Questions below  are through 2/2004 and generally appear in reverse chronological order.
Older Questions and Answers can be found by clicking here. 

Dear Dr. Grinspoon,

Of the 60+ cannabinoids in cannabis could any be beneficial in treating erectile dysfunction? Has there been any research done as yet?

Sincerely,
Erik Christian

Dear Mr. Christian,

A number of patients who suffer from quadriplegia and paraplegia have claimed that smoking cannabis helps them to achieve and maintain an erection.  While this clinical observation may eventually turn out to have much significance, at this stage there is very little more that can be said about this possibility.  As far as I know, there has been little or no research in this area.

Sincerely yours,
Lester Grinspoon MD

Dear Dr. Grinspoon,

  I have pseudo tumor cerebri. I've had it for almost ten years, and I'm relatively young, about to be 20... I've been ill for a very long time and I have other diseases...a lot of serious problems, osteoporosis, etc. I'm on Disability and you know how hard that is to get on! But I was wondering-- are there any specific diseases that pot would mess with? Any medications?

I'm on a lot of medicine, somewhere between 40-100 pills a day. So I have a lot wrong. I know you might not have a complete list, but I need some help...

 I'm scared to death of trying pot in all truth... Seriously, I'm afraid of it, but I'm running out of options... I'm slowly going blind and getting sicker and sicker. I shouldn't be disabled at 19.

 If you can give me any input on this, please do... my disease causes a lot of confusion, as you may know... I didn't mean to make this so long, I'm sorry... I just need some help here because I have no clue what to do... I'm sorry to bother you with all of this but i wanted your input specifically if it was possible...

 Also, I did not start out overweight, or have anything like that going on when I got pseudo tumor. I was underweight until I was put on prednisone (sp?) I'm also on Kadian (morphine) 200mg a day, and I can't list all of my other medications, because I don't know them all. My family takes care of that. But this is why I need to know what interactions come with it... I'm sorry!

Thank you...
Anonymous

Dear Anonymous,

I know of several other people diagnosed with pseudo tumor cerbri who have found cannabis useful in the treatment of this disorder.  If you look in the second edition of Marijuana, the Forbidden Medicine (Grinspoon and Bakalar, Yale University Press, 1997) you will find a discussion of a patient who suffered from this disorder and her apparently successful use of cannabis.  You may wish to bring this to the attention of your physician.

Sincerely yours,
Lester Grinspoon MD

Dear Dr. Grinspoon,

I am a woman of 39 who has been menopausal since the age of 22, when I had a hysterectomy because of pelvic inflammatory disease and scarring.

In the last 12 months, I have undergone four surgeries because of scar tissue returning, as well as extreme vaginal pain. Two of the surgeries have been partial vaginectomies; however, the pain continues.

I discovered, thanks to my best friend, that marijuana was a better pain reliever than the narcotics I was prescribed. I use it daily now, especially before bed, since that is when the pain is at its worst.

Inadvertently, however, I have also discovered that the hot flashes, night sweats, and severe depression/anxiety/irritability of menopause are also relieved when I use it.

Are you aware of any studies regarding cannabis use and menopause? Even anecdotal information would be interesting to compare with my experience.

I appreciate your time.

Sincerely,
Anonymous

Dear Anonymous,

Cannabis was widely used for the treatment of these symptoms by 19th-century physicians, and many contemporary women continue to find that it provides considerable relief.  For a fuller discussion of this use of cannabis, I suggest that you look at our book, Marijuana, the Forbidden Medicine (Yale University Press, Second Edition, 1997).

Sincerely yours,
Lester Grinspoon MD

Dear Dr. Grinspoon,

I have read your responses about Marijuana and its effects on the liver in people suffering from Hep. C.  What about those who suffer from liver damage as a result of alcohol abuse, specifically fibrosis or cirrhosis.  Will use of marijuana worsen these conditions?

Dear Anonymous,

There is no reason that I know of to believe that it would impact cirrhosis of the liver one way or the other.

Dear Dr. Grinspoon,

I am 24 years old, born and raised in Springfield, Massachusetts, now living in New Jersey.  I was diagnosed with Tourette's syndrome when I was 8 years old.  I experienced many problems in elementary school due to Tourette’s.  I would twitch, tense my muscles, and clear my throat excessively, loudly enough to disturb my class to the point where I was moved to a separate room during testing.  My doctors didn't help me at all; they told me it would eventually subside as I went through adolescence, but it didn't.  Over the course of the years, I've learned to deal with it, and cover it up.  About two years ago, it started to get more noticeable; almost as bad as it used to be when I was first diagnosed. 

I've been doing personal research on the relationship between Tourette’s and medicinal marijuana and stumbled upon your site.  It impressed me, and I'm interested in learning more about what I can do improve my day-to-day life while living with this syndrome. 

I understand that you are a Harvard professor, but would you ever consider meeting with me? I'd much rather speak with someone who has different views on Tourette’s and treating it, than to go to a local doctor and be prescribed medications that provide nothing but side effects.

