From RKSTROUP@aol.com Tue Sep 18 08:21:42 2001
Date: Tue, 18 Sep 2001 10:12:37 EDT
From: RKSTROUP@aol.com
To: NORML Affiliates <affiliates@mail.norml.org>
Subject: [affiliates] Lester Grinspoon - Part I

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Lester Grinspoon: defending medical marijuana
Free-thinking Harvard doctor discusses his three decade crusade for the 
healing properties of cannabis.
from Cannabis Culture # 32
http://www.cannabisculture.com/backissues/issue.cgi?num=32
by Pete Brady

In 1994, when I was disabled, dependent on prescription painkillers, and 
depressed due to a severe injury and failed surgery, a friend gave me two 
gifts that saved my life.

One of the gifts was a potent marijuana cigarette. The other was a book, 
Marihuana, The Forbidden Medicine, co-written by Harvard psychiatry 
professor Dr. Lester Grinspoon.

I'd used marijuana as a teenager, but had stopped using it. I didn't 
believe marijuana could help me, and was afraid of being arrested, but 
after Grinspoon's book taught me that marijuana might be an ideal 
medicine, I smoked the joint and felt years of pain and depression slip 
away.

I contacted Grinspoon to thank him, and found that he was more than just 
a respected medical expert, treating physician, and teacher. He was also 
a courageous, energetic iconoclast who put his career and personal safety 
at risk by telling the truth about marijuana.

Grinspoon's cannabis career started in 1971, when Harvard University 
Press published his groundbreaking book, Marihuana Reconsidered. Medical 
associations, public policy experts and the media praised the tome, which 
featured extensive description and analysis of marijuana's history, uses, 
and legal status. The book is accurately described as one of the best 
researched, academically bulletproof, persuasively argued evaluations of 
marijuana written in the 20th century.

Harvard's status quo was alarmed by Dr. Grinspoon's pot scholarship. 
Insiders say the doctor's chances of being promoted to "full professor" 
status were negatively affected by his marijuana research.

Undaunted, Grinspoon traveled the world, testifying in court and at 
government hearings, engaging in public debates with drug war proponents, 
and publishing dozens more books and essays. He joined the board of the 
National Organization for the Reform of Marijuana Laws (NORML), and 
became a movement icon, relied upon as a scholarly advocate whose Harvard 
credentials created automatic credibility.

Grinspoon generated controversy in 1997, when Harvard decided to honor 
drug czar General Barry McCaffrey with an award reserved for individuals 
who have produced innovative scholarly research.
"General McCaffrey was to be given an award for producing significant 
scholarship in the area of drug abuse," Grinspoon explained in a recent 
interview, "but he hadn't produced any. He knew as about as much about 
that subject as I knew about Sherman tanks."

Grinspoon's public opposition to McCaffrey's award was criticized by a 
Harvard official and by McCaffrey, who accused the doctor of perpetuating 
a "medical marijuana hoax." McCaffrey also refused to appear with 
Grinspoon when the two men were invited to debate on a major national 
public television program.

Although Grinspoon has scaled back his involvement with NORML and 
full-time Harvard teaching duties, he has not retreated from the war on 
the war on marijuana. The doctor runs two marijuana websites, helps 
patients, travels extensively lobbying for medical marijuana law reform, 
and is planning a new book about marijuana's ability to enhance pleasure 
and achievement.
Grinspoon wouldn't comment on the record about the time when the DEA 
tried to harass him for writing a prescription for pharmaceutical THC, or 
about other situations in which he suffered persecution and prejudice 
because of his marijuana advocacy.

Yet, the doctor's unparalleled importance in the worldwide marijuana law 
reform movement is illustrated by an adventure he had in 1990, when he 
traveled to the ultra-prohibitionist country of Malaysia, seeking to 
assist 35-year-old Kerry Wiley, a severely disabled computer scientist 
and American medical marijuana patient who was facing a death sentence 
for possessing ten ounces of marijuana.

In Malaysia, the death sentence is carried out via a rope around the neck.

