in Egypt, used hashish seemingly successfully against pestilence (Hirsch, 1884–1886). Nearly simultaneously, his compatriot and friend, the psychiatrist Jaques Joseph Moreau de Tours (1804–1884), began to experiment with hashish. He started out with experimenting upon doves and hares, giving them large doses of hashish extracts with their fodder. Then he tested hashish on friends, colleagues, patients and himself. He was convinced that hashish was the supreme medicament for use in psychiatry. His book, Du Hachich et de l’aliénation mentale (1845), caused a great sensation at the time, and is still understood as the origin of experimental psychiatry and psychopharmacology (Weber, 1971).
The works of Moreau de Tours had an impact not only in medical circles, but also among writers and artists. The poet Théophile Gauthier (1811–1872), for instance, received hashish samples from Moreau de Tours. In 1843 he described extensively a self-experienced hashish intoxication in the Paris newspaper La Presse under the title ‘Le Club des Hachichins’. The club of hashish eaters, of which Gauthier was one of the founders, had regular meetings in Hôtel Pimodan on the Seine island of St Louis.
He and Charles Baudelaire (1821–1867) shared a penthouse in the hotel for several years. Other prominent club members were Alexandre Dumas (1802–1870) and Honoré Daumier (1808–1879) (Moreau, 1904). Further well-known contemporaries such as Honoré de Balzac (1799–1850), Gustave Flaubert (1821–1880) and Victor Hugo (1802–1885) participated occasionally (Behr, 1982).
Inspired by Moreau de Tours and later by pharmacy professor Eugène Soubeiran (1797–1859), the pharmacist Edmond de Courtive published in 1848 his widely noted dissertation, Haschish. In addition to chemical analysis, he carried out self-experiments with miscellaneous hashish compounds and gave exact descriptions of their physical and psychic effects (De Courtive, 1848).
Many medical doctors took advantage of the promising results of the pioneers O’Shaughnessy, Aubert-Roche and Moreau de Tours and used these new drugs for therapeutic purposes. Initially, primarily doctors from the colonial powers of England and France showed interest in the use of compounds made of Indian hemp. The necessary commodities or compounds were imported in great quantities to Europe from the colonies, especially from India (Smith and Smith, 1847). Hemp was in this period sold to Europe primarily in three commercial variations:
Ganjah: consists solely of the blooming tips of the female, carefully cultivated plant. Mostly 24 blooming tips are bundled in a length of approximately 1 m, and 11 cm thickness.
Charras: consists of the resin, which is extracted foremost from the blossom, but also from leaves and stalks of the female plant. Today, the extracted resin is called hashish.
Bhang: extracted from the leafless stalks of the female hemp plant. Bhang was predominantly exported to Europe in powder form.
In Europe ganjah was the first to be pharmaceutically exploited. Initially, the fields of application known to O’Shaughnessy were adopted. Later on, the therapeutic application of hashish was considerably extended. In particular, the English and French medics applied this new wonder drug against tetanus (Martius, 1844). Encouraged by many positive reports, especially from England, the Bulgarian medic Basilus Beron intensively engaged in this problem in a dissertation. His work concludes:
I was so contented that, after having used almost all known antitetanic drugs without result, the sick person that had been assigned to me was totally cured after use of the Indian hemp (…) wherefore the Indian hemp is strongly recommended against tetanus. (Beron, 1852)
Homeopathy, founded by Samuel Hahnemann (1755–1843) and rapidly advancing in this period, was also quick to include Indian hemp in its medical catalogue. Towards the middle of the 19th century, in addition to the illnesses already mentioned, Indian hemp was mainly used against neuralgia and other pains, chorea, hysteria, insanity, haemorrhage and insomnia. Since prepared products did not yet exist, cannabis extracts and tinctures were mostly used.
The real success story of cannabis as a medicine began in the second half of the 19th century after the publication of Beron’s dissertation in 1852. In the same year, Franz von Kobylanski published a dissertation on the effect of cannabis as an oxytocic (1852). Four years later, the German Georg Martius wrote his comprehensive work Pharmakognostisch-chemische Studien über den Hanf, which attracted much attention.
Interest was also aroused by the experiments of the Viennese Carl Damian Ritter von Schroff (1802–1887). Martius was among the few who did not deem cannabis compounds as harmless. He wrote that:
the Indian hemp and all its compounds show great diversity concerning the degree and type of effect according to individual differences in healthy as well as in pathological conditions. It therefore belongs to the unsafe agents, and the medic should under all circumstances use it with great care.
