Thought to be the first cultivated plant, the use of cannabis by humankind goes back thousands of years, and it is known that its flowers and resin were used in meditation and various religious rituals in India and Tibet. In the first Chinese pharmacopeia written by Emperor Chen Nung (3200 BC), it is written that hemp was used in the treatment of fatigue, rheumatism and malaria, and according to sources, hemp seeds were used in Chinese medicine as an anti-inflammatory in eczema and psoriasis due to their oil and protein content. It is understood from the Ebers Papyrus and Assyrian tablets written approximately 3000 years ago that cannabis was widely used as medicine. Cannabis is also a well-known plant used as medicine in the Ancient Greek and Roman periods. When the data from this period are examined, it is observed that cannabis was used especially to relieve pain and improve mood. Galen, a Roman physician, was among the physicians who prescribed medical cannabis, and he added in his notes that Roman aristocrats would end their dinner with a dessert containing cannabis. In his work titled El-Kanun Fi’t-Tıb, Ibn Sina wrote that a compress made with boiled hemp root reduces fever.

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The spread of cannabis use for medical purposes first to Arabia and then to the entire Middle East dates back to the ninth century. When the famous traveler Marco Polo mentioned it in his travelogue upon returning from his eastern trip in the late 13th century, the cannabis plant attracted the attention of Europe and began to be used intensively. Leonhart Fuchs, a German botanist and physician, wrote in his book on herbal treatments written in 1542 that hemp root boiled in water and wrapped around the relevant area was good for gout. Portuguese physicians Garcia da Orta and Cristobal Acosta talked about the euphoric, sedative, appetizing, hallucinogenic and aphrodisiac effects of cannabis.

At the end of the 18th century, Napoleon’s army, returning from Egypt, introduced hemp to France. Irish Dr. O’Shaughnessy observed that the cannabis plant was used for analgesic, antispasmodic, antiemetic and hypnotic purposes in India, and with this information he obtained from India, he helped spread the medical use of the cannabis plant in the United Kingdom in the 1840s. It is stated that hemp was also used for Queen Victoria’s menstrual cramps in the 1890s. During these years, cannabis was used as a painkiller, anti-inflammatory, antiemetic and anticonvulsant in England.

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The cannabis plant was included in the American Pharmacopoeia between 1850 and 1942, and while its use reached its peak in these periods, it began to decline from the 1930s onwards. Recreational cannabis use was first banned in the United Kingdom in 1928, and then the name marijuana was used instead of the name hemp or cannabis, which created a perception that it was very dangerous. In fact, a propaganda film called “Reefer Madness” was made in 1936 to distract American youth from using cannabis. The reasons for this anti-propaganda include the presence of dangerous synthetic derivatives, variability in the effects of herbal products due to the difficulty in standardizing them, unreliable supply sources, commercial pressures, and abuse of their euphoric effects, especially in countries such as Egypt, South Africa and the USA. The scope of the ban was expanded with the “Marijuana Tax Law” enacted in the USA in 1937, and as a reflection of this, the drugs included in the Turkish drug codex under the names “Herba Cannabis Indica” and “Extra Cannabis Indica” were removed from the codex after 1940 and their sale was prohibited in Turkey. With the “Controlled Substances Act” enacted in 1970 in the USA, it was prohibited to possess, use, sell, buy and grow marijuana. All these controls and laws have prevented the misuse of cannabis, but this has also limited the supply of cannabis for scientific studies and its use in clinics.

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Today, there are a total of 4 cannabis-based drugs, 2 synthetic drugs using the active ingredient THC in cannabis as a prototype and 2 drugs using standardized extracts of cannabis. Dronabinol and nabilone are FDA-approved synthetic cannabinoids used for nausea and vomiting accompanying cancer chemotherapy. Nabiximols, on the other hand, is a standardized hemp extract containing 2.7 mg THC and 2.5 mg cannabidiol (cannabidiol-CBD) in 100 microliters and is used in the treatment of spasticity due to multiple sclerosis that does not respond to other available treatments in the form of oromucosal spray. Finally, in 2018, a cannabidiol-containing drug called Epidiolex was approved by the FDA for use in the treatment of Lennox-Gastaut syndrome and Dravet syndrome, two severe and rare forms of epilepsy. Various information about the 4 cannabis-based drugs mentioned below is presented in a table.)

Table 1. Cannabis-derived drugs used legally today, their contents, year of approval, countries and indications[23].