IN EARLIER TIMES Henrik Myhre Ihler – About the author Throughout history, cannabis has been suggested as a treatment for many diseases. Despite the fact that cannabis has been in use for over 5,000 years, the drug is still highly debated and the subject of political and professional discussions. Photo: David Diaz Arcos, NTB-DPA The first mention of cannabis is from China about 5,000 years ago, where the cannabis plant was used as a medicine. The Chinese character ma was used for fiber from hemp. The sign had two connotations: a meaning was many or chaotic , which probably stemmed from the appearance of the plant fibers. The other was numbness or senselessness , which probably originated in the effect experienced by consuming the plant’s fruits and leaves. Ma could also mean devil and paralysis in certain combinations (1) . The Assyrians had several names for cannabis: Gan-zi-gun-nu meant something in the direction of the remedy that removes the mind. Azallu referred to a cannabis preparation used against the unidentified disease ghost hand (2) . Azallu synonyms suggest that the word could also mean for or against panic (3) . Pliny the Elder, a Roman naturalist, used the term gelotophyllis – the leaves of laughter – for cannabis from Central Asia, which probably had a high content of psychoactive substances (3) . The modern word cannabis probably originated through the journey from Asia to Europe and Africa. The stem can is related to the English word cane , while the suffix bi means perfumed or fragrant (4) – ie a good-smelling stick. The word hash comes from the Arabic hashish , which means dry herb or grass. Hashashin – ie hashish user – is also considered the origin of assassins, or assassin in English. Originally, this was a derogatory term for people with a cannabis culture, and after the European Crusades, it became synonymous with assassin (5) . The word marijuana has a controversial origin. Some claim it originates from the Portuguese mariguango , which means poison (6) . Dictionaries point to the closeness of Maria Juana from Spanish-Mexican folk etymology (7) and that the Mexicans introduced the word to the United States. Others argue that the word has African roots and originates from mariamba (8) . The tension between the positive and negative linguistic connotations reflects cannabis’ varied role throughout history Contemporary synonyms for cannabis are innumerable, as are the theories behind their origin. The tension between the positive and negative linguistic connotations precisely reflects cannabis’ varied role throughout history and leaves a legacy of controversial views that we must shape further. Historical writings tell The earliest written accounts of the effects of cannabis on the psyche are found in China about 4,000 years ago. In the first pharmacopoeia, Pên-ts’ao Ching, it is described that with high intake one will be able to “see the devil”, and if ingested over time one can communicate with spirits and experience that “the body becomes light” (1) . A few thousand years later, the analgesic and time-distorting effect of cannabis is described (1) . It is worth noting that there was little difference between medicine and magic at this time. Medicine was seen as a magical miracle, and shamanism was widespread practice in Asian countries. Shamanism was also widespread among nomads, and human exploitation of the plant continued to spread geographically. 3,800-year-old clay tablets suggest that cannabis was used as a remedy for grief and epilepsy in Sumer (Mesopotamia) (3) . Later we can read in the Hindu scripture Atharvaveda ( ca. 1200-1000 BCE) that cannabis could “free us from anxiety” (9) . There was little difference between medicine and magic at this time The Greek historian Herodotus described the use of burnt cannabis flowers in funeral rites, in which the participants “screamed with pleasure” (3) . In 14th-century Egypt, on the other hand, it is warned that cannabis can cause sudden death or insanity (2) . Humans experienced early on the great variation in the plant’s potential effect. In Europe, however, the psychoactive effect was not particularly well known until the 19th century. Cannabis seeds were initially described as having a potentially beneficial effect on frightening dreams in depression (10) . The Frenchman Jacques-Joseph Moreau (1804–84) experimented with cannabis on himself. He reported that the drug could produce “pure ecstasy”, but also create disorganized thoughts and time distortion (11) . The Irish physician Sir William Brooke O’Shaughnessy (1809–89) studied the effects of Indian hemp while serving in the British East India Company in the 1830s (6) . His research culminated in the first modern scientific article on cannabis use (12) . In the introduction, he refers to the drug’s apparent two-part effect: in small doses it can have a stimulating effect, such as on appetite and the organism in general, but in larger doses the drug has a sedative and sensory-suppressing effect. He writes further: “As to the evil sequelae so unanimously dwelt on by all writers, these did not appear to me so numerous, so immediate, or so formidable…” Queen Victoria used cannabis for menstrual pain, the cultural elite in France had their own hash clubs Towards the end of the 19th century and