PRO:
By Lester Grinspoon, M.D.
Cannabis was first admitted to Western pharmacopoeias one and a half centuries ago. In 1839, W. B. O'Shaughnessy at the Medical College of Calcutta observed its use in the indigenous treatment of various disorders and found that tincture of hemp was an effective analgesic, anticonvulsant, and muscle relaxant.(1) Publication of O'Shaughnessy's paper created a stir within a medical establishment that at that time had access to only a few effective medicines. In the next several decades, many papers on cannabis appeared in the Western medical literature. It was widely used until the first decades of the twentieth century, especially as an analgesic and hypnotic. Symptoms and conditions for which it was found helpful included tetanus, neuralgia, labor pain, dysmenorrhea, convulsions, asthma, and rheumatism.(2)
Administering a medicine through smoking was unheard of until the late nineteenth century, when pharmaceutical houses prepared coca leaf cigars and cheroots were occasionally used in lieu of cocaine.(3) If physicians had realized that titration of the dose was easier and relief came faster when marijuana was inhaled, they might have preferred to administer it by smoking. However, in the nineteenth century it was prepared chiefly as a tincture (alcoholic solution), generally referred to as tincture of hemp, tincture of cannabis, or Cannabis indica. Use declined at the turn of the century, as the first synthetic analgesics and hypnotics (aspirin and barbiturates) became available. Physicians were immediately attracted to these drugs because their potencies were fixed and they were easily dispensed as pills.
Beginning in the 1920s, interest in cannabis as a recreational drug grew, along with a disinformation campaign calculated to discourage that use. In 1937, the first draconian federal legislation against marijuana, the Marijuana Tax Act, was passed. At that time the medical use of cannabis had already declined considerably; the Act made prescription of marijuana so cumbersome that physicians abandoned it. Now physicians themselves became victims of the "Reefer Madness" madness. Beginning with an editorial published in the Journal of the American Medical Association in 1945, the medical establishment became one of the most effective agents of cannabis prohibition.(4)
The modern renaissance of medicinal cannabis began in the early 1970s, when several young patients who were being treated with recently developed cancer chemotherapies discovered that marijuana was much more effective than conventional medicines for the relief of the intense and prolonged nausea and vomiting induced by some of these agents.(5) Word spread rapidly over the cancer treatment grapevine. By mid-decade, the capacity of marijuana to lower intraocular pressure had been observed, and patients suffering from glaucoma began to experiment with it.(6) As the AIDS epidemic gathered momentum, many patients who suffered HIV-associated weight loss learned that marijuana was the most effective and least toxic treatment for this life-threatening symptom. These three new medical uses of cannabis have led to wider folk experimentation. The use of marijuana in the symptomatic treatment of convulsive disorders, migraine, insomnia, and dysmenorrhea has been rediscovered.
We have now identified more than thirty symptoms and syndromes for which patients have found cannabis useful,(7) and others will undoubtedly be discovered. Many patients regard it as more effective than conventional medicines, with fewer or less disturbing side effects. Consider the pain of osteoarthritis, which was often treated in the nineteenth century with tincture of cannabis. Aspirin, the first of the non-steroidal anti-inflammatory drugs (NSAIDs), rapidly displaced cannabis as the treatment of choice for this and many other kinds of mild to moderate pain. But NSAIDs now take more than 7,000 lives annually in the United States alone; cannabis, by contrast, has never killed anyone using it for the relief of pain or any other purpose.(8) It is not surprising that many patients now treat their osteoarthritis with cannabis, asserting that it provides a better quality of pain relief than NSAIDs and also elevates their spirits.
