A SYSTEMATIC REVIEW OF MEDICAL CANNABIS

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This article is written by Tanishka Dhingra of University of Petroleum and Energy Studies.

ABSTRACT -:

Cannabis is the generic name for substances made from plants in the genus Cannabis.1 It is one of the most widely used recreational drugs; in 2012, 178 million people aged 15 to 64 consumed cannabis at least once globally.2 Cannabis was listed as a controlled substance in the Single Convention on Narcotic Drugs of the United Nations, which was convened in 19613; nowadays, most nations forbid the use of cannabis. The use of cannabis or cannabinoids as a kind of medical therapy to treat illness or lessen symptoms is referred to as medical cannabis. Smoking, inhaling, consuming them mixed with food, making tea, or using them topically are all ways to consume cannabinoids. They are available in herbal form, as naturally occurring plant extracts, as cannabidiol isomers, or as synthetically produced products. Dronabinol capsules, nabilone capsules, and the oromucosal spray nabiximols are examples of cannabinoids that are prescribed.

For people with chronic illnesses, medical-grade cannabis has been legalized in some nations. Government-run programs in Canada and the Netherlands allow for the distribution of herbal cannabis that has been rigorously tested for quality. There are laws allowing the medical use of cannabis in 23 US states and Washington, DC; similar regulations exist in other nations. This systematic review’s objective was to assess the evidence about the advantages and drawbacks of medical marijuana across a wide range of purposes.

INTRODUCTION

Vijaya, sometimes known as medical cannabis, has a variety of medicinal benefits. But the benefits of its divine health were mostly unknown to the modern world. Since the hemp plant is used recreationally, it has the unfortunate reputation of being a gateway drug that destroys lives.

The use of cannabis in India dates back to at least 2000 BCE.^[1] In Indian culture, the phrases “cannabis preparations” are “charas” (resin), “ganja” (flower), and “bhang” (seeds and leaves), with “bhang lassi” and “bhang thandai” being two of the most popular legal uses.

Over time, as society was exposed to data from reliable sources like clinical trials and scientific investigations, together with encouraging anecdotal evidence, people began to have a more favorable opinion of Vijaya. The “prevalence of usage” of cannabis in India was 3.2% in 2000, according to the UNODC.^[2] According to a 2019 survey by the All-India Institutes of Medical Sciences, 7.2 million Indians had used marijuana in the previous year.^[3] According to the “Magnitude of Substance Use in India 2019” survey conducted by the Ministry of Social Justice and Empowerment, 31 million Indians between the ages of 10 and 75 (2.83% of the population) reported currently using cannabis products. According to the UNODC’s 2016 World Drug Report, India has the lowest retail price in the world for cannabis at US$0.10 per gram.

Let’s explore the health benefits of the hemp plant and how India’s legalization of the herb has been impacted by shifting social perspectives. New Delhi and Mumbai were the third and sixth-largest cannabis-consuming cities in the world in 2018, according to a survey by the German data firm ABCD. These cities consumed 38.2 tonnes and 32.4 tonnes of cannabis, respectively.

HISTORY

Antiquity

Several Indian pieces of literature from before the year 1000 CE make reference to Bhanga. On whether associating this bhanga with either marijuana or contemporary bhang, however, Sanskrit scholars disagree. Cannabis sativa is one of the candidates for the plant that was used to manufacture soma during the Vedic era.^[4] The Rigveda, which was written between 1700 and 1100 BCE, highly praises the intoxicating ritual drink known as soma. Bhanga is listed as one of the five sacred plants in the Atharvaveda (c. 1500–1000 BCE) that reduce anxiety. Sayana thought of bhanga as a kind of wild grass, although many academics associate bhanga with marijuana.^[5]

Other ancient texts including the Dhanvantari Nighantu, Sarngandhara Samhita, and Kayyadeva Nighantu all make reference to cannabis. In modest amounts, it is also mentioned in Ayurvedic recipes for a variety of painkillers and aphrodisiacs. But there are no cannabis-based smoking recipes in Ayurveda.^[6]