(Von Schorff, 1858)
At the same time, Ernst Freiherr von Bibra (1806–1878) published his standard work, Die narkotischen Genussmittel und der Mensch. Here, he discussed hashish for over 30 pages. In addition to experiences of others, he describes a self-experiment with hashish. His concluding judgement was as follows: ‘Recent experiments and experiences made on the medical effect of the hemp plant and its compounds very much point to their advantage’ (von Bibra, 1855).
In this period, most European countries, as well as the USA, included Indian hemp in their national pharmacopoeia. The monographs Herba Cannabis indicae, Tinctura Cannabis indicae and Extractum Cannabis indicae enjoyed increased prominence,
whereas Semen/Fructus Cannabis and Oleum Cannabis became more and more rare. It was first of all France and England, and to a lesser extent the USA, that significantly contributed to the definitive breakthrough of the drug into Western medicine.
The study of Indian hemp was even pursued in Germany. A comprehensive work of Bernhard Fronmüller, written in 1869, is frequently cited. He had studied the qualities of the hemp plant for a long time, and carried out cannabis experiments within the framework of ‘clinical studies on the euthanising effect of the narcotic drugs’ with exactly 1 000 test patients. These test patients suffered from heavy insomnia due to various illnesses. The results of his investigation were positive. Thus, he concluded in his work: ‘The Indian hemp is, among the known anaesthetic drugs, the narcosis which most perfectly achieves a replacement of natural sleep, without particular repression of expulsions, without bad repercussions, without paralyses’ (Fronmüller, 1869).
Well-known medical experts or pharmacologists of the time wrote more-or-less comprehensive essays on Cannabis indica. Some of these articles criticise the unreliability of hemp compounds. Indeed, the standardisation problem continued to be an issue for cannabis compounds until they disappeared. Kobert is one of very few who discussed the dangers of long-term consumption: ‘The habitual consumption of any effective hemp compound deprives the human being and brings him to a mental institution’ (Kobert, 1897).
The period 1880 to 1900 can be considered a peak in the medical use of cannabis. The use of hashish compounds had become commonplace in almost all European countries and in the USA. Nonetheless, it was still scientists from England, France, Germany and the USA who persistently continued cannabis research. It is, therefore, not a coincidence that most of the products on the market (‘specialities’) originated in these
countries. It is first of all through the contribution of the company E. Merck of Darmstadt, Germany, that cannabis compounds became more widely used in Europe towards the end of the 19th century. One of the preferred source materials in the production of cannabis compounds in this period was Cannabinum tannicum Merck. In addition, the company Burroughs, Wellcome & Co. in England produced cannabis compounds. In the USA, cannabis compounds were manufactured by Squibb and sons in New York (‘Chlorodyne and Corn Collodium’), and, later, Parke-Davis & Co. in Detroit (‘Utroval’ and ‘Casadein’) and Eli Lilly (‘Dr Brown’s Sedative Tablets’, ‘Neurosine’ and ‘The One Day Cough Cure’). These companies delivered sufficient quantities of high-quality raw materials and produced compounds for the market.
Probably the most-used hemp compound was the sleeping pill Bromidia, of the American company Battle & Co. This was a combined drug, that is, in addition to cannabis extract it contained bromine potassium, chloral hydrate and henbane. While single compounds dominated during the 19th century, combination compounds were preferred in the 20th century. Most cannabis drugs were for internal use, but there existed topical compounds, for instance, creams or the common clavus tinctures.
In the meantime, France continued its 50-year tradition and honoured medical doctors and pharmacists with doctoral degrees based upon works on hashish. In 1891 Georges Meurisse (born 1864) published his work Le Haschich, and five years later Le chanvre indien by Hastings Burroughs (born 1853) appeared. The latter is strongly based on Villard’s work, but also upon his own therapeutic experiments. He summarises: ‘In therapeutic doses, the Indian hemp is safe and would deserve to be more frequently used’ (Burroughs, 1896).