I appreciate you taking the time to read this, and look forward to your response.

Sincerely,
Anonymous

Dear Anonymous,

While there is little in the medical literature on the usefulness of cannabis in the symptomatic treatment of Tourette's syndrome, there is much anecdotal evidence of its efficacy for people suffering from this disorder.  In my limited clinical experience it appears to be quite effective.  I have observed the cessation of ticcing within a minute or two of the inhalation of cannabis smoke.  However, there is no way that I can know whether it would be useful for you.

Sincerely yours,
Lester Grinspoon MD

Dear Dr, Grinspoon:

Hilary Black at the Compassion Club in Vancouver B.C. Canada gave me your name.  I am a Master's student who is conducting a qualitative inquiry on the relationship between ADHD and the use of marijuana.  I have had a very difficult time finding any literature on this specific topic.  It would appear that there is very little evidence on what marijuana does for these folks.  My research is almost completed and the stories from the five participants are great.  It is clear that cannabis offers a sense of calm and "normalcy".  But my lit review is still lacking and I was hoping that you could offer me some suggestions.  Has no one else ever published an inquiry on the effects of marijuana on ADHD?  Has no one else ever listened to their stories?

I look forward to your response.

Thank you very much.

Cheers,
Debbie Verkerk

Dear Ms. Verkerk,

It was more than a decade ago that I first had the experience of observing a high school student with ADHD treat this disorder much more successfully with cannabis than with his doctor-prescribed Ritalin.  His mother (now deceased), a vice president of the Massachusetts Institute of Technology, who had asked me to see him for evaluation, was also persuaded that he did much better while using cannabis than he ever did with Ritalin.  Since that time I have seen a number of patients, both young people and adults, who have had similar experiences.   I have also heard from many others; still I have seen no reference to this possibility in the scientific or medical literature.  I think that we are now in the same situation we were with Tourette's syndrome about a decade ago; a number of anecdotal reports but nothing in the medical literature.  Today you can find citations in the literature on cannabis as a treatment for Tourette's.  The bottom line is that this use of cannabis for the treatment of ADHD is still in the clinical observation or anecdotal stage, and it may be impossible to find the citations you seek.

With best wishes for success with your paper,

 Lester Grinspoon MD

Dear Dr. Grinspoon,

I was diagnosed with Crohn's disease 7 years ago. I am now 30 years old and single. I was going to school at the University of North Texas when the disease first struck. I was forced to drop out in my junior year because of the illness. When the disease first struck I lost 55 pounds within a year. Finally, after months of tests Dr. Cox diagnosed me with Crohn's. He placed me on a lot of drugs including asacol, bentyl, and prednisone, and an iron supplement. This made the disease easier to deal with, but not as much as I hoped.. I had used marijuana recreationally many times when I was younger. I did some research and came to the conclusion that it would help with my symptoms. I couldn't believe it. I had finally found relief.   But on the down side, it was illegal. I moved about two years after my diagnosis and lost my insurance. Dr. Cox said I needed to find a doctor in a timely manner to avoid a large flare-up. That was not an option, so I smoke more pot than I did before. It has been five years and I have not had a flare-up except the few times I have quit for legal reasons. I am now back at my normal weight. I have been looking for a job, so I quit for the drug test, but my symptoms have returned. I would like to try Marinol(or the generic) but the doctors I saw before I was laid off just wanted to put me back on the meds that didn't fully work. Do you know a doctor in the Houston area who is sympathetic or will at least listen to what works for the patient? Could I get a prescription from the companies on the internet if I had medical records from Dr. Cox to prove I have this ailment? Any help you could give me would be invaluable! Thank you!

                 Sincerely yours,
                 Anonymous

Dear Anonymous,

It is my impression that most people who use cannabis to treat Crohn's disease find smoking marijuana more helpful than ingesting Marinol.  Still, Marinol  is worth a try.  It is now a Schedule 3 drug, so you should not have too much difficulty finding a physician in Houston to prescribe it for you.

Sincerely yours,
Lester Grinspoon  MD

Dear Dr. Grinspoon,

I have had RSD (reflex sympathetic dystrophy) for several years now. I have been subjected to every type of medication imaginable. I was recently on a methadone program, which seemed to be working somewhat better except that I constantly felt doped up. It was a major inconvenience but one I was willing to deal with, considering the alternatives.. Recently, though, because of the stigma of methadone, the doctors do not want me to continue this program, which is even more aggravating.  Not only do you try everything they throw at you, but when you finally find something that works,  they want to take it away just as quickly because of its addictive qualities. I have always been a strong advocate of medicinal marijuana. I belong to a support group and have occasionally brought up the question of marijuana being an effective medicine for people with RSD. I have read many articles on the RSD Web sites but none that deal with that possibility.

