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Harvard Dr. Peter Grinspoon On Oxycodone And Cannabis For Harm Reduction: 'By Combining Opioids And Cannabis The Doses Can Stay Low'

Via El Planteo.

Dr. Peter Grinspoon is a general practitioner at Harvard University, writer, medical cannabis specialist, and lecturer. In 2016 he published the book “Free Refills: A Doctor Confronts His Addiction” which seeks to explain the vulnerability of healthcare personnel to addiction and quickly became a global bestseller as it confronts the stigma, taboo, and prejudice associated with addiction.

Peter’s relationship with medical cannabis is long-standing, dating back to his relationship with his father, Dr. Lester Grinspoon, who in 1971 wrote the book Marihuana Reconsidered, which calls for the legalization of cannabis. And in fact, the cannabis genetics bank, Barney’s Farm, in the city of Amsterdam, created a strain in his honor.

“Barney’s has a strain called Dr. Grinspoon. I have to admit I’ve tried it. And it’s really a good strain. It’s very perceptive. It’s very stimulating and cerebral, kind of like my dad,” says Peter proudly, from his home in Newton, Massachusetts.

Free Refills

In his writings and lectures, Dr. Grinspoon advocates for harm reduction policies for addiction treatment. His book addresses issues that are taboo in the medical field and in society at large.

Peter tells us that the idea of “Free Refills” refers to health professionals having unlimited access to prescriptions, but in general, the title also refers to a particular phenomenon starting in the US in 2000, when Purdue Pharmaceutical undertook a massive advertising campaign “to convince everyone that the treatment for chronic pain was opioids, specifically OxyContin.”

Oxycodone is a potent opium-derived analgesic that decreases discomfort by increasing pain tolerance, causes sedation, drowsiness, and depresses breathing. Prolonged use generates dependence and withdrawal symptoms such as cold sweats, cramps, dizziness, tachycardia, diarrhea, vomiting, and hallucinations.

“It was sold to all of us, doctors and patients. Millions of people were put on OxyContin, an incredibly addictive way to treat pain.”

Grinspoon explains that healthcare professionals are more prone to addictions “because we are under so much stress and have access to so many drugs which results in much higher addiction rates than the general public.”

“I became heavily addicted to prescription opioids to the point that the DEA raided my office in 2005. So I decided to write a book about my addiction and recovery,” Peter recalls.

Dr. Grinspoon understands that anyone can become addicted and so his book seeks to humanize drug users and overcome social stigma.

“Because stigma is what really hurts people. People are afraid to seek help. The book created a bit of a stir because no one else felt they could talk about it. If people feel they can get help, that they won’t be punished and they will be treated, so we’re looking to open up a safer path to recovery,” he clarifies.

-What does OxyContin generate in the brain and what are the risks?

Well, the reason people take it is that it numbs physical and emotional pain. I have found that many of the people struggling with addiction to Oxy have trauma or a history of untreated anxiety and depression.

It causes a very strong euphoria of optimism, and of course, once you use it for a while, you stop feeling the euphoria and start feeling miserable. You quickly go from pleasure to a very miserable lifestyle.

The pills are very expensive on the street and many users end up struggling with an addiction to cheap heroin, often tainted with fentanyl. That is why people overdose. And that is why it is important to have public health policies that seek to reduce harm, that accompany people in their recovery.

Adult-Use Cannabis and Harm Reduction

In 2020, 93,000 people died in the US from opioid overdoses and Dr. Grinspoon believes that cannabis has a big role to play in public health.

“Generally people can use cannabis instead of opioids for chronic pain. By combining opioids and cannabis the doses can stay low (since most of the problems you have with opioids are dose-related) and cannabis can help with opioid withdrawal symptoms.”

However, he explains that there is not enough scientific evidence to confirm the possibility of replacing methadone with cannabis, in reference to public health policies that seek to prevent the spread of STDs and HIV/AIDS.

-Why does cannabis work, why does it have so many uses?

Well, we have this receptor system in our bodies and in the brain, neurotransmitters that we’ve had for millions of years. Cannabinoids, which are molecules in cannabis, energize the functioning of this natural neurochemical system: the endocannabinoid system.

This natural system controls all kinds of critical bodily functions such as hunger, temperature control, memory, learning, processing, emotions.

There is a structural similarity between these natural chemicals in the human being and the chemicals that are in the cannabis plant.

This is probably why we started growing cannabis about ten thousand years ago.

One thing that’s interesting is that cannabis does several things at once, so it’s a little bit difficult to study. If someone has fibromyalgia, cannabis will treat their pain and inflammation, their anxiety and help them sleep, all of which make the patient able to participate more in the world and feel happier.

This sometimes requires our attention, as cannabis makes things taste better, and sometimes people can gain weight. It’s not that magically, everything cannabis does, it’s good.

-And speaking of improving people’s lives, what can you tell us about Q2 medical cannabis clinics?

Q2 is a very interesting clinic, which I am very proud to be part of. It has locations in Latin America and is designed to serve people with the desire or need to start health treatments with cannabinoids.

Each clinic (in Mexico, Peru, and Brazil) is a little different because the rules are a little different from country to country. We have a training program, designed by Dr. Raquel Peyranube, a wonderful Uruguayan professional, a specialist in endocannabinology and problematic drug use.

Q2 is a cohesive clinic that, while governed by country-specific parameters, also incorporates general principles to make it a global network for learning and best practices in medical cannabis.

What Should Lawmakers Do?

Grinspoon is convinced that harm reduction policies are a matter of maximizing freedom, access to cannabis, and its benefits.

He warns that a certain percentage of people can become addicted to cannabis and the plant should not be consumed by those who are pregnant or breastfeeding.

“You can’t drive after using it. And teenagers should be careful because it can affect their brain development. Those are the main harms of cannabis. However, these have been greatly exaggerated in the last 80 years, especially by the US government,” says Dr. Grinspoon.

According to the Dr., any good regulatory policy will maximize access to cannabis but minimize harm. Something complex, although the results of legalization in the US sound encouraging.

He explains that in the US the rate of cannabis use among adolescents has remained stable or even dropped a little, “because when it’s illegal, for example, a drug dealer will sell it to anyone. But now that it’s legal, you need identification.”

Dr. Grinspoon believes that drug harm reduction starts with education, and honest communication, to avoid infantilizing users and public opinion.

“If you tell the truth about cannabis, teenagers are more likely to listen to you. Given a mature education, most teens are sensible enough to listen to you.”

Another key issue for Grinspoon in regulating harm reduction is the taxation aspect of cannabis legalization.

He understands that “the tax problem” is complex because “if you don’t tax enough, you don’t have the revenue to educate people or to treat people” but if you tax it too much, “it becomes too expensive and everyone turns to the illegal market.”

“In the U.S., crime has not gone back up, teenage use has not gone up, revenues are great and hundreds of thousands of people are no longer at risk of going to jail for cannabis, which frees up public resources for the education and public health budget.”

Finally, Grinspoon stresses that a legal product is always a much safer product for human consumption.

Today, legal cannabis is carefully examined for fungi, heavy metals, pesticides, etc., “something unthinkable 15 years ago when we had to resort to the dealer. Now we know everything cannabis contains.

Original publication: September 13, 2021

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