The history of the medical Cannabis movement in the USA and its significance for pediatricians
Author: Lucie Garabasova
What is the history of medical cannabis in the USA? Let’s take a look at the history of cannabis, its effects on the human body (supported by studies), and especially its impact on pediatric patients. Are pediatricians ready to face the question asked by many parents: “Can cannabis help my child?”
History of Medical Cannabis in the USA
Cannabis has been used for thousands of years across the world. Its first medical records report improvement in rheumatism, constipation, and gynecological problems in China. In Europe, it gained recognition in the mid-19th century when Irish physician William O’Shaughnessy published an article based on his experience treating tetanus and convulsive diseases with cannabis during childbirth in India. Cannabis was first listed in the U.S. Pharmacopeia in 1851 as “Extract of Cannabis.”
The decline in cannabis use was fueled by prejudice against Mexicans who emigrated during the Mexican Revolution in 1910. Rumors spread that marijuana, traditionally used as a recreational drug, incited violent crime and endangered American children. Between 1914 and 1925, 26 states banned cannabis. In 1930, the Federal Bureau of Narcotics was established as a U.S. Treasury agency and spearheaded legislation passing the Marijuana Tax Act in 1937.
This law restricted cannabis to medical use only and heavily fined doctors who did not maintain overly detailed medical records in compliance with the law, effectively ending all medical use.
When the Controlled Substances Act was passed in 1970, creating federal oversight over drugs deemed dangerous and subject to restrictions, cannabis was classified as a Schedule I drug, the most restrictive category. This classification put cannabis on the same level as illicit street drugs (e.g., heroin, LSD), believed to have a high potential for abuse and “no currently accepted medical use.”
A doctor who supported cannabis as a viable medical therapy was Tod Mikuriya, a California psychiatrist dubbed the “grandfather of the medical cannabis movement” in the USA. In 1967, he briefly worked for the National Institute of Mental Health and was officially assigned to research cannabis.
Documents he collected and published in 1973 as a book titled Marijuana: Medical Papers, 1839–1972 became the foundation for his private consultative medical practice, in which he treated and recommended cannabis to more than 9,000 patients, including those with cancer and AIDS. He dedicated his professional life to studying, publishing, and advocating cannabis as medicine during a time when most doctors had never heard of it. He believed cannabis was therapeutic in over 200 health conditions.
During the AIDS epidemic in the 1980s, cannabis gained fame as an anti-nausea agent combatting the toxic side effects of HIV medications and also functioned as an appetite stimulant.
As more and more media stories emerged about cannabis’ many benefits for a variety of illnesses, medical cannabis gained broad public support: a Pew Research Center survey reported that 62% of Americans now support legalization. Fully, 33 of 50 states have laws legalizing cannabis for a range of medical conditions, from childhood seizures to PTSD, obstructive sleep apnea, and Alzheimer’s disease.
History of Cannabis – Clinical research
Renewed efforts in clinical cannabis research resumed in the USA when a 1971 letter in JAMA reported that smoking cannabis reduced intraocular pressure in 11 subjects. This effort continued through the 1970s with clinical research on cannabis in areas including asthma, antiemetics, and analgesia. One particularly promising area revealed that CBD, the primary pharmacologically active cannabinoid found in the cannabis plant, reduced seizure activity in animal models. This was confirmed in 9 epileptic patients by adding CBD to their treatment regimen, followed by another study of 15 epileptic patients who also improved with CBD. These two key studies began the search for CBD in combating seizures.
Dravet syndrome, formerly known as severe myoclonic epilepsy of infancy—a complex form of epilepsy—is classically difficult to treat and may worsen with antiepileptic drugs.
The first reports appearing in medical literature linking Dravet syndrome and CBD include a parent survey published in 2013 and the case study of Charlotte in 2014. The former was a survey of 19 families who shared information via Facebook about CBD-enriched cannabis to help their children with treatment-resistant seizures. The majority, 16 out of 19, reported reduced seizures using CBD.
The second report introduced a girl named Charlotte, who received high-CBD cannabis as a complementary treatment, and her seizures decreased from nearly 50 per day to 2–3 per month, with effects lasting for 20 months.
Nearly 40 years after the first human CBD study in seizure patients, a randomized controlled trial (RCT) showed that patients with Dravet syndrome who were additionally given CBD at a dose of 20 mg/kg/day on top of their standard seizure treatment significantly reduced seizures from 12.4 to 5.9 per month, compared to placebo controls, who reduced from 14.9 to 14.1.
A second study reported that patients with Lennox-Gastaut syndrome also given CBD at 20 mg/kg/day according to their standard treatment had a 43.9% reduction in monthly seizure frequency compared to 21.8% in the placebo group. This was followed by a third study showing that patients with Lennox-Gastaut syndrome who received CBD at 20 mg/kg/day, 10 mg/kg/day, or placebo in two divided doses over 14 weeks saw 41.9%, 37.2%, and 17.2% seizure frequency reductions, respectively.
Based on these findings, Epidiolex became the first FDA-approved medication in the United States containing active cannabis-derived CBD for seizures associated with Dravet syndrome and Lennox-Gastaut syndrome. Marinol and Syndros contain the active ingredient dronabinol, a synthetic delta-9-THC approved for treating anorexia in AIDS and nausea/vomiting associated with chemotherapy unresponsive to conventional antiemetics. Cesamet contains nabilone, a synthetic chemical similar to delta-9-THC approved for chemotherapy-associated nausea/vomiting unresponsive to conventional antiemetics.
The most comprehensive consensus report on cannabis to date was prepared by the National Academies of Sciences and published in 2017. It cites convincing or substantial evidence that cannabis is effective in treating chronic pain in adults, as an antiemetic for chemotherapy-induced vomiting, and for improving patient-reported spasticity in multiple sclerosis.
Cannabis and pediatricians
Doctors who relied on available medical literature and recommended cannabis for treating childhood seizures before Epidiolex became FDA-approved are now recommending cannabis for treating pediatric conditions, including autism and mood disorders. Much like the rise of CBD use against seizures, physicians believe that other cannabis applications will become popularized for children, increasingly raising pediatricians’ questions from curious parents hearing about cannabis as a potential therapy.
However, while some research shows the benefits of cannabis, there is counter-literature warning against cannabis use, especially in the neonatal period. This is primarily due to the lack of studies.
Therefore, pediatricians should be educated on the knowledge and current studies of CBD to be able to respond appropriately to parents when asked whether CBD can help their child.