Peter Grinspoon, Primary Care Physician at MGH
Peter Grinspoon, M.D. is a primary care physician at Massachusetts General Hospital and an Instructor at Harvard Medical School. He is a board member of the advocacy group Doctors for Cannabis Regulation. He is the author of the memoir ‘Free Refills: A Doctor Confronts His Addiction’. He spent two years as an Associate Director of the Massachusetts Physician Health Service helping physicians with addiction and mental health issues.
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[00:01:07] Welcome everyone. This is Thinking Outside the Bud. I'm Bruce Eckfeldt. I'm your host and our guest today is Dr. Peter Grinspoon and he is a primary care physician at Massachusetts General Hospital. He's also an instructor at Harvard Medical School. He's also an author. We're going to find out a little bit more about his book and he has a long and interesting connection to cannabis. And we're going to talk a little bit about that. And he is also part of a board member of the advisory group Doctors for cannabis regulation. We're going to talk about that as well. So a multifaceted program. I'm really excited about this. With that Peter. Welcome to the program. Thanks for having me. So why don't we actually start with doctors for cannabis regulation making kind of use that as a departure point and we can talk about the history and the insight you have around cannabis from both a personal and a medical professional point of view. But what is doctors for cannabis regulation.
[00:01:57] Talk to us a little bit about the organization and what it is focused on doctors for cannabis regulation is a fantastic advocacy group that was founded by Dr. David Nathan and he's a psychiatrist and addiction specialist in New Jersey and it is focused on legalization of cannabis under the assumption that whether you're pro neutral or anti cannabis legalization is much safer than prohibition for a whole variety of reasons which we can get into. But it's really focused on legalizing and regulating cannabis in a safe way to protect public health and safety with the assumption again being that legalization with safe and intelligent regulation would be a much better way to go than prohibition locking people up having the black market you know criminals be in charge of distributing cannabis is much safer if you legalize and regulate.
[00:02:54] Yeah yeah. So it's not necessarily sort of pro cannabis or pro cannabis use it's really focused on let's get the industry into a regulated controlled monitored situation so we can actually see what is happening with the industry. We can look at its use. We can we can put some guidelines actually develop some research and stuff around it. That's it sounds like that's really the goal for DFC are as as we say the acronym rather than really saying hey these are doctors that promote or are pro cannabis use necessarily.
[00:03:24] Absolutely and as physicians we don't think that cannabis should be in the criminal justice category. It should be in the health safety and regulation category. It's just in the wrong box. So we're trying to get it in the proper kind of arena in society so that we can you know have people use it anyways. The war on drugs doesn't stop anybody from using cannabis. Yeah but when it's legal the product that they use is safe you don't have you know cartels and gangs feeling it and providing it. You have a product that's you know tested and screened and you have taxes that you garner and you just have it. It's much safer and sensible for society.
[00:04:09] So again we're not pro cannabis were pro legalization regulation it's a much more sensible way to address this than putting people in cages.
[00:04:18] Yeah exactly.
[00:04:19] And I guess as a physician as a doctor what when you look at the legalization process in Europe in Massachusetts which has now legalized or adult or adult use and medical use state because what are what are the factors that you're looking at or the aspects of policy that you're most interested in from you know from a medical point of view as states and at some point as from a federal level we look at the legalization process.
[00:04:45] What are the concerns or what are the facets that you're looking at.
[00:04:48] Well different physicians and different contingencies or constituencies seem to have different concerns. Everybody's concerned with you know impaired driving though we don't really have a good metric or way to determine that and you certainly don't want to use a bad metric. A lot of the prohibitionists are saying 30 percent of drivers have cannabis in their system which is such a specious argument because you asked in your your blood for our urine for three weeks. So that doesn't mean anything that just means they're testing for it and there's more honesty about use or transparency but it doesn't have anything to do with intoxication. You know we're looking to protect you know. Essence from using it because we're concerned about the effect an adolescent brain development. Even though a lot more study and research needs to be done but out of us you seems to be very stable and it's been wildly exaggerated again by people who are against legalization. It seems like if anything in some states get out of us use has been declining but we are concerned about that. Everybody wants to lessen the black market quote unquote because that's just you know if you buy it legally no one will sell to a minor and the product will be clean without pesticides fungus heavy metals etc..
