Latest / The Permission Slip / S2 | E13 Dr. Peter Grinspoon
Transcript
- SE • E13 - Grinspoon === Matt Kosterman: Just gonna introduce you from your bio here that I grabbed off your web, off your, off your webpage, if that'll work. All right Dr. Peter Grinspoon: Of course Matt Kosterman: Hi, it's Matt, and I'm back with another episode of The Permission Slip. Today I'm with Dr. Cr- Peter Grinspoon. Dr. Grinspoon's a primary care physician and a board-certified addiction specialist at Massachusetts General Hospital. In addition, he's an instructor in medicine at Harvard Medical School. He has over 25 years of experience specializing in addiction treatment and cannabis medicine, otherwise known as weed or pot. A popular speaker, um, he's, he's often featured in the national media and, and, uh, we're here today to discuss, uh, topics really of cannabis addiction, uh, and, and, and all, all the things related. So welcome, Dr. Grinspoon. Thanks for being here. Yeah, you bet. Dr. Peter Grinspoon: Thank you so much for having me Matt Kosterman: so, I mean, let's just jump in. Let's just get a little, little, little background. Matt Kosterman: This-- You're actually the most, um, you're probably the most, uh, mainstream guest that I've had on here in terms of, of your credentials and your, your work, which is, um, amazing and a high calling into medicine, and not just medicine, but at the top, top of the game, uh, with Harvard and, and all the credentials. Matt Kosterman: But, I know from reading your newsletters, um, you've had, uh, your own share of struggles Dr. Peter Grinspoon: Absolutely. Uh, we all have, but, um, I, I can go into more detail. I- 20 years ago, I got v- very addicted to prescription painkillers. It was a really difficult time in my life. Uh, you know, I actually lost my medical license for three years. Then I, then I found a way to, to overcome the addiction, and it was really interesting. Dr. Peter Grinspoon: I was hired-- The group that drug tested me for five years and really monitored me was called the Physician Health Service, part of the Mass Medical Board. And five years into my recovery, they hired me to, um, to help other physicians. So I was sitting at the same table, just on the other side of the table, helping other doctors with their addiction. Dr. Peter Grinspoon: So I had the privilege to, to help other doctors, and now I'm addiction certified, and in addition to being a primary care doctor, I work at the addiction clinic in my hospital. Matt Kosterman: what do you attribute the slide into, I mean, like you said, we all have our struggles. What, what, were you, were you... If I recall from your newsletter, was it just, like, the pressure of the work? Uh, looking for an outlet? Dr. Peter Grinspoon: Absolutely. It was the pressure of the work. Uh, I wrote a memoir about it to try to de-stigmatize addiction. Anybody can get addicted and, you know, we need to help people, not judge and discard them. Uh, my memoir is called Free Refills because doctors have such access to medications, and we also have such pressure. Dr. Peter Grinspoon: You know, I was working 100 hours a week as a medical student and then as a resident, and I was just in an unhappy time of my life. And I, I really feel that in addition to a lot of other factors, uh, addiction, if you're not getting your needs met in a healthy manner, you're much more susceptible to addiction Matt Kosterman: and, and you actually come from a, a, a lineage of doctors and marijuana advocates Dr. Peter Grinspoon: Yeah, no, absolutely. My father was a, a very legendary psychiatrist. He wrote a book in 1971 called Marijuana Reconsidered, a really influential book. It was reviewed on the front page of The New York Times Book Review, and he was saying that, you know, of course cannabis has its harms, but the harms of arresting and criminalizing people are so much worse than the harms of cannabis, and that we should be regulating it and educating people rather than arresting people. Dr. Peter Grinspoon: Since he wrote that book, 20 million Americans have been arrested s- for simple cannabis possession, mostly people with Black and brown skin. It's been just awful, and at the same time, uh, support for legalization has been rising and rising and rising, and now it's legal medically in 40 states and recreationally in 25 states. Dr. Peter Grinspoon: So it's just been a really, really interesting issue with a lot of, you know, very positive momentum and a lot of horrible things that have gone on during the war, war on drugs. Matt Kosterman: reading if it was Haldeman or Ehrlichman on the Nixon administration that admitted on their deathbed that they criminalized marijuana n- not because it was bad, but because it w- it enabled them to target people with Black and brown skin with law enforcement. Matt Kosterman: Ehrlichman. Dr. Peter Grinspoon: Yeah, I believe it was Ernest Finn, yeah. But it was just so nihilistic. I, it was, it was kind of, like, amazing that he actually admitted it, but it was, like, really nihilistic. They didn't really believe that cannabis was bad. They were just using it to torture, you know, African Americans and, and people that opposed the Vietnam War. Dr. Peter Grinspoon: It's really awful Matt Kosterman: uh, the LSD and the psychedelics. They couldn't go after the hippies directly, so they targeted their source. Yeah. Dr. Peter Grinspoon: A- absolutely. And now look at it today, like most people are in favor of psychedelics. Most major academic medical center, the one in my hospital has a center for psychedelic research. It's so amazing how that issue has changed over the last 50 years Matt Kosterman: is to make just more people aware of this