The number of Americans who understand the medical uses of cannabis has grown greatly in the last few years. The passage of initiatives or legislation allowing some restricted legal use of cannabis as a medicine in eight states is the most striking political manifestation of this growing interest. The state laws have led to a battle with federal authorities who, until recently, proclaimed medical marijuana to be a hoax. Under public pressure to acknowledge the medical potential of marijuana, then-director of the Office of National Drug Policy, Barry McCaffrey, authorized a review by the Institute of Medicine of the National Academy of Science which was published in March of 1999.(9)
The report acknowledged the medical value of marijuana, but grudgingly. One of its most important shortcomings was a failure to put into perspective the vast anecdotal evidence of marijuana's striking medicinal versatility and limited toxicity. The report states that smoking is too dangerous a form of delivery, but this conclusion is based on an exaggerated evaluation of the toxicity of the smoke. The report's Recommendation Six would allow patients with what it calls "debilitating symptoms (such as intractable pain or vomiting)" to use smoked marijuana for only six months, and then only after all other approved medicines have failed. The treatment would have to be monitored with "an oversight strategy comparable to an institutional review board process."(10) This would make legal use of medical cannabis impossible in practice.
When I first considered this issue in the early 1970s, I thought that many of the problems surrounding marijuana could be solved by switching its status from a Schedule I to a Schedule II drug, meaning it would no longer be completely illegal but would have limited medical use because of its high potential for abuse. Today, I think it unlikely marijuana will be granted this in-between status.
Consider the effects of granting marijuana legitimacy as a medicine while prohibiting it for any other use. How would the appropriate "labeled" uses be determined and how would "off-label" uses be proscribed? Who will be allowed to produce and provide the cannabis? When urine tests are demanded for workers, how would those who use marijuana legally as a medicine be distinguished from those who use it for other purposes?
To realize the full potential of cannabis as a medicine in the setting of the present prohibition system, we would have to address all these problems and more. A delivery system that successfully navigated this minefield would be cumbersome, inefficient, and bureaucratically top-heavy. Government and medical licensing boards would insist on tight restrictions, challenging physicians as though cannabis were a dangerous drug every time it was used for any new patient or purpose. There would be constant conflict with one of two outcomes: patients would not get all the benefits they should, or they would get the benefits by abandoning the legal system for the black market or their own gardens and closets.
A solution now being proposed, notably in the IOM Report, is what might be called the "pharmaceuticalization" of cannabis: prescription of isolated individual cannabinoids, synthetic cannabinoids, and cannabinoid analogs. The IOM Report states that "if there is any future for marijuana as a medicine, it lies in its isolated components, the cannabinoids, and their synthetic derivatives." It goes on: "Therefore, the purpose of clinical trials of smoked marijuana would not be to develop marijuana as a licensed drug, but such trials could be a first step towards the development of rapid-onset, non-smoked cannabinoid delivery systems."(11)
Some cannabinoids and analogs may have advantages over whole smoked or ingested marijuana in limited circumstances. For example, cannabidiol may be more effective as an anti-anxiety medicine and an anticonvulsant when it is not taken along with THC, which sometimes generates anxiety. Other cannabinoids and analogs may occasionally prove more useful than marijuana because they can be administered intravenously. For example, 15 to 20% of patients lose consciousness after suffering a thrombotic or embolic stroke, and some people who suffer brain syndrome after a severe blow to the head become unconscious. The new analog dexanabinol (HU-211) has been shown to protect brain cells from damage by glutamate excitotoxicity in these circumstances, and it will be possible to give it intravenously to an unconscious person.(12) Presumably other analogs may offer related advantages. Some of these commercial products may also lack the psychoactive effects which make marijuana useful to some for non-medical purposes. Therefore they will not be defined as "abusable" drugs subject to the constraints of the Comprehensive Drug Abuse and Control Act. Nasal sprays, nebulizers, skin patches, pills, and suppositories can be used to avoid exposure of the lungs to the particulate matter in marijuana smoke.
The question is whether these developments will make marijuana itself medically obsolete. For most specific symptoms, analogs or combinations of analogs are unlikely to be more useful than natural cannabis.
