Editors’ Note: This is the transcript version of the podcast. Please note that due to time and audio constraints, transcription may not be perfect. We encourage you to listen to the podcast, embedded below if you need any clarification. We hope you enjoy!
What is the actual truth behind cannabis harms and benefits? Dr. Peter Grinspoon, Instructor in Medicine at Harvard Medical School and author of “Seeing Through the Smoke: Cannabis: An Expert Doctor Untangles the Truth About Cannabis,” shares his expertise on various topics related to cannabis. From the challenges of having non-judgmental conversations about cannabis between doctors and patients to the potential benefits and harms of cannabis, Dr. Grinspoon provides valuable insights across the board including.
The Government’s funding into cannabis research: harms vs. Benefits
The process of re-legalizing cannabis and how it affects institutional knowledge.
The truth behind the gateway theory of cannabis
His Perspective on Andrew Huberman Podcast
The potential for cannabis addiction and how it’s been greatly exaggerated
The urgent need to teach the endocannabinoid system in medical schools
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[00:00:00]Bryan Fields: What’s up guys? Welcome back to the episode of the Dime. I’m Brian Fields with me, as always, as Kellen Finney. And this week we’ve got a very special guest, Dr. Peter Grinspoon, primary care doctor at Mass General Hospital, instructor of medicine at Harvard and author Dr. G Grinspoon. Thanks for taking the
[00:00:18]Dr. Grinspoon: time.
[00:00:18] How you doing today? Doing great. Thank you so much for having me in your show. Ah, awesome. I’m
[00:00:23]Bryan Fields: to dive in and hit a ton of topics. Ke, how are you doing? I’m
[00:00:25]Kellan Finney: doing really well. I’m really excited to talk to Dr. Peter Grinspoon. I’m really excited to talk about cannabis and the medicinal side of it.
[00:00:34] Um, and just dive in. Uh, how are you, Brian? I’m
[00:00:36]Bryan Fields: excited. I’m excited. And obviously we have to just get for the record. Dr. Grinspoon, your location, please.
[00:00:44]Dr. Grinspoon: I’m in Boston and it’s a absolutely spectacular, uh, spring day in Boston. Everything is blooming. Uh, I couldn’t be nicer. Uh, well, you know, in the winter we freeze.
[00:00:52] In the summer we melt, but this spring is very nice and the fall is very pretty. Yeah, I love it.
[00:00:56]Bryan Fields: I think it’s best that we just kind of prevent the winter from ever happening here on the East Coast and [00:01:00] let ke on the West Coast kind of take all,
[00:01:01]Dr. Grinspoon: I think climate change is taking care of that. Honestly, it’s been very mild, the winters.
[00:01:06] I was pretty
[00:01:06]Bryan Fields: sure that wasn’t real. That’s what I was told.
[00:01:11] So Dr. Grinspoon, for our listeners on invite, you can give it all
[00:01:14]Dr. Grinspoon: background about. Well, I’m a primary care doctor. I’ve done that for 25 years. Um, I have a little bit of an atypical path to medical school. I was a philosophy major and a religion and sociology minor at college. And then I spent five years, uh, working for Greenpeace on the anti-nuclear campaign.
[00:01:30] Um, in the late 1980s and early 1990s. I got to travel around the world. I got to go to she Noble with a little guy, Geiger counter. Um, I’ve been in. Then I went to medical school and residency. Um, been a primary care doctor ever since I’ve been involved in the cannabis issue my entire life for several reasons.
[00:01:47] The first of which, uh, briefly is that my, my brother Danny was a pioneering medical cannabis patient in the early 1970s. Um, right when Nixon was gearing up his war drugs, my parents illegally bought cannabis for him, and it like [00:02:00] vastly alleviated the symptoms he was suffering from, from chemotherapy. And then the second, uh, reason is that my dad, Dr.
[00:02:06] Lester Grinspoon, was a very sort of legendary, uh, psychiatrist at Harvard who, uh, came out with a book in 1971 called Marijuana Reconsidered, which was reviewed in the front page of the New York Times book review, in which flat out called for the legalization of cannabis about 50 years, um, before everybody else did.
[00:02:24] Not everybody else, but before like mainstream America sort of adopted that. Um, and then, you know, I, I’ve been treating patients with cannabis my entire medical career. I’ve been a medical cannabis patient, and I feel like I have a pretty panoramic view of the issue from having witnessed the legalization movement, like from a front row seat, my, my entire life.
[00:02:43]Bryan Fields: I, I, that’s incredible. I can only imagine early on seeing some of the challenges and the differences, obviously seeing your dad get involved and then helping your brother. So talking about the openness of it, it must have been a topic that was always open in your household, but I’m guessing you saw it from a different perspective because not everyone else got to experience such an open conversation about [00:03:00] cannabis
[00:03:00]Dr. Grinspoon: and its benefit.
[00:03:02] What was really interesting is that our, our living room was always full of like the most interesting pro-social and influential like academics and scholars. My dad was very social. We had all kinds of people like the astronomer, Carl Sagan, or like the poet Ellen Ginsburg, all kinds of people, and they were having the most interesting, like non-stop motivating conversations about how to impact the problems in the world and about different academic intellectual subjects.
[00:03:28] It was like the most inspiring thing a kid could be possibly exposed to. Then I’d go to like school and there’d be like the DARE program and they’d be like, cannabis, these, like the same old policemen like waddle in every year and say, cannabis makes you a motivational. And it was very confusing as a kid.
[00:03:43] And then as a teenager I finally figured out that like the DARE program with complete BS and like what I was learning at home was actually the truth. So, so I went through a career in medicine. I was sort of immune to a lot of the nonsense that unfortunately they teach us in medical school about cannabis.
[00:03:57] I knew that it was a, a medicine, at least for one [00:04:00] indication cuz I saw my brother benefit. I mean, there’s nothing more impactful than witnessing the alleviation of suffering, um, in a family member, which is why 94% AER of Americans now support legal access to medical cannabis. So yeah, growing up was really just had a really huge impact on my career trajectory.
[00:04:18] What was it
[00:04:19]Kellan Finney: like, uh, kind of making, like from a social perspective kind of dabbling and letting the public know that you were pro cannabis and had this history? Was it like always kind of just out in front of everyone or did you kind of have to learn how to navigate those conversations as your, as a primary care?
[00:04:41]Dr. Grinspoon: Well, I definitely had to learn how to navigate the conversations. Cause I’m a big, um, believer in like meeting people where they are and, and, and trying to get along with ’em and come to some common understanding. I mean, certainly there are these still some, like a few hardcore anti-cannabis psychiatrists that are still bunkered in the 1950s that, that probably like greatly disapprove of what I do.
[00:04:59] But I [00:05:00] think most doctors are coming along in this issue and, and the patients are so far ahead of the doctors. They’ve been nothing but curious and interested in, in medicinal cannabis. Of course, it isn’t for everybody and some people can’t take it because of whatever psychosis or they get addicted to it or whatever.
[00:05:15] But for a lot of people it’s a, it’s a great tool to have in your toolbox is a primary care doctor. And I think that’s pretty increasingly every year accepted by both patients and doctors. Do you think conversations
[00:05:27]Bryan Fields: that are currently happening are, are very open and, and judgmental? Or do you think it depends on where you are and depends on the doctor when those conversations are being had?
[00:05:35]Dr. Grinspoon: Well, more of the conversations are being open. I mean, I think with like a 25 year old, my conversations would always be pretty open, but now you have like an 80 year old come in and sort of whisper, I’d like to try some medical marijuana for my arthritis. All my friends are trying it and you know, they look like they want to draw the shades and they as if a SWAT team’s about to smash in.
[00:05:52] And no, it’s unfortunate with all the stigma, they shouldn’t be made to feel guilty or bad or that they’re somehow doing anything wrong. So [00:06:00] I think the con who I’m having normalized conversations with is greatly expanding as, for example, older Americans are embracing medical cannabis and are desperate, eager to learn more about it.