My question is, do you know of anyone afflicted with this terrible and debilitating disease who has tried marijuana or anyone who is using it successfully? I have discussed this with my wife, and even though she would hate to break the law she has to agree that there could be nothing worse than all the oral medications I take now. I try to tell her that I would rather be high with energy than doped up and just sitting there. I know you are busy and get a lot of questions, but I have not seen anything on this subject. Please help me

 -William Fisher

Dear Mr. Fisher,

As with virtually all information about the medicinal usefulness of cannabis with respect of any particular system of syndrome, one has to cautiously rely on anecdotal evidence.  For that reason, I cannot provide you with a definitive answer to your question.  What I can say is that a small number of patients have reported that cannabis is most useful in the symptomatic treatment of reflex sympathetic dystrophy.  Keep in mind that I am more likely to hear about positive results than negative ones; that is one of the problems with anecdotal evidence.  Nonetheless, considering the seriousness of your symptoms and the minimal toxicity of cannabis, it is certainly something that you may wish to discuss with your physicians.

 Sincerely yours,
Lester Grinspoon MD

Dear Dr. Grinspoon,

My son suffers from ADHD.  He’s been using marijuana in the form of self medicating for a while, but got into some unrelated trouble resulting in probation and mandatory drug testing. He is a minor, and if he continues to test dirty, he will end up in juvenile detention. We are at a loss, because I've seen significant behavioral changes, and believe it to be helping him. I need to locate a doctor in northern. California who might be able to prescribe it. Is this possible? He is 16 years old.

Sincerely yours,
Lisa Arnold

Dear Mrs. Arnold,

Doctors in California cannot prescribe marijuana, but Proposition 215 allows them to recommend it.  However, because of increasing pressure from the federal government, it is increasingly difficult to find a physician who will do so.  And while a growing number of people report that cannabis is useful in the symptomatic treatment of ADHD, the fact that your son is only 16 will make it even more difficult to find a physician who will be willing to help.

Sincerely yours,
Lester Grinspoon MD

Dear Dr. Grinspoon,

     I recently read your article detailing some anecdotal evidence suggesting that marijuana can act as a mood stabilizer for treating manic-depression.  These anecdotes interested me as I have bipolar disorder myself.  About a year ago, I had my first hypomanic episode, after which I was diagnosed with manic-depression and put on a number of drugs: Lamictal, Haldol, Risperdal, Depakote, Cogentin, Klonopin for anxiety and Ambien to help me sleep.  Shortly after I was released from inpatient care I smoked quite a bit of high-potency marijuana.  I was warned by doctors not to smoke marijuana but I proceeded to anyway, I believe partly due to delusions about its ability to create some sort of higher consciousness for me.  During the few weeks after smoking I grew increasingly delusional, often insisting that I had become God and other such ridiculous claims.  In time I regained my grasp on reality and was taken off of all my medications except the Depakote..  At one point I tried smoking a very small amount of marijuana once again, hoping that I would be able to handle the effects and thus smoke recreationally as I had before my first manic episode.  This time I just experienced a small amount of anxiety. I felt as though I wouldn't be able to sleep, and thus trigger my mania once again.  I took a Klonopin and fell asleep, awakening in the morning to no noticeable change in perception, thankfully.  I haven't smoked any pot since then, as I am still somewhat fearful about any adverse affects that could trigger my bipolar.  My psychiatrist advises that I stay away from pot at all costs, but as far as I can tell that is standard procedure.  I also wonder if the anxiety that arose the second time I smoked was a result of my extreme worry that something just like that might happen.  I am now wondering, and I feel you may be able to enlighten me on this aspect, if I am able to smoke pot, as well as whether the medications I was on or my delusional state of mind when I smoked pot for the first time after getting out of the hospital contributed to the increased delusional and paranoid state that resulted.  I am going to be taken off the Depakote soon, and I'm looking forward to being free of prescription drugs for the first time in a long time.  I would however, if at all possible like to be able to smoke pot recreationally on occasion.  It would also be nice to be able to use pot to lift my mood when in a small depression or to calm me down if I become hyper at any time.  Right now I am still a little scared of smoking..  I have a gut feeling that those events would not repeat themselves, but if there was a good chance of that happening then it’s definitely not worth smoking pot. I could not put my family, my friends, or myself through that again.  So if you could try to shed a little light on my situation and give me an idea of what the results would be from smoking pot again, I would be eternally grateful.  Everyone I have contacted about this so far has declined to give me a definite answer.  I understand that there is probably not a clear-cut answer, so anything you can do to help will be much appreciated.  Thank you for your time and your interest in collecting information on this most interesting of plants.                                                                                                                 Sincerely,
Larry

Dear Larry,

Yours is an interesting but rather complicated story. While the anecdotal accounts we presented in the paper you refer to and many others which have come to our attention suggest that cannabis is useful in the symptomatic treatment of bipolar disorder, particularly the hypomanic phase, these accounts cannot be interpreted as meaning that it is useful for everyone suffering from this disorder.  Nor can we be sure that it is not detrimental to some people, of which you may be one. Nor do we know the consequences of using cannabis while being treated with the large battery of medicines you were taking at the time you smoked cannabis.  Given your experience, it seems prudent for you to be cautious about using it in the future, especially since you appear to be doing so well now.