fact. It's, it's interesting, I, I always bring it up with people when I'm, you know, just in conversation 'cause it's been a, such a big part of my own healing, and it's in- it's amazing the, the, the spectrum of people who are, "Oh, yeah, I think that microdosing thing is catching on." Matt Kosterman: I'm like, "Yes, it, it is, and more." Dr. Peter Grinspoon: I'm not really supposed to say this as a doctor, but it, it has been Matt Kosterman: I saw you were Dr. Peter Grinspoon: a big part of my healing as well Matt Kosterman: over in Spain looking looking for some, some enjoyment. Uh Dr. Peter Grinspoon: Well, you know, curiosity killed the cat. Uh, you see a big... You're a cannabis specialist. You're in Barcelona. You see a huge sign that says cannabis. Are you gonna walk by or are you gonna poke your head in? Matt Kosterman: Yeah, which... Dr. Peter Grinspoon: Of course. Matt Kosterman: Excuse me, sorry. Um, yeah, it's, uh, it- it's fascinating. I mean, m- neither marijuana nor, nor, uh, psilocybin mushrooms have killed anybody on the planet in as long as we have, ha- have known, you know, directly from being poisonous, and yet they're so vilified. What's your, what's your take on that? Dr. Peter Grinspoon: Well, it's interesting. They, they recently came out with a list of like a ranking of the dangerousness of all drugs, and they divided it into like harm to self, harm to society. And of all the drugs, of course, the top ones were like alcohol was number one, and fentanyl and methamphetamine. In the middle was cannabis. Dr. Peter Grinspoon: I don't think it's quite as dangerous. It has harms as they, as they portrayed it, but right in the middle. The lowest drug of all the drugs they considered were, Matt Kosterman: Yeah. Dr. Peter Grinspoon: psilocybin mushrooms. Really amazing Matt Kosterman: you can, you can walk into a liquor store and you can fill your pickup truck up by just flashing your ID with as much as you want, and yet you have to get it scanned and you have-- you're limited to how much cannabis you can buy and m- magic mushrooms, unless you're in Colorado or Oregon, forget about it Dr. Peter Grinspoon: Yeah, they're Schedule I, which means according to the government, no medical utility and high abuse liability. They don't have high abuse liability. You have to be careful. You have to be educated. You have to do it in the right set and setting, and they, they certainly unquestionably have always had medical value. Dr. Peter Grinspoon: So the government needs to sort of, uh, really update itself very drastically, uh, from the drug war sort of mentality where they just locked away all these medications. Matt Kosterman: what's your, what's your take on s- you know, so what are the benefits of, of cannabis? What, what, what have you found were the benefits? And we'll talk about some of the potential harms. Dr. Peter Grinspoon: Sure. Well, the benefits are, you know, certainly, uh, it helps people with, who have cancer with chemotherapy-induced nausea and vomiting. I had a older brother, Danny, who unfortunately passed away from childhood leukemia when I was eight years old, but my parents got him medical cannabis in the early '70s, you know, right when Nixon was starting his war on cannabis, and it was so amazing to see my brother before and after cannabis. Dr. Peter Grinspoon: Without cannabis, he'd just be, like, lying alone in his bedroom, barfing into a trash can. When he used cannabis, he could eat, he could maintain his weight, and he could, most importantly to me, go down and play with his little brother. I mean, it's like unquestionably helps people with cannabis, with nausea, vomiting, tolerate chemotherapy, with anxiety, with insomnia. Dr. Peter Grinspoon: But the main uses I see it for as a cannabis clinician are pain, uh, really good for pain. Uh, it doesn't work for everybody. Some people don't like the feeling. Some people it makes too sleepy. Uh, some people it makes too anxious. But generally speaking, especially senior people, which is why my most recent book is about how seniors are using cannabis. Dr. Peter Grinspoon: It's called Aging Well With Cannabis. Seniors in particular are using it for pain. You know, as you get older, your back, your knees, your hips become arthritic, and the alternatives we have for pain are pretty toxic. Like, the ibuprofen will kill your kidneys and give you an ulcer. The opiates, you know, get addicted. Dr. Peter Grinspoon: You get constipated. You will fall. So people are finding, in a harm reduction sense, that cannabis can be a very much safer alternative, for example, for chronic pain, than many of the traditional pharmaceuticals. The same could be said for in- for insomnia, for example. Cannabis is obviously safer than, like, Valium, Benadryl, Ambien. Dr. Peter Grinspoon: So I would say chemotherapy-induced nausea, vomiting, chronic pain, insomnia, anxiety, spasticity for people with multiple sclerosis, uh, colitis, uh, fibromyalgia. There, the list goes on and on, but those are the big ones. Matt Kosterman: about people going on Amazon, uh, when they're, like they do in the middle of the night on, uh, on Ambien with weed. Dr. Peter Grinspoon: No, no, Ambien Matt Kosterman: it's Dr. Peter Grinspoon: is really dangerous. People drive on Ambien. They have not a word they're dri- They wake up on Ambien after they're, there are like, you know, wrappers scattered around the kitchen, and they're like, "Who raided the, you know, fridge?" And then they realize it was them on Ambien, and they have these, like, amnestic dissociative states. Dr. Peter Grinspoon: And you don't get any of that with cannabis Matt Kosterman: It's just, uh, you just go to sleep harder. I do find-- I, I, I, I