The Daily Bell is pleased to present this exclusive interview with Lester Grinspoon
Daily Bell: In 2011 you revealed in the documentary “Clearing the Smoke: The Science of Cannabis” that you had cancer. How are you feeling these days? Is the cancer gone or in remission?
Dr. Grinspoon: No, I still have it. I’m getting a second treatment because I have developed some metastases. But I’m feeling all right, doing my work. I’m feeling pretty good.
Daily Bell: Let’s discuss cancer treatments for a moment. You have seen firsthand how effective marijuana can be in alleviating the negative effects of chemotherapy. Can marijuana also be an effective treatment for cancer, as some would suggest?
Dr. Grinspoon: I think the answer to that question is not yet available. There’s no question about the usefulness of cannabis in the treatment of cancer but the unquestionable use has to do with its capacity for palliation. For example, many people with cancer have to get chemotherapy, and some of these cancer chemotherapeutics are very, very difficult, primarily from the point of view of nausea and vomiting and cannabis will help alleviate that or will do away with that. It’s remarkable. It’s also very useful for pain, for depression and has a number of uses. It enhances appetite, for example, for people who’ve lost their appetite so I highly recommend it for people who have cancer.
What I’m afraid of is the people who say, “It cures cancer.” First of all, there are many different kinds of cancer and who knows? It may actually cure cancer. But for me to be convinced of that I’d want to see the data upon which the diagnosis was made and then I’d like to see the follow-up data. That’s just not available.
I had one patient who told me that he had treated his prostate cancer with cannabis and he was fine now. I asked him to send me the pre-treatment histopathology report and some other data and the follow-up. To make a long story short, after he felt he was cancer-free for some time and a few months after he had sent me the post-treatment pathology report, he again got cancer, or it came back, and he had to get treatment. I was on the verge of writing a paper about him. I had all the data and fortunately, he told me, though, “It’s there again,” so apparently it didn’t work. I said to him, “You should get yourself to an oncologist right away.”
I’m afraid that people hear the statement ‘marijuana cures cancer’ and some people are so afraid of cancer and having it treated properly by a well-qualified oncologist that they’ll go right to the cannabis and say, “I’m going to treat it myself with cannabis.” That’s very troublesome because some of those people might have been saved or their lives prolonged if they had actually gone and gotten the best that modern Western medicine has to offer. Allopathic medicine has a long ways to go with cancer but at least some can be cured and in some, life can be prolonged quite well. I’m afraid when people think that, it’s almost a religion with some people – “Yes, marijuana cures cancer.” My view is, use cannabis when you’re getting the cancer treatments but first, as soon as it’s diagnosed, start the treatment which medical science says is the best treatment for that but take marijuana right along. It will go much easier for you.
When someone comes to me – for example, someone came in with a pain yesterday. It’s apparently shingles, but shingles around the eye orbit, which I’ve never encountered before. And I said to him, “Look, I don’t know if it’s going to be useful for that pain. For most pain, it reduces it. A few pains it takes away altogether, like a migraine, but in many pains it will make it so much less uncomfortable that you can go on doing whatever it is without your consciousness being just filled up with the pain. So I will often say to most people who have illnesses that don’t have to be dealt with as soon as possible, if I think there’s a chance, “Look, try it. You’ve got to learn how to use it properly but try it. It will not hurt you. If it works, terrific. If it doesn’t, you’ve lost nothing.”
Daily Bell: As a result of information being made widely available via the Internet, we find that much of the information we grew up relying on has other interpretations – whether it’s alternative treatments for health issues or the beneficial effects of marijuana. Has the Internet changed or expanded the information that one can absorb and act upon?
Dr. Grinspoon: It’s extended it. And it’s also a double-edged sword. It’s expanded it, it’s made knowledge about it more available to people by far. Like my websites, RXMarijuana.com or Marijuana-uses.com, have brought a lot of information to people on marijuana, and a lot of other people bring responsible information to the Internet with respect to cannabis. However, there’s some of it that I think is really questionable. Some people speak with authority, which I sometimes question. So I think it works both ways but mostly I think it’s been very helpful.
