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some baseless myths that survive to the present day, culminated in the Marihuana
Tax Act (1937) that effectively ruled out both recreational and medicinal use. In
1941 cannabis was removed from the U.S. Pharmacopoeia. Scientific reports that
challenged claims that cannabis use was closely associated with insanity, addic-
tion, violence and crime were ignored by politicians, regulators and the American
Medical Association. Cannabis continued to be portrayed as a dangerous, addictive
drug that also acted as a “gateway” into opiate or cocaine addiction. In the late 1940s
the confused international situation regarding drug control led the United Nations
Commission on Narcotic Drugs (CND) to seek an international agreement. In the
resulting 1961 Single Convention on Narcotic Drugs, cannabis and cannabis resin
were placed in one of the most restricted categories (along with heroin). Signatory
nations were obliged to impose complete prohibition and “adequate punishment”
for transgressors. The 1971 Convention on Psychotropic Substances and the 1988
Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances
were subsequent developments. The 1971 convention placed dronabinol (Marinol),
a synthetic formulation of∆^9 -tetrahydrocannabinol (THC) for oral use, in a less
restrictive category. Following research funded by the U.S. National Cancer Insti-
tute, dronabinol was approved by the U.S. regulatory authority for the treatment
of nausea and vomiting associated with cancer chemotherapy.
U.S. Advocacy groups such as the National Organisation for the Reform of Mar-
ijuana Laws (NORML) and Alliance for Cannabis Therapeutics (ACT) have vigor-
ously opposed the suppression of medicinal cannabis (Mead 2004). Rescheduling
litigation was not, in the end, successful at a national level, but many individual
states enacted legislation to make cannabis available to specific patients. Numerous
cannabis buyers’ clubs sprang up to provide supplies, but these are certainly not
immune from prosecution by the federal authorities. California has been a par-
ticular focus for activity, and a Center for Medicinal Cannabis Research has been
established within the University of California at San Diego.
Nations have some flexibility in implementing the 1961 and 1971 conventions
(Mead 2004). For example, if a national court ruled that an individual had a con-
stitutional right to use medicinal cannabis, that nation would be relieved of any
obligation to punish such activity. This elasticity has resulted in a marked disparity
in approach between countries (for a full review, see Mead 2004).
Unfortunately, the blossoming of recreational cannabis during a period of social
turmoilinthe1960shashardeneditsimageasanagentofalienationandsubversion
in the eyes of many politicians and regulators. Rigorous prohibition has remained
the central policy, despite inescapable evidence that the “War on Drugs” is a futile
approachthatwastesbillionsofdollarseveryyear(Robson1999).Thepriceofblack
market cannabis continues to fall in real terms, and it remains easily accessible in
virtually every country in the world to anyone who wishes to consume it. However,
medicinalresearchinvolvingsuchapariahdrugpresentsprofoundmethodological
challenges, and this is reflected in the scientific limitations inherent in many of the
clinical trials conducted during the last quarter of the twentieth century.
Partly as a result of the discovery of the endocannabinoid system and a growing
realisation of its importance in both normal and pathological function, the final
years of the twentieth century have seen renewed interest in exploring the poten-