Grinspoon knew that more than a hundred people, including eight young 
visitors from Hong Kong, had been hanged because of the country's drug 
laws.

He traveled to the country anyway. Before directly intervening in Wiley's 
case, he conducted a marijuana seminar for influential Malaysian 
physicians and lawyers. Grinspoon told his audience about Irish doctor WB 
O'Shaughnessy, whose 18th century cannabis discoveries were based on 
observations of medicinal marijuana use by Indians and Malays.

Grinspoon also performed a thorough medical exam on Wiley in the hellish 
prison where he had been held without bail.

Wiley had already spent a year in the cruelly overcrowded Pudu prison, 
sleeping on a blanket on a cement floor in a small cell with several 
other prisoners, bathing in dirty water. Whereas the diet of the other 
prisoners was rice-based, Wiley's was restricted almost exclusively to 
potatoes - apparently because he was an American. He was receiving 
inadequate nutrition, his teeth were rotting, and he was seriously 
depressed.

In court, presiding judge Shaik Daud Ismaill immediately expressed 
irritation at Grinspoon's presence, and Wiley's prosecutor charged that 
Grinspoon had himself broken Malaysian law by examining the prisoner 
without official permission. Grinspoon sat in indignant disbelief as the 
prosecutor and the judge discussed whether he would join Wiley in prison.

The Harvard doctor testified anyway, unsure if he would be arrested after 
his testimony. He demolished the prosecutor's hostile line of 
questioning, gradually shaming the entire country with a vivid 
presentation explaining the origins of Wiley's painful injuries, his need 
for medical cannabis, and by implication, the inhumanity of the country's 
marijuana laws.

After his testimony, Grinspoon watched as court officials conferred with 
armed men about whether he would be arrested. The American embassy's 
legal counsel had to escort Grinspoon to the airport to prevent him from 
being arrested, never leaving Grinspoon's side until he was on the jet 
home with the doors closed behind him.

In early 1991, the judge decided that Wiley had been using cannabis for 
medical purposes. Instead of sentencing him to death, he sentenced Wiley 
to five years in prison and ten strokes from a hard rattan cane. The cane 
used in Malaysia is particularly cruel and burdens the caning recipient 
with motion limitation and pain for the rest of his life. Grinspoon wrote 
to Malaysia's Prime Minister, who was a physician, telling him that the 
rattan cane used in Malaysia cuts right to the periosteum of spinal 
column bones.

Wiley was released from prison in 1993 without serving his full sentence, 
and without being caned.

Grinspoon went on to work for justice and access to medicine for 
thousands of other patients. He spoke to Cannabis Culture from his 
Massachusetts home.

You told me that you used to believe that marijuana was very dangerous. 
How did you end up as one of the world's most respected marijuana experts?

In 1967 I had some time on my hands while waiting for colleagues to 
finish their contributions to a book I was writing. I decided to review 
the medical literature on marijuana because I had become increasingly 
alarmed that so many young people were using what I had understood was a 
very harmful drug.

Astonishingly, my literature review revealed that even though I had been 
trained in science and medicine, I had been misled about marijuana. I 
shared my findings in a paper that was published as the lead article in 
the December 1969 Scientific American. My article questioned whether the 
belief that marijuana was an exceedingly harmful drug was based on 
substantial scientific or medical data.

I soon received a call from Murray Chastain, Associate Director of the 
Harvard University Press. He suggested I write a book on marijuana. 
Murray called back a few weeks later. He was upset because the Board of 
Syndics of the Harvard University Press had rejected the book proposal. 
He had assumed that the approval would be pro forma; he was astonished 
that this board thought the book too controversial. I could have done the 
book for a trade publisher, but I wanted it to have the Harvard 
imprimatur. Fortunately, Murray and the director of the Press persuaded 
the Syndics to reverse their decision.