[00:06:07] And you know people are criticizing legalization in the states where it's legal because the black market hasn't been eliminated but without legalization the black markets 100 percent of the market. So exactly seems to me to be a silly argument as well. But you know marijuana like all I considered a medicine and like a whole medicine it's not entirely safe. The pregnant woman and breastfeeding woman shouldn't use it certainly until it is studied more. And you know again the driving thing and the adolescent use these are your concerns and these are the things we watch out for. You know legalizing something is complex. There are a lot of complex policy ramifications. So this is something that we're figuring it out in each state that legalizes it. He's doing it in a slightly different way. And there are going to be mistakes there are going to be things that can be done better. And you know it's sort of like a lab where people are trying to figure out how to work out the social justice component you know how to involve minorities and people who have been disproportionately harmed by this insane war on drugs in 40 years.
[00:07:18] And there's also in my opinion a very complex dynamic between you know the research has been very biased if night. The National Institute of Drug Abuse is only funded research into the negative aspects of cannabis. It's not into the positive aspects. So if you're trying to establish something negative and then you do ten billion dollars worth of studies into whether or not it's harmful you're going to find some stuff. The question is how valid is that if you're having a primary hypothesis that is negative and you're using your research dollars to prove that. So sort to feel like it's sort of like the baseball player who has a home run record but was on steroids. You're like an asterix by it. Yeah. So I think we need to sort of figure out how much of this research is valid. And there's also the problem that like there's two completely different non communicate narratives about cannabis. There's like the cannabis community which believes that they're using it medicinally and that it's helping them recreationally. Then there's like the Addiction Psychiatry community that thinks doesn't seem to be a way to conceptualize recreational or medical cannabis. And they put it all under the rubric of pathology. And I think that the over pathologies this but there needs to be more what I call cannabis common ground. There's got to be a way that sort of link or at least bring these two conversations a little bit closer together. So you know a lot of challenges.
[00:08:43] It's interesting it's interesting time to be involved in this issue.
[00:08:47] Now Abbas fascinating. I mean both as. I mean I think from you know the podcast we focused on you know a lot around the business and you know everything from kind of cultivation to dispensing practices to consulting services. But I think what is kind of gets underrepresented is a real kind of discussion of the medical kind of application of the medical facets of this because it is you know like any drug there is kind of pros and cons to it or there's applications and their side effects.
[00:09:14] And I think your discussion of the research side is fascinating committee just because it does seem like the the data that we have is both extremely limited and quite biased.
[00:09:25] And you know I'm quite curious about how what the future or what a future might look like where we've got better data and insight into the actual kind of application and use side effects positive benefits of when you look at the actual kind of research side of it. What needs to happen to start to create some of those data I mean you mentioned that we've got some data but it's quite biased. How do we get more better more kind of neutral or balanced understanding of this drug of this of this product.
[00:09:56] Well the good news is that is happening in Israel Canada and Europe. The bad news is it is not happening as quickly in this country. The United States as it could be because it's still a Schedule 1 and the Controlled Substance Act. Now we need to legalize cannabis. We remove the restrictions and then they're like people are chomping at the bit to do this research is starting to happen. A lot of people are starting to do it but I think what we're really accelerated is if we you know it's like C4 far safer than alcohol or tobacco. Nobody can argue that it isn't and it's regulated. In the same category as you know methamphetamine and LSD with a controlled substance act. So we just need to get it you know legalized and again regulated as per what we're working on with doctors per cannabis regulation and it'll be a lot easier to study Yeah.
