Cannabis sativa and the anthropology of pain
Medical Anthropology
Source: "Townsend Letter for Doctors and Patients",
Feb-March, 2004 by T.Batchelder
Cannabis sativa is a plant with a long and controversial history of use in food and medicine around the world. In this column I will examine this plant in cross cultural perspective as well as recent findings from clinical studies on its medical applications and interest among pharmaceutical companies. In particular, I will explore its applications in the management of pain, as occurs with fibromyalgia, MS and other related health conditions. This paper is the culmination of early research I performed for a natural products company. Much of this information is drawn from the excellent text by Conrad (1997) on this subject.
Traditional Use
In traditional medicine (Conrad 1997) formulas containing hemp's seed or flowering tops were frequently recommended for difficult childbirth, menstrual cramps, rheumatism and convulsions, earaches, fevers, dysentery, epilepsy and insomnia, as well as to soothe nervous tension, stimulate appetite, and serve as an analgesic and aphrodesiac.
The oldest confirmed medical use of cannabis was in China in 3750 B.C.A philosopher farmer named Shen Nung produced the first reported pharmacopoeia, the Pen Ts'ao which listed hemp, ta ma, as a superior immortality elixir. The female plant was said to possess yin energy as opposed to the male plant's yang energy and was recommended for "female weakness," rheumatism, beri-beri, malaria, constipation, gout and absent-mindedness, among other ailments. Hempseed is discussed in the 16th century Chinese manuscript Pen T'sao Kang Mu of Li Shih-chen. He described the ability of the seed to increase chi, slow aging, enhance circulation, preventing stagnation of lymphatic fluid, increase flow of milk in nursing mothers and help paralysis. Li also claimed a shampoo of the seed would accelerate hair growth
In the second century BC, Pliny the Elder prescribed hempseed for constipation, the herb for earaches, and root poultices to ease cramped joints, gout and burns. His contemporary, Galen, described how Romans would fry and consume the seed with desserts. With the collapse of the Roman Empire and the Dark Ages, the use and study of hemp was put on hold. The Inquisition banned use of the scientific method and herbal medicine in Europe in favor of the medieval Church, magic and witch-hunts.
Hemp was used in Ayurvedic medicine for the alleviation of migraine headaches and stomach spasms, as an analgesic, antispasmodic, to promote digestion, and to assist in the flow of urine. India is so heavily steeped in the cultural and spiritual use of resinous cannabis that its people won a cultural exception to the UN Single Convention Treaty on Narcotic Drugs. It allows them to continue to consume the plant, known as ganga. The Vedas are ancient writings that serve as the foundation of Hindu civilization. Ganga, like many other important medicinal plants, is said to have originated from the primordial nectar which arose during the churning of the oceans. Ganja is used by priests and yogis (to trigger meditation), devotees of Shiva and other gods (for ceremonies), people who perform hard physical labor and athletes such as the wrestlers called Chaubes (to relieve pain and fatigue), and people who are ill (to relieve their illness.) The female plant is acknowledged to contain the most potent medicinal effects.
Ganja is consumed as an ingredient in various foods, such as barfee, laddoo, sarabat (sweet drink), and a chewy green honey candy called ma'joun. Raw cannabis is chewed, sometimes along with the stimulant betel leaf. And finally, people smoke it through a chillum, a chimney-style pipe used by Sadhu monks. It is consumed in powdered form (curna), lumped into a bolus (modaka), pressed into a tablet (vatika), used as a tincture (leha and paka), boiled with milk (dugdhapaka) and boiled in water to produce a decoction (kvatha.)
Cannabis is seldom used alone but is combined with other medicines to reduce its natural psychotropic effects or broaden its therapeutic applications. It is considered appropriate for both healthy and ill people to consume cannabis in Ayurveda. Healthy people consume it as an aphrodisiac and rejuvenating agent. To reduce its psychotropic effects, a pinch of powdered calamus root is taken with honey in the morning and evening.
Rejuvenation therapies using cannabis usually involve mixing 500 grams of the powdered plant with 50g each of other medicinal herbs in a liter of milk with ghee and honey. Doses are 5 grams each. The catch is that one usually also has to live in a closed-up house for three years, be celibate, and eat only milk and rice. If one does this periodically one is said to be able to live free of disease or old-age for three hundred years.
During the European Renaissance, European explorers returned from Africa with reports of the use of hemp to treat malaria, blackwater fever, dysentary, blood poisoning, and anthrax.
Culpeper's classic pharmacopoia The Complete Herbal mentioned the use of cannabis to treat cough. In the early 19th century Europeans travelling in Africa and Asia further expanded our knowledge of the use of hemp. William B. O'Shaughnessy, the British East India Company surgeon in Calcutta, noted that it helped relieve the pain of rheumatism and calm convulsions of infants as well as the muscle spasms of tetanus and rabies. The United States Dispensatory first listed it in 1854. It noted that extracts have been found to produce sleep, allay spasm, relieve pain and calm nervousness. It was recommended for neuralgia, gout, tetanus, phobias, cholera, convulsions, spasticity, hysteria, mental depression, insanity and uterine hemorrhage. It was used in a number of pharmaceutical preparations including Eli Lilly's Dr. Brown Sedative Tablets, and products by Parke Davis and Squibb. In the early 20th century the hypodermic needle was invented. Since cannabinoids are fat soluble they cannot be dissolved in water or injected into the bloodstream easily. As a result, therapeutic use of cannabis began to decline.
