Cannabis (seeing through the smoke): The New Science of Cannabis and Your Health

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Batista LA, Gobira PH, Viana TG, Aguiar DC, Moreira FA. Inhibition of endocannabinoid neuronal uptake and hydrolysis as strategies for developing anxiolytic drugs. Behav Pharmacol. 2014;25:425–433. At the same time, there are separate medical cannabis conferences, for cannabis supporters, that, to a certain extent, “preach to the converted,” because if you are there, you have an interest, belief in the benefits of, and probably some facility with medical cannabis. This subject needs to be taken seriously, by our entire profession, as seriously as patients take it, if doctors wish to be viewed as legitimate, trusted partners and reliable sources of information. Legalizing sensibly Know the relevant laws in your area, and don’t get tangled up with law enforcement. You can’t (yet) legally fly with cannabis. Other states where the legality is different might not accept your medical cannabis card and could even arrest you if they don’t (yet) have legal medical cannabis.

Now that cannabis is being relegalized after almost a century, and is increasingly being normalized, the Cannatopians need to let go of their anger and distrust of both the U.S. government and, at times, science in general. Yes, science was distorted by the Drug War. To date, the U.S. government—as a whole—has almost certainly told many more lies than truths about cannabis. However, times are changing, policies are lightening up, and, increasingly, better people are in charge. Cannatopians need to trust the scientific process and to look at each study on its own merits, no matter whether it claims harm or benefit. It is just as important for all of us to know about harms as it is to understand benefits so that cannabis can be used safely and effectively, and so that cannabis users can make a truly informed decision. Any cannabis user should want to know about harms as well as benefits, including the concerning environmental effects of cannabis production, with its massive usage of energy and water. Grinspoon’s Harvard Health articles have reached tens of millions of readers, have been widely referenced in the national media, and have been cited in congressional testimony. His writing has been published in The Nation, the Los Angeles Times and Narrative Inquiry in Bioethics. An unflinching and utterly personal journey through the often-confusing cannabis landscape. Readers will delight in the historical as well as the scientific focus brought to life by Grinspoon, whose roots and professional experience provide a unique and fascinating perspective. Seeing through the Smoke has something for everyone – from the novice to the expert and everyone in between with an interest in cannabis.”– Staci Gruber, MD , Director of Marijuana Investigations for Neuroscientific Discovery (MIND) and professor of psychiatry at Harvard Medical School Ideally, skeptics can work with true believers to advocate for safe practices, many of which most of us can agree upon, such as avoiding cannabis during pregnancy and breastfeeding (except under certain very narrow circumstances), before driving, and during adolescence. There are certainly benefits that we can all agree upon, such as using cannabis to treat chronic pain and insomnia. We do better when we work together.The Reefer Pessimists must forget, or at least contextualize, much of what they have learned because so much of this knowledge was manufactured with an agenda (if not flat-out fabricated) by the dictates of the War on Drugs. This led to unrealistically negative beliefs and a lot of unhelpful mythology (e.g., breasts, sperm, I.Q.). The cynicism regarding cannabis from the War on Drugs, along with vastly lopsided funding into purported harms (but not into potential benefits), created an echo chamber of presumed negativity and flat-out dismissiveness, which continues to artifactually distort and obscure continuing explorations into the true nature of cannabis.

S Miller et al., “Δ9-Tetrahydrocannabinol and Cannabidiol Differentially Regulate Intraocular Pressure,” Invest Ophthalmol Vis Sci, 59, 5904 (2018). PMID: 30550613. Don’t smoke! (Unless you are a very occasional user). There’s no reason to expose yourself to combustion products, such as tar, benzene, polycyclic aromatic hydrocarbons, etc. (Even though cannabis has never been shown to cause lung cancer or COPD, there’s no reason to inhale all of this crap.) If you prefer to use cannabis inhalationally, use a dry herb vapor- izer, which doesn’t combust the cannabis, but instead heats it to a lower temperature (which is enough to extract the cannabinoids) and which produces a less irritating vapor. Or explore edibles, tinctures, inhalers, oils, suppositories, patches, and lotions—there are lots of options these days. Are there any lessons from the cannabis story that might apply to the broader War on Drugs? If the illegality of cannabis was such a social and financial disaster for millions of people—with absolutely nothing of benefit to show for it—why prohibit the use of other drugs? Is the criminalization of meth, opioids, and cocaine any more sensible or productive than that of cannabis? Is prohibition really the best way to protect people from the harms of these drugs? Or is it time for this policy to be broadly reconsidered as well? On the one hand, cannabis is less dangerous, and less rewarding, than these other drugs, so it is easier to contemplate legalization. On the other hand, many of the dangers of criminalization— tainted supply, needless arrests for nonviolent crimes, wasted resources, racially biased arrests—apply just as much to these more dangerous drugs. The “tainted supply” problem, in particular, relates to opioids more than any other drug right now, with 108,000 overdose deaths in the last twelve months of this writing, mostly from fentanyl and other adulterants. The latest book from Professor David Nutt is a one-stop-shop for everything you could ever need to know about cannabis.Writing in a conversational and engaging style, Peter couples solid science with personal anecdotes, and tempers cold hard facts with his informed opinions. Bibliographic endnotes document the text, yet scholarly research rarely impedes the flow of the narrative. While credentialed as an MD, Grinspoon is no stuffy pedantic academic. As an undergrad lit major and grad student in philosophy, the medical doctor taps into his creative inner writer throughout the book. Dr. Grinspoon is a widely recognized expert on cannabis science and drug policy. He regularly appears as an expert on national television and radio programs, including NPR’s All Things Considered, NBC Nightly News, C-SPAN’s Washington Journal, Fox and Friends and Fox News. He is quoted frequently in the national media, in such venues as People, the New York Times, New York Magazine, the Washington Post, USA Today, the Wall Street Journal, the Chicago Tribune, and the Boston Globe. He is a TEDX speaker. Dr. Grinspoon is a widely recognized expert on cannabis science and drug policy. He regularly appears as an expert on national television and radio programs, including NPR’s All Things Considered , NBC Nightly News , C-SPAN’s Washington Journal , Fox and Friends and Fox News . He is quoted frequently in the national media, in such venues as People , the New York Times, New York Magazine , the Washington Post, USA Today, the Wall Street Journal, the Chicago Tribune, and the Boston Globe . He is a TEDX speaker. Figure out, once and for all, how to detect (if possible) and discourage stoned driving (without getting people who aren’t impaired in trouble). Peter Grinspoon, M.D . is a primary care physician and cannabis specialist at Massachusetts General Hospital and an Instructor in Medicine at Harvard Medical School. He is a certified Health and Wellness Coach as well as a board member of the advocacy group Doctors for Cannabis Regulation, and has been providing medical cannabis care for patients for two decades.