[00:06:14]Kellan Finney: that been one of the motivations for the book, is trying to get that message more broadly out there?
[00:06:19]Dr. Grinspoon: Oh, there were many, many motivations for the book, but certainly that is one of them. I just think there’s a lot of nonsense. Honestly, the, the anti side doesn’t have a monopoly on the nonsense. There’s nonsense on the pro side too, are the extremes of both sides or both making claims that just aren’t true.
[00:06:34] So what I really wanted to do is point out how dysfunctional it is that we have two different narratives about cannabis, depending on who a random person goes to, what doctor, lawyer, politician, business person, policymaker, social worker they go to, they can get that it’s a, you know, benevolent, uh, wellness aid or that it’s like this evil, dangerous narcotic.
[00:06:53] It sounds like two different plants grown on two different planets nourished by two different sons. And I trace how we got to these two [00:07:00] different belief systems. And then I, I go through each of the harms and each of the benefits and try to, uh, debunk and really solidify what we do know and very honest about what we don’t know yet.
[00:07:09] And try to come up with a sort of a middle path, not a middle path, but like what, what I truly think is like. The most true take on each of these flashpoint issues on cannabis that hopefully we could all either agree with or at least live with so we can move forward without the acrimony of, um, you know, the last 50 years.
[00:07:29] So I think as we’re merging from, you know, the pretty widely, uh, agreed upon failure of the war on drugs, we, we need to come together on cannabis. And it, it just doesn’t work for us to have like these non uh, overlapping views of cannabis in different segments of our society. As far
[00:07:46]Bryan Fields: as you’re aware, is there any other areas of medicine that have such wide disparities between pros and cons as cannabis?
[00:07:55]Dr. Grinspoon: Well, I think in other drug policies, I mean, you know, opiates, uh, you know, some of the [00:08:00] conservatives are like, like, we shouldn’t share needles, you know, and now they’re like, we don’t want safe consumption sites or to give people Narcan. We don’t wanna support drug use. And I’m actually personally 15 years in opiate recovery.
[00:08:10] If you’re gonna use an opiate, if you’re withdrawing, you’re gonna use an opiate. You don’t care if the. Needle is safe or not. Um, so I think harm reduction is an area that I think there’s still a lot of, I, I think the drug related issues because there’s a lot of good science and there’s a lot of evolution and progression and thought, you know, harm reduction is great.
[00:08:29] Less people will overdose on fentanyl, whereas a lot of people are still, uh, have these stigmatized views of addiction and of drugs and of drug users, uh, from the war on drugs. So I would say any drug issue, um, has its, uh, polarization. But really cannabis seems to be a flashpoint for all of this. And I, and I go into this a lot in my book, is it just that it happened to be, you know, the symbol of the 1960s or is this something about the way the cannabis unlocks our thoughts and helps us be like mindful and [00:09:00] interconnected and creative and think out of the box that, that governments hate and wanna suppress?
[00:09:04] I mean, I talk a lot about what is it about cannabis that engendered all this controversy? What about
[00:09:10]Bryan Fields: for teens? Obviously that’s a hot flashing point where everyone’s worried about that. It, it, it’s harmful for teens and some of the research that’s come out, some people have been pretty against it.
[00:09:19] What’s your opinion
[00:09:20]Dr. Grinspoon: on that? Well, first of all, with the caveats, if a teens dying of cancer, like my brother Danny, I don’t think anybody would argue against it. And then, you know, as I did the book, the, the evidence for like treating teens with autism, um, was a lot more intriguing and solid than I thought it was gonna be before I wrote that chapter.
[00:09:38] And, you know, people are so afraid of using T HCN teens because of legitimate concerns about, you know, affecting the developing brain. But they’re happy to, the psychiatrists are happy to bombard the same, for example, autistic teenagers with Adderall, Haldol, Thorazine, all these heavy duty tranquilizers, psycho stimulants and neuroleptics.
[00:09:57] Like how could you argue, it’d be very difficult to argue [00:10:00] that Adderall is like better for your teen brain than, than a small dose of THC with C B D is. So I think there’s a real double standard when it comes to cannabis. But that said, I think that. Helping teens avoid and delay cannabis use The Just Say Wait campaign is an area that both sides can find a lot of common ground on.
[00:10:19] Uh, I think virtually everybody thinks that there’s enough data that teens should refrain from using cannabis use. Now, of course, teens won’t because they’re programmed to take risks. And it’s not a big secret that cannabis is interesting. So I think parents shouldn’t like freak out if their teenagers try it.
[00:10:37] But really try to have a sensible conversation about, you know, what the harms are, and, uh, reality-based conversation, not the DARE program where you try to scare them by saying things that aren’t true and then they reject your entire message. I believe in telling teens the truth and just explaining, we’re concerned about this.
[00:10:52] You have your whole life. You know, wait till you’re, I. People say 25, but no one’s gonna raise the drinking age of 25. Some people say [00:11:00] 21. I think most of the harm gets done before age 18 and that a really good line in this hand would just be like, we don’t accept this before age 18, and you just have to wait.
[00:11:08] But you know, again, the, the debate is not so much, should teens use cannabis is how to talk about teens. Do you pretend that it isn’t fun and interesting and lie to them, or do you tell them the truth and say, you know, this is difficult, but you just have to wait because it’s really, really bad for you and you really don’t wanna hurt your.
[00:11:26]Kellan Finney: So there’s kind of like two sides to canvas, right? There’s a, a recreational side where people consume it for enjoyment and pleasure, right? And then there’s this whole medicinal side of the conversation as well. What do you think is the best way to kind of separate those two buckets and kind of help society move forward with, with those two very different topics, you know what I mean?
[00:11:47]Bryan Fields: or
[00:11:47]Dr. Grinspoon: use cases? That’s a little bit of a trick question. It’s a great question, but it’s a trick question because I talk about my book, how it can be a very elusory sort of a fine line, a slippery line between recreational and medical use. You know, there’s some people that say, [00:12:00] All use is medical use. And I think of the time, like I went to a WHO concert at Outdoors at Fenway Park and shared a joint with my cousins and it’s like, that wasn’t medical.
[00:12:08] That’s using cannabis. That’s not medical unless you define medical so broadly that like having fun is a medical use that doesn’t make any sense. So I don’t agree that all use is medical. Um, that is a recreational use. Um, some use is definitely purely medical. Like my brother Danny Barfing chemotherapy dying of leukemia.
[00:12:27] That’s medical. You know, I’ll a patient say that works as a construction worker and she’ll be like really sore after, you know, lifting heavy objects all day. And then she’ll maybe take a puff or two after work and then that’ll like rejuvenate her muscles and sort of her frustration level from, you know, having been at work all day.
[00:12:43] And then she’ll be able to go out and do some activity like play ice hockey with her friends. Like is that medical or is that recreational? Sort of both. Right? It kind of fits in both. It’s recreational but it’s also medical because it’s healing the problem that was preventing the recreational. So I think a lot of the uses sort of.[00:13:00]
[00:13:00] Somewhere along the continuum between medical and recreational, and then there is some instances of pure medical and pure recreational. Are
[00:13:07]Bryan Fields: there any findings from your book that when you were doing research that really surprised you, that you were unaware of before kind
[00:13:12]Dr. Grinspoon: of diving in? Absolutely. Um, I was sort of aware, like surprised with how much we do know and, and also surprised with how much we don’t know.
[00:13:20] Um, for example, as I mentioned, alluded to before with autism, I, I thought it was skeptical, but then I read all the literature and it’s really suggestive. It’s not definitive, but it’s really suggestive that it can certainly help people, uh, autistic kids with some of the self injurious and aggressive behavior, self-destructive behavior, C b D with a little bit of THC mixed in.
[00:13:40] Again, it’s hard to argue that that’s more dangerous than Adderall or Thorazine or hell all or whatever. These drugs, they’re giving these poor kids. Um, so I was really surprised. For some of that, and then for some of the harms, like I thought that it was like a slam dunk, that it was bad for teens. But a lot of the studies are like, based on observational [00:14:00] studies, like these kids did more poorly on this IQ test, but then you read the limitations section of the study and it’s like, well, we didn’t factor out smoking.