[00:10:45] So let's talk a little bit about why you're interested in this or why you focus on cannabis. I know that you're an author and the book is free refills. A doctor confronts his addiction and it's also a memoir. So I'd love to hear a little bit more about that experience how that experience has kind of impacted or guided your approach or philosophy around cannabis. And I know you have some personal history that actually gives you some insight into the use of cannabis. So why don't we talk about those and I'll let you decide which one you want to talk about first and how they fit together because I think it does it creates a really interesting perspective. I think you have in terms of cannabis not only as well both as a physician as a doctor but also as you know someone who's who's seen the immediate kind of impact or application of cannabis in different ways. So I'll let you decide how you want to how you want to talk about it but I would love to hear that story.
[00:11:37] Absolutely. Well first the memoir. I know physicians are under a lot of distress these days is the big epidemic of burnout.
[00:11:43] And I unfortunately to come to a pretty severe opiate addiction this is unrelated to the whole cannabis stuff so I'll make it a brief war and I recovered I'm 11 years in recovery from opiate addiction and the whole issue of physicians and addiction is a taboo subject and there's so much love around addiction in general and particularly around physicians and addiction and particularly around opiate addiction in the midst of this opiate epidemic which is killing more people every year than we lost in the entire Vietnam War.
[00:12:15] I thought it was important to come forward and be public about my story. So I wrote a memoir about my struggles with addiction and recovery called free refills. A doctor confronts his addiction free refills because Doc cures have limited access to medications. We have free refills and unlimited guests. The combination of which is the perfect storm for physicians and addiction.
[00:12:39] And we have higher rates of addiction than the general population. Physicians also have the highest suicide rate of any profession. And we're in a lot of trouble. That's why a lot of physicians are leaving the profession. And there's a huge projected physician shortage coming up. So I came forward with my story and you know the way it relates to cannabis in a nutshell. I mean I think it's people would really enjoy the memoir but and people can find it on Amazon if they just Google free refills. They either get my book or they get you know like I don't know like McDonald's we can get free refills when they're sober. But most of my book comes up is that cannabis did help me a lot with the opiate withdrawal symptoms. And of course not sanctioned by physician health services or the medical board. So I didn't make this a huge part of the books I didn't want to get further crucified crucified the book starts with the DEA and the state police raiding my office for some bad descriptions that I wrote. So but again eleven years sober and I'm you know working very hard on two issues on physicians and addiction and on the cannabis issue. So that's like the memoir In a nutshell in terms of the cannabis stuff I can honestly say that I've been working on a prenatal Lee I'm 52 years old and I can honestly say I've been exposed to this issue for 53 years along with my twin brother in the womb because my father is Dr.
[00:14:01] Lester Grinspoon a very well regarded cannabis activist who wrote the book Marijuana Reconsidered in 1971 which challenged the predominant sort of anti cannabis climate that you know stemmed a lot from you know Harry Annesley gears war and cannabis which was fueled by racism and by competing commercial interests not by health or safety at all. And then continued by Richard Nixon and add to the racism and the competing commercial interests you know politics. He admitted that a lot of it was against the African-American community and against the anti-war anti Vietnam or left early. One of his senior staff members Erlichman admitted that the good news is that my dad's book was reviewed on the front page of The New York Times Book Review Richard Nixon actually called him a clown and that's kind of a badge of honor because he did my dad's book so much. But anyways my dad started researching this. It's sort of a long story because his friend Carl Sagan was using it a lot and my dad was sort of worry that his friend was sort of hurting himself and then so he delved into Carl Sagan the astronomer I guess people sort of know that and I guess delved into the research and found out that it was like it was sort of like an Emperor Wears No Clothes type moment like a lot of my dad realized sort of I guess like Sanjay Gupta did recently that like all the research was like done to prove that it was bad but it wasn't like you know so.
[00:15:29] Because he was like determined to confirm a pre-existing conclusion that was based on what the government wanted people to find. So my dad sort of stepped out of the box and started looking at the thousands year history of cannabis and sort of came to the conclusion that this actually helped people medically. You know it's not without harm. Yeah. Really. But it helped people you know with creativity medically interpersonally. So you know his book I think it's fair to say was pretty instrumental in contributing to the nation legalization movement back then in the 1970s which thankfully is coming to fruition now in 2010 19 dead.