Shiva, a Hindu deity, is claimed to have made cannabis his favorite food after spending one night dozing beneath the leaves of the plant and discovering that eating it in the morning revived him. Another myth claims that Shiva ingested the poison Halahala as it sprang from the Samudra Manthan to shield everyone from it. Bhang was used to calm him down later. The Shiva Purana advises worshipping Shiva while high on marijuana throughout the summer. But not every follower presents bhang to Shiva.^[7]

As opposed to tantric traditions, which refer to cannabis as samvid, many Ayurvedic texts refer to marijuana as Vijaya.^[8]

MODERN USE OF CANNABIS IN INDIA

Cannabis is still widely used as bhang in India.^[9] Additionally, it is blended into thandai, a dish resembling a milkshake. Bhang is a famous drug that is consumed as Shiva’s prasad between Mahashivaratri and Holi (February and March).^[10] Bhang is well-liked among Sikh Nihangs, especially during Hola Mohalla. Muslim Indian Sufis who practice bhang consumption places the soul of Khidr inside the cannabis plant.

Even in Assam, where marijuana has been expressly prohibited since 1958, hundreds of people smoke it at the Ambubachi Mela. In 2015, despite finding two persons ^[11]smoking tobacco in public locations in violation of the Cigarettes and Other Tobacco Products Act, the police did not prevent worshippers from ingesting bhang.

Uttarakhand legalized cannabis production for commercial reasons in November 2015.^[12] By introducing HERBBOX as a one-stop store for smoking accessories in India in June 2016, Pilares EXIM LLP, situated in Vapi, Gujarat, took a step towards the legalization of cannabis At its research and development facility in Haridwar, Patanjali Ayurved’s CEO Balkrishna announced in February 2018 that his business had started investigating the health advantages of cannabis and its extracts for use in the company’s medications and other goods.^[13]

According to the “Magnitude of Substance Use in India 2019” survey by the Ministry of Social Justice and Empowerment, 31 million Indians aged 10 to 75 (or 2.83% of the population) currently consume cannabis products, with 10% of the population classified as using cannabis “in a dependent pattern.” According to the report, 12% of people used charas or marijuana, or ganja, while 20% of people smoked bhang. Additionally, it was discovered that men consumed cannabis at a rate of 25% among the male population and 10% among the female population.

VIJAYA’S IMPORTANCE IN INDIA

One of the most revered plants in Ayurveda, Vijaya has long been used for medicinal purposes. Numerous ancient scriptures and Ayurvedic literature, such as the Vedas, the Sushruta Samhita, and texts written before 1000 CE, make reference to it. The effectiveness and safety profile of the hemp plant has been the subject of numerous clinical experiments and investigations by numerous researchers and organizations throughout the world. They have discovered that the herb has exceptional anti-inflammatory and pain-relieving qualities. Additionally, it eases the symptoms of illnesses such as-

Problems of the digestive tract (IBS, indigestion, diarrhea, constipation, ulcers, Crohn’s disease, etc.)
Mental illnesses
Insomnia and other sleep disorders
Sexual health issues (such as erectile dysfunction, early ejaculation, and poor libido)
Adverse effects and treatments associated with common prescription drugs
The physical dependence on addictive substances, such as opioids
Harmful postoperative side effects, notably in cancer patients

The same practice was maintained by the 1985 Narcotic Drugs and Psychotropic Substances Act (NDPS), which allowed the use of Vijaya’s leaves and seeds but forbade the use of its resin and flowers. In India, it was once allowed to grow Vijaya for horticultural and industrial purposes.

Additionally, the Government of India has consistently supported the growth of the herb with low THC content (one of the primary naturally-occurring chemicals in Vijaya) as well as scientific and medical studies. In addition, varied regulations from state to state in the nation restrict or forbid the use of this herb.