took, uh... I fortunately had a, um, have a, uh, uh, um, concierge doctor and have had for going on 10 years now, and when I was going through my chronic pain, I was basically nearly fibromyalgic and had pelvic floor disorder and, and it was, it was medical legal in Illinois at the time. Matt Kosterman: It's since become fully legal. And I was fortunate to be... You know, she prescribed me, uh, cannabis, and I was able to go to the dispensary and get some. And I found it, it-- while it didn't get rid of it, it definitely dulled things, um, and allowed me to sleep, uh, and was a whole lot better than, um... Gosh, what's the stuff that-- Lyrica, that, that they tried to give me? Ooh. Oh, man, Dr. Peter Grinspoon: Lyrica's Gabapentin, they're very similar. Matt Kosterman: Oh, just blah. Dr. Peter Grinspoon: Stuff that makes you feel brain dead and groggy the next morning. Yeah. That's where cannabis really excels with, like, pain. It, uh, it dulls the pain, but it also affects the part of your brain that says, "This pain is unpleasant." So people say, "I feel the pain, but it's not bothering me as much." Dr. Peter Grinspoon: And because the pain isn't bothering them as much, they start returning to the activities that they enjoy. Then when they're doing the activities they enjoy, they're not thinking about their pain. So it really is good for pain. It's funny that I still... I'm glad your doctor was enlightened. Doctors are coming along. Dr. Peter Grinspoon: They're getting there. We still have these, like, you know, uh, some psychia- addiction psychiatrists bunkered from the 1970s that still think, you know, they... Reefer Madness is, was a documentary, and they, they just think cannabis is, like, the devil's... Look, cannabis does have harms, but you just can't deny that it helps people with chemotherapy, it helps people with anxiety, Matt Kosterman: won't it Dr. Peter Grinspoon: insomnia, and chronic pain Matt Kosterman: their hips are hurting and their back is hurting that they'll turn to cannabis? Dr. Peter Grinspoon: I actually know one or two that were just so against it and gave me such a hard time. Uh, friendly, we're friends. We're allowed to disagree. Friends are allowed to disagree, and now they're turning to cannabis, and, you know, they're a little sheepish about it because they gave me such a hard time. But I'm happy that they're humble enough to, like, change their opinions. Dr. Peter Grinspoon: I really respect that in people, and I'm just happy that they're finding relief from their suffering Matt Kosterman: I, I first smoked, uh, I first smoked weed when I was about 12. grew up, uh, at the time in Madison, Wisconsin, and my buddy and I, he s- he, he swiped some from his older brother, some ditch weed, and we, you know, I think we got a toilet paper tube and some tinfoil. And we went into the woods and got a little high a few times, and then my parents found out, and I got in trouble. And then for years, my brother, my younger brother's been a big advocate of, of all the plant medicines and, and, and I was that straight-laced, you know, "I'm gonna make all the money. I'm gonna be the business guy," and, know, "We can't have any of this drug stuff. Matt Kosterman: It's bad." So I, I mean, I bought into the, I bought into the talk, and I'm, I'm glad, I'm, I'm very, very glad that I changed, uh, my position on it, uh, 'cause it's, all, all of the medicines... Yeah, I mean, they've been life-saving literally for me Dr. Peter Grinspoon: Eight people Actually, ironically, the cannabis can help people grow and change. Again, this is something that most doctors wouldn't say, but it can give you insight. It affects your brain. It can, it does some things that are detrimental to your brain. It can temporarily affect your short-term memory. Dr. Peter Grinspoon: Memory comes back. You don't remember quite as much of the conversation at the party if you got high. But it also gives people creativity and insight and introspection, and it can help them sort of evolve their, their thinking about, about issues. It's really... I talk about this in both my books on cannabis, about how the, it's not just medical, it's lifestyle enhancement, and it can really help people think, feel, work through problems, appreciate nature, be mindful, connect with other people. Dr. Peter Grinspoon: There's a lot more to it than just pain and insomnia. Uh, but again, this is sort of a taboo subject. It's getting a little easier to talk about, but it's, I'm definitely, like, on the, on the fringe in terms of, like, mainstream medicine. Matt Kosterman: gets your license pulled again, 'cause that's not That's Dr. Peter Grinspoon: I'll take the homeboy lessons for that. Matt Kosterman: Right? Dr. Peter Grinspoon: But don't Matt Kosterman: When you Dr. Peter Grinspoon: give him any ideas. Matt Kosterman: you know, creativity and stuff, I mean, look at Willie Nelson. How long a- how long has that guy been smoking cannabis? Y- y- yeah Dr. Peter Grinspoon: Carl Sagan. He wa- he was like, I think, brilliant. He like won Pulitzer Prize, bestsellers, and he used cannabis. He, he has a long essay on how cannabis, uh, deepened his creative and, um, scientific process. Really, really... Which was actually in my dad's book, Marijuana Reconsidered, in 1971. But at that time, he was, it was signed in my dad's book, if you read it, as Mr. Dr. Peter Grinspoon: X, uh, because he didn't want to lose his NASA grants. And then when he died in the early 1990s, my dad told everybody that Mr. X was Carl Sagan, and you could just look up Carl Sagan essay cannabis, and it's really, really brilliant essay on how it can improve your scientific process. And it, or your, your creative