Neurological Disorders
Unlike alcohol, some research suggests cannabinoids do not harm brain cells or nerve tissue. In fact, people have THC receptors in their brains, clustered in the cerebral cortex, the home of higher thinking, perception, emotions, and cognition, as well as the hippocampus, home of memory, cerebellum and striatum, associated with movement, and basal ganglia, associated with control and coordination.
The arrangement of these receptor sites indicates that THC analogs and antagonists might eventually be useful for symptoms of movement disorders like the tremors of Parkinson's disease and Huntington's chorea as well as Alzheimer's. Cannabis may ease neurological and muscle problems associated with diseases such as multiple sclerosis (MS) including cramps, spasticity and ataxia. Amputees who experience the phantom limb effect and spasticity caused by spinal cord injury may also be relieved. Cannabis is useful for pain control and is used by peasant farmers in Poland, Russia and Lithuania who inhale the vapors of smoldering seedling tops of hemp plants thrown onto hot stones.
Cannabis is useful for migraines and was taken with a tincture of yellow jasmine for this purpose before antipyrine and its cogeners were introduced. It combines an analgesic and anti-emetic and may help the patient sleep as well. Once an attack is underway, sleep in a dark room is the best solution. Some patients find that only a few puffs and a short nap completely control migraine attacks once the symptoms of flickering visuals begin.
Cannabis may be useful for depression since it moderates the manic mood swings experienced by manic depressives, including calming the manic rage. It also provides a distraction from traumatic or distressing life situations as noted among US troops in Vietnam. The US government has studied this effect in New Mexico using veterans suffering from Post-traumatic Stress Disorder. Symptoms include flashbacks and sudden fits of anger, anxiety, and depression. Gulf War veterans have reported similar benefits. Recent evidence suggests these troops were exposed to nerve gas.
One of the most consistent and marked symptoms of cannabis use is the sensation of prolonged time. In addition, a separation of the mental faculties occurs, during which one functions as both a participant and an observer. However, an advantage of cannabis over other mood-altering drugs is that the patient remains fully functional and in control. Cannabis smokers retain their mental faculties, personal responsibility and mental clarity. They remain aware of their physical pains and problems but also feel a sense of detachment that helps them keep things in proper perspective. This allows terminally ill patients to face their deaths with courage and dignity. The 19th century physician Williams O'Shaughnessy poetically described this effect as enabling the physician to "strew the path to the tomb with flowers."
Unfortunately, it's not easy to establish the cannabinoid profile of a given sample of herb. The process requires gas chromatography which is expensive. What we do know is that the biochemical pathway of the cannabinoids in the body is from olivetol to CBG (cannabinol), then to either CBC (cannabichromene) or CBD (cannabidiol), then to THC. The body performs this biochemistry by adding a hydroxyl group (hydrogen plus oxygen) to the molecule's terpene carbon. This occurs most readily in the liver and in digestion which may explain why eating the herb can cause much stronger effects.
The US government claims that THC is the only medically active drug in cannabis which justifies its acceptance of synthetic THC pills as a legal prescription drug while banning natural cannabis. The most important non-psychoactive compound in cannabis is CBD which occurs in greater concentrations in industrial hemp. Cannabidiol is a precursor in the organic pathway of the cannabinoids. It tends to maintain an inverse relationship with THC. Hence, industrial hemp is very low in THC but high in CBD. CBD acts as a chemical buffer to THC and suppresses its effects including increased pulse rate, time distortion and the anxiety response. CBD may be useful for convulsions, movement disorders and symptoms of Huntington's disease, as an anti-inflammatory (it is more effective than aspirin), aid for insomnia, and anti-psychotic. Many of these conditions respond well to natural cannabis but not to THC alone. The fatigue-inducing properties of marijuana leaf (high in CBD) in particular have made it a popular treatment for insomnia. Interestingly, cannabinoids are also found in chocolate which may contribute to the subjective feelings associated with eating chocolate.
Glaucoma
Cannabis flower can lower fluid pressure inside the eyeball itself which builds to high levels in diseases such as glaucoma (which accounts for 15% of blindness.) Regular use of the herb may help hold down the pressure and prevent this painful process. Cannabis drugs reduce IOP in animals as well as or better than conventional pharmaceutical drugs with fewer or no medical side effects. Orthodox medicine opens up drainage ducts, much like an engineer would, to lower ocular pressure using drugs or surgery. Cannabis works like nature to let the water spread out and be absorbed into marshes that suck the water down into an underground water table. Cannabis also dehydrates the eyes thereby reducing the volume of fluid that is trying to pass through them. Unlike currently legal drugs, cannabis does not cause damage to the liver or kidneys.
Resination (use of cannabis) causes bloodshot eyes. However, this is simply due to dilation of blood vessels which makes them more visible--not ruptures in blood vessels. No loss of objective visual acuity or perception of light brightness is caused by cannabis. In fact, increased sensitivity to light indicates improved night vision. Local fishermen who smoke cannabis or drink a beverage made of it have an increased ability to see in the dark, according to some anthropological studies.
Topical Applications
The flowers and leaves of the cannabis plant are a common topical folk remedy for the relief of swollen joints, inflammation, fever, infection, superficial injuries, burns, and rheumatism. In Mexico and Central America, cannabis leaves soaked in alcohol have traditionally been wrapped around aching, arthritic joints. The New English Dispensatory of 1764 recommends boiling cannabis roots in water and applying the paste to skin inflammations. The boiled root was also applied as a poultice to soothe joint pains and reduce inflammations.
The juicy resin pressed from the flowering industrial hemp plant with ripe seeds rich in CBD are very useful for burns, and as an antibiotic against bacterial infections that might invade a wound or the ear, nose, and throat. The extract was found to help control oral herpes and ulcerative gingivitis. Extracts of unripe cannabis tops demonstrate antibiotic activity against certain bacteria and fungi. CBD is effective against strains of staphylococcus that are resistant to penicillin and other antibiotics. In one study THC injected into tumors in the lungs of mice causes a 28 to 82% reduction in tumor size.