THE UPTURN

The Great Legalization Movement in India, which was established in 2014, held conferences on medicinal cannabis in Delhi, Bangalore, Mumbai, and Pune in 2015 in an effort to raise awareness of Vijaya’s untapped therapeutic potential and change the regulations surrounding the plant. As time went on, a number of Lok Sabha MPs and ministers expressed support for Vijaya’s legalization and worked to alter the NDPS statute to make it possible for patients to access the plant under medical supervision, regulation, and legalization. India voted in favor of excluding Vijaya from the 1961 Single Convention on Narcotic Drugs on December 9, 2020, at the United Nations Commission on Narcotic Drugs (CND). The majority of nations supported the resolution, which was adopted. Finally, the Central Government confirmed the Delhi High Court’s ruling in January 2022 and declared that Vijaya usage for medical purposes is permitted in India. The State Governments were also given authority by the Central Government to control and regulate the use of Vijaya and cannabis-based medicines for industrial, horticultural, scientific, and medical purposes, as well as the production, manufacture, transport, import, and export of these products.

Finally, the Central Government confirmed the Delhi High Court’s ruling in January 2022 and declared that Vijaya usage for medical purposes is permitted in India.

Bhang, the most popular variety of cannabis in India, is used to create “Thandai,” a milkshake flavored with cannabis seeds and leaves that is consumed on the Sikh holiday of Hola Mohalla as well as the Hindu holidays of Holi and Shiv Ratri. But is marijuana permitted in India? is the most frequent query that is still raised anytime the subject of pot, marijuana, or bhang is brought up

What does the law say about Weed or Marijuana?

The Narcotic Drugs and Psychotropic Substances Act, 1985(1) is the primary law in India that regulates cannabis (also known as marijuana or weed) use. Tobacco or marijuana consumption, possession, sale, or purchase are all subject to state-specific regulations. Possession of these narcotics is generally regarded as a criminal offense in India and can result in severe legal repercussions. For instance, marijuana is legal in the Indian state of Odisha, where users frequently utilize “chillums” to smoke it there. The first state in India to permit commercial hemp cultivation is Uttarakhand. Many other hilly states are contemplating the suggestion to permit the regulated growing of hemp and marijuana because it is a productive crop that uses little water. Cannabis is the part of the cannabis plant that is blooming or fruiting but from which the resin has not yet been removed. This does not include seeds or leaves that do not make up the top. As ‘bhang’ does not fall within this definition of a cannabis plant, it is publicly taken in India on many religious occasions.

According to the NDPS Act, marijuana is:

Charas, whether it be raw or refined, is a separated resin made from the cannabis plant that contains concentrated resin known as liquid or hashish oil. Ganja is the flowering or fruiting top of the plant, excluding the seeds and leaves that do not belong there any concoction or beverage made with charas or marijuana. Bhang is not included in the NDPS Act’s definition of cannabis as a plant component.

The NDPS Act forbids the sale and cultivation of cannabis resin and flowers, but permits the use of the plant’s leaves and seeds, with each state having the authority to regulate and establish its own laws.

Anybody caught in possession of any of these cannabis plant components will be arrested The Assam Ganja and Bhang Prohibition Act, passed in 1958(2), forbids the sale, possession, acquisition, and use of ganja and bhang.^[14] The production, possession, and use of bhang and items containing it are prohibited by the Maharashtra State of Bombay Prohibition (BP) Act, 1949(3).

What happens if you’re busted in India with marijuana or weed?

The NDPS Act makes it illegal to even possess marijuana or other illegal narcotics in India. The quantity of drugs in possession determines the punishment, not the reason for drug possession. If someone voluntarily chooses to receive de-addiction treatment after being found to be a drug addict or caught with drugs, they will not be prosecuted.

The following are the numerous laws that govern drug possession and use by minors, or children under the age of 18, in India:

Act of 1985 on Narcotic Drugs and Psychotropic Substances
Act of 2000 Concerning Juvenile Justice (Care and Protection) statewide drug laws

What is the penalty for possessing narcotics in India, such as marijuana or weed?

Advocate Pushkar Taimni says that manufacturing, sale/purchase, transportation, interstate import/export, or any other commercial action involving cannabis is punishable under section 20 of the Narcotic Drugs and Psychotropic Substances Act of 1985. The specified punishment for possessing a tiny amount is harsh imprisonment for up to 6 months, a fine of 10,000 rupees, or both. Possession of more than a moderate amount but less than a commercial amount carries a statutory punishment of Rs. 1 lakh, rigorous imprisonment for up to 10 years, or both.

