Your Highness Podcast

The Complexities of Cannabis Use Disorder

Episode Summary

Dr. Peter Grinspoon joins Diana to talk about his new book and discuss the complex nature of medical care and cannabis use.

Episode Notes

Dr. Peter Grinspoon joins Diana to talk about his new book and discuss the complex nature of medical care and cannabis use. 

0:16 - Welcome to Your Highness Podcast

1:46 - Fave Pot

4:45 - Fave not Pot 

6:46 - Main Segment 

23:45 - Calls to action 

26:00 - Where can people find you?

27:30 - Wrap up and goodbye

Important links:


The Healing Rose

Episode Transcription

Speaker 1  0:16  

You're listening to your highness podcast. I'm your host, Diana Krach and today I am joined by Dr. Peter Grinspoon. He is the author of seeing through the smoke, a cannabis specialist untangles the truth about marijuana. How're you doing today? Dr. Grinspoon


Unknown Speaker  0:36  

doing great, thank you. How about yourself?


Speaker 1  0:39  

Good. I'm glad that we're finally getting the chance to talk. Did I say your name correctly? I didn't even ask before.


Speaker 2  0:46  

You're actually one of the few people in human history that that didn't mangle my name. So I'm very impressed. Really? Yeah, no, I try. So I've had a patient who 10 years and she called me moonbird. Recently, instead of Dr. Grinspoon and I've been her doctor for like 10 years was pretty amazing.


Speaker 1  1:08  

Isn't it funny when people just come up with like, their own interpretations of your name? And you're like, Okay, that was so wild. I'll just let you run with it.


Unknown Speaker  1:19  

I was impressed. So


Speaker 1  1:20  

anyway, we're going we're going to start this episode as we do every episode with our recurring segment, vape pot, favorite pot. And we talked about our favorite cannabis related item, movie, TV show, whatever it is, and our favorite non cannabis related item and mine are both cannabis related today. I actually am going to make my fav pot, your book. And again, it's called seeing through the smoke, a cannabis specialist untangles the truth about marijuana. And I haven't been able to get through all of it yet. But everything I've read so far has been so interesting, and it resonates. So hardcore with me, I am just in love with the fact that this is out there in the world. Thank you for your hard work on this. And can you tell people where it's available?


Speaker 2  2:19  

Sure. The book seen through the smoke, you know, we're trying to figure out what's true and what's not true about cannabis? You know, obviously, I'm very have a lot of experiences, both personally and professionally. That makes me very eager to see cannabis legalized and available to medicinal patients and legalized recreationally, which is why I wrote the book to give people good information about this. And it's available in most bookstores people are seeing in airports, it's in the local bookstores. You know, if it isn't, you can certainly ask your local library, your local bookstore to order it. It's also available on Amazon or all the online bookstores, or on my website, Peter So it's pretty easy to get.


Speaker 1  2:58  

I love that you mentioned libraries because I feel like people don't think about that enough. Your local library is such a resource. And that that goes in so many different directions. If you have a book that you wrote, ask the library if they can carry it ask what the procedure is. Anyway, so what's your favorite pie right now?


Speaker 2  3:18  

Well, my favorite marijuana or cannabis related item, I think is my dad's book, marijuana reconsidered. My dad in 1971, as a psychiatrist at Harvard really did a deep dive into cannabis. He was originally thinking what are all these kids doing smoking this drug, and he ended up coming out in favor of legalization in 1971, with his book saying like, of course, there are some harms of cannabis that are harms with everything but the harms of criminalizing it are so much more than the harms of using it and to come out with that book in 1971 when only 12% of Americans supported full legalization now 69% Who was very, very brave, and it really gave a lot of intellectual credibility and firepower to the legalization movement. So that's my favorite cannabis related object. I was gonna say the Dr. Grinspoon strain because it's named after my dad and it's kind of cool to have a strain named after a family member, but I'll stick with his book. So