Juice of cannabis was used by the Roman physicians of the second century A.D., Pliny the Elder and Galen, as an analgesic for ear pains. In England the 1645 Compleat Herbal suggested using cannabis juice to eliminate earwigs. Culpeper's 1814 Complete Herbal agrees that the seeding flower can help expel worms in humans and other animals.
The Greek historian Herodotus described Scythians in 450 BC using hemp to purify and cleanse themselves which made their skin shining and clean. Today, a growing number of hempseed based personal hygiene products are on the market as soaps, shampoos, salves, cosmetics, and other skin and hair care items. Essential fatty acids are being researched to treat epidermal conditions such as psoriasis and eczema.
Eating Disorders
Cannabis causes the mouth to dry which increases appetite to moisten the palate. It is used clinically to treat people with anorexia nervosa, wasting caused by AIDS, tuberculosis, and cancer. It helps settle the stomach of people with motion sickness. Cannabis can control the nausea triggered by chemotherapy and radiation treatments. This may be caused by the resin's antispasmodic effect which suppresses the gag reflex and relaxes abdominal muscle spasms.
Cardiopulmonary Disorders
Smoking Cannabis introduces resin into the depths of the lungs where the drug is quickly absorbed across the alveolar membranes into the bloodstream. This avoids the liver and is a much more efficient way to introduce the drug into the body. Unlike tobacco smoke Cannabis appears to cause minimal damage to the lungs.
Cannabis speeds the heart rate by 10-40 beats per minute in response to THC doses of 2-70 mg. It also expands the blood vessels, improving blood flow throughout the vascular system which may lower blood pressure and help reduce stress. The breath rate is slowed as shown by studies of ascetics in India who used it for religious purposes. This may also reduce stress. A cooling of the body occurs, especially the extremities, explaining its historic use for fevers.
By dilating the bronchi and bronchioles (tiny air tubes in the lungs) and relaxing the bronchial muscles, cannabis can help control asthma. This increases exchange of gases in the lungs and total oxygen flow. A few puffs can bring fast relief to an asthma attack. The shallowness of breath, headaches, chest pains, and other symptoms of exposure to heavy smog might be alleviated by use of cannabis.
Cannabis is also an expectorant that helps the patient break up and expel phlegm and clear out congested air passages.
Reproductive Health
Cannabis has traditionally been used to control morning sickness, speed labor (by increasing uterine contractions), and wean children from breast-milk, in Africa, the Middle East, and Asia. It is also a sexual stimulant and dilates vasculature which increases blood supply to the reproductive organs causing erection in males and production of vaginal fluids in the female.
Nutrition
While the medicinally active compounds in hemp, the cannabinoids, require extraction in hot oil, alcohol tinctures, burning, or other techniques for use by the body, other components are available as nutrients with minimal processing. Hempseed is grown extensively in the former Soviet Union as a food and is consumed as an oatmeal. Drinking beverages made with boiled hempseed have been featured in the medical literature for millennia as a soothing remedy for coughs and throat irritations. Eating the seed lubricates the bowels and is a traditional treatment for constipation, diarrhea, and digestive problems.
Hemp is rich in linoleic acid (also called omega 6), a type of essential fatty acid, deficiency of which may cause infections, impaired wound healing, retarded growth, miscarriage, male sterility, skin eruptions, arthritic symptoms, behavioral disturbances, dehydration, liver or kidney degeneration, heart problems, poor blood circulation and hair loss. Hempseed is the highest in essential fatty acid of any plant, up to 81% of total oil volume. Raw hempseed oil is among the lowest in saturated fats, at just 8% of total oil volume
Hempseed is also a good source of gamma-linolenic acid (GLA), a particularly rare oil that is so beneficial to human growth and development that it is a component in mother's milk. Before hempseed was available once again, Americans have been able to obtain GLA only by consuming borage, black currant, or evening primrose seed oils. The oil's optimum refrigerated shelf life is less than 2 months after the seed has been pressed or the sealed container opened. Rancidity is measured by the Peroxide Value or PV (how many by-products of oxidation have formed as milli-equivalents per kilogram). If an oil has a strong or bitter smell, use it topically only. This number should be less than 10 PV. Cold pressed oils are best for consumption as heating the oil destroys much of the nutritional value.
The seed can be ground or sprouted. One pound of seed will yield three pounds of sprouts. Even sterilized hempseed will sprout though it will not germinate and grow into a viable plant. Like soybean, hempseed extracts can be made into vegetable milk. The seed is rich in dietary fiber, carotene, vitamins B1, B2, B3, B6, C and E. About 35% of the seed is fatty acids. The seed also contains a complete protein. The protein in hemp is more digestible than soy protein due to edestin, a special type of protein. Steam sterilization slightly reduces digestibility of the protein.
Recent Research
Many companies and organizations are now actively researching uses of Cannabis for nutrition and pharmaceutical products. Below is a brief review of some of this research.
Dr. Donald Abrams at University of California at San Francisco (UCSF) in partnership with Charlotte, North Carolina-based Multidisciplinary Association for Psychedelic Studies (MAPS), a nonprofit organization that supports research into psychedelic drugs and marijuana is studying marijuana, for flagging appetites and nausea as well as its safety with protease inhibitors. This teamwork has resulted in an application to the National Institute on Drug Abuse (NIDA) in Rockville, Md., to obtain marijuana in order to study its effects on people with HIV/AIDS. NIDA dragged its feet but finally granted Abrams a small $1 million grant. While Marinol is prescribed for nausea, many AIDS patients say they cannot keep the pills down and they are slower to take effect and to wear off than the smoked version. Abrams research has looked at patients' caloric intake, body weight and body composition (of fat and muscle), as well as the effects of marijuana and THC on protease inhibitor metabolism.