There will remain a problem of classification under the Comprehensive Drug Abuse and Control Act for analogs with psychoactive effects. The more restrictive the classification of a drug, the less likely drug companies are to develop it and physicians to prescribe it. Recognizing this economic fact of life, Unimed, the manufacturer of Marinol, has recently succeeding in getting it reclassified from Schedule II to Schedule III. Nevertheless, many physicians will continue to avoid prescribing it for fear of the drug enforcement authorities.
In the end, the commercial success of any cannabinoid product will depend on how vigorously the prohibition against marijuana is enforced. It is safe to predict that new analogs and extracts will cost much more than whole smoked or ingested marijuana even at the inflated prices imposed by the prohibition tariff. I doubt that pharmaceutical companies would be interested in developing cannabinoid products if they had to compete with natural marijuana on a level playing field. The most common reason for using Marinol is the illegality of marijuana, and many patients choose to ignore the law for reasons of efficacy and price. The number of arrests on marijuana charges has been steadily increasing and has now reached nearly 700,000 annually, yet patients continue to use smoked cannabis as a medicine.
I wonder whether any level of enforcement would compel enough compliance with the law to embolden drug companies to commit the many millions of dollars it would take to develop new cannabinoid products. Unimed is able to profit from its exorbitantly priced dronabinol only because the United States government underwrote much of the cost of development. Pharmaceutical companies will undoubtedly develop useful cannabinoid products, some of which may not be subject to the constraints of the Comprehensive Drug Abuse and Control Act. But this pharmaceuticalization will never displace cheap, readily-available natural marijuana for most medical purposes.
In any case, increasing medical use by either distribution pathway will inevitably make growing numbers of people familiar with cannabis and its derivatives. As they learn that its harmfulness has been greatly exaggerated and its usefulness underestimated, the pressure will increase for drastic change in the way we as a society deal with this drug.
References:
1. W. B. O'Shaughnessy. On the Preparations of the Indian Hemp, or Gunjah (Cannabis indica): The Effects on the Animal System in Health, and Their Utility in the Treatment of Tetanus and Other Convulsive Diseases. Transactions of the Medical and Physical Society of Bengal (1838-1840), p. 460.
2. L. Grinspoon. Marijuana Reconsidered. Cambridge, Mass.: Harvard University Press, 1971, pp. 218-230.
3. L. Grinspoon and J. B. Bakalar. Cocaine: A Drug and Its Social Evolution, Revised Edition. New York: Basic Books, 1985, p. 279.
4. Marijuana Problems. Editorial, Journal of the American Medical Association, Vol. 127 (1945), p. 1129.
5. L. Grinspoon and J. B. Bakalar. Marijuana, the Forbidden Medicine, Revised and Expanded Edition. New Haven: Yale University Press, 1997, pp. 25-27.
6. R. S. Hepler and I. M. Frank. Marijuana Smoking and Intraocular Pressure. Journal of the American Medical Association, Vol. 217 (1971), p. 1392.
7. L. Grinspoon and J. B. Bakalar. Marijuana, the Forbidden Medicine, Revised and Expanded Edition. New Haven: Yale University Press, 1997.
8. S. Girkipal, D. R. Ramey, D. Morfeld, G. Singh, H. T. Hatoum, and J. F. Fries. Gastrointestinal Tract Complications of Nonsteroidal Anti-inflammatory Drug Treatment in Rheumatoid Arthritis. Archives of Internal Medicine, Vol. 156 (July 22, 1996), pp. 1530-1536.
9. Marijuana and Medicine: Assessing the Science Base. J. E. Joy, S. J. Watson, Jr., and J. A. Benson, Jr., Editors. Institute of Medicine, Washington, D.C.: National Academy Press (1999).