It was a much bigger project than I expected because there was more than 
just medical and scientific literature to review. A lot of the ideas 
about cannabis originated in the gaudy writings of the French Romantic 
literary movement, so I examined the cannabis-related writings of 
Gautier, Baudelaire, and other members of Le Club des Haschischins, as 
well as those of Bayard Taylor and Fitz Hugh Ludlow. I suspect that our 
first drug czar, Harry Anslinger, would have recognized some of his 
reefer madness ideas in these 19th century writers' wild descriptions of 
the cannabis experience.

What were the most interesting discoveries you made in this early 
research?

I learned that while marijuana was not addictive, learning about it 
certainly had a strong hold on me! I was fascinated by it. It became 
inescapably clear that while marijuana was not absolutely harmless, its 
harmfulness lay not so much in any inherent psychopharmacological 
property of the drug, but in the social and legal consequences of 
prohibition. I also discovered that recreational use and medical use were 
not the only reasons people used marijuana. All this was detailed in the 
book, Marihuana Reconsidered, published in 1971.

After the book came out, people questioned how you could write about 
marijuana without having used it.

I flirted with the idea of using marijuana, not because I believed it 
would inform my research, but because I thought it would be a very 
interesting experience. I decided against it out of fear that it would 
compromise my goal of producing as objective a book as I could. I 
believed that my best shot at objectivity and scientific legitimacy lay 
in abstinence.

I had another reason for postponing personal experience with cannabis. If 
the book was successful, I expected to be called as an expert witness 
before legislative committees and in courtrooms. I correctly anticipated 
that some of my interrogators would want to know whether I had ever used 
cannabis, and I wanted to be able to deny it so as to preserve the 
appearance of objectivity.

It began to appear that when a legislator, lawyer, judge, or media person 
asked me if I used cannabis, they often hoped I would answer 
affirmatively and that this would discredit me. I was testifying before a 
legislative committee when a senator asked, "Doctor, have you ever used 
marijuana?"

This senator with a sneering tone in his voice had already revealed his 
hostility. I replied, "Senator, I will be glad to answer that question if 
you will first tell me whether if I answer your question affirmatively, 
you will consider me a more or less credible witness?" The senator 
angrily told me I was impertinent and stormed out of the hearing room. I 
decided that there was nothing more to be gained by abstention. The time 
had come.

So you asked one of the Harvard stoner students to get you some pot?

No. The first cannabis try came when my wife Betsy and I went to a 
Cambridge party. We had declined offers to smoke with these people in the 
past, but this time we joined in, taking big puffs as the joint was 
passed around.

We didn't experience any effect, and I became rather worried about my 
book's credibility. What if cannabis had no real effect? What if it is 
all a placebo effect? But at the same time I knew that most people do not 
get high the first time they use marijuana.

Betsy and I smoked a second time, but still felt nothing. Then, on the 
third try, we crossed the threshold. The first sign that I was high came 
when I noticed I was perceiving music differently. We were listening to 
the Beatles' Seargent Pepper's Lonely Hearts Club Band. It was a 
fascinating new musical experience for me!

A year later I was having dinner with John Lennon and Yoko Ono. I was to 
appear the next day as an expert witness at Immigration and 
Naturalization Service hearings that Attorney General John Mitchell had 
engineered as a way of getting the couple ejected on marijuana charges 
after they became involved in anti-war activities.

I told John how cannabis helped me to hear his music for the first time 
in much the same way that Allen Ginsberg had seen Cezanne for the first 
time after he smoked cannabis before going to the Museum of Modern Art, 
to determine if marijuana could help him break through his incapacity to 
relate to Cezanne. It did.

John replied that I had experienced only one facet of what marijuana 
could do for music. He said that it also enhanced the ability for 
composing and making music.

So you discovered marijuana as a recreational drug, but how did you begin 
to focus on its medicinal uses?

In 1972, I talked to a cancer specialist about a young male leukemia 
patient who found that the nausea and vomiting caused by chemotherapy 
were unbearable. Then, the young man began smoking marijuana 20 minutes 
before his chemotherapy sessions, and it helped him survive.

