Grinspoon, Lester

5 minutes with: Lester Grinspoon, the bush Doctor tell us all we need to know about cannabis; “Pot and The VALiens? What a combo!”


In the anti-smoking environment we live in, many people believe that smoking anything is detrimental to the pulmonary system. I, personally, believe that living in a polluted urban environment represents more of a pulmonary risk.  And those who are made uncomfortable by smoking can now use a vaporizer and get the same effects without smoke. There is no smoke. The cannabinoids volatilize off in a temperature window; and when you remove the spent material from the vaporizer you can see it hasn’t been turned into ashes because it hasn’t been ignited.
CH: So pulmonary delivery is still the method of choice?
LG: Smoking allows for a very fine tuning of the dose. One of the things that makes cannabis such an  impressive  medicine  is the fact that it can be taken through the lungs either directly or through a vaporizer, which gives a patient the capacity to titrate the dose quickly,  to get just the amount needed to get relief and no more. To me this is a great benefit, not just from the point of delivering a medicine at the right dose, but also because it gives the patient, the best judge of his needs, control.
CH: What is the combustion temperature of cannabis?
LG: The ignition point of cannabis is a little more than 4500F. Good vaporizers hold the temperature between about 2840F and below the ignition point. There are devices on the market which are called vaporizers but which do not hold the temperature steadily in that window.
CH: If vaporizers or just smoking work so well, why is GW Pharmaceuticals so negative about it?
LG: The GW people, in order to successfully sell their product, have to persuade people that there is a real danger to smoking marijuana. This plays into the hands of the prohibitionists. The argument goes: we are just getting on top of the tobacco problem, cigarette consumption has gone down. Clearly tobacco consumption is very dangerous, so why should we have another smokeable drug that will lead to the same kind of catastrophic health consequences. The problem with the argument is that there is very little empirical data to support equating the consequences of smoking marijuana to those of smoking tobacco.
CH: Can the patient receive the same medical benefits from cannabis use without having the feeling of being high?
LG: From my clinical experience, I am not  sure that in any of the many different ways in which cannabis is used as a medicine, that the therapeutic goal can  always be successfully achieved completely free of any psychoactive effect. I am also not certain that even if it were possible, that eliminating the psychoactive effects is a good idea. For example, people who suffer from multiple sclerosis who use marijuana primarily to get relief from pain and muscle spasms often say, “It makes me feel better.” There are two aspects to that; one is that they are getting symptom-relief and that makes them feel better. But clearly there is something beyond that and I believe it to be a function of the fact that they have some psychoactive, perhaps antidepressant effect.
It’s becoming increasingly important in medicine to recognize that people who feel better generally do better. Those who have a better attitude about their disease or disability tend to do better. Assuming there is some dosage difference between the point where cannabis can relieve the symptom and the point where there is some psychoactive effect, wouldn’t it better for those who want to avoid the psychoactive effect to be able to titrate it more finely than in the coarse way that Sativex is said to be titrated? You can’t really titrate in the usual sense of the word with an oral preparation of marijuana whether it be Marinol, Sativex or herbal marijuana brownies. If you suffer from chronic pain from some kind of serious arthritic condition, such as ankylosing spondylitis, you might want an oral preparation because its effects last longer.  But in those situations where you have severe nausea and vomiting, or the painful cramping of Crohn’s disease or some kind of neuropathic pain and you want immediate relief, the way to get it is by smoking. If you experience the prodrome of either a migraine attack or a convulsive episode, you may be able to nip it in the bud quickly by smoking.
CH: Should the patient be able to decide how much and what type of medicine works best?
LG:   In many situations patients are the best judges and certainly, once patients understand how to properly use cannabis, it’s both safe and clinically sound to let them make the judgment of how much to use. They might get a little uncomfortable if they are unused to or do not like the high, but they will learn and the next time they will be more careful. It will not do anything that is harmful or irreversible.
CH:  Is the “high” something to be concerned about?
LG: While the high may be uncomfortable for some people, it’s a very positive experience for others.  Once Sativex comes on the market some people who have never used marijuana will start using it and they will be introduced to the cannabinoids as therapeutic substances. Unless there is a lot of distance between the dose necessary for the treatment of their symptoms and the psychoactive dose, which for most symptoms I do not believe there is, many if not most patients will get some experience of the cannabis high. Then some may think, “Well, this must be the psychoactive effect, but it isn’t so bad; in fact, I have this slight consciousness altering effect and I find it interesting. I feel better, I have better appetite.” They may find these effects intriguing and be emboldened to try using herbal marijuana, even smoking it with or without a vaporizer.
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