We live in a society which is changing rapidly now but which has not been very news-partial to cannabis. A lot of newspapers have had an editorial policy, like the New York Times, that’s suddenly changed. Well, they could have come to that conclusion years ago. But as I say, the Internet is a Janus-faced proposition where cannabis info is concerned but on the whole I think it is positive.
Daily Bell: Let’s talk a little bit about the pharmaceutical model being applied to cannabis. What’s your take on the practice of using CBD derivatives in treatment as opposed to the whole herb?
Dr. Grinspoon: One example is that some states say they’re legalizing the use of marijuana for medicine but just CBD, cannabidiol. I think that’s foolish because CBD is remarkable but it seems to work best in what I call the ensemble effect. In fact, without the ensemble effect it very often doesn’t do much at all. For instance, with little Charlotte Figi, the little girl who was first brought to our attention with Dravet syndrome, the strain that works with her is one that is high in CBD and low in THC but also contains terpenoids. You need those three things; they comprise the essential ensemble of high CBD, low THC with terpenoids.
Now, we’re late in coming to the understanding of CBD, or beginning to understand it, because nobody was interested in the ’60s. The interest in marijuana began to blossom because, of the three categories of usefulness, the one that was predominant in the ’60s was the “high,” or psychoactive effect. So all the growers in the Netherlands, in Northern California, in British Colombia were developing strains high in THC. As a consequence, the CBD, cannabidiol, went down.
Now there’s a race in the opposite direction to have both – to have high THC strains and to have ones that are very high in CBD and low in THC. I think the latter for some people is the best medicine because some people don’t like the high that comes with marijuana and prefer to have a high CBD to THC ratio with terpene, because you don’t get a high. You don’t feel anything. In fact, it’s nice to take this before sleep because it has a somnorific effect. And I think that now we’re getting a lot of strains that are high in CBD and lower in THC and with this ensemble effect, with the terpenoids, they are quite successful as strains that will be useful in medicine.
Daily Bell: As a psychiatrist, please address briefly some of the issues around mental illness and marijuana use. What about causing, or curing, psychiatric disorders? There were a couple of studies, now being promoted in the adolescent mental health arena, that suggested that, among young persons with predisposing tendency toward mental illness, use of marijuana acted as the trigger for those illnesses to manifest.
Dr. Grinspoon: Most of that work has pointed to schizophrenia with the claim that marijuana “causes” schizophrenia. That is utterly false. And there’s a very simple way of determining that. The prevalence of schizophrenia is 1%. It’s 1% around the world. Now, starting in the 1960s you have increasing numbers of people who are using marijuana, so now we should certainly be seeing that 1% go up, maybe even just a fraction of a point, but it hasn’t.
Now, there’s one caveat to that. Schizophrenia is a disease that one is born with. It manifests itself usually in adolescence and its acute manifestation is often brought about by what we refer to as a precipitating event. It’s often not, that we know of, but many times you will see something like the loss of an important figure in somebody’s life or a bad automobile accident, something that really shakes up the pre-schizophrenic. Theoretically, a pre-schizophrenic person could have a bad trip because they don’t know how to use marijuana properly and they can experience a lot of anxiety and paranoia. I can imagine that that might happen sometimes but it doesn’t mean it causes it. The schizophrenia was there; it was just waiting for something to come along to nudge it over the line.
Daily Bell: We’ve also read that in some instances marijuana is being used to treat certain mental illnesses.
Dr. Grinspoon: Yes, but again, it’s hard for me to comment on that because I haven’t seen it myself and I just don’t know very much about that. There are two mental disorders I do know about where I’ve had experience with patients. One is manic-depressive disorder. Particularly in the manic phase, cannabis – and there is an illustration of this in my book, Marijuana: The Forbidden Medicine – cannabis will bring those people down very often and the mania will subside quite well.