Sincerely yours,
Lester Grinspoon MD

Dear Doctor Grinspoon,

19 months ago my husband, 41 now, had a horrific brain injury. Miraculously (that's what the doctors say), he regained almost all functions. But THE MAIN problem now is the increased muscle tone in the left side of his body (the right side of the brain was injured). The tone kicks in when he gets tired of exercises, gets nervous about walking , and then it's a vicious circle: he gets tense, the tone kicks in, he gets more tense, the foot and the arm start acting up. We KNOW that marihuana will help him. My questions are:

1. Should he smoke or eat it? If it's eating, how to prepare it?

2. He'll remain on Dilantin for the next three months. Are there any conflicts and/or bad reactions to this combination? If yes, we can wait.

Thank you so very much for your time. My husband is a great guy, humble and happy. And strong. We're looking forward to your response.

 Sincerely,
Anonymous

Dear Anonymous,

 The answers to your questions depend on your husband’s needs. If he seeks immediate relief, he would probably prefer to smoke.  Smoking cannabis will also afford him maximal capacity to titrate the dose.  If he ingests marijuana, in one form or another, a salutary effect will not generally be experienced for one and a  half to two hours and there will be no way of knowing until then whether he has taken too little or too much.  In other words, it is difficult to titrate an oral dose because it takes so long to experience the effect.  Eventually, patients who prefer to use cannabis as an oral medicine learn both the most appropriate dose and the best time to ingest it.  But, because of individual vagaries in the percentage of cannabinoids which are absorbed from the GI tract, it will always be a less precise way to take this medicine than smoking it.  The major advantage of oral ingestion is the longer duration of the effect.  Symptom relief will generally last two or more times as long as that achieved through the pulmonary route. A major disadvantage of smoking cannabis is, of course, the smoke.  In my view, the smoke of burning cannabis has very little deleterious effect,, but those who are concerned about the smoke are now able to use a vaporizer (see under Frequently Asked Questions).

A number of marijuana cookbooks offering a variety of ways to prepare cannabis dishes are now available.

 Sincerely yours,
Lester Grinspoon MD

Dear Dr. Grinspoon,

My mother has been suffering from the disease polyneuropathy for some years now.

She is struggling on a daily basis with the pain involved. The biggest problem for her is getting to sleep. Due to the pain, she only sleeps two hours a night. She tried several types of medicine, but nothing seems to help her. Since marihuana helps MS patients to increase the quality of their lives, I was wondering if the same applies to polyneuropathy patients. Are you familiar with PN-patients who have used it, and, more important, have benefited from it?

Yours sincerely,
O.J. Koopman
The Netherlands

Dear Mr. Koopman,

As is the case with most uses of cannabis as a medicine, the data  are almost exclusively anecdotal.  Having said that, I can assure you that many people suffering from neuropathic pain experience various degrees of relief with cannabis.

Sincerely yours,
Lester Grinspoon MD

Dear Doc. I'm a truck driver in California. I have a doctor’s recommendation for the medical use of cannabis, and I also have a prescription for Marinol. I will have to take a urine test for Dept of Motor Vehicles. Will the Marinol be a problem? What about orally ingested cannabis?

Thank you,
Anonymous

Dear Anonymous,

The standard urine tests for cannabinoids will not distinguish between the urinary products of smoking cannabis and those of ingesting Marinol.  There is a test which can distinguish between these two sources, but it is very expensive and is not used in routine screening.

Sincerely yours,
Lester Grinspoon MD

Dear Mr. Grinspoon,

I have only one short question for you: I would like to use the cannabis plant for various medicinal purposes. But (as it’s the only legal way in the Czech Republic) I would have to grow hemp with only a maximum of 0.3%THC. Is it worth using? In other words, is the cannabis healing effect based on the percentage of THC? Thank you very much in advance for your answer.

Best regards,
Viktor A. Debnar

Dear Mr. Debnar,

While the salutary effects of marijuana do not reside exclusively in THC, the percentage of this particular cannabinoid in any sample of cannabis is generally a good index of its potency and usefulness as a medicine.  Marijuana with a THC level of only 0.3% is not worth the trouble.

Sincerely yours,
Lester Grinspoon MD

Dear Dr. Grinspoon,

I have several problems, and I was wondering if medical marijuana would be of benefit to me.

First of all, I have hepatitis C, and all treatment has failed for me. After my last liver biopsy, my doctor said that his recommendation at this time is a liver transplant, as soon as possible, because of the rapid deterioration of my liver.. I have a lot of nausea and problems holding any food down. I also become sick to my stomach every time I smell something strong in our house (cleansers, food, body odor etc.)