process, and it generates a lot of ideas that you write down, and the next day when you're, not how you edit it, and some of the ideas are ridiculous, and some of them are really helpful, and they're ideas you wouldn't have thought of normally. Dr. Peter Grinspoon: I, I've used that in the past in my writing. It really can help Matt Kosterman: are you, are you a regular user or just frequent- like weekends? Okay. You Dr. Peter Grinspoon: Well, um, I'm gonna plead the fifth on that. No, I'm kidding. I, I got run over by a car three years ago and had a gruesome break to my leg, and I, I, I used, uh, cannabis instead of opiates. Opiates obviously for the first week. The pain was extreme. But I definitely used cannabis instead of opiates, and I, I don't think anybody would argue that cannabis is, i- isn't, y- is more dangerous than opiates. Dr. Peter Grinspoon: So I've used it, and, you know, if I can't sleep and I'm in a lot of pain, you know, I, I might take a gummy. I don't, I don't use it a ton Matt Kosterman: creative boost for your newsletter or your Substack, you know. Dr. Peter Grinspoon: Well, I am writing a novel and I, you know, it certainly is gonna play a role in, in the novel. Matt Kosterman: two books Dr. Peter Grinspoon: Yeah Matt Kosterman: uh, three, three nonfiction. Dr. Peter Grinspoon: Three nonfiction books. My first was my addiction memoir. Then there was Through the Smoke in 2023 about the true harms and benefits of cannabis from a really centrist position, and then the recent book about cannabis for se- for seniors. Dr. Peter Grinspoon: But I've had enough nonfiction, and I'm gonna try fiction. I love fiction. The only thing I read is fiction. My whole life I've wanted to write fiction. The fiction's a lot harder to me, and it's just a challenge, but I really enjoy the challenge. I love writing. I feel like I'm a writer trapped in a doctor's body. Matt Kosterman: Yeah, I'm, I, I'm just always, um, I, I'm amazed at what you doctors go through, uh, for medical school and residency and all that. It just seems barbaric and torturous that Dr. Peter Grinspoon: Well, not just that in practice. I mean, I'm a primary care doctor in an inner city clinic, and I can just tell you my job is so stressful. I can't even describe it. The hospital is becoming Amazon. They're just-- I feel like a corporate cog. N- we're losing the autonomy, the independence. The insurance companies torture us. Dr. Peter Grinspoon: The patients want Wegovy. They weigh 400 pounds. The insurance is like, "Nope, not gonna pay for it. Good luck." So it's just very, very stressful being a doctor, let alone becoming a doctor. It's like, you know, when my friends say, "Would you recommend my kid become a doctor?" I just don't know what to say. I mean, at the end of the day, you're still helping people, making enough money, and learning. Dr. Peter Grinspoon: So in that sense, it's really good, but it just gets more stressful every year Matt Kosterman: and pay goes down. Yeah, it's, uh, y- uh, yeah Dr. Peter Grinspoon: And there's more to do and more to keep track of, and it's almost impossible to keep track of everything these days Matt Kosterman: a consideration for you or... It's too altruistic Dr. Peter Grinspoon: Well, you know, I actually, I recently briefed the concierge model at my hospital. I had a great time, uh, talking to them and briefing them about medical cannabis, and it was just amazing how different the office was in the concierge practice than in my inner city clinic with a lot of immigrants, uh, and non-English speaking patients in Chelsea. Dr. Peter Grinspoon: It made me sort of sad. You know, the healthcare shouldn't be that different between rich people and poor people. And, you know, I just like, I'm, uh, I'm not against concierge doctors. I, I understand it's like almost impossible to be a regular doctor these days. At the same time, I don't wanna just personally take care of just the well-to-do. Dr. Peter Grinspoon: I just, for me, I feel like I'm helping out more taking care of people who, who, who, who sort of have the more complex life situations Matt Kosterman: uh, for sure. Um, let's t-talk a, a little bit about some of the potential, uh, harms of cannabis. Where, where, where do you see... You know, it's not-- It doesn't strike me as a traditional addiction like you, like it, with the opioid type of stuff, but I think there's a... I, I know from my own experience, you know, smoking or taking an edible one night a week can turn into two, can turn into three, and then I gotta go, "Okay, wait a minute." Matt Kosterman: Um, so there's a little bit of a hook for some of us. Um- Dr. Peter Grinspoon: Oh, yeah, absolutely. Well, harms of cannabis, certainly. We could-- First of all, I never recommend smoking. That's not good for your lungs. I recommend edibles, tinctures, topicals. You know, someone's dying of cancer, of course, let them smoke cannabis. But generally speaking, if you're gonna be using it for pain for twenty years, don't smoke it. Dr. Peter Grinspoon: It's gonna hurt your lungs. It is addictive. There's no question that cannabis is addictive. They exaggerate how addictive it is, uh, because they rope in all these medical patients who are actually using it really well. Um, and they say, "Oh, they have tolerance and withdrawal." But you have tolerance and withdrawal to many of the medications that we prescribe as doctors, uh, opiates, Valium, SSRIs. Dr. Peter Grinspoon: And, you know, they don't consider us addicted to those based on those two criteria. So they exaggerate the numbers of people that are addicted because they don't believe it's a medicine. If they-- If you categorize it as a medicine, you don't say people