The other thing about marijuana and mental illness is that it is an anti-depressant. Now, it’s not a powerful anti-depressant. If somebody has a real serious affective disorder, marijuana isn’t going to do much. But for people who just have a degree of depression and life doesn’t feel quite as fulfilling to them as it might, those folks might find marijuana sometimes helpful with that.
I treated a depressed professor here. His was not a really deep depression; it was the kind I described before. He finally found that the SSRIs, the kind of anti-depressant that I was prescribing – he gave them up and started to resume using marijuana, which he had used before, and it was every bit as effective as what I was prescribing. As a sideline note, he’s still doing that as a way of dealing with it.
Daily Bell: Is marijuana truly a miracle drug, meaning will we find more and more uses for it in the near future as it becomes more widely available?
Dr. Grinspoon: The answer to that is yes. When I first started to look at marijuana I went into the library, and this was in 1967, because many of my friends in Cambridge were using it and I would say to them, “You mustn’t do that. That’s harmful. You really shouldn’t smoke that.” I was an arrogant young doctor who felt that because it was a drug I knew something about it. But then I began to question – well, now, what do I actually know about its harmfulness? And so I went into the library. I had some unscheduled time because one of the junior authors of my book on schizophrenia wasn’t going to have his chapter in for two months.
So I took that time to go in there and start to look at that and I had an epiphany. This is a remarkably nontoxic drug and here we are arresting 300,000 – at that time – mostly young people, 89% for mere possession. Every year now, of course, we arrest about 750,000, 89% for possession, most of them young. In one year, 2011, it got up to almost 900,000. As I summed up that early paper that was published in Scientific American in November 1969, I said there is no psychopharmacological effect which is nearly as harmful as the way we as a society are treating people who use this drug. It was then that I understood that it was a very good recreational drug. It doesn’t have the drawbacks of alcohol. You don’t get crazy drunk and drive and get into accidents or get into fights in bars, have the aggression and so forth, you don’t have a hangover the next day. And it’s a very social drug. So I thought, as far as I’m concerned, this goes up to the top of the scale as a recreational drug.
So as to finding more uses for marijuana in the future, yes, but not just for marijuana as a pharmacologically active substance. You’ve also got the whole field of hemp. And we as Americans are way behind. You should see what the Europeans and the Chinese are doing with hemp because they can grow it. In this country, the people responsible for these awful laws believed that hemp was just tall marijuana bushes and therefore, we should not allow the farming of hemp in this country. And we are paying the price. Some cars can use hemp because it has a long, vast fibre, the longest fibre you can get in wool, cotton, etc., and it has the greatest strength and Mercedez is now using it for interiors of their cars. That’s just one of I dare say hundreds of different ways it’s being used. I’m wearing now a shirt that’s made of hemp. When it first came out it was rough; now it’s almost as soft as silk, and it lasts forever. So that’s another area in which we are losing out because of this absurd prohibition. That’s another whole area. When you ask is this valuable, it is. Marijuana is, in my view, the most valuable plant around and as for me, I see it as a blessing, as a real blessing. It has blessed my life and I’m sure it is blessing and will bless a lot of other people’s lives.
Daily Bell: In your early research you found that the history of the medical use of marijuana goes back quite a ways. When did Western doctors really begin using it?
Dr. Grinspoon: In that first book I wrote on the subject of marijuana, Marihuana Reconsidered, I was aware of its use as a medicine in the 19th century. But Western medicine took it seriously starting in the middle of the 19th century and between 1850 and 1900 I counted about 100 medical papers on it. The trouble with it as a medicine then was that because it is not soluble in water it had to be in an alcoholic solution. The biggest problem was that there was at that time no bioassay. A doctor didn’t know how many drops to tell his patient to take. The second problem was that if you take it orally, the effect doesn’t come on for an hour and a half to two hours. If you’ve got somebody with a bad pain, he’s got to wait a while for relief.
Nobody knew about smoking at that time. What was new about its widespread use beginning in the ’60s was that it began to be smoked. Actually, it was really before the ’60s because the jazz musicians knew about it but not many other people. But in the ’60s it began to be more widely used and it was now smoked. And this is a boon to it as a medicine because this means that the patient can titrate his own dose.