My second problem is that I have epilepsy and take Depakote for it. The Depakote caused me to put on about 60 pounds over the last five years and is now causing back and leg problems. I have had a back injury in the past, and I dislocated my neck at age ten (I am now 43). I also suffer from severe insomnia, a problem I have had since I injured my neck.. The doctors have given me trazodoneAmbien, oxazepam, Valium, Depakote and whatever else they can think of that might work. The only thing that they won't do for me is prescribe pain killers for prolonged periods, because of the addiction potential. My sleep medications are also taken from me at times to avoid  addiction.

I am at wit’s end here, and I am looking into medical marijuana. When I was in high school, my brother used to smoke marijuana with me occasionally to help me sleep. He would also smoke with me when my neck and back got so painful that I was laid up in bed for days. This really helped me a lot, but because I am from a very strict Mormon family, and because it is illegal. I have not smoked anything since then.

Now, because of all of the pills I have been given, the doctors say I have developed tardive dyskinesia.  I have trouble with facial contortions, etc. They have also taken me off all pain killers and meds for nausea because of the condition of my liver. The only things that I am taking presently are oxazepam and Depakote. These are not working for me and I have reached a point of sheer desperation!!!

I am not sure if marijuana would help me at this point, but I would really like to give it a try if it would make me feel better. Could you please give me some advice here so that I can make a rational decision?

Thank you in advance for your assistance in this matter.

Joel Ashford

Dear Mr. Ashford,

While cannabis will do nothing for the hepatitis C itself, it is quite likely that it will give you relief from the nausea and help you to better manage eating.  I know of no evidence that it adversely affects the course of hepatitis C.  And, of course, it will be useful to you for the relief of pain. In the19^th-century cannabis was widely used as a soporific, so it may help you sleep. Since it is also an anticonvulsant, it might even eliminate your need for Depakote.  Since the toxicity of cannabis is so limited, you may wish to discuss the possibility of giving it a try with your doctors.

Sincerely yours,
Lester Grinspoon MD

Dear Dr. Grinspoon,

I have supported the medical use of marijuana for quite some time, although only in the past year have I had personal experience with this issue. In the past year I have become seriously involved with someone who has been diagnosed both as bipolar and schizoaffective.  In the past year I have done much research online into these conditions and know firsthand the difference that marijuana makes in his life. It stabilizes him far more effectively and with fewer side effects than the other medications he's been bounced around on. My question is this: he now takes lithium, Depakote, and Zyprexa as well as cannabis, Although I have read much about using cannabis with lithium,  I have seen nothing on the interaction with Depakote and Zyprexa. Are there any issues with which he should be concerned while mixing these?

Sincerely yours,
Frank Sittidae

Dear Mr. Sittidae,

As far as I know, there are no adverse interactions with any of these three drugs, but of course, there has not been a systematic study of this possibility.  You may be interested in seeing the paper which Mr. Bakalar and I wrote about the use of marijuana in the treatment of bipolar disorder.  You will find it here.

Sincerely yours,
Lester Grinspoon MD

Dear Dr. Grinspoon,

On your website you remark that oral usage of cannabis varies according to time of day and state of gastrointestinal tract.  I have also experienced the same variation but I cannot as yet understand the differences.  I do know that when I ingest cannabis butter orally in the mornings, the effect is good for nearly six hours.  It allows me to function well and makes the day go pleasantly despite chronic back pain, degenerative disk disease, and operations at L4-L5.  But I cannot predict what the effect will be when I take it in the afternoon.  Sometimes it works and other times seem not to work as well or for as long.  Why is this and how can I counteract this?  Do I need to fast?  Or prepare a different potion?  I have done the experiment with cannabis butter in the mornings many times and always with the same result, except that after two or three days in a row, there is an additive effect, as if I have taken more than I should have.  Cannabis stays in the body longer than other medicines, does it not?  Recently I have found that a tiny dose of tincture of opium one hour before a half spoon of cannabis butter works extraordinarily well.  This combo of two natural plants is not addictive and lasts up to 24 hours against pain.  Finally, the opium in such a light dose will not constipate beyond the first day; the next morning bowel movements are normal.  I have also found I can vary this pain relief, using this combo one day, cannabis the next, nothing the next, and so forth.  At present I am a walking testimony to the pain relief provided by natural plants.

 Sincerely,
 Glenn Robinette

Dear Mr. Robinette,

While we do not know much about why there may be so much variation in the degree to which the various cannabinoids are absorbed from the gastrointestinal tract, we do know that there may be significant variation both between and within individuals. It may also be the case that there are some variable extra-absorption factors at play as well.  These are the reasons why most people find self-titration through smoking cannabis the most reliable way to treat a symptom like pain.  Because pain relief from using cannabis by smoking does not last as long as it does when ingested, most people who treat chronic pain in this fashion have to use it several times a day, and for this reason many of them use vaporizers.

Anecdotal evidence suggests that opiates and cannabis act synergistically as analgesics; smaller doses of each can be taken to achieve the same level of pain relief.

Sincerely yours,
Lester Grinspoon MD

Hello Dr. Grinspoon!