[00:16:12] I'm curious do you feel you because obviously you've been you've been exposed to this before or I'm assuming before you kind of made formal decisions to get into the medical profession.
[00:16:21] I mean do you feel like this is kind of completing your father's work in some way or you know at least continuing at a major kind of transformation or a major change in phase on this. I mean how to how to how does this how does this the current situation and what's going on in the cannabis world kind of fit for you in terms of the bigger the bigger story of your father and and the the the work that he did.
[00:16:46] Well first of all he's still chugging away. He's 9 so he's slowing down a lot. But he'll be working on cannabis legalization till his last breath. And you know I've always been interested in this. I gave my senior presentation for my residency program at the Brigham and Women's Hospital in the year 2000 a medical cannabis. And people thought I was nuts.
[00:17:08] So it's pretty amazing that I'm able to certify patients now and counsel patients and physicians about this. I think that it's just my dad was right. He was like a visionary and we're just all doing the right thing. And you know it's interesting the patients are so far ahead of the doctors on this issue you know. Ninety five percent of patients believe that medical cannabis should be have access but the doctors you know most doctors support it theoretically but they aren't educated about it in the medical schools don't teach it or they teach. They still teach the same 1950 Reefer Madness nonsense in their textbooks like the patients are so ahead of the doctors. So yeah it is continuing and furthering his work on the one hand on the other hand I'm a primary care doctor who is focusing and concentrating medical cannabis if you like and practicing like really excellent medicine that everybody else is going to be practicing in ten years.
[00:18:02] Yeah well I'll say a couple of things. First thank you for writing the book. I think that you know I know that was a vulnerable vulnerable act and I'm sure that was not easy but I think it's just crucial that we have these conversations and get these issues out on the table in an open and honest way.
[00:18:16] And as I as a member of a family who has many M.D. years you know both on the clinician and the patient side like I see the stress. You know I have no direct family members who have gone through years and years of medical school and research and peaches and see the personal and family impacts of all that. So I certainly I see the stress that the medical professionals go through in that space and you know I I get that you know in terms of the you know the questions that really come up for me is how how do we change this.
[00:18:49] So if we we're in a situation where the patient's kind of quote no more than the physicians or at least have a more kind of balanced open curious willingness to kind of consider different viewpoints point of view and physicians are you know I would say a little bit stuck in that the institutions information around them the structures around them are not serving them particularly well in this case in terms of the nature of cannabis the research or the lack thereof understanding FSA Casi and use how do we change the situation.
[00:19:23] What's the what's the what are the things we can do to help change the informational dynamic change the mindset around some of these issues on the medical side.
[00:19:33] Well that's a really great question and it's sort of complicated. It goes back to the one thing I forgot to mention about growing up which is that my brother Danny unfortunately when I was eight passed away from leukemia and the one thing that allowed him to eat and maintain food for the last two years of his life was medical cannabis. So I saw firsthand that it works sort of like it wasn't a randomized controlled blind study like a lot of physicians hunger for it. It was I saw it work in the way that you drop an apple and it falls how gravity works. So I've been you know going through I've been a doctor for twenty five years dealing with physicians some of which very very convinced and with great conviction say medical cannabis doesn't work at all because that's what they've been taught. And I know that it works. I've seen it work. I mean it is arguable that it works. So it's been. You know challenging for me personally is was really to deal with that mind frame and how do we address it. I think first of all it's being addressed in general as people you know as physicians interact with their patients to the extent those physicians that can learn listen and are humble enough to kind of learn from their patients are are slowly starting to change their mind. And as it's legal medically it's being brought more into the mainstream it's not this like shady from the point of view of the physicians illegal thing the patients you're doing it's actually something that they're doing legally and sanctioned by the state. So I think that's slowly starting to happen. I think there's advocacy to change was taught in medical schools. The endo cannabinoid system is one of the most important neurotransmitter systems in the in the body. There are tons of receptors in the brain and there are tons of receptors all over your immune system that's the neurotransmitter system whereby cannabis works and controls virtually everything in our body and as of recently was only being taught in 13 percent of medical schools. I mean.