Speaker 1  4:17  

how cool is that? That is amazing. I love that story. I mean, I've already done some research into your father but I haven't read the book yet. So that's next on my list after I finish your book. That is such a cool story. I love that. So I feel like anything I come up with I know that you're going to come up with an amazing fav not pot as well so I'm breaking my own rules and making mine both kind of cannabis related. Mine is the healing rose CBD organic CBD lip balm and coconut flavor. The healing Rose is one of my all time favorite CBD brands and Laura Boehner has been on the show before, she's an amazing person. So definitely check out the healing rose, I only have to use it twice a day. That's pretty major for lip balm. What is your fav, not pot right now?


Speaker 2  5:13  

I would say my favorite pot. And I'm not just trying to be promotional here, my first book free refills, really talks about my journey, getting addicted, and all the stigma and all the damage and all the harm. And then about my process of getting through recovery, I actually lost my medical license for three years, because of a vicious addiction to prescription opiates, which doctors are really susceptible to because they have access to when they you know, nobody really takes care of them. There's a lot of stigma. And I learned so much about addiction and about taking care of people with addiction. And it really helps my understanding of cannabis. Because my chapter in my new book seeing through the smoke, I mean, I just don't think the addiction, people understand addiction as well as I do, having been in the cannabis community and having been through an addiction and having treated a lot of people with addiction. So I really think my first book and my Which reminds me, sort of to embody all the qualities that you need to overcome an addiction, which is sort of gratitude and humility and in mindfulness. And I think that's really my favorite non cannabis related issue.


Speaker 1  6:20  

I love that. And I mean, the fact that you're being so open about your experience, and you have been it's just, it's revolutionary, because like you said, there the stigma is so thick already for patients, but then for doctors, I can't even imagine. That is that is very meaningful. And I'm definitely going to check that book out. Alright, so that just leads into what we're talking about today. I've been a fan of your work for a long time. And I'm beyond excited to talk to you today. And I'm trying to figure out which topic to talk about because there's so much but what I really would love to have you dig into more is cannabis use disorder. So what is a common misconception? Or something you wish people knew about cannabis use disorder?