I am a 23-year old mother and I smoked pot occasionally during my pregnancy; my baby-girl is perfectly healthy and very smart!

My question is: Is it safe to smoke pot while breast-feeding? I've read that marihuana has been used in folk medicine all over the world in order to increase milk flow and facilitate post-delivery recovering, but in all these accounts the herb was ingested orally. What is your opinion about smoking it?

Thanks!!
Paula

Dear Paula,

I know of no reason why whether you smoke cannabis or ingest it should make any difference with regard to the question you ask about the use of cannabis while breast-feeding.  Nor am I aware of a significant literature which identifies harm to the offspring of women who have smoked during pregnancy and breast-feeding.  Some of the most compelling studies in this area have been conducted by a nurse/anthropologist by the name of Melanie Dreher.  She has extensively studied the offspring of Jamaican women who smoke cannabis during childbirth and compared them to those of abstinent mothers.  You can find references to her work on the Internet.

Sincerely yours,
Lester Grinspoon MD

Dear Dr. Lester Grinspoon,

My name is Adam Caward I live in Chino hills CA and am 18, I have been suffering from chronic back pain for almost a year.  I have found that I have 3 bulging disks in my lumbar, and my sacrum is not fully fused, creating what looks like a 6th lumbar. I have been a daily marijuana smoker since I was 14.  I am currently taking Vicodin Es and Hp as well as Demerol and propoxyphene I have been prescribed various narcotic pain meds for about 10 months.  I find that marijuana helps me take my mind off the pain far better than the pain meds and also helps with the depression and insomnia created by my condition.  I have been taking [never heard of this unless he means mirtazepine, which I thought was an antidepressant, a sleep aid for about 2 months and have been prescribed Lexapro, an antidepressant I do not wish to take.  I see a neurosurgeon, an orthopedist and a psychiatrist as well as a primary care physician. Which one of these doctors should I ask about Marinol?  Do you think I have good enough reason? Thanks for your time.

Sincerely,
Adam Caward

Dear Mr. Caward,

Most people do not find Marinol as useful as marijuana, but it is certainly worth a trial.  The problem is that your physician may not want to prescribe it  for one of several reasons: he may not know enough about this drug to feel comfortable in prescribing it; he may be somewhat fearful, as many physicians apparently are, of the DEA; and he would have to prescribe it off- label, because it is not officially approved as an analgesic.

 Sincerely yours,
Lester Grinspoon MD

Dear Dr. Grinspoon,

I am a 6 ft 6 195lb male, 21 years old. I have had a little bit of extra breast ever since I was  ten I recently went to see a doctor about my problem.  The doctor told me that marijuana can cause male breast enlargement.  I am a frequent marijuana user and have been since the age of 16.  But I developed this long before I smoked marijuana.  Is there truth to her statement?

Sincerely,
Brandon S.

Dear Brandon,

It is not uncommon for boys to undergo some breast development during the hormonal changes of adolescence. These changes are usually temporary.  They became mistakenly connected with marijuana because of a claim by two Harvard surgeons in the mid 1970s. This claim attracted a great deal of attention, but a large study of Army recruits demonstrated that there was nothing to it. It is now generally accepted that marijuana use is unrelated to breast development in men.

Sincerely yours,
Lester Grinspoon MD

Dear Dr Grinspoon ,

I am a 45 year old employed scientist who was born with a severe spinal disease that has translated into a 250 year old spine. - Every level of my spine has experienced all forms of disk disease, fractures, stenosis and nerve damage. I have managed to maintain a certain style of life through will, meditation, extreme exercise and moderate use of raw cannabis.

My problem is that I was also born with a bad pumping system to my heart.  Last week I underwent a  by-pass operation and my heart was basically re-vascularized. It is un-damaged and is in great shape - As I am in great physical condition and practice good eating and life habits I can expect a full recovery.  In 6 to 8 weeks I should be better, as my heart is now being fully oxyegenated.

My question(s) - is it possible for me to continue to use cannabis to treat my spinal disease? Would any potential objection arise from combusting the raw leaf, i.e. would an "inhaler" suffice as opposed to a pipe, or is the THC the problem? Would inhaled cannabis lead to an increased plaque build-up at the arterial/vein replacement site? I am now taking anti-cholesterol drugs.  Would the cannabis be responsible for increased "blockage"?

I have had no heart complications from my past cannabis use. Again, it was the "plumbing" system, not my heart that was the problem.

I expect to live a full life and I would like to enjoy the benefits of cannabis in dealing with my chronic and degenerative spinal condition, but I must know the effect of cannabis on my heart.

Thank you -
Edgar D'Abre

Dear Mr. D’Abre,

I cannot answer any of your questions definitively. The decision on whether to use cannabis for your pain has to be made by you, your cardiac surgeon, and your internist. There are two cardiac effects of cannabis which they should know about.  The common effect is a moderate increase in the heart rate immediately upon smoking, which soon settles down to normal rate.  The second, uncommon effect is a significant drop in blood pressure which very rarely can lead to faintness.  Since you have already had considerable experience with cannabis and apparently have not noticed this effect, it would seem unlikely to appear now. As far as I know, there is no interaction between cannabis and anti-cholesterol drugs.