[00:14:09] You know, other drug use, like methamphetamine wouldn’t affected other drug use, uh, poverty. You know, I mean, poor kids do worse than IQ tests than than privileged kids. I mean, so a lot of the research was really, really biased. I mean, again, um, for the last 50 years, the US government has only funded research into harms of cannabis.
[00:14:28] They have not funded any researchers or any research into benefits. So there’s been a big finger on the scalp pointing towards finding harms and not finding benefits. So I was surprised at how, um, much we do know about some of the benefits and I was surprised at how sort of still concerning but not definitive, uh, the results were for some things like, uh, you know, teenage brain issues.
[00:14:52] I mean, and certainly I don’t advise the teenage use. I’m a very big believer in just say, wait, uh, because where there’s smoke there’s often fire. But I [00:15:00] saw that there was more smoke than fire. Do you think a lot
[00:15:02]Bryan Fields: of the reasons why the doctors are more keen on providing the Adderall versus cannabis is just based on the scientific studies behind it and the comfort level in prescribing that?
[00:15:09] Or do you think there’s other nuances behind it?
[00:15:12]Dr. Grinspoon: It’s based on the scientific studies that were done and promoted. Um, you know, you had pharma doing and promot. All these studies about Adderall and the ones that showed that it was bad or didn’t work, wouldn’t, they just wouldn’t publish. You don’t have to publish a study.
[00:15:25] I mean, I think the laws were changing a little bit on that, and the ones that were published that showed Adderall helps A D H D were pumped directly into the brains of our nation’s doctors. I mean, a lot of the medical societies are really compromised by pharmaceutical money. It, it’s really hard to believe that there’s a firewall between what they believe about these drugs, you know, pro Adderall, anti-cannabis, and.
[00:15:45] Funding they get from pharmaceutical companies. Um, now that said, Adderall is a extremely effective treatment for attention deficit hyperactivity disorder, uh, critical medicine. There’s a shortage of it right now, which is tragic and is harming a lot of people. It’s not bashing on Adderall. I’m just making the [00:16:00] point that the studies of cannabis, the only ones that doctors got and get to this day are the ones about harm.
[00:16:06] Um, most of the studies done were looking for harm. And then there’s another thing called publication bias, where if you find a harm, it gets in all the newspapers, you know, c n n marijuana causes your leg to fall off, whereas there’s no headline. Marijuana doesn’t cause your leg to fall off cuz that’s boring.
[00:16:23] That’s also true with the benefits Marijuana cures Pain gets on all the headlines. This study showed that marijuana didn’t cure this particular type of pain in this particular dose. That’s a boring headline. So something called publication bias, um, also affects doctors. What they get fed, uh, really inter, really impacts what they think and do.
[00:16:42]Kellan Finney: And like the physiological interaction of Adderall with like the, the human body is taught, right. It’s really well known in medical school. You probably take a test on how the molecule Adderall interacts with your body. That’s not taught though about cannabis. Correct? Like the endocannabinoid system isn’t taught in medical [00:17:00] school.
[00:17:00] Do you think that that contributes to a lot of doctor’s hesitancy, kind of prescribing it and, and working with the cannabis?
[00:17:07]Dr. Grinspoon: Yeah, well first of all, what they’ve taught us historically in medical school, like nonsense. I mean, it was like warmed over drug war nonsense. Like I was in medical school in the mid 1990s.
[00:17:16] Like I couldn’t believe what they were teaching us. Even at a good medical school, a complete nonsense. I think it’s getting a little bit better cuz no one really gets away with, uh, sperm damage, brain damage, bro, brass, all that stuff. But, um, I, it is really tragic that the endocannabinoid system is not taught in medical schools.
[00:17:35] It’s currently taught in 13% of medical schools and, um, you know, that’s growing, but it’s taught more in Europe and in other places. Sorry, it’s a little bit noisy here. So I’m changing the, uh, changing my room. It’s, um, currently taught to 13% of medical schools and you know, that’s really nuts whether you’re pro anti or neutral about cannabis.
[00:17:55] How could you not wanna insist on understanding the endocannabinoid system? I mean, the [00:18:00] endocannabinoid system is this central system of. Neurons and neurotransmitters that we all have. They’re very ancient. It’s like 500 million years old. Uh, humans have only been using cannabis for 5,000 years. The endocannabinoid system far predates humans.
[00:18:13] It just happens to be the receptor system that cannabis sort of bootstraps to work its effects. And, um, you know, it was late to be discovered because of the war drugs. And then it was late to be, it is very late to be incorporated into medical school curriculum as a hangover from the Warren drug. So again, it’s only taught in about 13% of medical schools.
[00:18:32] Hopefully that’s growing. That’s in the US and other countries. There’s certainly, uh, discussing the endo cannabinoid system and, and I think there’s a lot of pressure for them to open it up in the us but I, I think it really cripples, um, American physicians because they don’t have like the, the basic, um, intellectual mechanism to understand how cannabis works.
[00:18:52] I mean, it sounds ridiculous that with a fibromyalgia patient, you know, that’s a certain type of chronic pain syndrome that it could. [00:19:00] Numb your pain. It could help with your perception of the pain, so it’s less noxious to you. It can, um, help with your anxiety about the pain. It could help your sleep and it could help your quality of life.
[00:19:10] It could do like five different things. And it just sounds like magical thinking until you understand how central the endo cannabinoid system is, that it controls memory, learning, fear, extinction, temperature, reproduction, appetite, temperature. Um, and once you understand the endo cannabinoid system, what cannabis does, both in terms of benefits and harms and what it can’t do, make much more sense.
[00:19:32] So we urgently need to, to be teaching this in medical schools.
[00:19:36]Bryan Fields: How do we go from 13% to 90%? Is it federal legalization or, or something?
[00:19:42]Dr. Grinspoon: Well, federal legalization would really help. But I, I just think there has to be a lot of pressure on the medical schools, and I think there is, I think there’s a lot of public outcry.
[00:19:50] I mean, I think there’s a lot of pressure on doctors right now. You know, they used to get away with just, uh, repeating a couple sentences that they got. I don’t know, from the American Medical Association with the American [00:20:00] Psychiatrics Association, you know, cannabis is in a medicine, it’s dangerous. Don’t use it.
[00:20:04] I mean, now that Americans across the board have woken up to the fact that they’ve been sold a bill of goods about cannabis, and now that 94% of Americans support legal access to medical cannabis, they’re asking their doctors, and their doctors have to say something and they don’t know what to say. So it, it creates a lot of very awkward experiences, you know.
[00:20:24] Then of course, you know, studies have shown that like 60% of people want to get their information from their doctors, and like 2% actually do end up getting their information from doctors, cuz the doctors don’t know much about it. Then they end up getting their information from the bud tenders, which is equally inappropriate because bud tenders.
[00:20:40] Really nice people know a ton about cannabis, but they’re not medically trained. Of course, they shouldn’t be giving medical advice, but then the doctors criticize the fact that the bud tenders are giving them information, but the patients wanted to go to their doctors first and the doctors couldn’t help them.
[00:20:55] So it’s just a mess all around. If doctors and nurses and physician [00:21:00] assistants and all the healthcare providers aren’t up to date and educated on, on all about cannabis, the good and the bad. Do you think one
[00:21:07]Bryan Fields: of the challenges is the fact that modern medicine is used to working with a single compound and cannabis is a variety, and big pharma is unlikely to sponsor some of these trials in order to help some of that research come
[00:21:15]Dr. Grinspoon: forward.
[00:21:16] Absolutely. I mean, that’s a very complicated topic. Cannabis has about 500 different molecules in it. It’s a complicated plant, many of which are psychoactive, which is why different types of cannabis strains, or we call ’em QRSs, some make you like relaxed, uh, stuck to the sofa, listening to the Grateful Dead.