Alterna, a hair-care company that uses hemp seeds in products, granted researchers a $200,000 grant to study industrial hemp in Hawaii. While some states have moved to allow hemp growing, Hawaii is among the first to get a test project going. University of Hawaii plant geneticist David West who leads the research, notes that hemp seed oil contains essential fatty acids, protein and other vital elements, and serves as a base for skin- and hair-care products.
Cannabidiol has been found to work much like Enbel and Remicade, new drugs for rheumatoid arthritis, but unlike them can be taken orally according to researcher Dr. Marc Feldmann, a prominent arthritis researcher in London whose 2001 findings are described in the Proceedings of the National Academy of Sciences. Scientists gave laboratory mice injections of collagen, a connective-tissue protein that sparked an abnormal immune system attack on the mice's tissues and joints. Rheumatoid arthritis is characterized by such mistaken attacks by the body's own defense system, which leads to swelling, pain, inflammation and destruction of joints. The cannabidiol, purified from hashish, was injected into some rats and given orally to others, while control animals received a placebo. Researchers evaluated the drug's effect by measuring swelling, inflammation and joint stiffness in the animals. Some of the rodents' hind feet were removed so they could be studied for physical damage by the renegade immune system attack. Animals who got the drug had significantly fewer symptoms, and more of them escaped damage to their feet. Feldmann is a division chief at the Kennedy Institute of Rheumatology in London, the largest institution in the world studying rheumatic diseases and recently received a $500,000 prize from the Swedish Academy of Scientists for their showing that blocking TNF could help arthritis, which paved the way for drugs like Enbrel and Remicade. He notes that these drugs have to be injected by the patient or someone else twice a week, and that they are expensive with a year's treatment costing about $10,000. This makes cannabidiol a promising alternative. The only potential problem is that cannabidiol compound is only effective at a narrow range of doses. Feldmann credits Dr. Raffi Mechoulem in Israel for these discoveries, who he calls the "guru of cannabinoid chemistry."
Sativex is a whole plant medicinal cannabis extract containing tetranabinex (THC) and nabidiolex (cannabidiol--CBD) as its principal component and is administered by means of a spray into the mouth rather than smoked. It is indicated for the relief of symptoms of multiple sclerosis as well as treatment of severe neuropathy pain and was developed by GW Pharmaceuticals in March 2003. GW has also entered a licensing agreement with Bayer, which gives Bayer exclusive rights to market Sativex in the UK with the option to extend this to other countries around the world. Unfortunately US approval may take two or three years. Sativex is also undergoing phase III trials for the relief of neuropathic-related cancer pain. Between 10% and 30% of multiple sclerosis patients in Europe smoke cannabis to ease the pain and disabling symptoms of the disease according to estimates. GW Pharmaceuticals has increased production of cannabis at its greenhouses to 60 tons per year.
In Phase III placebo-controlled trials in 350 patients with multiple sclerosis, significantly more patients on Sativex experienced reduced neuropathic pain, spasticity, and sleep disturbances than placebos. Sativex can dull severe pain while allowing patients to perform daily activities. For more information see University of California's Center for Medicinal Cannabis Research (CMCR) http://cmcr.ucsd.edu/
Toxicity
Toxicologically, cannabis is fairly safe, having no practical lethal dose (IOM 1982). However, when smoking it is better to exhale it quickly as after a few seconds the ratio of beneficial to destructive compounds decreases.
Various studies have suggested that cannabis causes higher accident rates and infertility however they are often based on bias samples. For example, concerns over higher accident rates while using cannabis are due to faulty survey methods. A dramatic, recent increase in "emergency room mentions" of marijuana use was due to the fact that the hospital admission process was amended to ask patients if they ever used marijuana which led to a jump in reporting. Hemp has also been scape-goated for the dramatic, global decrease in human fertility in the last 50 years which may in fact, be caused by pesticides.
The psychoactive effects of even large doses of marijuana are milder and more easily controlled than those of LSD. THC even at large doses lacks the effects of physiological and mental stress found with the psychotomimetics. Tolerance does not occur to any significant extent with cannabis but occurs rapidly with psychotomimetics. In fact, frequent consumers of marijuana show reverse tolerance: they achieve a higher plasma level after a test dose and excrete the dose over a longer period than do infrequent consumers. Familiarity also leads to increased sensitivity and the use of lower dosages. The acute changes in brain wave patterns seen with LSD are absent and use of cannabis ends in sedation and sleep while restlessness occurs with true hallucinogens.
Likewise, in many ways THC is much safer than alcohol. Both cause a sedated phase at lower doses and an excited one at medium doses. However, in larger doses alcohol acts as a general anesthetic: depressing the central nervous system, and also slowing brain wave rhythms and decreasing mental and physical performance, but not altering sensory perceptions. Cannabis in contrast, affects perception but has little effect on brain waves. Marijuana leads to moderate overestimation of time while alcohol leads to extreme underestimation. Hunger and food consumption are increased by marijuana and decreased by alcohol. Alcoholic beverages must be ingested in grams rather than milligrams and they provide empty calories that can take the place of healthy food resulting in a loss of protein and vitamins and in some people, a thiamine deficiency that can lead to atrophy of the brain. Alcohol is also toxic to the liver, upper respiratory tracts, and brain.