Sincerely yours,
Lester Grinspoon MD

Dear Dr. Grinspoon,

   I will try to be brief as I know you are busy. It has taken me four months to work up the courage to write you. I am a 24 year old male from NJ, and I do not know who else to turn to. I believe the person in the medical field that told me about your web site has at least risked their job informing me of your site. I have written an extremely formal letter stating my reasons for the compassionate revocation of the medical marijuana ban and the conservative distribution of it, without response from my US representative.

   I do not know if agoraphobia, PTSD, or depression, is/are "covered" under the laws of the states that do allow medical marijuana use. Under medical guidelines I am disabled and receive federal and state money for my disability. Yet I do not know if these disabling conditions are "covered" under at least one medical marijuana law. I am aware NJ has no medical marijuana laws.

   If these conditions are not "covered" I believe the reason that I am agoraphobic and have PTSD and the uniqueness of my story may at least in a court of public opinion help the cause of making medical marijuana legal for these illnesses. 

  If there are no states that I could move to and receive medical marijuana legally in for these conditions, are there any groups or persons that you know of that I could contact if I felt in time courageous enough to go public with my story?

          ~deeply grateful,        
         Anonymous

Dear Anonymous,

To my knowledge there is presently no place in the United States where you can legally use cannabis for the treatment of the symptoms you describe. The federal government’s ongoing crackdown on the buyers’ clubs in California and other states is making it impossible for patients anywhere to legally use marijuana as a medicine for the treatment of any symptom or syndrome.

Sincerely yours,
Lester Grinspoon MD

Dear Dr. Grinspoon,

How many people die from marijuana?

Sincerely yours,
Anonymous

Dear Anonymous,

There is not to be found in the medical literature a single case of a death due to the ingestion or smoking of cannabis alone.

Sincerely yours,
Lester Grinspoon

Dear Dr. Grinspoon,

As a Hep C (1a) patient, I tried the combo therapy, but only made it 12 weeks. My doctors put me on 20mg Paxil for depression and 25mg Phenergan for nausea. I was a vegetable. I couldn't eat and slept 90% of the day away. I wouldn't have made it that long without eventually breaking down and trying to smoke one or two pin joints a day. I had smoked before, but felt I should stop during treatment so the medication could do its job without "interference". It did relieve most of the symptoms and I was able to discontinue the Paxil/Phenergan duo to feel almost human again. There were other complications that arose via gall stones, which kept me from completing the therapy.

Because my stage of the disease is relatively mild, I have decided not to continue therapy until modern medical science catches up with this epidemic.

I have discontinued drinking due to its proven toxicity to the liver. What about marijuana? Will it affect my ALT/AST or GGT levels or harm my liver in any way that I should be concerned about? 

Sincerely yours,
Anonymous

Dear Anonymous,

Cannabis is not hepatotoxic.  You can use cannabis to treat the symptoms of hepatitis C without affecting its course. Many people who have this problem use cannabis to get symptomatic relief.

Sincerely yours,
Lester Grinspoon MD

Dear Dr. Grinspoon:

I’m a Spanish family physician very interested in drugs and harm reduction. I have been working with an association here in Spain for two years focusing on MDMA and "designer drugs".

I’ve been asked to review the relation between cannabis, mental health and the a motivational syndrome. Most of the information I’ve found on the Net is not very evidence-based and focuses in the negative side. I’d be very pleased if you could give me a better orientation,

Sincerely yours
Fernando Caudevilla

Dear Dr. Caudevilla,

I d suggest that you  look at the classic edition of Marijuana Reconsidered by Lester Grinspoon,; Marijuana Myths, Marijuana Facts by Lynn Zimmer and John Morgan; and Marijuana, the Forbidden Medicine by Lester Grinspoon and James B. Bakalar. All are available through Amazon.com or Barnesandnoble.com.

Sincerely yours,
Lester Grinspoon MD

Dear Dr. Grinspoon,

  Would it help me to l boil marijuana and drink the liquid from it? This was the ordinary method my country, the Pacific islands, when we used roots, and leaves of trees and plants. My question is, will the potency  be less or be just the same?

Thank you for your time, sir.

Albert

Dear Albert,
The active ingredients in marijuana are not soluble in water, so the liquid you refer to will have no therapeutic value.  If you add butter to the brew and boil it for several hours, you can then separate the butter, which is now saturated with the fat-soluble cannabinoids.  Then you can cook the butter into foods or freeze it into small cones which can be used as suppositories.

 Sincerely yours,
Lester Grinspoon MD

Dear Dr. Grinspoon,

Until about three years ago I was quietly abnormal.  I had finished off my undergraduate political science / English degree and had entered the world of law school with the ambition of killing some time before something else happened.  I was drinking heavily, profoundly depressed, and constantly suicidal.  The depression and suicidal “ideation” had been a part of my little world for as long as I could remember.  As I said, I was quietly abnormal; no one knew a thing. 