[00:21:33] Others make you wanna go out and, you know, interact and talk to people or clean your house or like whatever. In my case, write a book. Um, so it affects people differently. And, you know, I don’t even think the f d A has a. Pathway for approval of a botanical medicine. And even if they did one with 500 different compounds, we’re not talking about like ginsy, which is one compound.
[00:21:55] And then who’s gonna pay for it? It’s very expensive to get, uh, a drug through the, [00:22:00] through the, um, approval process like millions of dollars and people can just grow their own. So there, there isn’t much financial incentive. And then we’re still fighting a lot of stigma and a lot of like institutional momentum against cannabis.
[00:22:13] It’s still schedule one in the Controlled Substance Act. The dea e a has been a disaster in cannabis since before birth. So as the National Institute of Drug Abuse n Ida. So we’ve got a lot of work to do. I mean, again, the patients have got it, but the physicians are getting there and the sort of infrastructure is fall as, as usual is sort of, uh, falling behind.
[00:22:34] Do you think
[00:22:34]Bryan Fields: some
[00:22:34]Kellan Finney: of these private companies could potentially start to spearhead some of this like fundamental research that’s needed to help educate the masses?
[00:22:43]Dr. Grinspoon: Well, absolutely. I mean, that’s always a little bit of a loaded question because Right search, but there’s bias, right? Well, the tobacco industry did a lot of research and then, you know, they’re like, Hey, there’s a lot of trust.
[00:22:56] And then, you know, that raised another interesting issue with like, you know, which I know [00:23:00] we discussed a little bit before the show, like what is the heart and soul of the cannabis industry? To a certain extent it’s all these spectacular, wonderful, pro-social people that have been fighting, risking everything for legalization, um, which was the right thing to do.
[00:23:15] And to a certain extent, it’s being colonized by people from tobacco, alcohol, and pharma who have resisted legalization cause they’ve viewed this competition. And now that they’re losing the legalization battle, they’re having a, well, if we can’t beat ’em, let’s join them attitude. And they’re, they’re sort of joining a lot of these companies and sort of kicking over, which is.
[00:23:32] You know, the prohibitionist are like big marijuana, this, big marijuana that, but the cannabis industry is actually a very complicated mixture of like, sort of really lame people from the tobacco, um, alcohol industries, people from the pharma industry, some of which are like great people and others just wanna make a buck like everybody else.
[00:23:50] And these really great people from the cannabis industry. So it’s a really heterogeneous group and it’s very difficult to, um, to, to kind of generalize about like the [00:24:00] cannabis industry or big marijuana or whatever they call it. But I just don’t think there’s a lot of trust from any industry. I mean, look what alcohol did.
[00:24:07] They managed to get people to think that drinking red wine was good for you. And now we know that up to three drinks a week can cause cancer. I mean, they snowed everybody. So I think they could, but there, there’s a big trust barrier that I would be very difficult to overcome. Uh, w with good reason, uh, historically.
[00:24:23]Bryan Fields: My mom loves that red wine fact.
[00:24:27]Dr. Grinspoon: I’m trying to get alcoholic patients to stop drinking. Uh, and they’ve said, I am worried about my good cholesterol. It’s like, you lost your dog, you lost your wife, you lost your car. You have blackouts, you know, three times a week your liver’s dying and you’re worried about your good cholesterol.
[00:24:43] I mean, it really amazing how much they, they snowed people on that.
[00:24:46]Bryan Fields: Yeah, for sure. I dunno, one of the things I think is most important is the public’s perception of cannabis. And I think with influential people like Interhuman coming on and speaking about cannabis more so on the harms, I think that’s, that’s challenging for a lot.
[00:24:58] So I’d love to get your perspective on what [00:25:00] he said on the psychosis and high th h c and some of the potential harmful side effects of it.
[00:25:05]Dr. Grinspoon: Right. Well, first of all, I thought he made a good faith effort to be two-sided on this podcast. And he really did make disclaimers like I’m, I’m not trying to, uh, demonize anybody or demonize this.
[00:25:17] And he, he did talk about his concerns with, uh, psychosis and, and the teen brand and so forth and high doses. I thought there were a lot of inaccuracies in this podcast, but you know, I think any specialist in any field that listens to a generalist, uh, do a podcast probably is afflicted by the same thing.
[00:25:33] You know, he is a podcast on bipolar, which sounds interesting. I’m interested in bipolar and I’m gonna listen to it one day. I’m a little bit skeptical because I know that some of the cannabis stuff wasn’t true. So I’m feeling like, how do I know what’s true in the bipolar podcast or not? But I’m sure if I were a bipolar specialist and I listened to the bipolar podcast, I’d be like, oh my God, this isn’t all true.
[00:25:52] So I think it’s very difficult to take that broad a topic. I thought the, the most true thing he said, um, in the entire [00:26:00] podcast was, I am not a cannabis user. Because if he had had some lived experience with cannabis, he certainly, uh, would’ve understood some of these things better. But, um, he says that it increases schizophrenia.
[00:26:10] It. Increase rates of schizophrenia. That’s like, glad out. Not true. The rates of schizophrenia have been stable across the world at about 1% of the population straight from the mid 1950s. When about, you know, maybe a hundred thousand people worldwide were using cannabis. To this date where 400 million people are using cannabis, it is absolutely impossible that the rate of schizophrenia would not go up if you go from a hundred thousand U users to 400 million users.
[00:26:37] Um, it’s simply not true. However, cannabis can trigger schizophrenia earlier in people that are genetically susceptible to it, which is a big deal. If you get schizophrenia at age 21 instead of 25, that’s four years where you’re not learning adult skills, not learning how to take care of yourself to work, to live in an apartment.
[00:26:56] So in that sense, it can precipitate, it can be one of many factors. [00:27:00] Alcohol, tobacco, amphetamine, steroids, many factors, uh, can trigger. Schizophrenia earlier, so it’s not, cannabis is not blame free in the psychosis area. Cannabis can also, um, trigger a substance induced psychosis. A very small percentage of people can become psychotic using cannabis or using psychedelics or amphetamines or steroids.
[00:27:22] I mean, there are psychosis related side effects. And then further, if someone. Psychosis such as bipolar or schizophrenia could, cannabis could be really destabilizing to them and it’s really recommended that they stay away from it. I mean, everybody’s different. Some people find a way to to, to incorporate it into their care, but in general, I recommend against it.
[00:27:42] So cannabis is not blameless, um, with psychosis, but it certainly doesn’t cause schizophrenia. So this is a perfect example of how the discussion is actually quite nuanced. And if you don’t have the background, you’ll just, you’re sort of susceptible to whatever, uh, whatever specialist you talk to. So if you talk to a [00:28:00] specialist, like an old school psychiatrist that’s still fighting the drug war, they’ll say, yeah, cannabis causes schizophrenia.
[00:28:06] And if you don’t have a very robust background and haven’t heard all the different theories, does the same gene cause cannabis and schizophrenia? Does sort of, uh, the people who are prone to schizophrenia have a attraction to cannabis because they’re self-treating their symptoms? Or does the cannabis.
[00:28:23] Triggered the schizophrenia. There are all these different theories. It’s a very, again, a nuanced discussion. And it’s very hard for someone to take like 50 years of like thousands of researchers and sort of summarize it in a way that’s gonna be a 100 accurate. Do you have
[00:28:37]Bryan Fields: any concerns with high THC products?
[00:28:40]Dr. Grinspoon: Well, there was one study that came out that tried to link the rates of psychosis to the levels of T H C in different European countries. And I just savaged the study. It was the most ridiculous study I’ve ever seen. I, I I 10 different points against it. Um, you know, for example, they say 50% of the cases of [00:29:00] psychosis in London and Amsterdam would be avoided if people didn’t use high.
[00:29:05] Um, THC cannabis, which they described as greater than 10%, that the police confiscated high T HC 10% is like, if you could find th HC this’s 10% in this country, you wouldn’t consider that high. You’d be like, why is there only 10% t h c? So it was a ridiculous study. I don’t think that you’re more likely to become psychotic with high t h c unless you want make the argument that smoking, you know, one joint of 5% th h c would make you psychotic more than smoking half a joint of 10% th h c because you get it more quickly.