Medical Anthropology
Source: "Townsend Letter for Doctors and Patients",
Feb-March, 2004 by T.Batchelder
Cannabis sativa is a plant with a long and controversial history of use in food and medicine around the world. In this column I will examine this plant in cross cultural perspective as well as recent findings from clinical studies on its medical applications and interest among pharmaceutical companies. In particular, I will explore its applications in the management of pain, as occurs with fibromyalgia, MS and other related health conditions. This paper is the culmination of early research I performed for a natural products company. Much of this information is drawn from the excellent text by Conrad (1997) on this subject.
Traditional Use
In traditional medicine (Conrad 1997) formulas containing hemp's seed or flowering tops were frequently recommended for difficult childbirth, menstrual cramps, rheumatism and convulsions, earaches, fevers, dysentery, epilepsy and insomnia, as well as to soothe nervous tension, stimulate appetite, and serve as an analgesic and aphrodesiac.
The oldest confirmed medical use of cannabis was in China in 3750 B.C.A philosopher farmer named Shen Nung produced the first reported pharmacopoeia, the Pen Ts'ao which listed hemp, ta ma, as a superior immortality elixir. The female plant was said to possess yin energy as opposed to the male plant's yang energy and was recommended for "female weakness," rheumatism, beri-beri, malaria, constipation, gout and absent-mindedness, among other ailments. Hempseed is discussed in the 16th century Chinese manuscript Pen T'sao Kang Mu of Li Shih-chen. He described the ability of the seed to increase chi, slow aging, enhance circulation, preventing stagnation of lymphatic fluid, increase flow of milk in nursing mothers and help paralysis. Li also claimed a shampoo of the seed would accelerate hair growth
In the second century BC, Pliny the Elder prescribed hempseed for constipation, the herb for earaches, and root poultices to ease cramped joints, gout and burns. His contemporary, Galen, described how Romans would fry and consume the seed with desserts. With the collapse of the Roman Empire and the Dark Ages, the use and study of hemp was put on hold. The Inquisition banned use of the scientific method and herbal medicine in Europe in favor of the medieval Church, magic and witch-hunts.
Hemp was used in Ayurvedic medicine for the alleviation of migraine headaches and stomach spasms, as an analgesic, antispasmodic, to promote digestion, and to assist in the flow of urine. India is so heavily steeped in the cultural and spiritual use of resinous cannabis that its people won a cultural exception to the UN Single Convention Treaty on Narcotic Drugs. It allows them to continue to consume the plant, known as ganga. The Vedas are ancient writings that serve as the foundation of Hindu civilization. Ganga, like many other important medicinal plants, is said to have originated from the primordial nectar which arose during the churning of the oceans. Ganja is used by priests and yogis (to trigger meditation), devotees of Shiva and other gods (for ceremonies), people who perform hard physical labor and athletes such as the wrestlers called Chaubes (to relieve pain and fatigue), and people who are ill (to relieve their illness.) The female plant is acknowledged to contain the most potent medicinal effects.
Ganja is consumed as an ingredient in various foods, such as barfee, laddoo, sarabat (sweet drink), and a chewy green honey candy called ma'joun. Raw cannabis is chewed, sometimes along with the stimulant betel leaf. And finally, people smoke it through a chillum, a chimney-style pipe used by Sadhu monks. It is consumed in powdered form (curna), lumped into a bolus (modaka), pressed into a tablet (vatika), used as a tincture (leha and paka), boiled with milk (dugdhapaka) and boiled in water to produce a decoction (kvatha.)
Cannabis is seldom used alone but is combined with other medicines to reduce its natural psychotropic effects or broaden its therapeutic applications. It is considered appropriate for both healthy and ill people to consume cannabis in Ayurveda. Healthy people consume it as an aphrodisiac and rejuvenating agent. To reduce its psychotropic effects, a pinch of powdered calamus root is taken with honey in the morning and evening.
Rejuvenation therapies using cannabis usually involve mixing 500 grams of the powdered plant with 50g each of other medicinal herbs in a liter of milk with ghee and honey. Doses are 5 grams each. The catch is that one usually also has to live in a closed-up house for three years, be celibate, and eat only milk and rice. If one does this periodically one is said to be able to live free of disease or old-age for three hundred years.
During the European Renaissance, European explorers returned from Africa with reports of the use of hemp to treat malaria, blackwater fever, dysentary, blood poisoning, and anthrax.
Culpeper's classic pharmacopoia The Complete Herbal mentioned the use of cannabis to treat cough. In the early 19th century Europeans travelling in Africa and Asia further expanded our knowledge of the use of hemp. William B. O'Shaughnessy, the British East India Company surgeon in Calcutta, noted that it helped relieve the pain of rheumatism and calm convulsions of infants as well as the muscle spasms of tetanus and rabies. The United States Dispensatory first listed it in 1854. It noted that extracts have been found to produce sleep, allay spasm, relieve pain and calm nervousness. It was recommended for neuralgia, gout, tetanus, phobias, cholera, convulsions, spasticity, hysteria, mental depression, insanity and uterine hemorrhage. It was used in a number of pharmaceutical preparations including Eli Lilly's Dr. Brown Sedative Tablets, and products by Parke Davis and Squibb. In the early 20th century the hypodermic needle was invented. Since cannabinoids are fat soluble they cannot be dissolved in water or injected into the bloodstream easily. As a result, therapeutic use of cannabis began to decline.
Neurological Disorders
Unlike alcohol, some research suggests cannabinoids do not harm brain cells or nerve tissue. In fact, people have THC receptors in their brains, clustered in the cerebral cortex, the home of higher thinking, perception, emotions, and cognition, as well as the hippocampus, home of memory, cerebellum and striatum, associated with movement, and basal ganglia, associated with control and coordination.