are addicted just for those two factors. However I know. Dr. Peter Grinspoon: Everybody does, it's a biolog- For opiates they say that doesn't mean addiction, it's a biological, um, op- opiate exclusion because the biological component of the medicine. But there's no cannabis exclusion because they don't consider it a medicine. The minute you say it's a medicine, and give the cannabis exclusion, and take away all the millions of medical patients that just have tolerance and withdrawal, the rates of addiction will go way down. Dr. Peter Grinspoon: But they just sort of, it's part of the alarmist hangover from the war on drugs. So but cannabis is addictive, just not as commonly as, you know, you, you read about these alarmist, uh, stories in the newspaper. But people who are addicted to cannabis, it's, it's tend, typically, stereotypically, it's like a young, you know, ear, late teen or early 20-year-old male bunkered in his parents' basement, smoking cannabis all the time, and like just not doing anything with his or her life. Dr. Peter Grinspoon: And, you know, being addicted to cannabis can affect your social relationships, your education, your progress in life, and it really, really can screw people up. That said, to put it in context, nobody dies from cannabis addiction like you do from opiates, alcohol. So, um, you know, if you're not gonna die, there's an opportunity eventually to treat them. Dr. Peter Grinspoon: So I think they have a much better prognosis. But it's simply not true that cannabis isn't addict- addictive. I treat cannabis addiction all the time. I, I treat addiction. I, I coach and consult on addiction on my website. People sign up, and I, a lot of what I do is cannabis addiction. In terms of the other harms, there are categories of people that we say do not use cannabis. Dr. Peter Grinspoon: We don't want teenagers using cannabis, 'cause teenagers tend to get addicted more than adults to everything, and because it could affect potentially their brain development. So teenagers, you know, we say just say wait. Uh, medical patients 18 in Massachusetts, recreational patients 21. Problem with that is like good luck getting college students not to use it, but that's another conversation. Dr. Peter Grinspoon: Uh, we don't want pregnant women or breastfeeding women to use it, 'cause it could potentially harm their offspring. And, um, we don't want people with psychosis or a family history of psychosis to use it, because it could trigger or aggravate, uh, and contribute to the development of psychosis. So there are categories of people who just should avoid it. Dr. Peter Grinspoon: And, you know, there's some concern that it could affect cardiovascular. If you've had a recent heart attack, you should be, um, very, very careful if you're using cannabis. And a lot of that is thought to be the smoking. They, you know, not like the edibles or the tinctures. When you smoke, you produce- A lot of the same combustion products that tobacco smoke has. Dr. Peter Grinspoon: Not quite as bad as tobacco smoke, but carbon monoxide can, can affect your heart, and if you have an unstable coronary syndrome, you shouldn't be smoking cannabis. So there are harms. Uh, short-term memory, you know, decrement, again, which resolves. We talked about that earlier. So cannab- you know, the anti-cannabis people think it doesn't cure anything, and that it, like, it has a satanic lettuce, it just has these horrible, horrible side effects. Dr. Peter Grinspoon: The pro-cannabis people think that it's not addictive and it has no side effects, and that's just all nonsense, and that it cures everything. And honestly, the truth, I know people always say that, but with cannabis, the truth is somewhere in between. A final harm I should say is that heavy users, people use it to help with nausea. Dr. Peter Grinspoon: Incredibly helpful to help with nausea. However, if you use very heavy cannabis every day, some people get a paradoxical reaction, and they start throwing up like crazy. It's called cannabis hyperemesis, hyperemesis syndrome. It's really ugly. They end up in the emergency room, and that's also a very, uh, serious harm of cannabis. Dr. Peter Grinspoon: Again, people don't die, but they can spend night after night in the hospital, and if they can't stop the cannabis, it just happens over and over and over again. It uses up tons of resources that people are really sick, and it just is a bad side effect of cannabis. So I definitely believe that cannabis has harms that we may need to take care of. Dr. Peter Grinspoon: But again, it's a nuanced conversation. Like, if I give you penicillin, it probably cures your strep throat, but it could give you an anaphylactic reaction. In context, millions of people are using medical marijuana, and it's a small minority of them that are having problems. So like any other drug, cannabis has its harms, but that doesn't mean it isn't an effective medicine. Matt Kosterman: know, I took ciprofloxacin for my, what they thought was the bladder pain, and it blew away my whole gut biome. I'm still rebuilding that sucker. I mean, it's just Dr. Peter Grinspoon: Yeah. No, exactly. I mean, cannabis doesn't work as an antibiotic per se. It doesn't, uh, Matt Kosterman: Right, Dr. Peter Grinspoon: yet. It doesn't cure COVID. It doesn't cure cancer. Some of the, some of the statements by some cannabis advocates, like if you have cancer, please get an oncologist. If you have symptoms from the cancer Matt Kosterman: opposed to Dr. Peter Grinspoon: use cannabis Matt Kosterman: more, potentially more harmful medicines. Yeah. Um So for, um, for sleep, what do you, how do you, i- if somebody's having trouble sleeping, what do you, what