[00:29:36] But no one seems to be making that argument. It’s sort of like saying that port wine is twice as dangerous as regular wine cuz it’s twice as strong. Sure, you might get drunk a little faster, but it doesn’t trigger alcoholism any, any more robustly. Um, the one harm. The main harm, uh, two main harms of very high T HC are one, it is very easy to over consume.
[00:29:57] I’m the one at the parties who people [00:30:00] say, is there a doctor in the house? The people who took the same three bong hits they did in college when it was 4% t h c, now take three bong hits cuz they wanna try it again cuz it’s legal and end up like on the floor with their head spinning like, oh, I’m gonna throw up.
[00:30:14] Like, it definitely is a miserable, um, experience. So I think people can accidentally over consume. Nobody dies. But it’s an awful experience for, you know, many of us have been there, done that. You know, people go to Amsterdam and take space cakes and like hide in their closet for two days. Like, it’s really not fun if you take too much cannabis.
[00:30:32] And, um, that’s the main thing. I I, I do have some concerns. I mean, people argue the, the prohibitionist argue that the concentrates are dangerous cuz they’re so potent. Um, you know, the cannabis advocates argue, well, we’ve always had hashish for hundreds or thousands of years. And that’s the concentrate.
[00:30:49] But you know, you think of these teens and like, you know, when I was a teenager, I mean, I, I did start smoking at age 13. I don’t recommend that for teenagers. We didn’t know as much about that. Back then, and of course at age 13 I didn’t [00:31:00] care, but you know, we’d smoke a puff or two of like 4% t h c. Now these teens have access to these easily concealable vape pens with like 80% t h c, and, and you do sort of worry that they’re like blasting their brains out.
[00:31:13] So I do have some reservations. I’m not arguing to make them illegal, cuz all that does is put it on the illicit market and then the teens end up with the same vape except who knows what the heck is in it is like gonna cause eval lung syndrome. So, um, I’m not a big believer in criminalizing these things.
[00:31:29] I think we need to educate and regulate, but I am a little bit worried about sort of the like teens blasting their brains out with like super high T H C. So I’m not, I have, it’s not that I have no reservations about the high, uh, T h C concentrates, but I just don’t think they necessarily contribute to psychosis.
[00:31:44] The the last point is that as my dad always used to point out, as I mentioned, he was a cannabis specialist. And as any cannabis user on Earth knows and as cannabis. People that don’t use cannabis don’t know. And that’s why, as I mentioned very early, I think lived experience is a very important [00:32:00] part of understanding the cannabis experience.
[00:32:02] People titrate to their own level of comfort. So nobody wants to take more because they get anxious and uncomfortable. So if you get some and it’s too strong, the next time you just take one puff. So I really think that, that that fear is a little bit overblown, particularly cuz people tend to titrate to their own level of comfort and enjoy.
[00:32:22]Kellan Finney: So the, the dose is in the poison or the poison is in the dose. Right. And so do you think for all drugs? For all drugs, for sure. And so do you think that like, so with alcohol, right, you can’t go buy a hundred percent ethanol as a, a consumer, right? Like you can get moonshine, which is close, but it doesn’t really sell that well.
[00:32:40] Clear to make
[00:32:40]Dr. Grinspoon: attention ever clear. Yeah. But only drink it. It’s disgusting. And like, why would you drink Everclear as opposed to drinking twice as much vodka.
[00:32:48]Kellan Finney: So do you think that, uh, like a, a cap on T HC products for recreational purposes is like a potential approach to regulating the exposure that people are gonna [00:33:00] have to high t
[00:33:01]Dr. Grinspoon: HC products?
[00:33:02] I think we need much better education and much better labeling. Um, I remember speaking to a bunch of addiction psychiatrists at a dispensary. It was a really fun event. And they had a candy bar which had 1100 milligrams. Each piece had 110 milligrams. Like if I take 10 milligrams, I’m good. If I took 110 milligrams, one square of chocolate, I’d be like, yeah, have a horrible experience.
[00:33:24] And if I ate the whole chocolate bar, I might even end up in the hospital. And the thc, you needed like an electron microscope to see infused with. Th h c was written really small. And you hear all these stories if someone eats part of a chocolate bar and puts it in the fridge cause they don’t wanna waste it, and then someone else doesn’t see the wrapping or there isn’t any wrapping and they eat it and they have the same awful experience and they could drive and they could crash into people.
[00:33:45] So I really think that the labeling is critical, but I don’t think cap, t h c caps work at all because again, people titrate to their own level of comfort. If you. Criminalize certain levels of heat. C they’re just gonna end up [00:34:00] more dangerous on the illicit market. And then finally, if a medical patient, many of my medical patients, they’re elderly or they’re veterans or they’re just impoverished patients, I work as a primary care doctor in a inner city clinic, it just makes it twice as expensive.
[00:34:13] You have to buy twice as much of the 10% cannabis as you would the 20% cannabis. Maybe it would cost a little less, but generally it makes it more expensive for people. And then that will drive them to the illicit market. So I don’t think the THC caps work at all. Maybe, maybe some attention could be given to the, to the very high end of the concentrates just to reign them in within reason, not enough so that it goes immediately to the illicit market.
[00:34:37] But, but beyond that, I’m not a, not a believer in, in TC caps for the reasons I just described. If someone does have
[00:34:43]Bryan Fields: over consumption, is there certain things that they can do in order to help regulate their body? Or is it just kind of like wait it out and uh, hope for the best?
[00:34:50]Dr. Grinspoon: Well certainly wait it out and hope for the best.
[00:34:52] Um, sitting in a quiet place, talking to friends,
[00:34:56]Bryan Fields: any food or, or things you can consume and helper to help [00:35:00] kind of lower that feeling.
[00:35:01]Dr. Grinspoon: Well, people say that consuming c b D, you know, changes, um, the. The shape of the cannabis receptor and that that could make it bind less tightly and that C B D, um, can mitigate some of the effects of T hc.
[00:35:13] I don’t think that’s been well proven. Um, I, I think it’s worth trying. Other studies have shown that T H C can increase the serum levels of the THC because they compete for liver enzymes in exactly the same way that grape use does. It just uses up the liver enzymes. But I think some people believe in using C B D, um, but, uh, I don’t really think there’s a good antidote just yet.
[00:35:33] Um, now I do wanna say that if like your heartbeat’s going at a 200 beats per minute, or if you’re having a full-blown anxiety panic attack, like if you ate that 1100 milligram candy bar, or if you’re having chest pain, then you, you should call 9 1 1. I think most of these, uh, episodes can just. Um, addressed with like calm reassurance and waiting it out.
[00:35:54] But if you, for example, happen to have taken an accidental overdose with a really strong [00:36:00] edible that could actually be in a medical emergency and you know, better safe than sorry, get some again, nobody’s died. But cannabis can trigger arrhythmias, especially if you take too high a dose and you know, there’s some concern that it could trigger if you have an unstable cardiac condition, that it could trigger a heart attack and.
[00:36:17] Most people know if they have coronary disease. And then you could educate them, either don’t use cannabis or use it very gently, use very low doses. Don’t take an edible that’s unlabeled, et cetera, et cetera, et cetera. But a lot of times you could have heart disease and not know that you have heart disease because you’ve never had a heart attack before any symptoms.
[00:36:33] So you just wanna be careful of the dosing. And finally, in my experience, the main I I, I told that sort of story of like the boomer who took the same thong hits, but I think usually the culprit is the edibles. People take edibles that are unmarked or they don’t understand the difference between five or 20 milligrams.
[00:36:50] And you know, Went to dispensary in Maine just to visit, and they had these sodas with a hundred milligrams, like nobody drinks half a soda. And if like someone who doesn’t have a tolerance drinks a [00:37:00] hundred milligrams of cannabis, they’re gonna be in trouble. So I think a lot of it could be avoided by common sense.