Speaker 2  7:13  

Well, cannabis use disorder is the series of criteria that the psychiatrists use to define cannabis addiction. So cannabis use disorder and cannabis addiction are sort of synonymous. And I think both sides of the issue the pro cannabis people and the anti cannabis people both have misconceptions about cannabis use disorder. So that's a great question the pro cannabis, people tend to think cannabis isn't addictive, and to dismiss cannabis addiction and in fact, it can be addictive and just like any other addiction that can really take over someone's life and needs to be responded to with empathy, understanding and high quality treatment. So I think the fact that cannabis can be addictive and can really derail people's lives, is one misconception. On the other hand, the anti cannabis people are really exaggerate how many people are addicted to cannabis, the criteria for cannabis use disorder cannabis addiction, you only need two out of 11 criteria to qualify. And for example, one of the criteria is tolerance. And another of the criteria is withdrawal. Now, when we prescribe opiates to people medicinally we don't include tolerance or withdrawal. Because everybody who uses opiates, medicinally has tolerance to the medication and gets withdrawal when they stopped taking it. So 100% of our opiate patients would be addicted to opiates if we included those why Ropin and pathologize. All these medicinal patients for no profit, no reason yet with cannabis. Due to stigma due to the drug war, and due to like old fashioned sort of anti cannabis thinking, in my opinion, I go over this very, very meticulously in my book. That's a very controversial but hard hitting chapter about cannabis addiction. I think that the psychiatrists are by including tolerance and withdrawal. The Aussie us think things like cravings. No, these are things tolerating withdrawal you get with your benzodiazepine with alcohol with your antidepressant and, you know, most medical cannabis patients have tolerance and withdrawal. So the way cannabis use disorder or cannabis addiction is defined ropes in needlessly and needlessly pathologize as many of the medical cannabis patients and they act by doing so they exaggerate the numbers of cannabis addiction. And you know what, you wonder why they do this? Is it just not understanding cannabis? Or is it because they've been on the anti side of all the legalization debates, and this was a good weapon to use. Oh, look, 30% of adult cannabis users get addicted to it. I mean, the the number we don't know because our our definition is broken, but it's probably like two to 5% It's not 30%. You know, Dr. Lena Wen just had an op ed in The Washington Post a week ago saying 30% of American adults get addicted to cannabis. That's because of these. Like really flawed and overly broad criteria and, and when you give someone a definition of addiction and they don't have an addiction, you're harming them. There's a lot of stigma. People don't get treated as well by their doctor, if they see the word addiction, they don't get pain medications. We need to change how people with addiction are treated, which is what my first book was about. But we need to not be diagnosing people who don't have an addiction with an addiction, including and especially to cannabis, if you're a medical cannabis patient. So I think it is addictive. It's just not nearly as addictive as the psychiatrists say it is we need to have much better criteria so that we're not roping in people who aren't addicted, but we are helping people who are addicted. And then the final thing I'll say, having been addicted to opiates, the the quality of the cannabis addiction is different than the quality of for example, an opioid addiction. Nobody's like robbing pharmacies, or injuring themselves to get opiates. It doesn't like take over your life, the withdrawal symptoms for cannabis. If you're a heavy user, and you stop it or you know, you're grumpy, you know, sleep well. It's hard to eat. They're bad, they're noxious, they're uncomfortable, but they're not like the soul crushing withdrawal symptoms from opiate use disorder. They cause people to do these desperate things. And you don't die from them like you would from an addict. Withdrawal from alcohol or from benzodiazepines like Valium. So I think we need to accept the reality of cannabis addiction but put it in context and not exaggerate it. So we're not actually harming people by over diagnosing it.


Speaker 1  11:26  

Can you talk about the difference between physical dependency and addiction?


Speaker 2  11:34  

Absolutely. I mean, it depends with the definition of addiction keeps evolving and the most recent one, they had, you know, physical dependency, and they merged them all together to kind of make it to make it simple. But physical dependency for cannabis is, you know, we have cannabinoid receptors in our brains. And we have natural cannabinoids that mediate so it's called the endocannabinoid system and we have these natural endocannabinoids like natural cannabis like molecules that mediate so many different things that her body like mood temperature, learning, feeding reproduction. It keeps her body in homeostasis or control. The endocannabinoid system really controls all the other neurotransmitter systems. And if you use cannabis very heavily every day, your natural cannabis receptors thin out. It's not permanent damage. It's not a permanent change. They grow back after a couple of weeks, but they certainly thin out. That's why people need more and more cannabis or to use it more frequently. To get the same effect. I've certainly experienced this I'm sure a lot of your listeners have experienced that. The problem is if you were to use cannabis everyday heavily, and then to stop abruptly, your natural cannabis like molecules, your natural endocannabinoids have very few receptors to work on until they come back over the next couple of weeks. So your natural cannabinoid system is out of whack. And you can experience as I mentioned before, a very difficult time sleeping very a lot of grumpiness and anxiety. poor appetite for a week or two until your natural cannabinoids come back. So when people take a tolerance break for a week or two, they the cannabis they use works a lot more efficiently because your cannabinoid receptors are back. So that's a physical dependence like you just feel bad in those ways for a week or two until your body re normalizes. Now, the psychological dependence is a lot more complicated. I mean, a lot of people really need something at the end of the day, it would be perfect, wonderful if at the end of our day, we all did yoga, meditated, ate tofu, whatever Dudley's like super healthy things and didn't eat anything but but a lot of people just really like or need something at the end of the day, and the only legal option has been alcohol. And I really think that now there's going to be illegal choice between alcohol and cannabis, people are going to find not only is cannabis, less fattening, it doesn't have like all the calories and all the carbohydrates. But it doesn't really give you a hangover, but I suppose sort of more interesting and less harmful for you and more relaxing and I think a lot of people are going to be switching from from alcohol to cannabis is going to be really interesting to see. And, you know, with any drug again, or any medicine, there's no free lunch, and then people can become dependent on it, either physically or psychologically, you know, which is not a good thing. But again, that's what harm reduction is all about. If they're ideally again, nobody would need anything but every single society in human history is used things to change or enhance their consciousness and it will be a big harm reduction when if people start transitioning from alcohol to cannabis.