do you r- what do you recommend? How do, how do you recommend they, they go about starting with cannabis? Dr. Peter Grinspoon: Well, I always start by saying, "How much caffeine are you drinking?" As my primary care doctor background, if they say six cups of coffee a day, we chip away at that. You'd be surprised at how many people, you know, "Uh, oh, I didn't know caff- you know, I couldn't drink a f- cu- cup of coffee at 4:00 in the afternoon." Dr. Peter Grinspoon: It's like, yeah, it lasts a long time. You know, exercising, doing something restful before sleep. So all the sleep hygiene stuff to set them up for success. Then I'll often start them on CBD. CBD is low-hanging fruit. That's the non-intoxicating component of cannabis, and that helps people with chronic pain, anxiety, and insomnia. Dr. Peter Grinspoon: It relaxes people. A lot of the times they take some CBD, they drift off into sleep. If that doesn't work, I'll slowly add to the CBD a little bit of THC. A, a puff is five to seven milligrams, 'cause, you know, it's, Matt Kosterman: yeah Dr. Peter Grinspoon: cannabis is stronger now than it used to be. I'll start with the one milligram in senior patients or maybe two and a half milligrams in someone younger. Dr. Peter Grinspoon: And ju- like a sub ther- sub-perceptual dose, and just work their way up really, really, really slowly so we get them gently falling to sleep without any side effects Matt Kosterman: helped me in the past with the, with trouble sleeping. One of the side effects I do find is I don't remember my dreams, uh, Dr. Peter Grinspoon: Yeah. Well, it does REM sleep. I mean, all the sleeping pills affect your sleep architecture, and we don't know what Ambien, the long-term effects of that are. Same thing with cannabis. It does affect your sleep architecture. It suppresses REM sleep, um, so you, you remember your dreams less. You probably dream less. Dr. Peter Grinspoon: Uh, we don't actually know what the long-term effect of that is. Of course, the long-term effect of not sleeping is probably worse, and the long-term effect of, like, Ambien, Valium, Benadryl, Trazodone is probably worse. So it's a little bit of a pick your poison situation, but again, at the end of the day, it's all about harm reduction and picking what you think is the safest option Matt Kosterman: Yeah, Dr. Peter Grinspoon: alleviate the suffering of your patient Matt Kosterman: what would you, so what, what's your, I'm curious your position on legalization versus decriminalization Dr. Peter Grinspoon: Um, I'm a huge fan of legalization. If you decriminalize it, people don't get arrested for using it, but they don't have a legal way to obtain it. It doesn't make any sense. It's kind of incoherent to buy it illegally so you could use it legally. That's sort of like in Spain, where it just was-- You read that my substack. Dr. Peter Grinspoon: I have a free substack where I talk about all these issues. They had decriminalized cannabis, so in theory, you're allowed to use it privately, but you're not allowed to buy it legally, so you have to make an illegal purchase if it's decriminalized to use it legally. So legalization is great. It's been a vast success. Dr. Peter Grinspoon: The arrests are down. The racial disparity in arrests are down. Um, p-people are using it successfully for medical treatment. You know, more people are using it, and there are stronger products, which are not great. You know, teen use has not increased with legalization, which is really good news. But there's some concern that the products that teens are using are stronger, so that is not good. Dr. Peter Grinspoon: And, um, you know, we generate a ton of tax revenue. We're spending it on getting tax revenue and spending on schools and hospitals instead of, like, using state funds to arrest people unnecessarily for cannabis use. So it's been a huge success. I don't love these big multi-state conglomerate cannabis companies. Dr. Peter Grinspoon: They're sort of seeming to me more and more evil. Uh, you know, they're, they're making these donations to really, uh, some politicians I really can't astoundingly that they're making contributions to, and they are advertising in ways that could potentially involve teens. There are 10,000 cannabis stores that are like mom and pop shops in the country that are like stand for social justice, like really nice people, and then there are these like corporate conglomerates, and I just urge people, go to the local mom and pop cannabis store. Dr. Peter Grinspoon: Don't use like the big companies. I probably shouldn't name names, but they're just awful. They're really, really bad. They're giving cannabis a bad name. And again, it just, you-- it's like u-using a local bookstore versus using Amazon. Like who do you really wanna support at the end of the day? Support the local store. Matt Kosterman: My daugh- my younger daughter went to school in Eugene, Oregon. I love, I love that city, and I like to go to, it's Electric Lettuce is the name of the, the local shop there. So I- Dr. Peter Grinspoon: Right, it's a mom and pop shop. It's not one of these, like, s- increasingly evil corporations that are like... It is awful. It's just, it's really sad. My dad would be, like, rolling in his grave if he saw these, these companies. It, it cr- trading nuts. Matt Kosterman: Yeah Dr. Peter Grinspoon: Yeah. And so the, the, these big cannabis conglomerates are looking more like the alcohol conglomerates and the tobacco conglomerates. And we fought this social justice movement for the last 50 years so people would stop getting arrested and would have access to legal cannabis, not so that these huge conglomerates could, like, make cannabis like tobacco and