[00:37:05] And then I already said finally, but really finally, I think a lot of this is a self-inflicted industry, uh, injury by the cannabis industry. Uh, you know, they’re getting all this bad press press about pediatric overdoses. And if you just have a bag of gummies that looks to a four-year old, like a yummy bag of gummies, like the job of the four-year old is to eat all the gummies.
[00:37:24] And like the four olds not gonna read or understand the th h c warning to the extent there even is a good t h C warning. So I think we’re playing by fire, just making it into chocolates. Into gummies in the first place. What about
[00:37:36]Bryan Fields: driving? Well high, obviously your book kind of expands on that, but I’d like to get your perspective on a, how do we regulate that with everyone having different tolerances, and B, do you see that being a current issue?
[00:37:45] And if not, will that be one in the future?
[00:37:48]Dr. Grinspoon: I don’t think it’s safe or ethical to drive one high, particularly cuz you could crash into some innocent person and like kill their whole family. It is more dangerous to drive when you’re high than when you’re not high. The studies have shown that like people [00:38:00] feel like after a couple hours of smoking they could drive, but that the, the deficits in the driving lab can last like three to four hours, not just one to two hours.
[00:38:07] So you actually feel like you could drive before you actually can drive. And the things that get worse, you know, the joke is that people who are drunk speed through the red light and people who are high, like stop gently at the green light. You don’t really want to do either. But what they find in driving labs is that people don’t respond to signals as quickly.
[00:38:24] Like they’re spacing out listening to the dead on the green light or, and there’s more lame deviation. But that said, on average, if you look at all the studies driving at, you know, just above the legal limit of like, Like a hundred alcohol. The legal limits like 80, your increase of crash risk is like 14 times and driving high, all things considered is about one to two times more dangerous, uh, than driving, uh, non stone, which is about exactly as much as Benadryl or the opiates we were all allowed to take.
[00:38:54] Or the gabapentinoids for pain or the antihistamine. I mentioned Benadryl or the [00:39:00] benzodiazepines, the Valium, the Klonopin prescription medications impair you in the same way as cannabis does. So the question is why are we having such a strict double standard against cannabis? Uh, if people really wanna stop, uh, driving deaths, uh, they need to focus on alcohol and educate people about all the prescription drugs, not just medical cannabis.
[00:39:19] And then the final thing I’ll say is that it it, it also depends on the dose, but also on how you use it. Um, the college kid who uses takes five bong hits once a month is gonna be like completely impaired and an utter menace on the road. The. Medical cannabis patient that takes a small puff twice a day for five years is probably not gonna be very impaired, probably on the lower end of the Benadryl, Valium, opiates, gabapentin, um, antidepressant scale of things.
[00:39:47] So it sort of depends on the dose and the context. So cannabis is dangerous to drive on. It’s not at all recommended yet. As with everything else cannabis related, there’s a huge double standard and sort of a moral panic that’s [00:40:00] been sort of fluffed up with, again, I don’t think it’s safe or ethical to drive when you’re high, but I do think that to a certain extent this has been a moral panic that’s been fluffed up, um, as an argument, um, against, uh, legalization.
[00:40:11] And if I could just say one more thing, they check blood levels, they check survival levels. None of this stuff works at all. It literally doesn’t work because a medical patient who uses it every day could have very high levels and not be impaired at all. And someone who. Hasn’t used it in six months, who took an edible four hours ago, could be completely zonked out, utterly unsafe to drive and not have high levels.
[00:40:33] Um, the drug recognition experts don’t work at all. If you’re black or Hispanic, you’re impaired. I mean, it’s a disaster. So I just don’t think that we can police it now. I think it would be great if we came up with something to police it. But again, a lot of it comes to common sense and education. And of course you police the person who’s like weaving down the road, but you have to ask yourself, you really want to arrest the modest medical cannabis user who’s not impaired at all.
[00:40:59][00:41:00] And you know, similar to your person who took an opiate the night before for their back pain. Yeah,
[00:41:05]Bryan Fields: that’s,
[00:41:06]Kellan Finney: that was just gonna make that point is that, uh, medical patients tend to have like a higher baseline level of THC in their blood. So right now, I know, I don’t know what the exact measurement is, but you can get a D U I for.
[00:41:20] Being hot, driving high and it’s tied to
[00:41:23]Dr. Grinspoon: blood levels. Correct. Is that five nanograms per milliliter or something
[00:41:26]Kellan Finney: Per deciliter, right? Yeah. Yeah. Um, totally. So I mean, is there, in your mind, is there a way that we are gonna be able to police this at all with like a standard like measurement device as B a C or something like that?
[00:41:39] Do you think that that’s the way that it’s gonna be policed? Because like if they’re, if an officer is making a judgment call, if someone is impaired or not, they’re gonna need some sort of of number to tie that to
[00:41:50]Dr. Grinspoon: numerically, right? I, I absolutely agree. I mean, if you have a certain level, that means you’ve used cannabis within the last three weeks.
[00:41:58] It doesn’t mean that you’re impaired. So they can’t [00:42:00] respect, but everybody’s looking for this, this is like the holy grill because it’s gonna be a huge industry. Certainly if a police officer pulls over someone who’s like blatantly impaired, you wanna figure out what they’re impaired on and how impaired and, um, They’re looking at saliva tests, at drug tests, at like sweat tests, at, um, urine tests, and they just haven’t got there yet either with the biological testing or with the drug recognition experts.
[00:42:27] I mean, I, you know, I sort of, half jokingly, my book suggests they should just get some cannabis users to, you know, um, help with the drug recognition. I mean, the police officers don’t know anything about cannabis. How would they have any idea if you’re stoned or not? And it’s sort of a coin toss. They, they’re wrong about a third of the time.
[00:42:44] And, um, you know, they have false positives at least 10% of the time, which means an innocent person is going to prison and they have false negatives, like they miss it like 33% of the time. And it begs a question that if like a third of the time a police officer [00:43:00] is evaluating you, you’re high, you’re nervous.
[00:43:04] And they miss it. How impaired could you possibly be? So I, I just don’t think we’re anywhere near, uh, solving this one. And, and you just have to read the newspaper headlines really skeptically because people puff up their discoveries and then you read in the limitation section of the studies, well, we actually missed 99.9% of the cases.
[00:43:22] But, you know, the headline, uh, always makes it sound better than it is. You have to read the studies for yourself. Yeah, I don’t know how many
[00:43:28]Bryan Fields: people do that. I think the headline is really what people like to take away, especially in today’s day and age. So let’s slightly switch gears. Cannabis for pregnant women.
[00:43:36] In your experience or in some of your research, have you find it to be safe or something that people should stay away from?
[00:43:41]Dr. Grinspoon: Well, keep in mind that my other hat is a primary care doctor. And as involved in the cannabis legalization movement as I’ve been my entire life, I’m still like so cautious about giving anything that could be, be potentially harmful to a pregnant woman.
[00:43:55] And we don’t know the cannabis is safe. We very hard to prove you can’t [00:44:00] study it on pregnant women. A lot of the. Harm data has been hyped up. We don’t know how dangerous it is because it’s been very exaggerated. But I think anything during pregnancy is guilty until proven innocent. So, you know, there are exceptions if a woman’s having very severe nausea, vomiting, that they require being in the hospital and they’re being given these, again, despite the autistic kids, these heavy duty neuroleptic medications that are very bad for the fetus is hard to argue.
[00:44:26] The TC is worse than that. So I think there’s certainly exceptions and it certainly does help women with morning sickness, but I tend to ask people to avoid it because we don’t know that it’s safe. Now that said, as my wife pointed out when I was writing the book, you can’t just tell pregnant women not to take anything if they have a blistering migraine.
[00:44:42] Tylenol’s not safe. Ibuprofen’s not safe. You know, opiates aren’t particularly safe like they have to take something. So, and what I do every moment as a primary care doctor is say, is this whatever I’m using cannabis or any other drug, less harmful or toxic than whatever else I would be using. And we just need to have [00:45:00] more neutral.