The following list of medications is available in India in small and commercial quantities:

5 to 250 grams of heroin

100 grams of cocaine in 2 grams.

100 grams to 1 kilogram of hashish or charas

25 grams to 2.5 kilograms of opium

1 kg to 20 kg of ganja

If you allow the use of your property for such an offense, you are in violation of section 25 of the NDPS Act and shall be punished in accordance with section 20. Dealing with drugs has become even more difficult as a result of the fact that many Indian states have created their own policies and amendments to the legislation. Just be aware that the law can be strict on you before you even consider having the least bit of property

REGIONAL LAWS ON CANNABIS

Bhang usage is permitted under the NDPS, but some states have their own regulations that forbid or limit its use. Only authorized dealers may sell marijuana in several states. Some states also set restrictions on the amount of marijuana that one individual may possess and the minimum age for purchasers.^[15]The Assam Ganja and Bhang Prohibition Act, of 1958, makes it illegal to sell, buy, possess, and use ganja and bhang in Assam. Bhang manufacture, possession, and consumption are all prohibited in Maharashtra under Section 66(1)(b) of the Bombay Prohibition (BP) Act, 1949.^[16]

Ganja and bhang are classified as “intoxicating drugs” in Karnataka under the Karnataka Prohibition Act of 1961, which forbids their production, possession, and use except for medical needs.

Bhang was taken off the list of “intoxicating drugs” listed by section 23 of the Gujarat Prohibition Act on February 21, 2017, making it legal in Gujarat. Bhang is solely consumed as Lord Shiva’s prasad, according to Pradipsinh Jadeja, the minister of state for home and prohibition in Gujarat.

The state administration has been accused of abusing the prohibition laws to target people who were caught smoking bhang. As a result, the government decided to exempt Bhang from the scope of the Gujarat Prohibition Amendment Act while also considering the opinions of the general population. The effects of bhang are less potent than those of ganja.^[17]

WHY IT’S NOT POSSIBLE TO ‘LEGALISE’ MEDICAL MARIJUANA IN INDIA?

Under the influence of the West, cannabis has been illegal in India for 35 years. Many history-based texts claim that Indians had been using cannabis products for medicinal and recreational purposes prior to it being banned. India fought against the designation of cannabis as a hard drug during the 1961 Convention on Narcotic Drugs, but it eventually gave in to pressure from the Reagan administration in 1985. The Indian cannabis law needs to be reviewed as America transitions to a green wave. Numerous studies point to the expanding benefits of the cannabis plant, and once its cultivation, sale, and use are legalized, the stigma associated with them will dissipate as well.

Maneka Gandhi, the minister of women’s and children’s affairs in India, had argued in favor of legalizing medical marijuana in a meeting of MPs. Gandhi told PTI, “Marijuana should be legalized for medical uses, especially since it serves a purpose in cancer (treatment).” She added, “The possibility of the same may be explored in India,” and “(In) some of the developed countries like the US, marijuana has been legalized, which ultimately results in less drug abuse.” ^[18]What if, however, we told you that because it is already legal in India, medicinal marijuana use cannot be made lawful there?

According to the Narcotic Drugs and Substances Act of 1985, “No person shall (a) cultivate any coca plant or gather any portion of coca plant; (b) cultivate the opium poppy or any cannabis plant; or (c) produce, manufacture, possess, sell, purchase, transport, warehouse, use, consume, import into India, export from India, or tranship any narcotic drug or psychotropic substance, except for medical or scientific purposes and in compliance with applicable laws.”

So, is it possible to obtain a license and exclusively use cannabis for medical purposes?