[00:21:38] Absolutely crazy absolutely seen that they wouldn't. He said it just shows and I think that unwittingly the physicians have been sort of participating in this war on cannabis that Harry answer started and that Richard Nixon accelerated by you know either just ignoring it or sort of mindlessly going along with the position that cannabis is evil with no medical benefit to my dad. I think my dad started it but a lot of doctors still my dad and other people not just my dad started to resist that but I still think a lot of doctors sort of mindlessly kind of collude with this like again candidates is illegal. Not at all because of health but because of racism holiday quality competing commercial interests you know whenever there's a cannabis initiative the people who contribute against it are the private prison industry the alcohol industry and big pharma and how we treat the rehab industry too. I know it's not about public health it's about competing commercial interests so to get physicians up to speed we need continuing medical education and tons of people were working on that. But I mentioned before that there are two separate narratives there's a narrative from the cannabis medical community where cannabis is a fairly benign helpful material that treats a whole variety of conditions like pain insomnia and anxiety fibromyalgia and PTSD. And then there's a narrative from the academic from the addiction psychiatry community you know I just read tried to read a paper yesterday tweeted about it and then I stopped reading it after the second paragraph because it said 80 percent of the cannabis smoked within the last year was smoked by people with psychiatric disease.
[00:23:23] And I just like this is so completely off base like they pathologies somehow it just seems to me like and I don't want to overly generalize it out of my friends or addiction psychiatrists and they you look absolutely phenomenal lifesaving work on the opiate crisis and now it seems like with other drugs but with cannabis I just think a lot of them like they don't understand recreational cannabis or medical cannabis and view it through a lens of pathology. And so they're just two completely different narratives. And so if they're the ones like educating physicians it's just never going to work because there's still going to be this like this like unbridgeable gap between what the patients not only think but like experience like a patient is using cannabis for sleep. It's working really well. And then what's the addiction psychiatrist going to do say Well it doesn't work for sleep so stop using it use ambien. I mean that wouldn't make any sense. So I guess we have a lot of work to do teaching physicians about basic cannabis medicine in medical school and residency providing continuing medical education to physicians who are practicing and sort of like dealing with the fact that a whole swath of physicians that are supposedly the experts on this have this view of it as like pathological when a lot of what they think is pathological actually isn't pathological and they think I'm completely pathological for saying this. I just you know I've been exposed to this from every angle I've smoked acres of it I've a lot of experience with it I've dealt with thousands of people I've treated people and I honestly you know this is gonna get me shot. But I just you know it's such a benign substance for like an adult with no other medical problems I feel like these addictions psychiatrist if they tried it they'd actually realize it's not this scary substance that's going to take they stop believing their own kind of self reinforcing ideology about it it's like you legs don't fall off you take a path it's actually they should read Carl Sagan's essay that was in my father's book.
[00:25:28] I've been tweeting. Recently Carl Carl Sagan's like smarter than all of them and me and everybody else put together. And he wrote this beautiful essay in my father's book about what it does for him how it enhances his creativity how it works for him and I just feel like they should aid either try cannabis so they know what they're talking about or b read Elisa be open minded enough to read an essay that explains what it does for people so that they understand why people use it you know just very briefly and I'm giving a TED talk here. But when I was at rehab you know my opiate addiction they were like a drug is a drug is a drug that was like their ideology and I'm like oh so cannabis is the same thing as methamphetamine. And you know Doug Talbot the director of the Talbot Recovery Center was like yes a drug is a drug is a drug and I'm like Oh my God I can't believe I'm dealing with this. And I just think they need to understand that there are positives and negatives in cannabis isn't in the same category as opiates or alcohol and not all highs of the same. And this is just a very complex substance in the way that other substances aren't.
[00:26:38] Do you think I've just kind of curious do you think that the current.