alcohol. Dr. Peter Grinspoon: It's really disappointing. And again, I think the consumers have to vote with their pocketbooks Matt Kosterman: 100%. I'm c- I'm curious your take, uh, if you've done any research or have any knowledge about 'Cause I, I've heard this anecdotally with regard to tobacco, not cannabis, but tobacco, that its, i- its use in, in South America, Central and South America, I mean, it's an indigenous, um, substance that's been used for millennia, and that the, the leaves are not as processed and it's not as chemically, uh, processed as it is in the States, and therefore the, the, the rates of ca- of cancer and harms are lower because it hasn't gone Okay. Dr. Peter Grinspoon: I, I believe that. I don't know for sure, but I believe that's probably true. I mean, look at coca leaves in Peru. Uh, you know, if you, if you, Matt Kosterman: No worries Dr. Peter Grinspoon: Sorry, my phone just went off. I'll turn it off. If you... Sorry, that's really bad. Um, if you, if you look at the coca leaves, they- people make coca tea. It's weak. It helps a sore throat. Dr. Peter Grinspoon: It elevates your mood. Matt Kosterman: altitude. Dr. Peter Grinspoon: coca leaves. It's a very common practice in, you know, alt- altitude, stomach ache, minor pains. If you concentrate it a million times and turn it into a powder that has contaminants in it and snort it, it's obviously really bad for you. So there's a difference between, like, the indigenous, like, leaves and sort of the hyper-concentrated product that people make. Dr. Peter Grinspoon: Kratom, people are talking about kratom, that, that there, that kind of thing from Southeast Asia that people use for pain and for opiate addiction. You know, y- you make a little kratom tea, it helps your aches and pains, or if you're withdrawing for opiates, it can help with that. But now they have these super concentrated products. Dr. Peter Grinspoon: It's called 70H. People are getting really addicted to them, and we're seeing a lot of people in the addiction clinic for kratom, for withdrawal. It's like someone withdrawing from heroin. So again, I agree with you, whether it's tobacco, coca leaves, or, or kratom, you know, botanical products, of c- it's just, I agree it's a lot safer if it's just the natural leaf that hasn't been concentrated 1,000 times and Matt Kosterman: Yeah. Straight, Dr. Peter Grinspoon: laced with industrial chemicals Matt Kosterman: I've been, yeah, I-- the last-- A-as we're in summer here in the Northern Hemisphere, I've been-- made a, a concerted effort to go to the farmers market every, every weekend and, and get some vegetables and some fruits, and I get my meat from the, from a local farm, and I just feel better Dr. Peter Grinspoon: Much healthier, you know, of all the crap. I mean, you know, the whole processed food thing is another thing. That's so lethal, the processed food. And we didn't... I mean, we should have known, but we really know now. And, you know, the more you can do what you're doing is get things right from the source, the healthier it is Matt Kosterman: uh, uh, much, much better. Uh, e- even I, I ate healthy anyway, but just the difference is, of getting it, uh, straight from the farm, which I know isn't an option for everybody, but, um, if it is an option, I would highly encourage it Dr. Peter Grinspoon: Healthy food is expensive. Uh, uh, food is medicine, number one. But number two, like, healthy food is expensive, like the vegetables and the fruits and, you know, uh, unfortunately I work at this inner city clinic, and people are really, really poor. So, you know, they can't go to Whole Foods or the farmers market. Dr. Peter Grinspoon: They, you know, it, it's-- they're barely surviving. They just get the cheapest food they can get. So I, I agree with you 100%, but I, again, I feel a little bit bad, uh, because a lot of my patients just, like, could never afford to do that. It, it's very unfair. Matt Kosterman: the point that the closer you can get it, you know, the, the closer you can get it from the source, u-usually the better. Dr. Peter Grinspoon: Absolutely. I just wish we could do that for everybody, but absolutely Matt Kosterman: some, some boards I'm, I'm on, uh, some medicine boards about, uh, cra- uh, kratom, kratom, kratom, and a couple people looking for somebody to help with addiction to that stuff. Matt Kosterman: Uh, it's, uh, pretty nasty Dr. Peter Grinspoon: Yeah, no, it's, it's awful. And we didn't have that problem before. They concentrated it and made these, like, super potent... Like, kratom has, like, 20 different molecules. It's a plant. It's related to the caffeine plant. Gives people energy, helps them with, like, stomach aches, helps them with pain, and they were using it, like, pretty, you know, reasonably. Dr. Peter Grinspoon: And now that it's super, super concentrated, there's this type of kratom called 7-OH. They took one of the components of kratom and sort of magnified it 100 times, and you could take a syrup or a pill, and it's just like taking fentanyl. It's a really strong opiate, and it's over-the-counter. Gas stations, smoke shops, people are getting addicted left and right. Dr. Peter Grinspoon: You can get it online really easily Matt Kosterman: Yeah. Dr. Peter Grinspoon: Yeah, it acts like an opiate-like sedative. And again, people get into like opiate withdrawal. We have to use like Suboxone, which is what we use for opiate addiction for these people who are addicted to kratom. You know, but then what do you do? Do you make it illegal? Dr. Peter Grinspoon: Then people just get it from the gray market and it's even more dangerous. There's no regulation. You know, it's, it's the same, you know, uh, delicate