10. Ibid, pp. 7-8.
11. Ibid, p. 11.
12. R. R. Leker, E. Shohami, O. Abramsky, and H. Ovadia. Dexanabinol; A Novel Neuroprotective Drug in Experimental Focal Cerebral Ischemia. Journal of Neurological Science, Vol. 162, No. 2 (January 15, 1999), pp. 114-119; E. Shohami, M. Novikov, and R. Bass. Long-term Effect of HU-211, a Novel Non-competitive NMDA Antagonist, on Motor and Memory Functions after Closed Head Injury in the Rat. Brain Research, Vol. 674, No. 1 (March 13, 1995), pp. 55-62.
Lester Grinspoon, M.D., is an Associate Professor Emeritus of Psychiatry at Harvard Medical School.
CON:
Lester Grinspoon blithely dismisses any serious health considerations in the smoking of marijuana. Indeed, Dr. Grinspoon a longtime proponent of legalization of not only marijuana but also of a wide range of psychedelic drugs has routinely dismissed most evidence of the deleterious effects of smoked marijuana, attributing it to the propaganda of anti-drug warriors and their friends in the National Institutes of Health. In his article, he rejects the assertions in the 1999 report of the Institute of Medicine on medicinal marijuana that smoked marijuana is dangerous because it increases smokers' chances "of cancer, lung damage, and problems with pregnancy."
More recently, on January 23, 2002, Grinspoon was quoted in the Toronto Globe and Mail(1) criticizing a comprehensive position paper on medical marijuana from Physicians for a Smoke-Free Canada(2) that labeled smoked medical marijuana risky. Grinspoon is described as calling their report on smoked marijuana dangers an "urban myth." The highly respected group which supports research into and therapeutic use of non-smoked medical marijuana and its derivatives such as THC warned that smoked marijuana produced 50% more tar and 70% more benzopyrene than cigarettes, noting that recent research has shown that smoking two to three marijuana cigarettes a day probably has as much cancer-causing potential as twenty to thirty cigarettes. They point out that even the much ballyhooed treatment of glaucoma with smoked marijuana (used to reduce intra-ocular pressure), requires the smoking of marijuana every two to three hours.(3)
In response, Grinspoon, sounding for all the world like a tobacco industry executive, is quoted saying, "Who has seen the pulmonary consequences of smoking marijuana?" further predicting that it "will be considered one of the least harmful substances in our entire compendium."
While Grinspoon minimizes the dangers, even Cannabis News has posted on its own website a January 2000 Washington Post article, "Researchers Link Marijuana to Cancer," about research at Sloan-Kettering that links marijuana use with cancers of the head and neck, including tumors of the mouth, throat, and larynx.(4)
One recent study at UCLA's Jonnson Comprehensive Cancer Center found that tetrahydrocannabinol (THC), marijuana's most psychoactive component, may promote tumor growth and weaken the body's immune response to cancer. That study's authors warn that marijuana may be much more carcinogenic than tobacco. The study expanded on earlier research findings indicating that THC can lower immune resistance to bacterial and viral infections.(5)
Not only does Grinspoon dismiss the increasing evidence of marijuana's carcinogenic effects, he also seems to ignore other disturbing research associating marijuana use with problems of aggression, amotivational syndrome, bronchitis/chronic cough and respiratory system damage, chronic anxiety, depression, distorted perception, impaired learning, impaired judgment, impaired problem-solving, complex motor skills impairment, immune system damage, memory damage, reproductive system problems, secondhand smoke effects, and schizophrenia.(6) While some limited medicinal uses for marijuana and/or its active ingredients may be discovered, clearly it is not simply a benign substance nor a wonder herb.
While the dietary supplement business, herbal medicine industry, and other areas of "alternative medicine" may routinely ignore such scientific evidence of potential adverse health effects, one hardly expects a Harvard psychiatry professor to be so dismissive of the many warning signs, especially about smoked marijuana. Why has Lester Grinspoon emerged as such a champion of medical marijuana smoking?