The arrangement of these receptor sites indicates that THC analogs and antagonists might eventually be useful for symptoms of movement disorders like the tremors of Parkinson's disease and Huntington's chorea as well as Alzheimer's. Cannabis may ease neurological and muscle problems associated with diseases such as multiple sclerosis (MS) including cramps, spasticity and ataxia. Amputees who experience the phantom limb effect and spasticity caused by spinal cord injury may also be relieved. Cannabis is useful for pain control and is used by peasant farmers in Poland, Russia and Lithuania who inhale the vapors of smoldering seedling tops of hemp plants thrown onto hot stones.
Cannabis is useful for migraines and was taken with a tincture of yellow jasmine for this purpose before antipyrine and its cogeners were introduced. It combines an analgesic and anti-emetic and may help the patient sleep as well. Once an attack is underway, sleep in a dark room is the best solution. Some patients find that only a few puffs and a short nap completely control migraine attacks once the symptoms of flickering visuals begin.
Cannabis may be useful for depression since it moderates the manic mood swings experienced by manic depressives, including calming the manic rage. It also provides a distraction from traumatic or distressing life situations as noted among US troops in Vietnam. The US government has studied this effect in New Mexico using veterans suffering from Post-traumatic Stress Disorder. Symptoms include flashbacks and sudden fits of anger, anxiety, and depression. Gulf War veterans have reported similar benefits. Recent evidence suggests these troops were exposed to nerve gas.
One of the most consistent and marked symptoms of cannabis use is the sensation of prolonged time. In addition, a separation of the mental faculties occurs, during which one functions as both a participant and an observer. However, an advantage of cannabis over other mood-altering drugs is that the patient remains fully functional and in control. Cannabis smokers retain their mental faculties, personal responsibility and mental clarity. They remain aware of their physical pains and problems but also feel a sense of detachment that helps them keep things in proper perspective. This allows terminally ill patients to face their deaths with courage and dignity. The 19th century physician Williams O'Shaughnessy poetically described this effect as enabling the physician to "strew the path to the tomb with flowers."
Unfortunately, it's not easy to establish the cannabinoid profile of a given sample of herb. The process requires gas chromatography which is expensive. What we do know is that the biochemical pathway of the cannabinoids in the body is from olivetol to CBG (cannabinol), then to either CBC (cannabichromene) or CBD (cannabidiol), then to THC. The body performs this biochemistry by adding a hydroxyl group (hydrogen plus oxygen) to the molecule's terpene carbon. This occurs most readily in the liver and in digestion which may explain why eating the herb can cause much stronger effects.
The US government claims that THC is the only medically active drug in cannabis which justifies its acceptance of synthetic THC pills as a legal prescription drug while banning natural cannabis. The most important non-psychoactive compound in cannabis is CBD which occurs in greater concentrations in industrial hemp. Cannabidiol is a precursor in the organic pathway of the cannabinoids. It tends to maintain an inverse relationship with THC. Hence, industrial hemp is very low in THC but high in CBD. CBD acts as a chemical buffer to THC and suppresses its effects including increased pulse rate, time distortion and the anxiety response. CBD may be useful for convulsions, movement disorders and symptoms of Huntington's disease, as an anti-inflammatory (it is more effective than aspirin), aid for insomnia, and anti-psychotic. Many of these conditions respond well to natural cannabis but not to THC alone. The fatigue-inducing properties of marijuana leaf (high in CBD) in particular have made it a popular treatment for insomnia. Interestingly, cannabinoids are also found in chocolate which may contribute to the subjective feelings associated with eating chocolate.
Glaucoma
Cannabis flower can lower fluid pressure inside the eyeball itself which builds to high levels in diseases such as glaucoma (which accounts for 15% of blindness.) Regular use of the herb may help hold down the pressure and prevent this painful process. Cannabis drugs reduce IOP in animals as well as or better than conventional pharmaceutical drugs with fewer or no medical side effects. Orthodox medicine opens up drainage ducts, much like an engineer would, to lower ocular pressure using drugs or surgery. Cannabis works like nature to let the water spread out and be absorbed into marshes that suck the water down into an underground water table. Cannabis also dehydrates the eyes thereby reducing the volume of fluid that is trying to pass through them. Unlike currently legal drugs, cannabis does not cause damage to the liver or kidneys.
Resination (use of cannabis) causes bloodshot eyes. However, this is simply due to dilation of blood vessels which makes them more visible--not ruptures in blood vessels. No loss of objective visual acuity or perception of light brightness is caused by cannabis. In fact, increased sensitivity to light indicates improved night vision. Local fishermen who smoke cannabis or drink a beverage made of it have an increased ability to see in the dark, according to some anthropological studies.
Topical Applications
The flowers and leaves of the cannabis plant are a common topical folk remedy for the relief of swollen joints, inflammation, fever, infection, superficial injuries, burns, and rheumatism. In Mexico and Central America, cannabis leaves soaked in alcohol have traditionally been wrapped around aching, arthritic joints. The New English Dispensatory of 1764 recommends boiling cannabis roots in water and applying the paste to skin inflammations. The boiled root was also applied as a poultice to soothe joint pains and reduce inflammations.
The juicy resin pressed from the flowering industrial hemp plant with ripe seeds rich in CBD are very useful for burns, and as an antibiotic against bacterial infections that might invade a wound or the ear, nose, and throat. The extract was found to help control oral herpes and ulcerative gingivitis. Extracts of unripe cannabis tops demonstrate antibiotic activity against certain bacteria and fungi. CBD is effective against strains of staphylococcus that are resistant to penicillin and other antibiotics. In one study THC injected into tumors in the lungs of mice causes a 28 to 82% reduction in tumor size.
