Cannabis has a rich history as a medicine in many countries, including the United States. In 1854, the U.S.Dispensatory recommended cannabis tinctures for a wide range of pathologies, including depression, neuralgia, hemorrhage, pain, and muscle spasms.

Six years later, the Ohio Medical Society issued a positive report about cannabis, deeming it helpful for numerous indications, including epilepsy, infantile convulsions, dysmenorrhea, hysteria, delirium tremens, mania, palsy, whooping cough, asthma, nervous rheumatism, chronic bronchitis, and tetanus, among others.

Dr. Tod Mikuriya, who was instrumental in kickstarting the successful effort to legalize marijuana for therapeutic use in California in 1996,compiled an extensive list of chronic conditions treatable with cannabis. Based on his o wn experience counselling thousands of patients and information provided by other physicians, Mikuriya concluded that cannabis therapy was potentially beneficial for nearly 300 diseases.

How could this be? Shouldn’t we be skeptical of claims that one herb – cannabis – could be a viable treatment for so many diseases?

SNAKE OIL OR SERIOUS MEDICINE?

As unlikely as it may seem, there’s actually a solid scientific basis for understanding marijuana’s versatile therapeutic applications. Cannadidiol (CBD) and its intoxicating cousin tetrahydrocannabinol (THC), two key components of cannabis, mimic and augment the effects of endogenous compounds in our own bodies. These “endocannabinoids” are part of what scientists refer to as “the endocannabinoid system.” This pervasive neurotransmitter network regulates a plethora of physiological processes that profoundly impact our everyday experience.

When theendocannabinoid system doesn’t function properly, our health suffers. Definitive scientific research has shown that the endocannabinoid system is dysregulated in nearly all pathological conditions. According to Pal Pacher and Geroge Kunos, leading scientists with the U.S. National Institutes of Health, “[M]odulating endocannabinoid system activity may have therapeutic potential in almost all diseases affecting humans, including obesity/metabolic syndrome, diabetes and diabetic complications, neurodegenerative, inflammatory, cardiovascular, liver, gastrointestinal, skin diseases, pain, psychiatric disorders, cachexia, cancer, chemotherapy induced nausea and vomiting among many others.”

By modulating the endocannabinoid system andimproving endocannabinoid tone, CBD and THC can slow, or in some cases stop, the progression of various diseases. The federal government, however, refuses to acknowledge what people have known for thousands of years – that cannabis is a medically useful plant.

Instead, the Food and Drug Administration (FDA) only recognizes the medical utility of isolated components of cannabis. Single-molecule CBD and single-molecule THC are both FDA-approved prescription medications. But the plant itself, the natural source of CBD and THC, is still an illegal Schedule I substance, a category reserved for dangerous drugs with no medical value.

SINGLE-MOLECULE SOPHISTRY

The FDA simply isn’t in the business of approving plants as medicine. And because herbal cannabis isn’t anFDA-approved remedy, cannabis product-makersrun afoul of the law if they make medical claims about their formulations. That puts cannabis businesses in an untenable position – they have to market their products without being able to say what they’re good for.

While favoring the pharmaceuticalization of individual cannabis components, federal policy has stymied clinical research that could validate the therapeutic use of the whole plant and its full-spectrum derivatives. Prohibitionists rely on this artificial gap in clinically relevant research to argue that there’s insufficient proof that cannabis is truly a disease modifier.

But there’s been extensive preclinical research, much of it sponsored by Uncle Sam, which explains how cannabis components confer various effects through multiple molecular pathways. And there’s also an abundance of anecdotal evidence that doctors and dispensaries have accumulated over the years in states where medical cannabis is available. The significance of this real-world evidence should not be discounted just because it doesn’t meet the so-calledgold standard of double blind, randomized clinical trials, which don’t always reflect real-world outcomes.

The gold standard might be right on the money when it comes to assessing Big Pharma’s single-molecule interventions aimed at single, primary outcomes. But that’s not how cannabis works. And double blind, randomized clinical trials, while important,  aren’t the only way – and might not be the best way – to illuminate the medical value of a complex plant with many components and myriad effects.