Dr. Grinspoon first engaged in marijuana research in 1968 at Harvard University, research that he claims convinced him of the relative benignity of marijuana. The newly graduated Harvard M.D., Dr. Andrew Weil, assisted Grinspoon in this research.(7) At the very same time, Weil had fallen under the spell of Harvard psychologists Timothy Leary and Richard Alpert (a.k.a. Ram Dass) and was extremely busy using marijuana, LSD, and other psychedelics to explore his "natural mind."(8)
Weil left Harvard, first to pursue a career proselytizing for the revolutionary "mind altering" and spiritual effects of psychedelics, then to be an alternative medicine guru. Weil's own advocacy of the herbal medicinal uses of marijuana (hemp) and LSD as a treatment for such things as cat allergies indicate that he has effectively combined his two career paths of drug advocacy and alternative medicine.
Grinspoon, too, has made a career out of his 1960s conversion, writing seminal works championed by the marijuana and psychedelic drug sub-cultures with his frequent co-author James B. Bakalar. Their book Psychedelic Drugs Reconsidered was published in 1979 and was recently republished by the Lindesmith Center in 1997. Another book of theirs, Psychedelic Reflections, was published in 1983.(9) One of their most recent books, Marijuana, The Forbidden Medicine, was published in 1997. Solo, Grinspoon wrote the book Marihuana Reconsidered, published in 1971, immediately after his Harvard marijuana studies. The book was republished in 1994.
Like Weil, Grinspoon seems to believe there are "no bad drugs." Over the years, he has insisted on the relative safety of cocaine, ketamine, ecstasy (MDMA), LSD (under proper supervision), and other psychedelics. Many who have maintained their association with him for decades come out of the inner circles of psychedelic spiritualism. In addition to being the Lindesmith Center's expert on marijuana, he serves as a scientific advisor, consultant and/or collaborator with such psychedelic advocacy groups as the Albert Hofmann Foundation, the Multidisciplinary Association for Psychedelic Studies, and the Heffter Research Institute. He is currently a scientific advisor to a bizarre "anti-psychiatry" group called the the Alchemind Society, whose executive director specializes in "the jurisprudence of extraordinary states of consciousness, dissident thinking, and shamanic inebriants." The rest of the society's advisory board is made up of mystics, paranormalists, psychedelic spiritualists, psychedelic "therapists," and other psychiatric "dissidents," including Ram Dass.(10)
Grinspoon's own commitment to the use of psychedelic drugs as part of spiritual psychotherapy was detailed in a 1986 article in the American Journal of Psychotherapy entitled "Can Drugs be Used to Enhance the Psychotherapeutic Process?" in which he argues that LSD can and should be used to trigger spiritual conversion as a psychotherapeutic treatment.(11) The central "evidence" he presents is a late 1960s experiment run by a paranormal New Age mystic named Stanislav Grof at the Spring Grove State Hospital in Maryland. Grof subjected terminally-ill cancer patients to horrendously nightmarish LSD-induced hallucinations as part of an "experiment" in stress reduction.(12, 13)
Grinspoon's 1986 endorsement of "therapeutic" psychedelic spiritual conversion is used to give credibility to a resurgent psychedelic mysticism movement that is now arguing for the psychotherapeutic or "self-therapeutic" uses of ecstasy, LSD, ketamine, psilocybin and other currently illegal drugs. Indeed, a 2000 Wired.com article "Lucy in the Sky with Therapy" describes this currently underground movement.(14)
After citing experts warning about research showing potential brain damage from use of Ecstasy and other such drugs, the Wired article mentions Dr. Grinspoon:
"Dr. Lester Grinspoon, an associate professor of psychiatry at Harvard Medical School who sued the DEA when it declared ecstasy a schedule 1 controlled substance in 1985, said he doesn't quite trust studies performed by the National Institute of Drug Abuse. 'The NIH is a wonderful institution as a whole and truly their interest is in science,' Grinspoon said. 'But the NIDA really lost it where science is concerned and has become a ministry of drug propaganda.'"