Juice of cannabis was used by the Roman physicians of the second century A.D., Pliny the Elder and Galen, as an analgesic for ear pains. In England the 1645 Compleat Herbal suggested using cannabis juice to eliminate earwigs. Culpeper's 1814 Complete Herbal agrees that the seeding flower can help expel worms in humans and other animals.
The Greek historian Herodotus described Scythians in 450 BC using hemp to purify and cleanse themselves which made their skin shining and clean. Today, a growing number of hempseed based personal hygiene products are on the market as soaps, shampoos, salves, cosmetics, and other skin and hair care items. Essential fatty acids are being researched to treat epidermal conditions such as psoriasis and eczema.
Eating Disorders
Cannabis causes the mouth to dry which increases appetite to moisten the palate. It is used clinically to treat people with anorexia nervosa, wasting caused by AIDS, tuberculosis, and cancer. It helps settle the stomach of people with motion sickness. Cannabis can control the nausea triggered by chemotherapy and radiation treatments. This may be caused by the resin's antispasmodic effect which suppresses the gag reflex and relaxes abdominal muscle spasms.
Cardiopulmonary Disorders
Smoking Cannabis introduces resin into the depths of the lungs where the drug is quickly absorbed across the alveolar membranes into the bloodstream. This avoids the liver and is a much more efficient way to introduce the drug into the body. Unlike tobacco smoke Cannabis appears to cause minimal damage to the lungs.
Cannabis speeds the heart rate by 10-40 beats per minute in response to THC doses of 2-70 mg. It also expands the blood vessels, improving blood flow throughout the vascular system which may lower blood pressure and help reduce stress. The breath rate is slowed as shown by studies of ascetics in India who used it for religious purposes. This may also reduce stress. A cooling of the body occurs, especially the extremities, explaining its historic use for fevers.
By dilating the bronchi and bronchioles (tiny air tubes in the lungs) and relaxing the bronchial muscles, cannabis can help control asthma. This increases exchange of gases in the lungs and total oxygen flow. A few puffs can bring fast relief to an asthma attack. The shallowness of breath, headaches, chest pains, and other symptoms of exposure to heavy smog might be alleviated by use of cannabis.
Cannabis is also an expectorant that helps the patient break up and expel phlegm and clear out congested air passages.
Reproductive Health
Cannabis has traditionally been used to control morning sickness, speed labor (by increasing uterine contractions), and wean children from breast-milk, in Africa, the Middle East, and Asia. It is also a sexual stimulant and dilates vasculature which increases blood supply to the reproductive organs causing erection in males and production of vaginal fluids in the female.
Nutrition
While the medicinally active compounds in hemp, the cannabinoids, require extraction in hot oil, alcohol tinctures, burning, or other techniques for use by the body, other components are available as nutrients with minimal processing. Hempseed is grown extensively in the former Soviet Union as a food and is consumed as an oatmeal. Drinking beverages made with boiled hempseed have been featured in the medical literature for millennia as a soothing remedy for coughs and throat irritations. Eating the seed lubricates the bowels and is a traditional treatment for constipation, diarrhea, and digestive problems.
Hemp is rich in linoleic acid (also called omega 6), a type of essential fatty acid, deficiency of which may cause infections, impaired wound healing, retarded growth, miscarriage, male sterility, skin eruptions, arthritic symptoms, behavioral disturbances, dehydration, liver or kidney degeneration, heart problems, poor blood circulation and hair loss. Hempseed is the highest in essential fatty acid of any plant, up to 81% of total oil volume. Raw hempseed oil is among the lowest in saturated fats, at just 8% of total oil volume
Hempseed is also a good source of gamma-linolenic acid (GLA), a particularly rare oil that is so beneficial to human growth and development that it is a component in mother's milk. Before hempseed was available once again, Americans have been able to obtain GLA only by consuming borage, black currant, or evening primrose seed oils. The oil's optimum refrigerated shelf life is less than 2 months after the seed has been pressed or the sealed container opened. Rancidity is measured by the Peroxide Value or PV (how many by-products of oxidation have formed as milli-equivalents per kilogram). If an oil has a strong or bitter smell, use it topically only. This number should be less than 10 PV. Cold pressed oils are best for consumption as heating the oil destroys much of the nutritional value.
The seed can be ground or sprouted. One pound of seed will yield three pounds of sprouts. Even sterilized hempseed will sprout though it will not germinate and grow into a viable plant. Like soybean, hempseed extracts can be made into vegetable milk. The seed is rich in dietary fiber, carotene, vitamins B1, B2, B3, B6, C and E. About 35% of the seed is fatty acids. The seed also contains a complete protein. The protein in hemp is more digestible than soy protein due to edestin, a special type of protein. Steam sterilization slightly reduces digestibility of the protein.
Recent Research
Many companies and organizations are now actively researching uses of Cannabis for nutrition and pharmaceutical products. Below is a brief review of some of this research.
Dr. Donald Abrams at University of California at San Francisco (UCSF) in partnership with Charlotte, North Carolina-based Multidisciplinary Association for Psychedelic Studies (MAPS), a nonprofit organization that supports research into psychedelic drugs and marijuana is studying marijuana, for flagging appetites and nausea as well as its safety with protease inhibitors. This teamwork has resulted in an application to the National Institute on Drug Abuse (NIDA) in Rockville, Md., to obtain marijuana in order to study its effects on people with HIV/AIDS. NIDA dragged its feet but finally granted Abrams a small $1 million grant. While Marinol is prescribed for nausea, many AIDS patients say they cannot keep the pills down and they are slower to take effect and to wear off than the smoked version. Abrams research has looked at patients' caloric intake, body weight and body composition (of fat and muscle), as well as the effects of marijuana and THC on protease inhibitor metabolism.