[00:45:01] Unbiased studies about cannabis to try to get a gauge of how harmful or, or blameless it is. So we know whether it should be a tool with pregnant women, but at this point we don’t know enough to recommend it. Do
[00:45:13]Kellan Finney: you think that the form factor will significantly affect how safe cannabis really is? I’m sorry, the form factor?
[00:45:20] So if you’re smoking it versus eating it, right?
[00:45:23]Dr. Grinspoon: Oh, or not, it’s probably just about the thc. I mean, you know, can it affect the placenta? Can it enter the placenta more quickly? Can enter the breast milk more quickly as the serum levels rise more quickly. Certainly. But I think it’s all gonna come down to, you know, with the fetus and then with the newborn, the endocannabinoid system is like critical to any everyth.
[00:45:44] Every process and you have this newly forming, very vulnerable endocannabinoid system. And the question is, these extra doses that we use when we smoke or take an edible, these super physiological doses, they’re like huge doses. Mm-hmm. They sort of take over the endocannabinoid system and we just don’t know.[00:46:00]
[00:46:00] But using these huge doses of cannabinoids due to the developing endocannabinoid system, it might not do anything harmful or it could be really, really bad. We don’t know yet. And again, from the perspective of a primary care doctor, sort of anything is guilty until proven innocent with the understanding that if someone’s suffering, they need to take something.
[00:46:20]Kellan Finney: so I have a question. When you, when you smoke cannabis, you’re in the molecule, THC is going into your blood. When you eat cannabis, it’s processed by your liver in the 11 hydroxy. Right? So is there different pharmacokinetics associated with those different a, those different APIs or those different molecules in the blood?
[00:46:38]Dr. Grinspoon: That, that’s part of why it lasts longer. When you take an edible, you know, you smoke, it lasts a couple hours, you know you shouldn’t drive for four hours, but you know, you go on with your day, you take an edible, it can last for like 6, 8, 12 hours and it also, it takes longer to kick in. So it’s definitely metabolized very differently.
[00:46:56] And also the quality of the high and ultimately the quality of [00:47:00] some of the medicinal effects is we’re gonna, once we start actually studying benefits and not just harms, might be very different. People describe the edible version of getting high as more like psychedelic and spacey, and it can be more stressful.
[00:47:12] Um, for some people it might be dose related. Um, so it, it affects the quality of the high, the quality of the experience, the metabolism, the timing of onset and offset. And I think it very well in the future we might discover it to have, um, different medical uses.
[00:47:28]Bryan Fields: I wanna read a quote from your book and then get your opinion.
[00:47:30] Cannabis was widely embraced by medical institutions between 1840 and 1900 as more than 100 papers were published in the Western Medical Literation recommending its clinical use for various ailments. How many average people do you
[00:47:43]Dr. Grinspoon: think would know that? Um, I would say, if I’m just gonna guess pull something outta my rear end, I would guess a fifth.
[00:47:51] Uh, cuz there a fifth of Americans seem to be like very diehard cannabis enthusiasts. And, and they would know a lot about the history. I mean, anybody who read my [00:48:00] dad’s book, marijuana Reconsidered in 1971, which I mentioned at the very beginning, uh, which was, uh, in reviewed in the front page of the New York Times book review and was a bestseller like Would, would know that.
[00:48:09] And I think it’s a very common, uh, part of like cannabis lore. I think your average American that’s just grown up under like the last 50 years of drug war nonsense would’ve no idea that we’re not actually legalizing cannabis. We’re re-legalizing it and it went really well. And you know, it’s really interesting.
[00:48:26] We re-legalized alcohol after 11 years. There was still the infrastructure, there were still people remembered the same generation, remembered going to the package store and buying some beer, where now it’s like several generations later. And a lot of institutional knowledge, a lot of the knowledge that physicians used to have has been lost about cannabis.
[00:48:44] So, uh, they’re just a lot of things that people are rediscovering and they’re like, wow, I didn’t know it was legal in the us. Um, I mean, it’s really kind of fun to watch people relearn this stuff.
[00:48:54]Bryan Fields: Yeah, it was really powerful. When I saw that. I was shocked to see like, how many people probably would believe that.
[00:48:59] Let’s do a quick [00:49:00] rapid fire. True or false? Cannabis stunts,
[00:49:03]Dr. Grinspoon: brain growth. False, unless potentially you’re a teenager with heavy use before the age of 18, it could potentially have a negative effect on the brain. Though honestly, stunts brain growth is a little bit too general. It the very specific things that they’re worried about, about, um, impulsivity and a certain part of the brain called the prefrontal cortex.
[00:49:26] Um, so I would say no, but so
[00:49:30]Bryan Fields: true or false, today’s marijuana is not just a plant. It’s genetically modified, potent, and contains toxins.
[00:49:36]Dr. Grinspoon: Every crop that we have is, uh, genetically modified. We’ve been breeding them for thousands of years. So like that’s a strawman argument. You, you couldn’t possibly find a plant anywhere that we eat that hasn’t been genetically modified.
[00:49:51] And um, honestly, if you buy it legally, the pesticides are tested for. The fertilizers, they, they only use fertilizers that are allowed. There [00:50:00] are no heavy metals. Uh, there’s no fungus. So ironically, if you’re concerned about that, uh, legalization is like by far the safest way to go so that the cannabis people using is safe, monitored, and, and regulated
[00:50:12]Bryan Fields: through false, genetically engineered marijuana may cause mass
[00:50:15]Dr. Grinspoon: shootings.
[00:50:17] Well, the word may as a philosophy major, like I guess may, if you get stoned, burn your finger, drop the gun, it goes off accidentally and kills eight people. Sure. But generally speaking, cannabis has not been associated with violence. That was the whole Alex Barron thing. I debated him at Yale Law School.
[00:50:33] It was a bloodbath, and believe me, I wasn’t the one covered with blood. He was trying to argue that cannabis causes psychosis, which causes people to be violent. Now he’s just exploiting stereotypes against the mentally ill. People who suffer from psychosis are far more often to be victims of violence that are really persecuted and need empathy and compassion not to be targeted.
[00:50:57] Um, I think that the, there’s been no consistent link [00:51:00] whatsoever, uh, to cannabis and violence. So I would, I would, I couldn’t possibly str push back against that claim more strongly.
[00:51:06]Bryan Fields: or false.
[00:51:06]Dr. Grinspoon: Cannabis is, Cannabis can be addictive. Um, I think it’s particularly addictive to teens who learn to treat their boredom, anxiety, anger, loneliness, um, with a drug that makes you feel better than to self-soothe.
[00:51:21] They don’t learn like normal coping skills, that they use too much cannabis. So I think it can be addictive. It’s also reinforcing, it makes people feel good. Anything that’s reinforcing could be addictive. However, the rates of addictive addiction have been greatly exaggerated because the ways in which we describe it, the psychiatrist, for some reason have been in control of this, I guess.
[00:51:40] Have been dealing with a lot of the cannabis addiction. Um, they include tolerance and withdrawal. Now, we don’t include tolerance and withdrawal when we prescribe opiates, when we try to determine if someone’s addicted, because everybody who’s on medicinal opiates has tolerance and withdrawal. They’d all be addicted.
[00:51:55] So I think the way we, uh, define addiction ropes in [00:52:00] unnecessarily, in pathologizes, many of the medical cannabis users, which is doing them a great harm. So I think cannabis can be addicted for addictive for teens and for adults, but it’s not nearly as addictive as it’s been claimed to be. So it’s sort of like true, but very exaggerated.
[00:52:17] True or
[00:52:17]Bryan Fields: false. Marijuana more than doubles the risk of developing opioid use disorder or initiating non-medical prescription
[00:52:23]Dr. Grinspoon: opioid. False. The gateway theory of drug use was, um, a complete fever dream of the war on drugs. Unfortunately, a lot of doctors and psychiatrists still cite this, uh, much more com.
