extensively, it may have been introduced by workers from India and elsewhere in
Asia during the mid-1800s (Rubin and Comitas 1975 ; Wills 1998 ). By the late
nineteenth century, recreational marijuana usage had migrated to Mexico and the
southern U.S., where it remained a stigmatized drug associated with the poor and
underprivileged, particularly with Hispanics and Blacks.
The use of Cannabis as a highly popular recreational inebriant of urban
sophisticated people began substantially in the latter half of the twentieth century.
In the 1960s“hippies”made pilgrimages to Asia in search of enlightenment and
established what came to be known as the“Hippie Trail” or“Hashish Trail”
extending across Eurasia. Up until then, drug preparations ofCannabiswere used
predominantly as a recreational intoxicant in poor countries and the lower
socio-economic classes of developed nations. In the late 1960s, marijuana became
associated with the rise of a hedonistic, psychedelic ethos,first among college
students in the United States (Abel 1980 ; Booth 2004 ), and eventually over much of
the world, with the consequent development of a huge international illicit market.
During the last century the recreational usage of marijuana increased to the point
that cannabis became the world’s leading illegal recreational drug.
Medicinal usage of cannabis in ancient Europe was very limited (Zuardi 2006 ).
Scythian invaders are suspected of bringing some medicinal knowledge of cannabis
from the Middle East to Europe more than 2 millennia ago. Cannabis was employed
medicinally in ancient Greece and Rome, as recorded in the Herbal of Dioscorides
(ca. 40–90 AD), and the records of Galen (AD 129–ca.200 to216). For thefirst
millennium in Europe, there was limited medicinal usage of cannabis, and while
subsequentlyC. sativawas employed in various remedies, it appears that the
species was grown almost exclusively forfiber hemp. Asian medicinal usage of
high-THC cannabis was mostly ignored in Europe until the nineteenth century.
The French psychiatrist Jacques-Joseph Moreau (1804–1884, nicknamed
“Moreau de Tours”) and (more significantly) the Irish physician William B.
O’Shaughnessy (1809–1889) introduced cannabis into Western medicine in thefirst
half of the nineteenth century.Cannabisdrug preparations were extensively used in
the West between the middle of the nineteenth century and World War II, partic-
ularly as a substitute for opiates, and as antispasmodic, analgesic, hypnotic and
sedative agents (Mikuriya 1969 ). Cannabis was used to treat a very wide range of
ailments, including insomnia, headaches, anorexia, sexual dysfunction, whooping
cough and asthma. Orally administered tinctures, especially alcoholic, were par-
ticularly popular, with hundreds of brands in circulation (Fankhauser 2002 ).
Following the Second World War, medical use declined because of several
developments: quality limitations of available cannabis (such as variable potency,
poor storage and erratic absorption offluid products); the introduction of new
medications including vaccines and alternative pain relievers; the development of
hypodermic syringes allowing the injectable use of morphine; the use of synthetic
analgesics and sedatives; and the progressive criminalisation of cannabis. From the
middle to the end of the twentieth century there was very limited authorized
26 E. Small