The History of Medical Marijuana in America: From Pharmacopeia to Schedule I to Your State Law

In 1851, the United States Pharmacopeia — the official compendium of recognized medicines in America — listed cannabis as a treatment for neuralgia, tetanus, typhus, cholera, rabies, dysentery, alcoholism, opiate addiction, anthrax, leprosy, incontinence, gout, convulsive disorders, tonsillitis, insanity, excessive menstrual bleeding, and uterine bleeding.

That's not fringe medicine. That's the same reference book that standardized aspirin, morphine, and digitalis. Cannabis wasn't a counterculture drug — it was a mainstream pharmaceutical, available in tincture form at every pharmacy in the country.

Understanding how we got from there to here — and where we're going — requires tracing a history that involves racism, tax policy, pharmaceutical patents, political calculation, a war on drugs, and a patient-driven backlash that has reshaped American law.

The Golden Age: 1850-1937

Cannabis arrived in Western medicine largely through the work of William Brooke O'Shaughnessy, an Irish physician working in Calcutta who published his observations on cannabis's therapeutic effects in 1839. He documented its use for rheumatism, tetanus, rabies, and convulsions — noting particular efficacy for muscle spasticity and seizures.

By the 1850s, cannabis extracts were widely available in American and European pharmacies. Key developments:

• 1850: Cannabis added to the United States Pharmacopeia (USP)
• 1854: Listed in the United States Dispensatory with detailed preparation instructions
• 1860: The Ohio State Medical Society published the first clinical conference report on cannabis, documenting its use for pain, stomach complaints, psychosis, and chronic cough
• 1890: Sir J. Russell Reynolds, Queen Victoria's personal physician, wrote in The Lancet: "When pure and administered carefully, [cannabis] is one of the most valuable medicines we possess"
• 1900-1930: Major pharmaceutical companies — Eli Lilly, Parke-Davis, Squibb, and others — manufactured and sold cannabis tinctures and extracts

During this period, there was no cultural stigma attached to medical cannabis. It wasn't associated with recreational intoxication, racial minorities, or social deviance. It was simply medicine.

The Turn: Racism, Xenophobia, and Harry Anslinger

The transformation of cannabis from medicine to menace happened in roughly two decades, driven by a convergence of factors that had nothing to do with pharmacology.

Mexican Immigration and "Marihuana"

The term "marijuana" entered American English through Mexican Spanish. Mexican immigrants arriving in the Southwest during and after the Mexican Revolution (1910-1920) brought with them the practice of smoking cannabis recreationally — a practice unfamiliar to most Anglo Americans, who knew cannabis only as a pharmacy tincture called "cannabis."

The deliberate rebranding of "cannabis" as "marihuana" was a political strategy. By using a foreign-sounding word, prohibitionists could associate the drug with Mexican immigrants and, by extension, with criminality, violence, and racial threat — without most Americans realizing they were talking about the same plant that sat in their medicine cabinet.

Reefer Madness and Media Hysteria

William Randolph Hearst's newspaper empire amplified anti-marijuana sentiment with lurid, racially charged stories throughout the 1920s and 1930s. Cannabis was linked to violent crime, sexual deviance, and insanity — with perpetrators almost always identified as Mexican or Black.

This media campaign created a feedback loop: sensational stories generated public fear, which generated political pressure for prohibition, which generated more stories.

Harry J. Anslinger

The single most influential figure in American marijuana prohibition was Harry J. Anslinger, the first commissioner of the Federal Bureau of Narcotics (1930-1962). Anslinger's testimony before Congress was openly racist:

"Reefer makes darkies think they're as good as white men."

"There are 100,000 total marijuana smokers in the US, and most are Negroes, Hispanics, Filipinos, and entertainers."

Anslinger's motives are debated by historians. His bureau was new, underfunded, and looking for a mission. Marijuana prohibition gave it one. Personal ideology, institutional self-interest, and genuine (if wildly misguided) drug concerns all played roles.

The Marihuana Tax Act of 1937

Rather than outright prohibition, the federal government used taxation to effectively ban cannabis. The Marihuana Tax Act of 1937 imposed a prohibitive tax on the sale, possession, and transfer of cannabis — with such burdensome paperwork requirements that compliance was functionally impossible.

The American Medical Association opposed the act. Dr. William Woodward, the AMA's legislative counsel, testified against it, arguing that the law would prevent further medical research and remove a useful therapeutic agent from physicians' arsenals. His objections were dismissed. One congressman reportedly asked: "If this is the AMA's position, then what in the world are they doing coming here and testifying against this bill?"

Cannabis was removed from the United States Pharmacopeia in 1942.

The Controlled Substances Act and Schedule I

In 1970, Congress passed the Controlled Substances Act (CSA), which classified all drugs into five schedules based on their medical use, safety profile, and abuse potential.

Cannabis was placed in Schedule I — the most restrictive category, defined as:

1. High potential for abuse
2. No currently accepted medical use
3. Lack of accepted safety for use under medical supervision

This classification was intended to be temporary. President Nixon appointed a commission — the National Commission on Marihuana and Drug Abuse, known as the Shafer Commission — to study the issue and make recommendations.

The Shafer Commission's 1972 report recommended decriminalization of personal use and acknowledged that cannabis's dangers had been overstated. Nixon rejected the recommendations entirely. He had privately stated that marijuana was a tool to target his political enemies — a claim later confirmed by his domestic policy advisor John Ehrlichman in a 2016 interview with Harper's Magazine:

"We knew we couldn't make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities."

