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National Highway Traffic Safety Administration, “Marijuana-Impaired Driving: A Report to Congress” (2017). Available at: bit.ly/3W0LLuP Chapter 21, as if channeling Beethoven’s “Ode to Joy,” could be subtitled, “Ode to Pot.” It begins with several questions, among them, “Why do people use cannabis?” and “What is its appeal?” Grinspoon eloquently and astutely answers his probing questions by exploring the “false dichotomy” between medicinal and recreational use. As though to placate those impatient among us who crave short answers, the chapter concludes: “Is cannabis a shortcut? That’s complicated. Is it harmless? No. Does it work for people? A resounding yes!” The Reefer Pessimists must forget, or at least contextualize, much of what they have learned because so much of this knowledge was manufactured with an agenda (if not flat-out fabricated) by the dictates of the War on Drugs. This led to unrealistically negative beliefs and a lot of unhelpful mythology (e.g., breasts, sperm, I.Q.). The cynicism regarding cannabis from the War on Drugs, along with vastly lopsided funding into purported harms (but not into potential benefits), created an echo chamber of presumed negativity and flat-out dismissiveness, which continues to artifactually distort and obscure continuing explorations into the true nature of cannabis. Dr. Grinspoon is a widely recognized expert on cannabis science and drug policy. He regularly appears as an expert on national television and radio programs, including NPR’s All Things Considered, NBC Nightly News, C-SPAN’s Washington Journal, Fox and Friends and Fox News. He is quoted frequently in the national media, in such venues as People, the New York Times, New York Magazine, the Washington Post, USA Today, the Wall Street Journal, the Chicago Tribune, and the Boston Globe. He is a TEDX speaker.
Chapter 4, “Doctors and the War on Drugs,” brands this MD as a heretic within his courtly profession. Nevertheless, he is respectful of and circumspect about his medical colleagues’ ignorance or skepticism regarding cannabis as a therapeutic herb. He lays blame mostly on the institutional bias of the old school medical schools whose curriculums are still teaching politically motivated falsehoods. In the United States, the falsehoods were propagandized during the losing War on Drugs waged by the Nixon administration, then were escalated into the lost War on Weed waged by the Reagan administration, and under the present Biden administration are still soldiered on by diehards and holdovers within the DEA, the FDA, and NIDA. If your own doctors plead ignorance about medical marijuana, bestow upon them copies of this book. If you must be thrifty, then make them photocopies of just Chapters 4 and 22. Legalize federally so that regulation, safety standards, labeling, and commerce can be coherent and consistent, throughout the United States and, ideally, the entire world. Overall, the amount of literature on the effects of cannabis use on vision is scant. The main challenge, at least in the US, is that cannabis is still a schedule I drug at the Federal level, and this makes obtaining institutional review board approval for research studies difficult. Even where cannabis is legal in a state or municipality, it is still not always clear to governing bodies how cannabis studies can be approved or funded with the Federal classification standing. Peter Grinspoon is uniquely qualified to dispense verifiable knowledge about cannabis use and misuse as both prescriber of therapeutic cannabis to qualified medical patients and a councilor to cannabis misusers. Steeped in a deep pharmacological understanding of cannabis and aided by up-to-date analysis of scientific cannabis-related studies, Seeing through the Smoke amplifies a voice trusted by both sides of the ongoing debate about functional and responsible cannabis policies post-prohibition.” - Allen St. Pierre , former Executive Director of NORML Seeing Through the Smoke provides refreshing insights into the biases that have challenged cannabis research to date. Grinspoon presents both sides of the divisive issues polarizing society today, allowing the reader to reconsider what is and isn’t true about cannabis. Honest, personal, poignant, comprehensive, and totally current, this book emphatically reminds us that the absence of evidence is not the same as evidence of absence of effectiveness for this extremely therapeutic botanical.”– Donald I. Abrams, MD , professor emeritus of medicine, University of California San Francisco
A Cannabis Specialist Untangles the Truth about Marijuana
Beyond this, there is perhaps the issue of classifying and enrolling subjects as regular users or abusers – which are a vulnerable population that some feel should not be enrolled in studies. The final issue is trying to standardize a form and dosage(s) that researchers can study; as an aside, the NIDA/NIH recently published a notice for researchers to measure and report research on cannabis using a “standard unit” defined as 5 mg of THC (6). What areas of research would you like to see covered by future studies? Ask your doctor, or a cannabis specialist, about any potential reactions there may be between THC, CBD, and any medications you are taking. This is particularly true if you are on blood thinners or other medications that need to be kept within a narrow range (e.g., antiepileptics, immunosuppressants, chemotherapeutic agents). Also, if you use cannabis frequently, make sure the anesthesiologist knows, before surgery, as you might have higher anesthesia requirements. This book looks at four aspects of cannabis. It tells the history of cannabis, where it came from and how it became illegal. Then it talks about how cannabis works and what it does to the brain and body. Then it looks at how cannabis, which for thousands of years with the medicine, suddenly became illegal. The last section talks about how to minimise the harms of cannabis. Confession. I did not read one-quarter of the book. Its scope is too encyclopedic and some discussions too detailed for even this omnivorous reader to consume in its entirety. I did read the chapters whose subjects interested me. Those on topics outside the orbit of my small world I omitted, just as I would not read from cover-to-cover any single volume of a thirty-volume encyclopedia. Hence, I skipped the chapters on use during pregnancy (I’m male), on use by teenagers (I’m already old), and on any link with psychosis (I’m already looney). Likewise, I dropped from my reading syllabus the chapters on using medical marijuana to treat for insomnia (I’m a sound sleeper), for autism (I’m childless), and for symptoms from cancer and for side effects from chemo (I’m planning on dying, just not of cancer). S Ortiz-Peregrina et al., “Effects of cannabis on visual function and self-perceived visual quality,” 11, 1655 (2021). PMID: 33462319.