Speaker 1  14:38  

Right? So basically if you're in chronic pain, and the cannabis is relieving the pain, let's say you use RSO every single day but you use a small amounts. Then one day you don't use that and you don't use everything, all the other things that you use to help your pain. Then your body isn't in homeostasis any More. So physically, you have a reaction. Like, I'm just trying to decipher between that and terming it withdrawal because I feel like as someone who has so many issues, health wise, if I don't keep up with everything that I do every day, my body revolts. So how does someone explain that situation without using the term withdrawal, or


Speaker 2  15:27  

addiction? Absolutely, well, your body gets used to it. And you know, the more you use, the more your body gets used to it, if you were using a large dose of Rick Simpson oil and stop abruptly, you would feel worse than if you were to use a small dose of Rick Simpson oil every day. And you were to stop. In fact, if we're a very small dose, your body wouldn't even notice. But again, with any medicine or drug, recreational, we try to keep the doses low because of and I'm using the word you told me not to use tolerance and withdrawal like it just doesn't work as well. And you need more it cost more, and it's worse for you. So, you know, again, I'm not anti cannabis at all, it should be illegal, I use it all the time as a medical doctor. And I have every single right to use it recreationally as long as they're not harming other people. But if you keep the doses low, there's so many people that are counsel for cannabis, who just want to get their doses down because they find themselves using more and more and more and more and more. It's and again, it's more expensive. If you smoke, they're always coughing and wheezing. And that's because your body just gets adjusted to it. So if you take tolerance breaks, like twice a year, take two weeks off. Or if you make a concerted effort to keep the doses low, it's just a healthier way to use it. And again, I'm not against cannabis at all. I'm just as a doctor,


Speaker 1  16:48  

your instinct, right? You're a doctor. But you're not full, like my next question is, what about how doctors are? What would you? What advice would you give to people who are visiting their primary physician or whatever health caretaker, who is not considering what they're using as real medicine or real treatment option, but it's something that has gotten them off of opioids or other harmful pharmaceuticals. Like my doctors, for instance, in Maryland, every single doctor I've seen here, doesn't even write down the list of supplements that I take including CBD or cannabis or kratom. They come in with a whole list and they just go Oh, so you take vitamins. Like they, they don't even put it in my chart most of the time unless I insist on it because I have drug allergies. And I think that it's important to have things like that on your in your record, right? How does someone combat that sort of situation when they're in a state that is not adult use yet? Or even just embracing the idea of cannabis and plant medicine?