The Consequences of Schedule I

Schedule I classification didn't just make cannabis illegal — it made it nearly impossible to study. Researchers who wanted to investigate cannabis therapeutically needed to obtain approval from the DEA, the FDA, and the National Institute on Drug Abuse (NIDA). NIDA controlled the only legal source of research cannabis: a single growing facility at the University of Mississippi that produced notoriously poor-quality, low-potency material.

This created a Catch-22 that persisted for decades: cannabis couldn't be approved for medical use because there wasn't enough research, and there wasn't enough research because cannabis was classified as having no medical use.

The Patient-Driven Rebellion: 1996-Present

California Breaks Through

In 1996, California voters passed Proposition 215 — the Compassionate Use Act — making California the first state to legalize medical marijuana. The measure passed with 55.6% of the vote, driven by AIDS patients, cancer patients, and their caregivers who had witnessed firsthand how cannabis helped with wasting, nausea, and pain.

The federal response was hostile. The DEA raided dispensaries. Federal prosecutors threatened physicians who recommended cannabis with loss of their DEA licenses. The Supreme Court ruled in United States v. Oakland Cannabis Buyers' Cooperative (2001) that there was no "medical necessity" defense under federal law.

But the states kept going:

• 1998: Alaska, Oregon, Washington
• 2000: Colorado, Hawaii, Maine, Nevada
• 2004: Montana, Vermont
• 2008: Michigan
• 2010: Arizona, New Jersey, Washington D.C.

The Cole Memorandum and Federal Retreat

In 2013, Deputy Attorney General James Cole issued a memo directing federal prosecutors to deprioritize enforcement against state-legal marijuana operations that complied with state regulations. This wasn't legalization — it was prosecutorial restraint. But it provided enough breathing room for state programs to expand and stabilize.

The Cole Memo was rescinded by Attorney General Jeff Sessions in 2018, then effectively replaced by a bipartisan congressional rider (the Rohrabacher-Blumenauer amendment) that prohibited the DOJ from spending money to interfere with state medical marijuana programs. This rider has been renewed annually since 2014.

Florida's Medical Marijuana Journey

Florida's path to medical marijuana involved two ballot initiatives and a constitutional amendment:

The Charlotte's Web Era (2014)

In 2014, the Florida legislature passed the Compassionate Medical Cannabis Act, allowing low-THC cannabis (under 0.8% THC) for patients with cancer, chronic seizures, or chronic muscle spasms. This was an extremely narrow law — it didn't give most patients meaningful access, and the low-THC restriction limited its therapeutic utility.

Amendment 2: First Attempt (2014)

The first attempt to legalize broader medical marijuana appeared on the 2014 ballot as Amendment 2. It received 57.6% of the vote — a clear majority, but short of the 60% supermajority required for constitutional amendments in Florida.

Opponents, funded primarily by casino magnate Sheldon Adelson, ran an aggressive campaign arguing the amendment was too broadly written and would be a backdoor to recreational legalization.

Amendment 2: The Comeback (2016)

A revised Amendment 2 appeared on the 2016 ballot. This version included tighter language while expanding the list of qualifying conditions. It passed with 71.3% of the vote — the largest margin of any medical marijuana ballot measure in American history.

The amendment added Article X, Section 29 to the Florida Constitution, establishing the right of qualifying patients to use medical marijuana under physician supervision.

Implementation and Expansion

The Florida Department of Health implemented the program through 2017-2018, creating:

• A physician certification system
• Patient ID card registry
• Medical Marijuana Treatment Centers (MMTCs/dispensaries)
• Qualifying conditions list including chronic pain, PTSD, cancer, epilepsy, glaucoma, HIV/AIDS, Crohn's disease, Parkinson's disease, MS, and other debilitating conditions

As of 2026, Florida has over 800,000 registered medical marijuana patients — one of the largest state programs in the country. Telehealth certification is permitted, making access easier for patients across the state.

Where We Are Now: The Federal-State Disconnect

The fundamental contradiction of American marijuana policy persists: cannabis remains Schedule I federally while 38+ states have legalized medical use and 24+ have legalized recreational use.

Recent federal developments:

• 2018: The Farm Bill legalized hemp (cannabis with <0.3% THC), creating the CBD industry
• 2022: President Biden issued a blanket pardon for federal simple possession convictions and directed HHS to review cannabis scheduling
• 2023: HHS recommended reclassification to Schedule III
• 2024-2025: DEA rulemaking process for potential rescheduling to Schedule III continues

Schedule III classification — the same category as testosterone, ketamine, and Tylenol with codeine — would not legalize cannabis but would:

• Remove barriers to medical research
• Allow cannabis businesses to take standard tax deductions (currently prohibited under Section 280E)
• Signal federal acknowledgment of medical utility
• Not directly change state programs, which operate under state law

The Longer Arc

Standing back, the history of medical marijuana in America follows a pattern: medical legitimacy for a century, politically and racially motivated prohibition for half a century, and a patient-driven correction that's still ongoing.

The medical marijuana patient of 2026 exists in a strange position — using a medicine that their state constitution protects but that federal law technically prohibits, buying products from licensed dispensaries that can't use regular banking services, certified by physicians whose training included almost nothing about cannabinoid medicine.

At CORAL, Dr. Kim navigates this reality every day. Medical marijuana certification in Florida is straightforward, evidence-informed, and conducted via telehealth. The history matters because it explains why the system looks the way it does — but the system works, and access is available now.

Ready to get certified for medical marijuana in Florida? [Start your evaluation at coral.clinic/start](https://coral.clinic/start).