In Germany, the PhD students H. Zeitler (‘On Cannabis indica’, 1885) and M. Starck (‘How to apply the new cannabis compounds’, 1887) first wrote their graduation dissertations, before the pharmacist Leib Lapin in 1894 published his dissertation, ‘A contribution to the knowledge of Cannabis indica’, under the guidance of the leading figures Johan Georg Dragendorff (1836–1898) and Rudolf Kobert (1854–1918). In the first part of his work, he gives an overview of ‘common, manufactured and officinal hemp compounds’ in use at the time. In the second part he describes the pharmacology of ‘cannabindon’, a cannabis derivate first studied by him. In the preamble of his investigation, he makes a remark which shows the uncertainty that existed regarding the medical safety of Indian hemp:
Had it been so simple to solve the hashish question, it would certainly have been solved by one of the numerous previous investigators. I believe that I have contributed to the definitive resolution, and this belief gives me the courage to publish the following as a dissertation.
(Lapin, 1894)
A scientific contribution of extraordinary importance within the cannabis research of the 19th century was the so-called Indian Hemp Report of 1894. This census, carried out by Great Britain in its colony India, primarily studied the extraction of drugs from cannabis, the trade in these drugs and the implications for the total population. Additionally, the study set out to clarify whether prohibition of the compounds might be justified, and an expert commission was established for this purpose. Its report impressively shows the significance of the stimulant and drug cannabis in India towards the end of the 19th century. The main conclusion of the commission was: ‘Based upon the effects of the hemp drugs, the commission does not find it necessary to forbid the growing of hemp, nor the production of hemp drugs and their distribution’ (Leonhardt, 1970).
Towards the 20th century, Indian hemp enjoyed an important position in the materia medica of Western medicine. Evidence of misuse of cannabis compounds was practically non-existent until then. Kunkel writes:
The chronical misuse of cannabis compounds — cannabism — is believed to be widespread in Asia and Africa. It results in chronic, heavy disruption of the entire organism, especially mental disorder — attacks of raving madness and a subsequent condition of weakness. It is not observed in Europe, Indian doctors report however daily frequent cases of this disease.
(Kunkel, 1899)
To sum up, hashish played a significant role as a medicine in Europe and in the USA towards the end of the 19th century. The most important applications were against pain, especially migraine and dysmenorrhoea, pertussis, asthma and insomnia. Additionally, hashish was relatively frequently used as an additive in clavus supplements. Rare applications were stomach ache, depressions, diarrhoea, diminished appetite, pruritus, haemorrhage, Basedow syndrome and malaria. Cannabis compounds were also used in numerous single cases, partly with good results. These were, however, of smaller significance.
Typically, doctors who worked intensively with cannabis drugs for years would classify them as valuable medicines. Others criticised them, and frequently looked upon them as worthless or even dangerous. However, both groups agreed on the unpredictable effect of cannabis compounds.
After keen use of cannabis compounds around the turn of the century, they disappeared completely in the middle of the 20th century. The main reasons for the disappearance of hashish medicaments are medical developments. Even before the 20th century, new, specific medicines were introduced for all main applications of cannabis compounds.
Vaccines were developed for the treatment of infectious diseases (cholera, tetanus, etc.), which not only fought the symptoms as cannabis did, but also gave protection against infections. Other bacterial illnesses, such as gonorrhoea, that were frequently treated with cannabis could somewhat later be treated successfully with chemotherapeutica.
Cannabis indica received competition as a sleeping and tranquillising drug in the form of chemical substances such as chloral hydrate or barbiturate. Contrary to the numerous opium drugs, cannabis compounds were also replaced as analgesics by chemical substances. In this area, aspirin achieved great importance shortly after its introduction in 1899.
Another reason for the decline of cannabis as medicine was pharmaceutical instability. The varying effectiveness of the hashish compounds has often been noted. Very different factors, such as origin, age, storage and galenic preparation, affected effectiveness of the medicine. Unlike, for instance, alkaloid drugs such as opium, the isolation of active ingredients was not successful until the middle of the 20th century. This resulted in standardisation problems. There were also legal constraints. The use of cannabis compounds became more and more restricted in international and national law.
Hashish compounds were defined as anaesthetics sometime in the 20th century. This complicated their use enormously, until finally a general ban made it impossible to apply them.
Finally, economic aspects contributed to the decline in use of medical cannabis. Import into Europe of high-quality Indian hemp became more and more difficult due to constraints in the producing countries (mainly India) and the influences of the two world wars. Laws of supply and demand also applied to cannabis, resulting in a massive price increase for raw materials (e.g. herba Cannabis indicae) as well as for compounds (e.g. extractum Cannabis indicae).