[00:26:41] Well I mean it seems like the long term the long term changes. You know the next generation right. Like as we got a new generation of physicians that are hopefully trained or you know go through their professional development with some better data and some more balanced you know opinions or positions on some of the stuff that will that will change. But in terms of the current physician base I mean it seems like there is probably a group that just are not going to change right. There's probably not much we can do for the people that are going to have an opportunity or have a likelihood to change. What would you I mean I guess you recommended that you know that they actually experience the kind of us in some way that they kind of keep an open mind have some of these conversations read some of those literature. Is there anything I mean in terms of really helping convert more physicians and understanding this this substance better that you would recommend that they do in terms of what do you do over the next month to to really start getting into this.
[00:27:37] Well first of all I think physicians are very hungry for good information and very openly changing. You know there's a recent study that some very someone very intelligent from Childrens Hospital did where like 80 percent of oncologists were talking to their patients about medical cannabis because virtually all of their patients were asking them about medical cannabis but only 30 percent of the oncologist felt comfortable or qualified to be having these conversations.
[00:28:02] So you know 50 percent of people were actually of doctors were actually having this conversation but didn't feel comfortable or that they had enough information. I mean doctors are starving for this information. The last time I spoke to a physician group about medical cannabis I only got through like five slides because there are so many questions people were so excited to actually talk about it and have their questions answered. So physicians are starving for this information for good information. So I think you know having more of us available to speak about it and I know that tons of people are working on continuing medical education units for medical cannabis really good stuff. So I think that there's going to be a lot of really good information coming out in the next couple of years so I think that the huge huge vacuum we have is going to be narrowed pretty quickly.
[00:28:50] Yeah. And I hope so. And I think you know thinking from the industry point of view and working with a lot of companies who are developing various kind of cannabis products and cannabis based services and kind of seeing the industry develop I think you know it is going to happen. And there's a lot of pressure both business and political to to make these things more more available. I just I think that the more that we can train up get the medical community educated onboard in the forefront of all those I think it's going to it's going to help everyone. I'm afraid if we don't we're just gonna continue to see a lot of these unfortunate problems. And I think that's you know I think we have an opportunity. And I'm doing whatever we can do to not miss out on what we're going to hit time here. If people want to find out more about you about the book about DFC are what what are the best ways to get some of this information.
[00:29:40] Well for me they can just go to my website which is PeterGrinspoon.com you know grin like smile spoon like for PeterGrinspoon.com and they could access my book or they could contact me directly with any questions for dfcr.org that's pretty easy to it's just dfcr.org it's a phenomenal organization really just great doctors are associated with it and we've got a very positive message and I can't I can't emphasize highly enough how much I respect the other doctors that are involved in this group and how important I think the mission is. Again the slogan I can't remember the exact slogan but it's the essence of it is you don't have to be pro cannabis to think that it should be legal. I mean legalization makes so much sense like it should not be in the. Justice realm it's sort of like you got put in the wrong bias and there's any special interest trying to keep it there. It should be legalized and regulated. Let's see first for society and you know I'm sorry if it hurts the private prison industry which is currently thriving but money locking people in boxes anyways. I'm sorry if that hurts the alcohol industry but it's much safer use cannabis than alcohol. I'm sorry if it hurts Big Pharma. But you know it's safer to use a little cannabis than to use ambien. So I just think that this group EFCA is a phenomenal group and I'd love it if people check out the website.
[00:31:03] Yeah and I'll make sure that the that the URLs to dfcr.org are and to your book and to your Web site are all in the show notes so people can click through and get those. Peter this has been a pleasure. Thank you so much for taking the time. Great story. I'm sure there's probably several episodes that I'd love to do about this in terms of the background. Yeah. Scratches certainly. I know but it's important service and like I said I think that this is a really important conversation for anyone in the cannabis industry at any level is to really understand this facet of it because I think this is you know this is really the root of many of the good historical kind of history of cannabis in terms of you know the politics and regulation and the legal side of it understanding this and understanding where we are it's going to be important for anyone in this space to really appreciate it. And I look forward to kind of staying in touch and seeing how this all plays out for all of us.
[00:31:56] Well really nice chatting with you and thank you for having that your podcast.
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