the beginning of the 20th century, cannabis became increasingly widespread and accepted in Europe. Queen Victoria (1819–1901) used it for menstrual pain, the cultural elite in France had their own hash clubs, and Elisabeth of Bavaria used cannabis for coughs and to stimulate appetite (11, 13, 14) . The renowned British neurologist John Russel Reynolds (1828–96) summarized his experiences with cannabis in The Lancet (15) . He referred to his colleague, Dr. Williams, who in the teaching of medical students warned against very uncertain effects and the risk of intoxication. However, Reynolds claimed that as long as one had a good copy of the plant, cannabis was “one of the most valuable medicines we have.” He reported a good effect on “senile insomnia” (delirium patients who walk at night), alcoholic delirium and melancholy. For mania, on the other hand, he thought the effect was “worse than useless.” 20th century iron hand Scholars dispute how so-called recreational use of cannabis was imported into the United States. Did it develop among slaves of African descent who worked on hemp plantations, or was it through immigrants after the Mexican Revolution in 1910 (16) ? In terms of time, the latter seems to have the greatest significance, as at the beginning of the 20th century it was increasing, especially in jazz circles. However, its use was most widespread among Mexican immigrants, and marijuana was linked to insanity and crime through the media (17) . It all culminated in the Great Depression after the stock market crash of 1929 and resulted in The Marijuana Tax Act of 1937, which heavily taxed cannabis (18) . Several states had already begun banning cannabis, in addition to the 1925 Geneva Convention including cannabis among the substances to be subject to international control (19) . The cannabis wave spread as part of the hippie movement in the 1960s, and in 1965 came the first cannabis seizure in Norway (19) . The cannabis wave spread as part of the hippie movement in the 1960s The war on drugs became a resounding slogan in the campaign against drugs, with the United States and President Nixon at the helm. This greatly limited the continuation of the drug-liberal attitudes of the 1960s. Criminalization of cannabis became a fact and probably contributed to the decline in research in the field. The legislation was much debated for both professional and cultural reasons. Several physicians pointed out that cannabis was non-toxic and had potential as a medicine. At the same time, it was recognized that the effect was very variable, and drugs with less potential for abuse took over for cannabis in several of the indications, e.g. aspirin for headaches (11, 18) . Packaging of medical cannabis at UNIVO Pharmaceuticals, Israel 2022. Illustration photo: Tsafrir Abayov, AP / NTB Modern research is making great strides Tetrahydrocannabinol (THC) was isolated in the 1960s (20) , and the so-called endocannabinoid system was discovered in the 1990s (21) . Despite over 5,000 years of experience, we have just under 30 years of specific knowledge of the biological system that is affected by cannabis use. In recent years, extensive research has been done on cannabis use, but the knowledge base is still thin in several areas. Regarding the effect on the psyche, there is much to suggest that the most potent ingredients can induce psychosis symptoms (22) as well as aggravate the condition of people with mental disorders (23) . This is not necessarily the case for other cannabinoids, such as cannabidiol. Studies on the global disease burden show that cannabis use is associated with addiction and mental disorders, including psychosis. On the other hand, it does not appear to increase mortality in the population, such as opioids, amphetamines and cocaine (24) . What can we learn from history? A journey through history makes one thing clear: The use of cannabis has always been diverse and full of contrasts. There is potential for fun intoxication, relief of pain and nausea, but also psychosis, anxiety and confusion. Precisely because of the plant’s heterogeneous properties, we have to differentiate potential uses and test the effects separately. Black paint is useless: No one doubts the place of morphine in hospitals’ medicine cabinets – at the same time we take into account the potential for addiction and fatal overdose. No one doubts the place of morphine in hospitals’ medicine cabinets – at the same time we take into account the potential for addiction and fatal overdose In order to continue the debate on cannabis in a sensible way, we must first acknowledge the parallel discussions that are often mixed: discussions about cannabis as medicine and discussion about cannabis as drugs . It may be a bit reminiscent of the shamans’ mix between medicine and magic. If cannabinoids can play an important role in the medicine cabinet of future doctors, then this does not legitimize the use of cannabinoids as intoxicants. Similarly, it is dangerous to believe that cannabis is a miracle cure based on the euphoric feeling it can give when intoxicated. In addition, it is important to nuance the effect of each individual cannabinoid. Maybe some can be used as medicine, while other cannabinoids have the greatest potential as a drug with few harmful effects?