Indeed, who are we to believe on psychedelics and on smoked marijuana? Will it be the anti-drug conspirators of the U.S. Government's National Institutes of Health and virtually all of modern medical science...or the estimable Dr. Lester Grinspoon who still delights in those wondrous dreams shared with Andrew Weil, Tim Leary, and Ram Dass at Harvard in the halcyon days of the 1960s? Perhaps the readers of HealthFactsAndFears.com will now have somewhat better information upon which to make their choice.
Documentation:
1. Toronto Globe and Mail, 1/23/02, "Smoking Medical Marijuana Too Risky, Lobby Group Says," by Oliver Moore: http://www.theglobeandmail.com/servlet /RTGAMArticleHTMLTemplate/C /20020123/wmari2301?hub=homeBN& tf=tgam%252Frealtime%252Ffullstory.html &cf=tgam/realtime/config-neutral &vg=BigAdVariableGenerator&slug= wmari2301&date=20020123&archive= RTGAM&site=Front&ad_page_name= breakingnews
2. Physicians for a Smoke-Free Canada Web-site:
http://www.smoke-free.ca/
3. Position Paper on Marijuana as Medicine from Physicians for a Smoke-Free Canada:
http://www.smoke-free.ca/
pdf_1/psc-position-on-
marijuana.PDF
4. Washington Post, 1/11/00, "Researchers Link Marijuana to Cancer", Susan Okie:
http://www.cannabisnews.com
/news/thread4267.shtml
5. NIH, 6/20/2000, Study Finds Marijuana Ingredient Promotes Tumor Growth; Impairs Anti-Tumor Defenses:
http://www.health.org/
reality/articles
/2000/press/july2000.asp
6. Governmental and medical sources with reports of research:
National Institute on Drug Abuse:
http://www.drugabuse.gov
/DrugPages
/Marijuana.html
MedlinePlus Marijuana Abuse page:
http://www.nlm.nih.gov
/medlineplus
/marijuanaabuse.html
Note the latest study, "Long-time Pot Users Show Mental Deficits."
The National Clearinghouse for Alcohol and Drug Information:
http://www.health.org
/catalog/ordersystem2.
asp?Topic=54#pubs
A British House of Lords report (1997-98) on adverse effects of cannabis use, with many citations, declaring the evidence is stronger than ever of its potentially harmful effects:
http://www.parliament.
the-stationery-office.co.uk
/pa/ld199798/ldselect/
ldsctech/151/15105.htm
7. Andrew Weil describes his research collaboration with Grinspoon in "No Bad Drugs: The Newservice Interview: Dr. Andrew Weil," 1983:
http://www.doitnow.org
/pages/weil.html
8. Arnold Relman, M.D., "A Trip to Stonesville: Some Notes on Andrew Weil (1998)":
http://www.quackwatch.com
/11Ind/weil.html
9. Review of Grinspoon/Bakalar Psychedelic Reflections on website of the Council of Spiritual Practices, dedicated to the use of psychedelic "entheogens" to achieve spiritualty:
http://www.csp.org/
chrestomathy/psychedelic_
reflections.html
10. The Alchemind Society:
http://www.alchemind.org/
alchemindadvisors.htm
11. Lester Grinspoon, M.D. and James Bakalar, American Journal of Psychotherapy, Vol. XL, no. 3, "Can Drugs be Used to Enhance the Psychotherapeutic Process?":
http://leda.lycaeum.org
/Documents/Can_Drugs_
Be_Used_to_Enhance_the_
Psychotherapeutic_
Process.16866.shtml
12. E. Patrick Curry, "Carl Jung, Stanislav Grof and New Age Medical Mysticism," to be published in the Spring 2002 issue of the Scientific Review of Alternative Medicine.
13. A chapter on the paranormal, mystical Dr. Stanislav Grof is included in Paul Edwards' Reincarnation: A Critical Examination, Prometheus Press, 1996. Dr. Grof's mystical ideas can also easily be determined by simple Web searches. He is a major champion of New Age mysticism.