Daily Bell: So you’re saying that smoking marijuana is the preferred method of taking it as a medical treatment, the most efficacious?
Dr. Grinspoon: Yes. This is one of the beauties of cannabis as a medicine. For instance, I want to treat your Crohn’s disease with smoked cannabis – and you can use a vaporizer if you want but smoking cannabis has been proven not harmful to the pulmonary system. When you take marijuana through the lungs, whether by smoking or vaporizer, you can titrate your own dose. You take just the number of puffs to get relief of the cramps, then stop.
For older people or others who are marijuana virgins I insist they wait two to three minutes between each puff to make sure they’re not getting too much, because it takes some experience to learn to recognize its effects. I tell them take a puff and then just put it down for a couple of minutes, then take another puff. Do that until one of two things happen: You get a little anxious or you see that your symptom, like nausea or pain, is going down.
Daily Bell: And the third category that you referred to earlier?
Dr. Grinspoon: The third area of benefits of marijuana that I’ve started to write about – and I meant to do a book on it – is an important area, in my view. I’ve got a website, Marijuana-uses.com, which has a lot of essays from people who have had the experience that I believe is there for some people if they can find it, and that is the capacity to enhance a variety of experiences.
For example, my closest friend, Carl Sagan, used it partly for this reason. Carl has been dead now for a long time but he used it frequently, and he used it not just for recreation and relaxation but also for work. I remember when we partied one evening using a new strain that someone from California had sent me. We both liked it and when we were leaving he said to me, “You know, Lester, I’ve got to finish a chapter of the book I’m working on tomorrow and I notice you have one more of those joints. I’d love to have it for tomorrow. It would be very helpful for me.” Many of us have found that to be true.
For most people there are a couple of things it enhances that you don’t need to find, it’s just there, like taste. An ordinary meal can taste like a culinary treat when you’re a little bit high. And, of course, many people have discovered how it enhances the sexual experience. But for the phenomenon I’m talking about you need a lot of experience to be able to achieve this kind of enhancement of creativity. For instance, if you use it in the evening you may get some very interesting ideas. Some of us jot those down at night, or put them into a tape recorder, because you have to look at it sober the next morning to say, ‘Oh, well, that’s a lousy idea,’ or ‘Wow, that’s a good idea. I hadn’t thought of that before.’ So there is this capacity to enhance, which is much less well known as a property of cannabis. And of course, these three categories are conflated to a degree.
Daily Bell: Back to the use of marijuana in medical treatment now. You mentioned Charlotte Figi earlier and the use of marijuana oil as a treatment for children with Dravet syndrome and other forms of severe epilepsy. What is your position on using marijuana as a treatment for children in other situations?
Dr. Grinspoon: My position on marijuana and people who are under the age of 21 is that they shouldn’t use it. Now, why do I say that? Because the brain is not fully developed until the early 20s. And while people can say, and say with authority, it compromises development, I haven’t seen any data that really prove that. But one just wants to be sure and so many parents are very conservative about that, like I was. I would say not until you’re 21.
The exception to that, of course, is the child who is sick. My own son, who suffered from acute lymphocytic leukemia and had chemotherapy, which became so awful, the nausea and the vomiting. I don’t want to go into how he discovered this here only because it’s a long story. And there are many other things that children get for which this is more helpful with fewer side effects, less toxicity, than the pharmaceutical products that they would get otherwise. So I have no problem having it used in children like, for example, the many autistic children who have benefitted from it. Well, listen, if you can accomplish what you can with cannabis in autistic children, particularly those who throw things around and are just sort of out of control some of the time, this is very helpful – and who would deny them this? And in the back of your mind, you do have some concern about using it in young children. But it’s not a data-based concern. It’s a good concern that we as parents always want to protect our children from everything, and that’s good, except when they’re sick and they have to take these things.