Our son Danny had been struggling with acute lymphocytic leukemia since 
1967. He had been hospitalized several times, and in 1971 he started 
taking chemotherapy drugs that caused severed nausea and vomiting. 
Standard drugs didn't allay his misery; he started to vomit shortly after 
chemotherapy and would continue retching for as long as eight hours. I 
considered the idea of his using marijuana, but it was against the law, 
and I was afraid it might cause problems with the hospital staff. I 
discussed it with Betsy, but took no further action.

A few weeks later, I arrived at the hospital to find that Betsy and Danny 
were already there awaiting his next chemotherapy session. When I arrived 
at the hospital, Betsy and Danny were in a joking, relaxed mood, and I 
felt they were keeping a secret from me.

It turns out that on their way to the hospital, they had stopped at the 
high school and Betsy asked one of Danny's friends to get her some 
marijuana. Danny smoked it in the hospital parking lot before entering 
the clinic. When I joined them, I was so relieved and happy to see how 
comfortable Danny was. He didn't complain about the treatment, and he was 
not nauseous afterwards. Betsy even stopped on the way home to buy him a 
submarine sandwich.

The next day I told Danny's doctor how marijuana had helped him. The 
doctor suggested that at the next treatment Danny smoke in the treatment 
room so he could observe the effects. Again, Danny became relaxed and 
free from nausea. He used it during the remaining year of his life. It 
eased his pain and gave comfort to our whole family. Danny said of the 
experience: "Pot turns bad things into good."

You first published Marihuana, The Forbidden Medicine, in 1993. Many 
people credit that book with helping to educate voters, journalists, 
judges and politicians. Your stature is part of the reason that medical 
marijuana is legal in nine states. Still, your opponents say marijuana's 
medical usefulness is overestimated, and that it is more harmful than you 
believe. How do you feel about this debate?

I am very concerned about the approach of institutions such as the 
Institute of Medicine, which grudgingly admitted in its 1999 report that 
marijuana had some medical value, but overall it views medical marijuana 
as a "problem." For patients, the problem is getting marijuana without 
going to jail. For the government, the problem is how to acknowledge 
marijuana's medical benefits while still maintaining prohibition.

The government's solution is what I call the "pharmaceuticalization" of 
cannabis. Pharmaceuticalization means that drug companies and chemists 
will isolate and produce natural cannabinoids, synthetic cannabinoids, 
and cannabinoid analogs. They want to avoid the alleged dangers of smoked 
marijuana by designing drugs that lack the psychoactive effects, and by 
making new cannabinoid medicines that do not involve inhaling smoke. In 
their view, it is preferable to use nasal sprays, pills, skin patches, 
nebulizers, and suppositories to avoid exposing the lungs to the 
particulate matter in marijuana smoke.

This is a hot topic in the marijuana science world. I discussed this at a 
conference with Geoffrey Guy, whose company GW Pharmaceuticals is 
attempting to use naturally derived cannabinoids in products and delivery 
systems that will avoid smoke and the psychoactive effects.

Dr Guy is researching the effectiveness of delivering cannabis extracts 
under the tongue or via nebulizers, which are inhaler devices. His 
nebulizer looks like it will be an expensive, complicated device. It will 
have some kind of computerized controls that control dosage to prevent 
patients or unauthorized persons from using it recreationally.

I said to Dr Guy, "You're talking about this expensive aerosol dispenser, 
but if I can get safe medical relief by smoking marijuana through a 
vaporizer what is going to compel me to buy your very expensive product?"

He didn't know what to say, but somebody interjected that insurance 
companies will pay for the inhaler. I said, "But 40 million Americans 
aren't insured, and insurance companies are upping the prescription 
co-payments, so regular marijuana will continue to be medically effective 
and cost effective."

Do you see any value in the pharmaceuticalization approach?

It's reasonable to find out what marijuana's components do, and to try to 
isolate them, chemically modify them, and put them in pills and inhalers. 
That's why the armed forces are paying for studies of a synthetic 
cannabinoid, HU-211, otherwise known as dexanabinol, because Raphael 
Mechoulam's studies found that it reduces brain damage from stroke and 
brain syndrome. Researchers in San Diego showed that THC, just like whole 
marijuana, probably accomplishes the same thing.