14. "Lucy in the Sky with Therapy", Wired.com, November 2, 2000:
http://www.wired.com
/news/technology
/0,1282,39796,00.html?
tw=wn20001109
Note: The full text of the Institute of Medicine report "Marijuana and Medicine" is posted at the National Academy Press site at:
http://www.nap.edu/
readingroom/books/
marimed/
The April 28, 1999 JAMA article "Therapeutic Marijuana Use Supported While Thorough Proposed Study Done" is posted at:
http://jama.ama-assn.org/
issues/v281n16
/ffull/jmn0428-1.html
E. Patrick Curry has written for the Scientific Review of Alternative Medicine and has received the 2000 Scientific and Professional Integrity Trophy from The Science & Pseudoscience Review in Mental Health.
April 24, 2002
I found the discussion between E. Patrick Curry and Lester Grinspoon to be curiously unproductive. While much research needs to be done, two facts are clear. One, marijuana does have medicinal value. Two, continual long-term use poses numerous health risks. Curry is dismissive of the former, Grinspoon dismissive of the latter. Doctors who have prescribed marijuana have generally done so for short periods of time, under six months, in order to maximize the benefits and minimize the risks.
The question is, what do we do with this information? There are several options. One is to maintain the status quo. But this seems hard-hearted toward the sick and, pace Curry, seems not to be in keeping with current medical knowledge. A second option is to shift marijuana from Schedule 1 to Schedule 2. This is perfectly defensible. Third, we could legalize and regulate the production and distribution of marijuana. This is what I favor because I am unwilling to continue to pay the costs of prosecuting and housing large numbers of individuals for doing something my friends and I did in college before starting productive careers and happy families.
Josh Kilroy
April 26, 2002
Curry replies:
Josh Kilroy is incorrect in labeling me as merely "dismissive" of the possible medical value of non-smoked marijuana, particularly of its psychoactive derivatives such as THC. Given the prominence of this as a national issue due to the generous funding of medical marijuana initiatives by billionaires such as George Soros and Laurence Rockefeller, research is called for to clarify the medical facts. If clear, safe medicinal uses for which there exist no better alternative treatments are identified, then I would certainly support them; I would not dismiss them.
The subject of my exchange with Dr. Grinspoon, however, involves smoked marijuana. Kilroy seems to support "smoked marijuana" for "short-term" use. However, even "short-term" ingestion of the carcinogens in marijuana smoke is hardly something I would consider healthful. Also, given the increasing evidence of possible harm to the immune system, even short-term use could be damaging for seriously ill persons.
Kilroy's claim that medicinal uses of smoked marijuana are limited to the short-term does not correspond with the facts. Recently, the "godfather" of California's Medical Marijuana Act, Dennis Peron, who drafted California's Proposition 215, was arrested in Utah while having a pot party with friends. He was found with a pound of marijuana. His defense to the police was that his doctor had prescribed marijuana as a treatment for alcoholism! It is my understanding that, at least in California, smoked marijuana can be prescribed for a variety of long-term, chronic conditions.
As for "legalization", that was not the subject of this debate and is another issue altogether, except to the degree that one's passions around such issues may affect one's medical/scientific judgment. As to my biases, I must confess that I personally am in the "moderate" camp, not supportive of legalization, yet opposing draconian sentencing for ordinary users. I also support the expansion of rehabilitation and education programs. However, I do not believe that exaggerations about the medical usefulness of marijuana and, even more seriously, about its "spiritual" or "creative" effects helps the debate one iota. Honestly, I fear that a substantial portion of the "marijuana as medicine" lobby may be driven more by ideology than the facts of modern science and medicine. My contra-Grinspoon piece should have made that clear.
I am very pleased that Mr. Kilroy and his friends had benign experiences with their own recreational drug usage as youngsters, but not everyone has been so lucky.
E. Patrick Curry
P.S. See the San Francisco Chronicle article on the arrest of Dennis Peron: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2001/11/21/MN165171.DTL