balance of like what i- You certainly don't wanna be arresting people who are suffering from pain Matt Kosterman: Yeah, Dr. Peter Grinspoon: trying to alleviate their pain Matt Kosterman: I tried it, I tried that stuff once. It didn't do a lot for me, but I, I also know that I, uh, genetically I have, my gene, m- I have genes that don't react to caffeine. So I, I can, I can take, I can take an Adderall and go to sleep Dr. Peter Grinspoon: Really? That is amazing. I tried kratom once too. I hated it. Ugh, disgusting. But, um, that's really funny. You know, I, I have a, a cousin who's a rabbi, and he... I saw him at Whole Foods, uh, drinking an espresso at, like, 8:00 at night. I'm like, "What are you doing?" And he's like, "It Matt Kosterman: Same Dr. Peter Grinspoon: affect me." So he sounds like Matt Kosterman: a Dr. Peter Grinspoon: Yadagar. Matt Kosterman: were carpenters, and my, my paternal grandfather would have a cup of coffee after dinner every night and sleep like a baby. Yeah Dr. Peter Grinspoon: Amazing. If I've a cup after like 10:00 in the morning, I'm up for days. Yeah Matt Kosterman: always-- I drank it. I love it. I love the taste of it, but it, it never... Matt Kosterman: I was always looking for the, for the high. And I also, you know, I had a psy- a psychiatrist years ago who insisted I was ADHD and I take Adderall, and, and I was taking it, and I was drinking coffee, and I, I still couldn't get anything done. It was mostly 'cause I didn't wanna do what I was doing. Dr. Peter Grinspoon: That, well, that is a big thing. Some people use cannabis for their ADHD Matt Kosterman: and microdosing different substances as well is, is Dr. Peter Grinspoon: It's gonna really be really effective for ADHD in a certain subset of patients. Other patients, it makes them less focused and less sort of able to get anything done. But a certain subset of patients that are really, really focused on cannabis, it's really Matt Kosterman: they'll take an edible and they get really focused. I'm like, "Nah, no, I'm not that guy." But Dr. Peter Grinspoon: Yeah, no, most people aren't. But, but you know, it's like it's, it sh- that's why it should be available as a medicine 'cause it can help some people. Different, different medications help different people Matt Kosterman: prohibition has just got, gotta end. Uh, it's gotta stop. Uh, we are getting there. It's, it's amazing the Dr. Peter Grinspoon: We're getting there Matt Kosterman: in, in just five years. Um, so you're writing some fiction. What, what books are... What, what are you taking in these days? What... Any, any recommendations for books? Yeah Dr. Peter Grinspoon: To read? Well, I'm reading two great books right now. One is a book about writing, but, uh, by Anne Lamott, but it's a really funny, great book, and really anybody would like it. It's called Bird by Bird, meaning when you're trying to write something, you don't, like, think of the whole project. You just think of, like, one little thing at a time, and it makes it much easier. Dr. Peter Grinspoon: Uh, it's actually true for any of the tasks we have in life. And I'm reading a good fiction book called The Inheritance of Loss by Kiran Desai, and it's just a great book. She's a great writer, and I'm just really, really enjoying it. I wish I read nonfiction. I'd be, like, a more educated person, but I just only read literary fiction 'cause I just love good writing more than anything else Matt Kosterman: your share of reading, uh, uh, of nonfiction. Dr. Peter Grinspoon: Yeah, I was a philosophy major. We read a lot of Matt Kosterman: nice. Dr. Peter Grinspoon: very dense nonfiction. And Matt Kosterman: Yeah, did you do any Kafka or Camus or, uh... Yeah. Dr. Peter Grinspoon: Oh yeah, all that stuff. Absolutely. I loved that stuff when I was in college. Absolutely Matt Kosterman: Yarbrough, shout out to him, my senior year, and he had us reading all that stuff. He was a, he was a little Buddha figure. He was great. We did, uh, we did Hesse. Yeah Dr. Peter Grinspoon: That's great. I had a great English teacher too. Believe it or not, over the summer he made us read The Brothers Karamazov, uh, before the class, and then he gave us an open book final at the end of the class, uh, that just said, "Is man free?" Matt Kosterman: you had to have, Dr. Peter Grinspoon: So just a great topic, you know? And it really... My answer back then, I was such a wise ass, was like, "Yes, no, no, yes, and no," and I explained the different... Matt Kosterman: gets a little Dr. Peter Grinspoon: Yeah. Matt Kosterman: Yeah, yeah, for sure. Dr. Peter Grinspoon: Yeah, well, it's complicated Matt Kosterman: anything else to add? uh, what- Dr. Peter Grinspoon: No, I just really appreciate, um, being here. Uh, uh, you know, I, as you mentioned, I do have a Substack. It's free. Um, and, you know, it talks about cannabis, talks about addiction. Um, I, I do addiction consults, if anybody's interested, on my website. Um, I treat cannabis addiction. And, uh, you know, my most recent book is called Aging Well With Cannabis. Dr. Peter Grinspoon: People can find it on Amazon. Um, and I just really, really appreciate the conversation and the fact that we can talk about the pros, the cons, and, and put everything in context. Matt Kosterman: to that stuff will be in the metadata, um, so you can find, uh, Dr. Grinspoon's stuff. I read his Substack, uh, whenever it comes out. I always enjoy it, and I highly recommend it. Um, so thanks for being here. Thanks for Dr. Peter Grinspoon: Thank you Matt Kosterman: appreciate you taking the time out of a busy schedule. Dr. Peter Grinspoon: Yeah, thanks for the great conversation. Have a great rest of the day. Okay. Bye-bye. Thanks