Speaker 2  18:01  

That's a great question. It's actually a really complicated question. Like you just asked, like, the most complicated question there is, and I will try to answer it so sorry. No, no, it's a great question. First of all, you have to be careful what you ask for. Because until just a couple of years ago, for example, there is no way for doctors in our medical electronic medical record, which is the whole medical record, to denote or indicate cannabis use without the words cannabis misuse, cannabis abuse, or cannabis use disorder. So it got really pathologized because of the way in which doctors documented it, you know, it was asked for and then we got now we can say medical cannabis patients. So if you would ask your doctor and they actually did what you asked for eight years ago, you would have had a diagnosis and that computer is cannabis use disorder. That's another way they the psychiatrists and some of the epidemiologists and make a living coming up with all these anti cannabis studies over and over again, inflate the rates of cannabis addiction, getting to the earlier question. The only way to put it in the medical chart was cannabis use disorder, then they look at something else. And there'd be like, Look, 90% of people with X have cannabis use disorder. And the only reason it looks like that is because that was the only way to put it in the computer. Now, studies show that most people want to get their information about medicinal cannabis from their doctors, but very, very few people do because doctors don't know anything helpful about cannabis. The one of the most hard hitting chapters in my book, seeing through the smoke, my new book is called doctors are supposed to do no harm. That's the oath that we all take is called Dubey. No harm. And it's about how doctors have been on the wrong side of the war on cannabis. Interestingly, doctors used to prescribe cannabis very freely in the 18th century in the first part of the 19th century in this country until was criminalized and one of the leading voices against criminalizing cannabis was the American Medical Association doctors were very pro cannabis but then under withering pressure from the government In the war on drugs, the doctors completely flip sides, they abandon their patients. And they just started repeating all the drug war nonsense about cannabis for the last 50 years. And so what we were taught in medical school is just vaguely, it's a drug of misuse, it doesn't have medical benefits. And currently the endocannabinoid system, which we just talked about, is only taught in 13% of medical school. So doctors know very, very little, that's helpful about cannabis. As a consequence, patients can feel very uncomfortable talking to their doctors. That is a very dangerous situation, because your doctor needs to know if you're on CBD. CBD is perfectly safe, except that it can interact with other drugs and raise the level of other drugs in your body. In the same way that grape produce cancer, you need to tell your doctor that you're on CBD, cannabis has some medicine interaction. So doctors have to do a much better job at creating a climate where patients can feel comfortable talking about their cannabis use, they need to document it like any other medication. And they need to learn a lot more helpful and practical information so that they can help advise patients. All they do right now is complain that patients talk to bud tenders. And it's true, the bud tenders shouldn't be giving medical advice. But the doctors can't complain about this if the doctors don't know anything about it, and can't help the patients at all. So we need humility on the part of the doctors, we need education on the part of the doctors so they learn enough to help patients and the patients have to advocate for themselves and bring it up even if a doctor is a little bit dismissive or critical. The patients have to make a good faith effort to let their doctors know about their cannabis use and their CBD use like you did, which I really admire you for because otherwise, what we get is what we have now, which is sort of two parallel systems, the medical system, we get your blood pressure medications and your cholesterol medications and a different system where you get your THC and your CBD and they don't communicate with each other at all. And that's really dangerous. So all parties involved, need to do a better job like you did and communicate. And the most important thing is good, complete, open, honest communication between doctors and patients. If we don't have that it could turn out to be a disaster. So I told you a complicated answer.


Speaker 1  22:11  

No, that's a great answer. And I've heard of people bringing, you know, studies and things like that to their appointments and changing doctors minds. And I actually even interviewed one of these doctors, he had kind of a public profile a few years back. And he had been anti cannabis staunchly. And you might even know who I'm talking about. I can't remember his name right now. But he did like some TED talks about it. And said that this woman came in was like, read this and then basically get back to


Speaker 2  22:40  

me, David, what's his name? Yeah, no, exactly. Yeah, he's, he's really, he seems really good.


Speaker 1  22:45  

But I don't have those experiences. I bring the stuff in. And they're like, that's nice. Anyway. I mean, I think it's even more difficult now, like after everything we went through collectively, in the last few years for health care workers to be able to take the time and listen to you. But like you said, it's absolutely needed. I mean, even before people started becoming more aware of plant medicine and the possibilities, we still have this communication gap in the healthcare system, right? Like, if you're seeing one specialist, that specialist isn't talking to the other one, and it goes like that for, for on and on and on and on. So it's such a broken system. It's almost like how can we really repair it? Well, people like you are a start, that's for sure. Having having this book out there in the world. That's a that's a start for sure. So how can people support you? And like, Do you have any calls to action as far as this book and just education in general when it comes to, you know, arming yourself as a patient?