I was at a conference with Raphael, and I questioned whether, given the 
time sensitivity of this treatment, that instead of moving people to a 
hospital to give them dexanabinol right after a traumatic accident 
involving the head, why not give soldiers who remain conscious or regain 
consciousness khaki-wrapped joints that they could smoke right away.

It's possible that some of the new cannabinoid products will be useful 
and safe, but I question whether drug companies will find them all worth 
the enormous development costs? In most cases, new products will not be 
more useful or safer than natural cannabis. Synthetic 
tetrahydrocannabinol, known as Marinol or dronabinol, has been available 
for years, but patients usually find smoking marijuana is preferable to 
using Marinol. Unimed, the company that manufactures dronabinol, is 
charging a very high price for their product, despite the fact that the 
US government partially subsidized their development costs.

McCaffrey and his troops say medicines are not smoked. However, inhaling 
cannabinoids via vaporization devices is a particularly safe and 
effective method of delivery. Vaporizers have to be sophisticated enough 
to precisely maintain a temperature of between 400 and 440 degrees 
Fahrenheit. I have personally tested several vaporizers that work very 
well in this regard. People can read about some of them on my website.

Furthermore, the harms of smoked marijuana have been exaggerated. If a 
patient smokes a pack of joints a day, that might cause respiratory 
irritation. But for people who smoke a few puffs a day there is no great 
respiratory danger- they're probably more at risk if they breathe the air 
in Houston.

I don't for a second believe that pharmaceuticalization efforts will 
result in less medical use of whole smoked marijuana. We will probably 
end up with two distribution systems: there will be the system that says 
get a prescription, go to a pharmacy, and get a pill, but there will also 
be the distribution of plain marijuana, just like any other herb.

What about the assertion that marijuana's medical usefulness and safety 
have been exaggerated?

Many of the people who say this are not doctors or nurses who deliver 
direct care to patients.

Every day, doctors are faced with a dilemma that balances the harmful 
side effects of a medicine with its benefits. Most medicines have harmful 
side effects and differing degrees of effectiveness from patient to 
patient.

Marijuana is by far one of the safest and most versatile medicines we 
know of. It is surely less toxic than most of the conventional medicines 
it will replace when it is legally available. It has never caused an 
overdose death. Increasing the potency of cannabis and developing 
vaporizer technology so people can inhale cannabinoids instead of 
particulates could significantly lessen whatever respiratory problems are 
caused by it.

Cannabis is extremely versatile. It stimulates appetite, which is useful 
for cancer and AIDS patients. It prevents nausea and vomiting. It lowers 
intraocular pressure associated with glaucoma. It provides relief from 
seizures, spasms and convulsions. It reduces pain, and is a great 
alternative to potentially lethal and addictive opioid analgesics. It 
also may act as an anti-inflammatory, and as an anti-depressant.

Have you found it ironic that some medpot critics describe 
marijuana-induced euphoria as an "unwanted side-effect?"

Pharmaceuticalization advocates want to achieve therapeutic doses without 
producing psychoactive effects. I'm not sure this is very well thought 
out. Patients who use cannabis for severe pain or to lower intraocular 
pressure in glaucoma, for example, need to smoke regularly. They'll stop 
feeling the high when they have developed a tolerance to the psychoactive 
effects, but they won't develop a tolerance to pain relief, the lowering 
of intraocular pressure or other medical effects.

The people who smoke all day long aren't getting much of a high out of 
it. Most marijuana users know that the less you use the more you 
experience the psychoactive effect. But there's no evidence of tolerance 
for the medical effects.

I also question whether the psychoactive effect is always separable from 
the therapeutic effect, and in any event, is necessarily undesirable. 
Many patients suffering from serious chronic illnesses say that cannabis 
improves their spirits. If they note psychoactive effects at all, they 
generally speak of a slight mood elevation.

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