Daily Bell: Speaking of your close friend Carl Sagan, in 1969 he anonymously contributed an essay – you revealed him as the author only after his death in 1996 – to your book, Marihuana Reconsidered. In that essay he referred to the day cannabis is legalized, saying “I hope that time isn’t too distant; the illegality of cannabis is outrageous, an impediment to full utilization of a drug which helps produce the serenity and insight, sensitivity and fellowship so desperately needed in this increasingly mad and dangerous world.” Now, nearly 50 years later, marijuana prohibition continues almost globally though we’re finally moving toward legalization. Are you encouraged with this progress?
Lester Grinspoon: It’s funny you bring this up because Carl and I used to read the manuscripts of each other’s books and he read the manuscript of Marihuana Reconsidered, which was published by Harvard University Press in 1971. He said something like, “Lester, that’s a good book but you made one big mistake.” “What’s that, Carl?” “In the last chapter you said it would be 10 years before the prohibition was gone.” I said, “Well, what would you think?” He said, “Oh, it will be gone in two years, three at the most.” So we both had a much more optimistic view of what would happen. It moved pretty slowly and there was a time I thought I’d never see it in my lifetime. But now, as far as I’m concerned, prohibition is collapsing. That cat is never going to be put back in the bag; what we are now seeing is a Western culture struggling to find accommodations to this new kid on the block. But I think it’s going to take a few years to establish these changes.
You know, it’s fortunate we’ve got these now 23 states that allow medical marijuana – although some of them, like New Jersey, are so restrictive that few people can take advantage of its medicinal properties. Other states are enacting “medical marijuana legislation” involving CBD only. It’s not really medical marijuana in these instances and people in those states will soon discover if they take CBD only they will be disappointed in their results.
But nevertheless, we’ve got these different kinds of social experiments going on and we are learning from them so that eventually we as a society can find a sane, rational approach to the fact that marijuana is a useful drug. Like any other drug it can be abused but less so than any other drug that I can think of. And that’s going to take a while to sort out but I am absolutely thrilled now that we are in the process. The debate has been going on for a long time and now it’s beginning to be translated into action.
Daily Bell: You wrote in 2010: “The present attitude of the government and anti-marijuana crusaders bears the same relationship to reality that the film ‘Reefer Madness’ bore in 1936. But the dissonance is even more striking now, because we know so much more. Since 1971 millions of dollars have been spent by the National Institute of Drug Abuse to study the dangers of cannabis. This vast research enterprise has completely failed to provide a scientific basis for prohibition.” Looking back, how was it possible that a plant that had been used by people successfully for thousands of years was demonized and its possession criminalized?
Dr. Grinspoon: That’s a good question and I don’t know the answer. There’s a historian, Charles MacKay, who wrote a book in 1850 on widespread popular delusions. For example, he wrote about tulipmania in 17th-century Flemish countries, where tulips became worth maybe $3,000 or $4,000 and the whole economy was beginning to be based on tulips until they got over this. And he wrote about other grand delusions like the witch hunts. I think a future historian is going to look at this. We’ve been into this prohibition for 77 years now, since the passage of the first draconian act against marijuana, the Marijuana Tax Act of 1937, and over the years the law has become more and more severe about this and we’ve arrested between 24 and 28 million people. But now you can see that we’re going the other way – not as fast as I’d like to see but we’re going there as fast as one can expect this culture to go.
But someone like a historian, as I mentioned, is going to look back on this – how many years it takes, I don’t know; as I say, it’s already been 77 years – and ask, what in the world? How could this have happened and existed for more than whatever number of years by the time we can close the book on it, the view of it as a terrible drug rather than a widespread belief that this is a very useful substance, whether from the point of view of using it as hemp, a plant that can be made into many industrial products, or as a recreational drug or as medicine. That’s going to take some time but eventually someone’s going to try to figure out what in the world? How did this all come about?
