Medicinal use of cannabis in the United States: historical perspectives, current trends, and future directions

J Opioid Manag. 2009 May-Jun;5(3):153-68. doi: 10.5055/jom.2009.0016.


Cannabis (marijuana) has been used for medicinal purposes for millennia, said to be first noted by the Chinese in c. 2737 BCE. Medicinal cannabis arrived in the United States much later, burdened with a remarkably checkered, yet colorful, history. Despite early robust use, after the advent of opioids and aspirin, medicinal cannabis use faded. Cannabis was criminalized in the United States in 1937, against the advice of the American Medical Association submitted on record to Congress. The past few decades have seen renewed interest in medicinal cannabis, with the National Institutes of Health, the Institute of Medicine, and the American College of Physicians, all issuing statements of support for further research and development. The recently discovered endocannabinoid system has greatly increased our understanding of the actions of exogenous cannabis. Endocannabinoids appear to control pain, muscle tone, mood state, appetite, and inflammation, among other effects. Cannabis contains more than 100 different cannabinoids and has the capacity for analgesia through neuromodulation in ascending and descending pain pathways, neuroprotection, and anti-inflammatory mechanisms. This article reviews the current and emerging research on the physiological mechanisms of cannabinoids and their applications in managing chronic pain, muscle spasticity, cachexia, and other debilitating problems.

Publication types

  • Historical Article
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review

MeSH terms

  • Cachexia / drug therapy
  • Cannabinoid Receptor Modulators / metabolism
  • Cannabinoids / adverse effects
  • Cannabinoids / history
  • Cannabinoids / therapeutic use*
  • Cannabis / chemistry*
  • Crime / history
  • History, 19th Century
  • History, 20th Century
  • History, 21st Century
  • History, Ancient
  • Humans
  • Muscle Spasticity / drug therapy
  • Pain / drug therapy
  • Phytotherapy* / history
  • United States


  • Cannabinoid Receptor Modulators
  • Cannabinoids