Nope. It all gets complicated at this point. While the use of medical cannabis, or any narcotic for that matter, is theoretically lawful, its growth is restricted based on whether it satisfies the scientific requirements set forth by the government of the relevant state (such as the maximum allowable THC level, cultivation security measures, etc.). Cannabis grown for non-commercial purposes is prohibited. The legality of consumption is therefore regarded irrelevant if the source itself is ruled illegal, according to Tripti Tandon, Deputy Director of Lawyers Collective. The Act allows each Indian state to establish its own laws and regulations in this area, but no state has done so out of fear of being at odds with the center

Currently, the NDPS Act of 1985 regulates the consumption, production, and distribution of cannabis. According to this report, consumption of cannabis can result in a six-month jail sentence or a fine of Rs. 10,000, while illegal production and cultivation can result in a 10-year jail sentence. The punishment would still apply whether you grew a single plant or a thousand. However, Indian tradition and medicine have used cannabis for a very long time. It is a well-known fact that cannabis extracts have been employed in Ayurveda, homeopathy, and every type of traditional medical tradition. Only during the 1980s was marijuana regarded as illegal in India, partly as a result of pressure from the Reagan government.

WHY LEGALISE THE CULTIVATION OF MEDICAL CANNABIS?

Consider legalizing the production of high-quality cannabis for medical use for a number of different reasons. For starters, many research organizations and medical professionals would be able to acquire licenses to carry out studies on various cannabis strains, their THC, CBD, and CBN levels, and truly have a library of primary research on the therapeutic effects of cannabis. Numerous studies conducted in the West have demonstrated the therapeutic benefits of cannabis when used on patients suffering from epilepsy, chronic anxiety, multiple sclerosis, and, of course, chemotherapeutic side effects. These kinds of studies can pinpoint the therapeutic benefits of native strains and work out how to treat kids even with modest doses of psychoactive substances. Cannabis has also been proven to lessen the misuse and dependence on opioids, such as heroin, which is a problem that is sweeping Punjab and Manipur like wildfire. In 2014, a team of researchers finished a time-series analysis comparing medical cannabis laws and opioid-related mortality across all 50 US states over a 12-year period, according to a piece on Talking Drugs. The study’s conclusion was that “medical cannabis laws are associated with significantly lower state-level opioid overdose mortality rates.” The study was published in the Journal of the American Medical Association. Additionally, reasonable prices and protection from black market transactions will benefit small-scale growers, for whom growing cannabis has been a way of life for generations. In the Indian context, legalization also makes sense because it gives the government control over distribution. “We are one of the few countries that may use the bhang licencing system, which is a proven system of marijuana management. According to Suchitra Rajagopalan of the Drug Policy Alliance, “Bhang is entirely legal because the NDPS Act expressly stipulates that the “seeds and leaves” of the cannabis plant are not deemed “cannabis hemp”. Bhang is purchased by individual states from government warehouses and then distributed to retailers with permits. Medical cannabis can be regulated with a similar approach.

The livelihood of small farmers may be in jeopardy if the crop were to be legalized for cultivation because growing medicinal cannabis would necessitate more stringent regulations; contrary to popular belief, it doesn’t all grow in the wild. These businesses will have ample resources to assure standardized testing and cultivation, which small-scale farmers cannot afford. In conclusion, there is still much work to be done before the practical realization of the legalization of medical cannabis in India can or will occur. State governments must take aggressive action, identify the significance of this indigenous plant’s medical benefits, and clear the path for its legal production.

NO COMPLETE BAN ON CANNABIS, MEDICAL USE ALLOWED

The Centre has informed the Delhi High Court that the use of cannabis is not entirely prohibited in the nation because its legal use for medical and scientific purposes is permitted. The petitioner Great Legalization Movement India Trust requested an early hearing, but the Justice Rajiv Shakhder-led panel rejected their request, arguing that there was evidence to suggest that cannabinoids may have mitigated the effects of COVID-19. The application cannot be taken into consideration at this time based on the board’s current position. Justice Talwant Singh was also a member of the bench, and they told the petitioner’s attorney, Abhishek Avadhani, that they were attempting to do everything they could. The Narcotic Drugs and Psychotropic Substances Act (NDPS Act) regulations that forbid the use of cannabis have been contested in the petition, which is scheduled for further hearing in March. The argument made in the petition is that cannabis has both medical and industrial uses. The petitioner has asked the federal government for guidance on how to write regulations allowing and regulating the use of cannabis, particularly for medical purposes. The Centre urged the court to dismiss the petition with costs in its affidavit from last year, claiming that by giving state governments the authority to permit, control, and regulate the cultivation of any cannabis plant, production, manufacture, possession, transport, importation into one state from another, exportation to another, sale, purchase, consumption, or use of cannabis (excluding charas) for medical, scientific, and industrial purposes, it had adopted a balanced approach to the drug.