There are theories, of course, as to how this happened. One that seems to have some weight has to do with Harry Anslinger, who was the first drug czar, so to speak, the head of what was then called the Bureau of Narcotics, which became the Bureau of Narcotics and Dangerous Drugs and finally the Drug Enforcement Agency. Harry Anslinger, I think, wanted to find a way to do what J. Edgar Hoover was doing. Hoover was able to get a lot of money for the FBI through the communist scare, and I wonder if there wasn’t something parallel going on with one of the people who shaped this dastardly prohibition, the man who was first appointed to that job, Harry Anslinger.
Daily Bell: Given that, as you said, there is no scientific basis for prohibition, what will it take to convince policy makers in the US to finally deschedule marijuana?
Dr. Grinspoon: I think there’s a lot of pressure on them now to take it out of Schedule I because they keep saying we haven’t got the clinical research we need for people like you, Grinspoon, to say it’s useful in the treatment of, let’s say, migraine headaches – for which Sir William Osler said, of cannabis, it was the best treatment available and in many ways it still is. There’s a lot of pressure on the Congress now and they’re the only ones who can really change it, to take it out of Schedule I of the 1970 Comprehensive Drug Control and Abuse Act, which placed drugs with psychoactive effects in five categories, Schedule I being the most severely restricted. Nobody can use a drug in Schedule I for research or any other purpose. Along with cannabis in Schedule I are LSD, heroin and so forth. Cocaine is in Schedule II because there is some medical use for that. But with Schedule I, we’ve not been able to do the research because it’s illegal. Well, I think there’s an enormous amount of pressure now and I think that’s going to happen pretty soon.
Daily Bell: You have endorsed initiatives to legalize marijuana for decades, including as former chairman of the board for NORML. Has your activism had any negative effect on your career?
Dr. Grinspoon: Oh, very definitely. I was put up for early promotion to full professor in about 1975, a few years after Marihuana Reconsidered came out. My chief, who had put me up for early full professorship, was on the promotions committee. He came back from the promotions committee meeting and asked me to come to his office to give me the bad news. They had turned me down. When I asked him why he said, “Well, they loved your work on schizophrenia, but Marihuana Reconsidered – they hated that.” I asked why. He said, “They said it was too controversial. It was very controversial.” I said, “What has controversy got to do with it? We’re in the academy. Isn’t scholarship the criterion, or one of the most important?”
The funny thing is that 20 years later, in 1995, I announced I was going to become emeritus in 2000 and apparently somebody on the promotions committee apparently said that maybe they ought to reconsider the decision they’d made 20 years prior about my professorship, and it was passed. But the chief of psychiatry, Dr. Joseph Coyle, at the McLean Hospital, refused to sign it. He told my chief that it would have to wait for the new dean to come in “because I want him to co-sign it,” as though it was some terrible responsibility that had to be co-signed. That was in December and it was the following July 1st that the new dean came in, Dean Joe Martin – Dean Martin, as he was called. They met, apparently, and decided to not sign it. The dean never called me or asked to see me or anything. I just heard via the grapevine that it had been vetoed.
So there’s no question about it. A lot of people were very unhappy with my involvement. Now, I have written other books on other things, but the marijuana issue bothered me so much, the idea of arresting so many people and seizing property and so forth, I just had to become involved in it.
Daily Bell: As you know, many people thank you for doing so. Being right on the edge of legalization, as you see it, what would you say to the millions of mostly young people in the US still being sentenced for tiny amounts of marijuana to long periods of incarceration, expensive and lengthy probation periods, high fines, etc. who will have a criminal record that stays with them for life, never again qualify for college assistance or scholarships, etc.?
Dr. Grinspoon: It’s one of those things that just blow your mind, that they could do this. It’s so outrageous. They are not alone now. These individuals have the company of between 24 million and 27 million people who have been arrested on marijuana charges, 89% for mere possession, most of them young people. Now, if that isn’t a horrendous crime, what is? Fortunately, their children will not face these problems.
Daily Bell: Thank you for what you’ve done to bring that about and for your time in providing this interview to our readers.
Dr. Grinspoon: It’s been a pleasure to talk to you. Take care.