What a Hundred Years of Medical History Reveals About Cannabis, Standardization, and the Unfinished Project of Trust
Authors: Dr. Karyemaître Aliffe, MD and Harold Han, PhD
This article tells the story of cannabis medicine roughly a hundred years ago: what it was used for, who relied on it, who provided it, and the surprising range of forms it came in. It also tells the story of how that history came to an abrupt end, not because the medicine failed, but because of the law. The same broad wave of social reform that swept through the United States in the early twentieth century, the era of Prohibition that made wine and spirits illegal, also gave rise to the separate state and federal laws that made marijuana illegal during that same period. Understanding that history matters today, as cannabis works its way back toward mainstream medicine, because it tells us exactly what was interrupted, and what still needs to be finished.
A Popular, Trusted Medicine for a Wide Range of Conditions
In the early 1900s, cannabis was not a fringe remedy. It was a widely-used medicine prescribed by medical doctors and listed in the Physician's Compendium along with formal dosage guidelines. Cannabis medicines were documented in the official U.S. Pharmacopeia, primarily in the form of Cannabis indica and Cannabis sativa plant extracts, patent medicines, and pharmacist-compounded products.
Patients turned to cannabis for an extensive list of conditions, many of which will sound immediately familiar to anyone following the therapeutic uses of cannabis today: pain, neuralgia, migraine and headache; insomnia and other sleep disorders; muscle spasms and spasticity, epilepsy, and other convulsive disorders; digestive disturbances and appetite disorders, e.g., dyspepsia and cachexia. Cannabis was also a common ingredient in patent medicines recommended for the treatment of: cough and breathing difficulties; menstrual pain and other gynecological problems; anxiety and “nervous conditions”, lethargy, malaise, melancholia, and other mood disorders. Notably, cannabis preparations were regularly prescribed as remedies for the treatment of opium addiction and withdrawal to mitigate the harsh symptoms and craving.
This historic list is— almost point for point— the same set of conditions approved in medical marijuana laws across the entire United States. Many of these diseases and disorders are avidly studied in contemporary cannabis research— e.g., epilepsy, chronic pain, anxiety, sleep disorders, and opioid use disorder. The plant was not recently-discovered by modern science for medical uses— 125 years ago, cannabis was already known as a safe and effective medication trusted for the treatment of largely the same human conditions it is being studied and recommended for today.
Who Was Practicing, Prescribing, and Compounding It
Cannabis medicine in that era was not produced or prescribed by any single, uniform type of practitioner. The people working in this space differed enormously in training and background, much as health advisors do today. A patient in 1905 might consult a university-trained physician, a pharmacist who learned chemistry through apprenticeship, or rely on a self-taught compounder working from inherited recipes. That spectrum— from rigorously-trained doctors to amateur health practitioners, closely mirrors the vast sea of providers that patients navigate today: from medical school-trained physicians to fitness trainers, health coaches, and dispensary staff of varied backgrounds.
Physicians of the period did not simply rely on tradition or anecdote alone. Many conducted research as well— small observational series, published case reports, and developed dosing guidelines based on accumulated clinical experience. These early professional publications documented cannabis's therapeutic benefits as well as its risks, specifically noting dizziness, brain fog, and hallucination at higher doses as adverse effects to watch out for. Pharmacists, meanwhile, served as the era's chemists and formulators, routinely asked to fabricate custom preparations to a physician's precise order, or a patient's particular needs and preferences. The roles of researcher, prescriber, and compounder were intertwined in a way that placed enormous responsibility, and enormous trust, with individual practitioners.
The Inaccuracies and Challenges — and Why the Medicine Still Worked
None of this happened with the analytical precision we associate with modern pharmaceuticals today, and it is worth being direct about the gaps. This era predated the advanced analytical chemistry techniques we now take for granted. There was no reliable way to test a sample for its exact cannabinoid or terpene content. As a result, cannabis medicinal products varied widely in potency and composition from one preparation to the next.
Even identifying the plant itself was a point of genuine confusion. Cannabis plants could be wildcrafted, grown in home gardens, or cultivated on company-owned farms. It was generally difficult, often impossible, to distinguish high THC cannabis (marijuana) from low THC cannabis (hemp) without test smoking a sample. The standard analytical method of the day was “organoleptic” examination— smelling and tasting plant material. But even the most trained nose cannot smell THC, CBD, or any other cannabinoid. It can only detect the fragrance of terpenes and other aromatic plant compounds. Cannabis plant material in commerce therefore contained marijuana and hemp in unpredictably variable ratios, a problem further compounded by the rudimentary extraction, packaging and storage methods of the day.
These were real limitations, but even without modern chemistry, standardized potency, or any way to verify its precise composition, cannabis still produced reliable therapeutic benefits for the conditions physicians were treating.
Their science of measurement and analysis was primitive by today's standards. The plant's effects were not. This distinction is the whole reason this history is worth telling. Cannabis was known as a safe and effective medicine of the time, despite being imprecise, which says something important about the plant itself, not just about the limits of the era.
It is also worth noting that the broader medical establishment was already moving toward greater rigor. In 1906, the Pure Food and Drug Act mandated strict labeling and purity standards alongside greater scrutiny of therapeutic claims and composition. This was a federal standard that cannabis products were subject to as much as the other medicines of the time. The trajectory toward standardization and reliability had already begun.
The Interruption: A Lost Period of Pharmaceutical Development
But then the law stopped it. The early 1900s saw many popular sobriety and social reform movements gain force across the United States. The Temperance Movement, which culminated in the consumption of wine and spirits becoming illegal under federal Prohibition, was part of that same broader era. Separately, that same period of social reform also produced state and federal laws prohibiting marijuana, enacted between the 1910s and 1930s. These were distinct legal actions arising from the same reform-minded era, and together they forcibly removed cannabis from the practice of medicine altogether. It was made illegal, full stop.
What that means in practical terms is something easy to overlook— cannabis missed out on the single most important period of development in the history of modern science and pharmaceuticals. Over the century that followed, every other branch of medicine went through an enormous transformation, building the analytical chemistry, clinical trial infrastructure, and manufacturing standards that define pharmaceuticals and medicine today. Researchers spent decades learning how to characterize a compound's composition, its degradation over time, its absorption into the body, and determine its precise dosing. Cannabis was not allowed in the room for any of this— it was not studied through that new lens, nor standardized using modern technologies. Cannabis science and medicine was left behind during that century of biomedical advancement and accumulated pharmaceutical practice, simply because it was marginalized with no opportunity for mainstream research and development.
Where That Leaves Cannabis Today
This missing period is not abstract history. It is the direct explanation for a fact anyone in the cannabis space recognizes immediately: cannabis today is consumed through an unusually wide range of formats— smoked, eaten as “edibles”, and tinctures that are consumed orally, sublingually, in beverages, or applied topically— with no clear, standardized answer for which format a physician should best prescribe. This fragmentation is not a failure of the modern cannabis industry— it is the direct, visible consequence of a hundred-year gap banning cannabis from progress in ways that other medicines were not forced to endure.
This raises the question our series turns to next. With cannabis rescheduling now underway, and the real possibility of cannabis re-entering the medical mainstream, what will it take to restore the scientific and medical advancement that prohibition interrupted a century ago? This is what we will explore in the next article.
About the Authors
Dr. Karyemaitre Aliffe, MD, is a physician-scientist with over 25 years in phytomedicinal discovery and cannabinoid clinical pharmacology, currently leading natural health product development at Praxigen Biomedia.
Dr. Harold Han, PhD is the founder of Vertosa and PhytoRX, and a leading voice in water-compatible cannabis technology and plant-based medicine.