According to the central government, the current legal system governing cannabis use does not infringe upon Articles 14 (right to equality), 19(1)(g) [freedom of trade], 21, (right to life), or any other fundamental rights protected by the Constitution. According to the affidavit submitted by the Director of Narcotics Control, Department of Revenue, Ministry of Finance, there is no outright prohibition of cannabis under the NDPS Act; nonetheless, it may be utilized for medical, scientific, industrial, and horticultural reasons with the proper authorizations from the relevant State Governments.

Inferring that the cultivation for industrial/horticultural reasons, as specified in Section 14 of the NDPS Act, can be taken into consideration by the State Government, it was further said that the State governments are empowered to license the cultivation of cannabis for industrial and scientific purposes. The Centre also explained that the NDPS Act makes a distinction between the fiber, flower, and seed—three different elements of the cannabis plant—and does not treat them and their derivatives similarly.

CANNABIS IN AYURVEDIC MEDICINE

Susruta, the well-known treatise on Hindu medicine, recommends cannabis leaves as anti-phlegmatic, as a remedy for catarrh associated with diarrhea, and as a cure for biliary fever. Rajanirghanta, edited by Narahari Pandita (A.D. 300) and again published in A.D. 1500, detailed a description of the cannabis plant and its medicinal properties. In addition to being astringent and relaxing, it is said to have the ability to dissolve phlegm, relieve flatulence, lessen costiveness, improve memory, and pique the appetite. The substance is mentioned as a general stimulant in Sarangadhara Samhita, a medical treatise produced during the Mohammedan era. Ganja is described as a soporific by Dhurtasamagama (about the year 1500) who claims that it “corrects derangements of humor and produces a healthy appetite, sharpens the wit, and acts as an aphrodisi.

ABUSES OF CANNABIS DRUGS

Cannabis preparations are commonly used in India, but not often to such an extent as to constitute a definite abuse and menace. Religious mendicants use bhang to induce mental concentration and communion with God, while nomadic classes live in small camps and are exposed to inclement weather. It is believed that bhang drinking is less harmful than smoking ganja and charas. It can cause impairment of digestion, but ganja and charas smoking can lead to mental derangement, behaviour problems, crime, and insanity. ^[19]

The following preparations containing cannabis are used in indigenous medicine at the present time:^{^[20]}

	Name of preparation	Disease against which used
1.	Madnanand modak	Tonic with aphrodisiac action.
2.	Trailokya Vijaya vati	Mania, renal colic, dysmenorrhoea.
3.	Jatiphaladi jog	Dyspepsia, bronchitis and sprue type of chronic diarrhoea.
4.	Lai chourna	ditto
5.	Vijayableh	ditto
6.	Grahni shardool	Diarrhoea, dysentery, and fever.
7.	Brehat myka ch.	Coryza, cough, piles, diarrhea, dysentery, and sprue.
8.	Gangadhar ch.	Diarrhea, sprue, fever, cough, coryza.
9.	Swalp nayaka ch.	Chronic diarrhea (sprue type).
10.	Mundyadi Vatika.	ditto
11.	Kamashwar Modak	Asthma, cough, piles, indigestion, debility.
12.	Madan modak	ditto
13.	Agni Kumar modak	Asthma, cough, gout, sprue.
14.	Jatiphaladi vati	Diarrhoea, cough, acidity, piles, sprue.
15.	Kumari asava	Cough, piles, tumor, or swelling in the abdomen.
16.	Laxmi Vilas (Nadya)	Fever.
17.	Trailokya samohan	Tonic with aphrodisiac action.
18.	Madhya nayika ch	Diarrhoea, cough, asthma, colic, gout, and piles.