Alterna, a hair-care company that uses hemp seeds in products, granted researchers a $200,000 grant to study industrial hemp in Hawaii. While some states have moved to allow hemp growing, Hawaii is among the first to get a test project going. University of Hawaii plant geneticist David West who leads the research, notes that hemp seed oil contains essential fatty acids, protein and other vital elements, and serves as a base for skin- and hair-care products.
Cannabidiol has been found to work much like Enbel and Remicade, new drugs for rheumatoid arthritis, but unlike them can be taken orally according to researcher Dr. Marc Feldmann, a prominent arthritis researcher in London whose 2001 findings are described in the Proceedings of the National Academy of Sciences. Scientists gave laboratory mice injections of collagen, a connective-tissue protein that sparked an abnormal immune system attack on the mice's tissues and joints. Rheumatoid arthritis is characterized by such mistaken attacks by the body's own defense system, which leads to swelling, pain, inflammation and destruction of joints. The cannabidiol, purified from hashish, was injected into some rats and given orally to others, while control animals received a placebo. Researchers evaluated the drug's effect by measuring swelling, inflammation and joint stiffness in the animals. Some of the rodents' hind feet were removed so they could be studied for physical damage by the renegade immune system attack. Animals who got the drug had significantly fewer symptoms, and more of them escaped damage to their feet. Feldmann is a division chief at the Kennedy Institute of Rheumatology in London, the largest institution in the world studying rheumatic diseases and recently received a $500,000 prize from the Swedish Academy of Scientists for their showing that blocking TNF could help arthritis, which paved the way for drugs like Enbrel and Remicade. He notes that these drugs have to be injected by the patient or someone else twice a week, and that they are expensive with a year's treatment costing about $10,000. This makes cannabidiol a promising alternative. The only potential problem is that cannabidiol compound is only effective at a narrow range of doses. Feldmann credits Dr. Raffi Mechoulem in Israel for these discoveries, who he calls the "guru of cannabinoid chemistry."
Sativex is a whole plant medicinal cannabis extract containing tetranabinex (THC) and nabidiolex (cannabidiol--CBD) as its principal component and is administered by means of a spray into the mouth rather than smoked. It is indicated for the relief of symptoms of multiple sclerosis as well as treatment of severe neuropathy pain and was developed by GW Pharmaceuticals in March 2003. GW has also entered a licensing agreement with Bayer, which gives Bayer exclusive rights to market Sativex in the UK with the option to extend this to other countries around the world. Unfortunately US approval may take two or three years. Sativex is also undergoing phase III trials for the relief of neuropathic-related cancer pain. Between 10% and 30% of multiple sclerosis patients in Europe smoke cannabis to ease the pain and disabling symptoms of the disease according to estimates. GW Pharmaceuticals has increased production of cannabis at its greenhouses to 60 tons per year.
In Phase III placebo-controlled trials in 350 patients with multiple sclerosis, significantly more patients on Sativex experienced reduced neuropathic pain, spasticity, and sleep disturbances than placebos. Sativex can dull severe pain while allowing patients to perform daily activities. For more information see University of California's Center for Medicinal Cannabis Research (CMCR) http://cmcr.ucsd.edu/
Toxicity
Toxicologically, cannabis is fairly safe, having no practical lethal dose (IOM 1982). However, when smoking it is better to exhale it quickly as after a few seconds the ratio of beneficial to destructive compounds decreases.
Various studies have suggested that cannabis causes higher accident rates and infertility however they are often based on bias samples. For example, concerns over higher accident rates while using cannabis are due to faulty survey methods. A dramatic, recent increase in "emergency room mentions" of marijuana use was due to the fact that the hospital admission process was amended to ask patients if they ever used marijuana which led to a jump in reporting. Hemp has also been scape-goated for the dramatic, global decrease in human fertility in the last 50 years which may in fact, be caused by pesticides.
The psychoactive effects of even large doses of marijuana are milder and more easily controlled than those of LSD. THC even at large doses lacks the effects of physiological and mental stress found with the psychotomimetics. Tolerance does not occur to any significant extent with cannabis but occurs rapidly with psychotomimetics. In fact, frequent consumers of marijuana show reverse tolerance: they achieve a higher plasma level after a test dose and excrete the dose over a longer period than do infrequent consumers. Familiarity also leads to increased sensitivity and the use of lower dosages. The acute changes in brain wave patterns seen with LSD are absent and use of cannabis ends in sedation and sleep while restlessness occurs with true hallucinogens.
Likewise, in many ways THC is much safer than alcohol. Both cause a sedated phase at lower doses and an excited one at medium doses. However, in larger doses alcohol acts as a general anesthetic: depressing the central nervous system, and also slowing brain wave rhythms and decreasing mental and physical performance, but not altering sensory perceptions. Cannabis in contrast, affects perception but has little effect on brain waves. Marijuana leads to moderate overestimation of time while alcohol leads to extreme underestimation. Hunger and food consumption are increased by marijuana and decreased by alcohol. Alcoholic beverages must be ingested in grams rather than milligrams and they provide empty calories that can take the place of healthy food resulting in a loss of protein and vitamins and in some people, a thiamine deficiency that can lead to atrophy of the brain. Alcohol is also toxic to the liver, upper respiratory tracts, and brain.
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