I think eye care professionals need to ask specifically about cannabis use. In some places, we might still expect patients to report this in our intake forms asking about “illicit drug” use, but not all patients will want to answer such a question. Additionally, with increased legalization, cannabis is no longer considered an illicit drug in many places and thus specifically asking about cannabis use is important. From there, asking about the regularity of use as well as the dosage, type, and form can be important (certain forms have much higher concentrations and certain forms, like edibles, have delayed effects). Batista LA, Gobira PH, Viana TG, Aguiar DC, Moreira FA. Inhibition of endocannabinoid neuronal uptake and hydrolysis as strategies for developing anxiolytic drugs. Behav Pharmacol. 2014;25:425–433.PDF / EPUB File Name: Seeing_through_the_Smoke_-_MD_Grinspoon_Peter.pdf, Seeing_through_the_Smoke_-_MD_Grinspoon_Peter.epub The Brain and Mind Centre and Discipline of Pharmacology, University of Sydney, Sydney, NSW, Australia. Arnold JC, Boucher AA, Karl T. The Yin and Yang of Cannabis-induced Psychosis: the Actions of Delta 9-Tetrahydrocannabinol and Cannabidiol in Rodent Models of Schizophrenia. Curr Pharm Des. 2012;18:5113–5130.
Don’t smoke! (Unless you are a very occasional user). There’s no reason to expose yourself to combustion products, such as tar, benzene, polycyclic aromatic hydrocarbons, etc. (Even though cannabis has never been shown to cause lung cancer or COPD, there’s no reason to inhale all of this crap.) If you prefer to use cannabis inhalationally, use a dry herb vapor- izer, which doesn’t combust the cannabis, but instead heats it to a lower temperature (which is enough to extract the cannabinoids) and which produces a less irritating vapor. Or explore edibles, tinctures, inhalers, oils, suppositories, patches, and lotions—there are lots of options these days. My one gripe is that at times it does feel somewhat like an extended advertorial for Drug Science, a UK based drugs advisory body and research organisation founded by Nutt in the aftermath of his infamous dismissal from the chairmanship of the Advisory Council on the Misuse of Drugs in 2009.Educating people about the higher risks that likely pertain to specific populations, such as teens; those with, or predisposed to, certain psychiatric conditions; and pregnant/breastfeeding women. If you have a particularly good or bad reaction to a particular strain or chemovar, write it down. Journaling is good practice in any case—dosage, benefits, side effects, formulations, and delivery mechanism. Grinspoon’s Harvard Health articles have reached tens of millions of readers, have been widely referenced in the national media, and have been cited in congressional testimony. His writing has been published in The Nation , the Los Angeles Times and Narrative Inquiry in Bioethics . Stop making cannabis into tasty edibles, chocolates, or candies that any small child (or pet) would happily overconsume. A very useful book. Professor Nutt starts with telling us the history of cannabis use and then its tortured political history, both around the world but especially in the UK. This culminates in his own extensive involvement in the attempt to get a rational risk/benefit attitude in UK policy. This is very much an ongoing job with the UK currently one of the most behind and restrictive in its laws on the use of cannabis, both medically and recreationally. Professor Nutt is much more interested in the medical uses and the harm that is being done to many UK citizens through the establishment's over-cautious approach. He includes a number of illustrative real life stories, some of which would make you grind your teeth with frustration at the suffering that is not being prevented by this over-caution. He's not so much interested in the recreational use of cannabis, except to point out that it is overall much less dangerous than tobacco or alcohol, but that the current predominance of skunk (largely home grown) is likely to mean that street cannabis is more harmful than it need be.
In experiments carried out on two groups of rats, the first were prevented from playing with other apps at all and the second group was allowed to play with rats one hour a day. Scientists watched the rats as they grew up and noted differences. By the time they became adults, the play deprived rats experienced much more fear and anxiety and they were less able to deal with unexpected events. The rats who got to play were braver, more likely to explore and better able to cope with new situations. The rats who had been allowed to play were also significantly smarter and able to problem solve much better than the play deprived rats.Use CBD along with your THC. Get cannabis that has both CBD and THC in it or take the CBD separately—current research suggests this can help protect your brain. The latest book from Professor David Nutt is a one-stop-shop for everything you could ever need to know about cannabis. If your use is escalating and you find yourself craving cannabis frequently, or if you have trouble cutting down, ask for help. Addiction is a disease of isolation; be open and honest— especially with yourself. If people don’t take you seriously because it’s “just a weed addiction,” seek help elsewhere. Any addiction—and people do get addicted to cannabis—should be responded to with empathy and competent treatment. Figure out, once and for all, how to detect (if possible) and discourage stoned driving (without getting people who aren’t impaired in trouble). Program of Neurosciences, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona 31008, Spain; Department of Biochemistry and Genetics, School of Science, University of Navarra, Pamplona 31008, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona 31008, Spain.
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