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Ferre
Cannabis Sacrament Minister.
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Location: Amsterdam
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 Posted: Tue Oct 18, 2005 1:45 am Post subject: An Interview With Lester Grinspoon, M.D. |
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An Interview With Lester Grinspoon, M.D.
Lester Grinspoon
Interviewed By Gary Greenberg
October 17, 2005
Gary Greenberg, a Mother Jones contributing writer, is a psychotherapist and professor of psychology, and the author of "Respectable Reefer," in the November/December issue of the magazine.
Lester Grinspoon, M.D., is associate professor emeritus of psychiatry at Harvard Medical School, and the author of Marijuana Reconsidered.
LG: Sativex is the kind of thing I was concerned about when I first spoke of the concept of pharmaceuticalization in 1985 to describe Marinol. At the time the federal government was under a lot of pressure to look at the medical uses of marijuana. So the government supported this little company Unimed to create Marinol, which is simply synthetic THC [tetrahyrdrocannabinol], which is identical to the THC that you find in cannabis. But that THC they put into Schedule II -- it’s so ridiculous! So Unimed comes out with it. It was very expensive, and I’ll tell you Gary, I have yet to have a patient or to hear from a patient who thinks Marinol is as good as whole smoked herbal marijuana. With Sativex, Geoffrey Guy went to the home office and said in effect, “Look, everybody knows that cannabis has medicinal utilities,” and the British government, just like the U.S. government, was being pressed to do something about it. He then said, “I have the plans for a product which will deliver all the medical capacities of cannabis, but at the same time not impose on the medical user the two most frightful things about cannabis -- the high and the pulmonary effect.” To me, that was based on a deception because we know now that the pulmonary problems are minimal. As for the high, I don’t believe that the high is a big problem in people with Crone’s Disease or Multiple Sclerosis, who feel better when they smoke cannabis—that’s probably a function of the anti-depressant effect of this substance. What’s the problem with that? Secondly I question whether one can, in all instances where cannabis is useful as medicine, bring that utility in below the level at which one gets some degree of a psychoactive effect.
GG: G.W. [Pharmaceuticals] claims that people who use this inhaler titrate to the point that they feel relief from their symptoms—which is MS pain or spasticity—don’t get intoxicated. What do you think about that?
LG: Well, if you can get relief from the spasticity without getting a high, then you could do the same with the smoked stuff. It’s much easier to titrate when you’re using the pulmonary system than when you’re using the sublingual [under the tongue] or oral system. You can feel it within seconds, whereas orally -- that is if you swallow it -- it’s going take an hour and a half. You take it sublingually, it’s maybe 15 minutes. It’s faster than oral. But it’s nowhere near as fast as smoking it. That to me is one of the great advantages of smoking cannabis -- that the patient can have control. He can get just the right amount for his symptoms. You are not going be able to titrate it for a while if it’s going to take you 15-20 minutes to get an effect.
GG: G.W. claims that every patient has his own learning curve, so you figure out “Oh that time I took too much or this time I didn’t take enough” and eventually know exactly how much to take. The advantage of the sublingual preparation is that they’ve managed to make each spray contain a whole lot less THC than even one puff on a  .
LG: But the same thing can be done with marijuana if you know what the potency is.
GG: So whatever is achieved with the sublingual spray could be achieved as well as or better with the old fashioned herbal preparation?
LG: Better and faster. And there’s another reason. The sublingual was the idea with G.W. Pharmaceuticals, but the fact of the matter is in reality, you can’t hold it under the tongue very long.
GG: Is that because preparation stings or…?
LG: It has a dreadful taste.
GG: I see.
LG: Secondly, just try to hold anything under your tongue for a while, it leaks down into the esophagus and so an undetermined percentage of the stuff that’s supposed to be sublingual is really an oral use of a substance. Now, when you have an oral use, you’re talking about pushing the effect back an hour and a half. So now you’ve got two different curves, and I think it makes it much more difficult for the patient to find the right dose, no matter how good a learner he is. That’s complicated by the fact that the absorption rate from the gastrointestinal tract is quite variable—depending on the state of my GI tract, when I’ve eaten, and so forth—so even though you may take the same amount orally, you don’t get the same effect orally on any two occasions. Now the other thing G.W. Pharmaceuticals claims is that people can’t get high—that’s absolutely untrue.
GG: Yeah, they’re actually backing off of that claim.
LG: I mean for Christ’s sake…
READ MORE...
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Stokes
Cannabis Sacrament Minister
Joined: 28 Nov 2004
Posts: 1426
Location: PA
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| Posted: Fri May 05, 2006 9:50 pm Post subject: |
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More from the good doctor, Lester Grinspoon.
OPED: PUFFING IS THE BEST MEDICINE
The Food And Drug Administration is contradicting itself. It recently
reiterated its position that cannabis has no medical utility, but it
also approved advanced clinical trials for a marijuana-derived drug
called Sativex, a liquid preparation of two of the most therapeutically
useful compounds of cannabis. This is the same agency that in 1985
approved Marinol, another oral cannabis-derived medicine.
Both Sativex and Marinol represent the "pharmaceuticalization" of
marijuana. They are attempts to make available its quite obvious
medicinal properties -- to treat pain, appetite loss and many other
ailments -- while at the same time prohibiting it for any other use.
Clinicians know that the herb -- because it can be smoked or inhaled
via a vaporizer -- is a much more useful and reliable medicine than
oral preparations. So it might be wise to consider exactly what Sativex
can and can't do before it's marketed here.
A few years ago, the British firm GW Pharmaceuticals convinced
Britain's Home Office that it should be allowed to develop Sativex
because the drug could provide all of the medical benefits of cannabis
without burdening patients with its "dangerous" effects -- those of
smoking and getting high.
But there is very little evidence that smoking marijuana as a means of
taking it represents a significant health risk. Although cannabis has
been smoked widely in Western countries for more than four decades,
there have been no reported cases of lung cancer or emphysema
attributed to marijuana. I suspect that a day's breathing in any city
with poor air quality poses more of a threat than inhaling a day's dose
-- which for many ailments is just a portion of a -- of
marijuana.
[snip]
Pubdate: Fri, 5 May 2006
Source: Los Angeles Times (CA)
Copyright: 2006 Los Angeles Times
Website: http://www.latimes.com/
Details: http://www.mapinc.org/media/248
Author: Lester Grinspoon
Continues: http://www.mapinc.org/drugnews/v06.n566.a03.html[/quote]
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