Pot Proponent Just Says No

Medical marijuana's elder statesman is not convinced that the therapeutic benefits of cannabis can be separated from the psychoactive effects — or that cannabis should be "pharmaceuticalized."

This Web Exclusive is offered as a supplement to Fast Company's February 2004 article "The Cannabis Conundrum."

You might think that the eminence grise of the medical-marijuana movement would enthusiastically support an effort by the British biotech GW Pharmaceuticals to produce and market medicines derived from Cannabis sativa. But in the Aboveground Marijuana Economy, there's no such thing as a safe assumption.

Lester Grinspoon is a grandfather, an emeritus professor of psychiatry at Harvard Medical School, and the author of two seminal books on the therapeutic benefits of pot: Marihuana Reconsidered and Marihuana: The Forbidden Medicine (co-authored with James B. Bakalar). In an interview in his office in a Boston suburb, Grinspoon declared that the efficacy of cannabis as a medicine is beyond question, citing its versatility in treating a whole host of illnesses and symptoms, from glaucoma to arthritis pain to Krohn's disease to migraine headaches. "Not a single death has ever been attributed to a marijuana overdose," he says. "Marijuana is one of the least toxic drugs known to humankind."

Grinspoon was opposed to marijuana use until the early 1970s, when his 10-year old son was diagnosed with acute lymphatic leukemia. In his book, The Forbidden Medicine, he movingly describes how the drug relieved the violent nausea his son experienced from chemotherapy "during the remaining year of his life." Since then, he has interviewed hundreds of patients who say they have been helped by marijuana.

Nevertheless, Grinspoon is critical of GW's plan to market Sativex, a cannabis-laced oral spray that shows promise in relieving the pain and muscle rigidity that accompanies multiple sclerosis. It's a curious stance, given that GW has reported to the House of Lords' committee on science and technology that in recent trials, the vast majority of Sativex users indicated "significant alleviation" of at least one symptom, including pain, spasticity, and bladder problems; in some cases, the improvements were "sufficient to transform lives."

Grinspoon has two problems with Sativex, which he laid out in an email that was widely circulated amongst medical-marijuana activists: "GW Pharmaceuticals," he wrote, "sold this product to the Home Office on the assertion that it will provide all of the medical benefits of cannabis without imposing on the patient the 'two dangerous' effects — those of smoking and getting high...Although cannabis has been smoked widely in this country for four decades now, there are no reported cases of cancer or emphysema which can be attributed to marijuana...Those who are, in today's antismoking climate, concerned about any toxic effects on the pulmonary system can now use a vaporizer, a device which frees the cannabinoid molecules from the plant material without the necessity of burning it and thereby producing smoke.

"As for the psychoactive effects," Grinspoon continued, "I am not convinced that the therapeutic benefits of cannabis can be separated from the psychoactive effects, nor am I persuaded that that is always a desirable goal. For example, many patients with multiple sclerosis who use marijuana speak of mood elevation as well as the relief of muscle spasm and other symptoms. If cannabis contributes to their feeling better, should patients be deprived of this effect?"

Geoffrey Guy, GW's founder and chairman, vigorously disputes that last point. "Only about 10% of the people who come into our trials have tried illegal cannabis to ease their symptoms — they show no pent-up desire to get stoned. They just want to ease their pain or spasticity. MS is a condition that dominates your life. And if you get a large chunk of your life back by taking this medicine, the last thing you want to do is throw it away again by getting intoxicated."

But Grinspoon has a bigger beef with GW, which is that Sativex will contribute to what he calls the "pharmaceuticalization" of cannabis. According to his reasoning, GW is giving the British government — and in the future, other governments as well — a way to say that they are making medical marijuana (read: Sativex) available to patients, while at the same time enabling regulators to continue banning it for recreational use. Grinspoon's bottom line: U.S. drug regulators would use approval of Sativex to claim that there is no need for smoked marijuana.

"GW's marketing pitch for Sativex will be that it doesn't require smoking, it doesn't get you high, and it's completely legal," predicts Grinspoon. "Without a continued prohibition on marijuana, the pharmaceutical industry just won't invest in this area, because they know they can't compete with the plant, which is every bit as safe and effective — and a whole lot cheaper — than a cannabis-based pharmaceutical product. The plant's only drawback is that it's illegal. Ultimately, the commercial success of any cannabinoid product will depend on how vigorously the prohibition against marijuana is enforced."

What, then, does Grinspoon propose? He argues that cannabis "should be removed from the medical and criminal control systems. It should be made legal for adult use and taxed, just like alcohol."

Geoffrey Guy, GW's founder and chairman, concedes that Sativex might, in fact, enable the British government to separate medical marijuana from the debate over decriminalizing the drug for recreational use. But he believes that in the long run, the chance that marijuana might one day be decriminalized will help more than hurt him.

"The British government's policy in this area has been to maintain recreational cannabis as an illegal activity but to give aid to a program that could bring forward a legitimate, cannabis-based medicine," he said when I interviewed him in southeastern England. "We have basically been the animators of the medicinal part of that policy. Frankly, if our program disappeared tomorrow, the government wouldn't have a policy.

"The debate over legalizing the recreational use of marijuana is best dealt with by politicians and the plebiscite, not by businessmen and clinicians," he continued. "But to the extent that societal views of cannabis become more tolerant, it reduces some of the hurdles and enables us to position our medicines in the context of normal medical practice, without all the baggage of a debate that's mainly fueled by a range of fictitious propositions."

Concludes Guy: "The more acceptable the drug becomes, the bigger our markets become — we'll be able to treat a much, much wider range of patients."

On that last point, Grinspoon and Guy might agree. Regardless of the delivery system — spray, pill, or vaporizer — cannabis is slowly (some will say insidiously) making its way back into the medical mainstream. As it does so, says Grinspoon, "people will learn that it's harmfulness has been greatly exaggerated and its usefulness underestimated — and the pressure will increase for drastic change in the way we as a society deal with this drug."

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