Speaker 2  23:58  

Well, doctors are getting there, but patients are way ahead of doctors. And in this particular issue about medical cannabis, the patient's 94% of Americans are now in favor of medical cannabis name, anything else that 94% of Americans agree with a degree on who would have thought cannabis would be like the great uniter my dad would be so happy to see that doctors are getting there, about two thirds of them believe in the cannabis is a legitimate medicine. And unfortunately, doctors get a lot of good information and a lot of bad information. This is like this hardcore small subset of psychiatrists that is going to be putting out anti cannabis nonsense to the until the end of time. And the doctors are sort of exposed to that as well. So there's a little bit confusing, you know, people can give doctors a copy of my book, my book goes over all the harms, all the benefits, all the latest science about what is harmful, what isn't harmful. How can it be beneficial? How can it not be beneficial that people think about so you know, you buy two copies of the book, one for yourself and one for your doctor? But I think it's really important. I think the reason that doctors are evolving on this issue in the right direction is because they're under a lot of pressure from their patients to get it right. And to know something about it and to be helpful, and to be a trusted, non judgmental, helpful partner. So the more people can continue being brave, speaking up, being open about how cannabis does and doesn't help if you had a bad experience to your doctor as well. That's how doctors learn, you know, some drugs, penicillin house, most people, some people have a terrible reaction to it, we need to know about that. So if you take cannabis companies, it is enough to let your doctor know that as well. But again, bring them studies, bring them a copy of my book, talk to him about your use, and have expectations for them that they know about this and that they're a helpful participant in your care it. It's all heading in the right direction because of what people like you are doing. Probably people like you and me, educating the doctors, but we need to keep going. Because we're getting there. But we're not there yet.


Speaker 1  25:55  

Still a lot of work to be done. And I appreciate all the work that you're doing. And so just again, really quickly, is there a place that people can find you where I know that you're very active on LinkedIn. But where where can people find you?


Speaker 2  26:13  

Oh, it's easy. Just my website, Peter And you spoke Grinspoon grin like smile spoon, like fork, and there's a Contact Me button. So if people have questions, please send me a question. I'm happy to answer it.


Speaker 1  26:26  

I love that I just, I just love everything about you. It warms my heart so much seriously, when I see a medical doctor being like this active in trying to change the conversations and actually advocate for the patient. And it's, it's, it's, it's very special. I'm just like at a loss for words, honestly, because I'm such a fan of you. And I want you to come back. Anytime, please. I know there's so much more to talk about. This was just a little, a little preview.


Speaker 2  27:04  

I'd love to come back anytime. And I love I love your questions, and I'm really enjoying the conversation, you know, you can help as many people more people as the doctor by educating people, then, you know, I could see like, what 510 15 patients in any given day. But if there's an issue that that people were just not educated on, you could help millions of people. So it's just a caregiver giving different, it's just a different way of looking at caregiving, right?


Speaker 1  27:29  

I think this is the most important Well, obviously, there's other. But I think this is so important. This is because when you're going and seeing different, you know, patients all day, like when you have a whole list of patients that you have to see, you also have to adhere to the insurance guidelines and the scheduling restrictions. And so you know, you're getting maybe 15 minutes with somebody and you know, this is this goes beyond I mean, you're changing generations. So thank you. And like I said, Please come back again. And until next time, stay high and beautiful.


Unknown Speaker  28:12  

Thank you so much.


Speaker 1  28:14  

This episode of Your Highness podcast is brought to you by Nietzsche meter is giving listeners a 10% off discount when they use the code YH pod. That's why H pod at Mitra, a top rated kratom company. Also, you can keep up on the recent events and all the news surrounding our show by subscribing to our substack Your Highness newsletter. This episode was edited and produced by James crash and myself Diana crash and is a production of Your Highness media. intro music is brought to you by your mom likes my music. Thank you for listening


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