While records of medical and therapeutic use of cannabis go back thousands of years, several points in history proved instrumental to furthering the ongoing body of research. A key figure in this story was Dr. William Brooke O’Shaughnessy, who actively practiced medicine and worked as a researcher in the 1800s. While in India in the 1830s, he worked to validate area folk remedies that used cannabis, including its role in mitigating pain and spasticity, eventually bringing this knowledge back to England—and formal Western medicine.

Years later, Israeli scientist Raphael Mechoulam, Ph.D., professor at The Hebrew University of Jerusalem, first isolated tetrahydrocannabinol (THC) working in the university’s Center for Research on Pain in 1964. Israel was subsequently an early adopter of medical cannabis use in the 1990s.

Patients suffering from symptoms related to HIV and AIDS in the 1980s and 1990s in California realized that treatment with cannabis eased suffering. Vietnam veteran Dennis Peron played a pivotal role in this movement after seeing how cannabis benefited these patients by opening the country’s first medical dispensary in San Francisco and coauthoring California Proposition 215—also known as the “Compassionate Use Act”—legalizing medical cannabis in the state in 1996.

Medical Cannabis Today

According to a 2018 nationwide poll from Harris Insights & Analytics, nearly 9 out of every 10 adults (85 percent) believe cannabis should be legalized for medical use.

As of July 2019, 33 U.S. states plus the District of Columbia and four permanent U.S. territories have passed legislation permitting some level of medical cannabis use. States that have most-recently passed such legislation include Missouri, Oklahoma and Utah during 2018, and West Virginia in 2017.

Despite this progress, the current classification of cannabis as a Schedule I drug serves as a significant barrier to medical research (definition of Schedule I classification dictates that the drugs have not accepted medical use in the U.S.). But federal approval of the 2018 Farm Bill, which legalized cultivation of industrial hemp—a primary source of cannabidiol (CBD)—will serve as a catalyst for cannabinoid research.

In June 2018, FDA approved Epidiolex, a cannabis-derived prescription drug designed for the treatment of seizures associated with two forms of epilepsy. It is the first FDA-approved drug that contains a purified substance derived from cannabis—specifically, CBD. This regulatory move subsequently catalyzed the Drug Enforcement Administration’s declassification of Epidiolex to Schedule V, lowest level of drug classification designed for substances with a proven medical use and the lowest potential for abuse. This holds promise for potential declassification of CBD.

In January 2017, the National Academies of Sciences, Engineering, and Medicine (NASEM) released the findings of its research into medical uses of cannabis in its report, “The Health Effects of Cannabis and Cannabinoids.” Its findings included a wide range of potential medical and therapeutic uses for cannabis, including strong support for:

• Pain. NASEM notes that a common therapeutic use of cannabis and cannabinoids is to treat chronic pain in adults. During the course of its research, they found evidence to support that patients treated with cannabis or cannabinoids were more likely to experience a significant reduction in pain symptoms.
• Multiple sclerosis. For adults with multiple sclerosis-related muscle spasms, there was substantial evidence that short-term use of certain cannabinoids improved their reported symptoms. This indication holds promise for use of cannabis to help with nerve pain in general.
• Cancer treatment side effects. In adults with chemotherapy-induced nausea and vomiting, NASEM found conclusive evidence that certain oral cannabinoids were effective in prevention and treatment. (FDA has also approved the synthetic cannabinoids dronabinol and nabilone to treat nausea and vomiting associated with cancer chemotherapy; dronabinol is also approved to treat loss of appetite and weight loss in people with AIDS.)
• Schizophrenia. The report also found that individuals with schizophrenia and some other psychoses who have a history of cannabis may display improved performance related to learning and memory tasks.

NASEM also found moderate evidence for cannabis and cannabinoids in helping with:

• Secondary sleep disturbances
• Decreased appetite
• Tourette syndrome
• Anxiety
• Post-traumatic stress disorder

Some initial research showed promise for use of cannabis in treatment of symptoms related to glaucoma. However, recent medical findings have suggested that more research is still needed to explore the exact effects of cannabis and cannabis compounds on eye pressure and glaucoma.

Israel remains a global leader in medical cannabis research. Medical cannabis research pioneer Professor Mechoulam founded the Multidisciplinary Center for Cannabinoid Research in 2017, with areas of concentrated study, including use of medical cannabis and:

• Cancer
• Pain
• Inflammation and stress management
• Immunity
• Metabolism
• Pharmaceutical chemistry
• Neuroscience
• Plant science and genetics

Domestic Research Surges

The U.S. is starting to increase its medical cannabis research efforts on a state-by-state level. In June, the Pennsylvania Department of Health launched a landmark research program for medical cannabis designed to help physicians make clinical decisions for patients. The program will involve conducting clinical research on 21 medical conditions at three universities: Penn State College of Medicine, Drexel University and Thomas Jefferson University.

Colorado is also actively conducting medical cannabis research. The Colorado Department of Public Health and Environment awarded funds to the Children’s Hospital Colorado in Aurora, CO to study cannabis use in the treatment and management of a variety of pediatric conditions, including:

• Epilepsy and tuberous sclerosis complex
• Inflammatory bowel disease
• Brain and spine tumors

California is also making research-based progress. The Center for Medicinal Cannabis Research (CMCR), part of the University of California, San Diego, currently has several open studies examining the potential of cannabis in association with specific medical conditions, including:

• “The Effects of Cannabidiol (CBD) on Symptoms of Severe Autism”
• “Cannabis Use and the Endocannabinoid System in Bipolar Disorder”
• “Effect of Cannabis and Endocannabinoids on HIV Neuropathic Pain”
• “A Randomized, Cross-Over Controlled Trial of Dronabinol and Vaporized Cannabis in Neuropathic Low Back Pain”

CMCR’s mission is “to facilitate high-quality scientific studies intended to ascertain the safety and efficacy of cannabis and cannabinoid products and examine alternative forms of administration.”

In 2018, the Centers for Disease Control and Prevention released a report that an estimated 50 million Americans—over 20 percent of the U.S. population—deal with some form of chronic pain. According to CDC:

• Approximately 68 percent of the more than 70,200 drug overdose deaths in 2017 involved an opioid
• In 2017, the number of overdose deaths involving opioids was 6 times higher than in 1999
• On average, 130 Americans die every day from an opioid overdose

While current scientific positions regarding medical cannabis and its potential to help with the opioid crisis are cautionary at best, the potential of cannabis and cannabinoids in helping with pain management is an area of significant importance.

According to recent analysis appearing in Health Affairs (“Qualifying Conditions of Medical Cannabis License Holders in the United States”), chronic pain is currently and historically the most-common qualifying condition reported by medical cannabis patients (64.9 percent). Also, the article notes that 85.5 percent of medical cannabis patients are opting for treatment based on “substantial or conclusive evidence of therapeutic efficacy.”

Overall, the ongoing body of research related to cannabis and medical and therapeutic use for an expanding range of conditions holds great promise for the industry.