[00:52:35] I mean, you know, everybody who develops opiate addiction drank milk as a child, but the milk didn’t cause the opiate addiction. There’s just an association. Um, you know, cannabis is thought much more these days to be a gateway off of addiction, off of opioid addiction, off of alcohol addiction as opposed to a gateway onto addiction.
[00:52:53] So I like a hundred percent flat out disagree with that statement. True or
[00:52:57]Bryan Fields: false, cannabis can help cure
[00:52:58]Dr. Grinspoon: cancer. [00:53:00] That’s complicated. Um, cannabis has not been shown to help cure or treat cancer in humans. There’s very intriguing laboratory cell and animal data, so I wouldn’t be surprised if in 10 years we use it as an adjunct, uh, to chemotherapy.
[00:53:16] But right now it has no role whatsoever in treating the cancer. Cannabis is incredibly helpful in treating the symptoms of cancer, the anxiety, the pain, the insomnia, the lack of appetite, uh, the nausea. So cannabis is critical in cancer care. It’s hard to find an oncologist that is in a supporter of medical cannabis, but at the same time, the cannabis does not treat the cancer.
[00:53:38] And I sort of strongly disagree with these. Rick Simpson oil advocates. I mean, they’re harming people to the extent that people will use that instead of going to an oncologist. We’re much better at treating cancer than we used to be even 25 years ago when I was in medical school. I have patients that have had lung cancer that are alive.
[00:53:54] 20 years later, he used to be dead in a year or two. Uh, we’re, we’re getting really good at [00:54:00] treating many types of cancer and it just breaks my heart when people are like, oh, I’m just gonna use Rick Simpson Oil. I haven’t even met with an oncologist. I think that’s very dangerous. What is one
[00:54:09]Bryan Fields: factor statistic about cannabis that would surprise
[00:54:11]Dr. Grinspoon: others to learn?
[00:54:14] There’s so many. Um, well I think it’s interesting that the first time people use it, a lot of times they don’t get high and people don’t really understand why that’s the case. My dad had a theory that sort of, the brain receptors had to be kindled, but I remember as a teenager we smoke and smoke and smoke and be like, are we high yet?
[00:54:32] Am I high? And a lot of people experienced that the first time that they used cannabis. And believe me, if you’re high, you know it, especially the first time cause you’re not used to it. But, so I think it’s a really interesting fact that the first time you use it, a lot of times nothing happens. When you got started
[00:54:45]Bryan Fields: in the cannabis industry, what did you get?
[00:54:47] Right? And most importantly, what did you get
[00:54:49]Dr. Grinspoon: wrong? Well, I was lucky to get a lot of things right because I learned from the best I learned from my dad. He was my mentor for my entire life. And he’d been, he was like the world [00:55:00] leading expert on it. Like since 1971. I was born in 1966. So for my entire adult in childhood of life, I’ve had like the world’s best mentor.
[00:55:09] Uh, you know, the things I got wrong about it. Um, you know, for a while I was thinking it, it isn’t addictive. And I mean, you know, and then as I treat patients and learn more about it, I mentioned the rates of addiction are exaggerated, but definitely can be addictive. I mean, a lot of what I got wrong about it is because the US government lied about the harms so much for so long that today many cannabis advocates.
[00:55:35] Reflectively reject any study that shows any purported harm. And I think that’s a very dangerous state of events, which is why in my book I tried to focus as much on what are the harms as, what are the benefits? Um, and I think I fell into that for a while before, particularly before I went into medical school because, you know, I even had people say, why would I have, uh, why would I get a Covid vaccine?
[00:55:56] The government lied about cannabis, they’re lying about covid. And that’s a really, [00:56:00] nothing scares you more as a doctor than to hear that kind of thinking. Um, so I think just because not only did the government lie about cannabis for the last 50 years, like flat out lie and only support research into the harms, there wasn’t a very fine line between what the government was saying.
[00:56:17] About cannabis and what the medical community was saying. There was very little, uh, thinking for yourselves on the issue. My dad was able to do it. Dr. Andy Weyle was, um, Norman Zi. A lot of doctors were able to, but, but many doctors didn’t. They just bought the party line. So I think that there’s a real credibility gap and that affected a lot of, um, cannabis users, myself included, until I was forced by a, my interest in the issue, and b, by my medical training.
[00:56:41] To take a, a very deep look at the, at the literature,
[00:56:45]Bryan Fields: before we do predictions, we ask all of our guests, if you could sum up your experience in a main takeaway or lesson, learn to pass onto the next generation, what would it be?
[00:56:54]Dr. Grinspoon: Be humble and learn things with an open mind. Um, because a [00:57:00] lot of this stuff is more complicated than the little sound bites that we get.
[00:57:03] So I just say, Humility is an important part and to be open to the fact I might have been wrong about that, I wanna rethink that. Be willing to, to rethink things because you know, you could either, you know, get your backup against the wall and say, Nope, I’m sure of X. Or you could say, well, your whole life is X true, or is X not true?
[00:57:19] I don’t have a on cannabis. I say very early in the book, I don’t have a monopoly on the truth. And a lot of this stuff’s really complicated. So I think humility is like the most important factor.
[00:57:30]Bryan Fields: Alright, prediction time. Dr. Grinspoon, what specific topics in cannabis is no one talking about now that historians will study in the future?
[00:57:40]Dr. Grinspoon: The ways, just like psychedelics and cannabis is a psychedelic that cannabis can help with insight, motivation, understanding yourself, mindfulness, connecting with other people, and the vast potential cannabis has in therapy, in psychotherapy that we literally have just ignored because the psychiatrists have been programmed to be so [00:58:00] anti-cannabis.
[00:58:01] Well said, Kelly.
[00:58:04]Bryan Fields: I
[00:58:04]Kellan Finney: agree. I think that in a hundred years we’ll look back and realize how important plants have been to like human consciousness.
[00:58:13]Dr. Grinspoon: Amen to that.
[00:58:15]Kellan Finney: Right. Uh, what do you think, Brian?
[00:58:17]Bryan Fields: Uh, I don’t know. Uh, I thought about the, it’s my question, but, but, but
[00:58:23]Dr. Grinspoon: as I’m saying, I
[00:58:24]Bryan Fields: was allowed to see that, but, but as, as I’ve said before, I don’t think about an answer.
[00:58:27] Cause I don’t think that’s fair for the others. Um, I, I think the entourage effect, the endo cannabinoid system. I think there’s still so much to learn that it’s hard to imagine what historians will look back on and pinpoint specifically on, on how critical it was. Dr. Dr. Gson, you breaking down on the endo cannabinoid system and how critical it is for human beings.
[00:58:45] And the fact that it’s not studied in, in medical school continues to just alarm me at a very, a high rate. I mean, how can you make accurate recommendations when we’re not even sure how it works? I think we’ll unlock different areas and, and be surprised and shocked on what these findings done, which [00:59:00] hopefully can influence medicine in variety of different ways.
[00:59:02] Plant medicine being one at the core. Absolutely. So, so Dr. Gitman, for those who want to get in touch, they want to read the book, where can they find you?
[00:59:13]Dr. Grinspoon: Well, the book comes. On four 20 and it’s gonna be in all bookstores. You could find an Amazon or Barnes and Noble or book seller. And, um, the easiest way to get in contact with me or to find the book or all these great events, uh, like dozens of great events, is to check out my website, which is just www.petergrinspoon.com and grinspoon spelled written like smile spoon, like fork.
[00:59:38] So it’s www.petergrinspoon.com and you can get the book, you can read about the book, you can see all the fun events, you can see a lot of media hits. Um, you know, it’s a fun website if someone really, uh, with an artistic sense who designs it. Yeah, it is
[00:59:52]Bryan Fields: great stuff. I really appreciate the conversation.
[00:59:54] We’ll link it up on the show on so that everyone can find it. Thanks
[00:59:56]Dr. Grinspoon: for taking the time. Thank you guys so much. I really enjoyed our [01:00:00] conversation.