In my second year of law I started becoming outwardly very erratic and temperamental.  Of course I didn’t notice, but I had a very good friend who eventually made it quite clear that she didn’t want to deal with me anymore unless I got myself help.  With this incentive I finally went to see the university MDs.  Did you know that students are scheduled in ten-minute slots?  Is it the same in your institution?  In any case, after a good five- minute workup I was prescribed Wellbutrin.  I didn’t shake, I vibrated.  I jittered.  I was nauseous.  But I also got to actually speak to an MD/counselor, and I think that I was almost making progress.

Then it came.  The darling of antidepressants: Effexor.  I cannot be sure what happened chemically, but I started feeling a tad odd, and then I had a puff of nature’s miracle.  I saw everything all at once.  Do you have any idea how many cognitive gymnastics one will go through to convince oneself that everything is normal and O.K. when the world is actually slowly collapsing?  All of those filters fell down.  And it broke my mind.

So after much ranting and raving in public, a friend got me to a psychiatric institution.  London, Ontario, Canada is not well known for its psychiatric institutions.  It was ugly and scary, and somehow I almost immediately managed to get those blinkers back up and everything was nice and normal.  They let me go and my parents took me back to my original base of operations, Toronto.  My parents can be somewhat toxic.

Now until the other day, the next year and a bit were very fuzzy.  I know I was in the Clarke institute in Toronto and then somewhere else with attractive white walls and beds that jingled with poorly disguised restraints.  At one point I had done a number on my wrists and later swallowed lots of pills.  During that particular incident I believe that I was strongly tempted to kill my father.  He is a toxic man.

So I was put on lots of medications; lanzapine and Ativan to start, eventually dropped in favour of Epival, Paxil, Celexa, and a few others that I don’t remember very clearly. I do remember experiencing many of the symptoms of mania, all of which were embarrassing moments I’d rather forget.   What I do remember is that I had access to pot during that time, and my most lucid moments seemed to be when I was mentally floating far above sea level.  But when I had those moments I was inevitably plagued by manic impulses.   Somehow I made my getaway back to London, got engaged to the coolest of cool people (who is herself a bipolar sufferer) and have spent the last year and a bit making her life miserable.  I was back to my old temperamental unpredictability.  Of this I was blissfully ignorant.

During this time I moved from a combo of Epival and Paxil, to a combo of Epival, Celexa and Lamictol.  Another drug, trazodone, was tacked on to help me with what had been diagnosed as a serious sleep disorder.  Trazodone is the gift of the gods.  I sleep.  No one appreciates sleep.  I do.  I slept when the sun went down and woke up when the rest of the world did.  Eventually the Celexa was dropped and lithium took the place of Epival.  I seem to have been a minor experiment in drug regimens and the joy of side effects).  I didn’t touch pot for a year (lack of availability and financial means). 

However, over the past two weeks I’ve been toking some very good pot, and yesterday I suddenly was able to clear my head.  For the past three years I have been living my life as if it were some kind of movie that was happening to somebody else.  Now, I’m back in my own shoes.  I can almost think through the fog that I draped over my hospital year.  I have apologized to my fiancé and taken the dog out on a nice walk.  I am lucid but I am afraid of the mania (though it hasn’t struck yet).  I don’t want to put myself or my fiancée through the misery of me going back to hospital.  I’ve managed to get back to law school. Everything seems to be going swimmingly and I don’t want to jeopardize it.  But I’m awake.  I’m conscious.  I can see and I have good ideas and I want to do something about it all.  But I am terrified that I will end up as a ranting raving loon again.

Have you found that any medications are particularly helpful in preventing the possible mania from going off the deep end?  Should lithium keep me in line?  I’m not looking for simple approval from the “Pot is good” movement (though I heartily approve of the sticky green).  I honestly want your opinion of whether of not I am playing with fire.  I do have an excellent doctor (new head of the bipolar clinic here in London) and she might be amenable to discussing pot (though she probably won’t prescribe it) but I doubt that she has had much experience using cannabis as a medication.  On a balance of probabilities, from the research you have conducted, am I likely to be doing myself more harm than good in trying to use pot to keep my head above the water?

Thanks very much

Dear Anonymous,

I wish that I could answer your question definitively but the reality is that there are no large double-blind studies on the use of cannabis in the symptomatic treatment of bipolar disorder.  The only publication on the subject that I know of  is ours (The Use of Cannabinoids As a Mood Stabilizer in Bipolar Disorder: Anecdotal Evidence and the Need for Clinical Research, Journal of Psychoactive Drugs, Volume 30,April-June, 1998). In this paper we present the case histories of four people who have found that cannabis is at least as useful as and less toxic than conventional medicines in the symptomatic treatment of bipolar disorder.  We know of many more patients who have the same experience. We have not observed that it is in anyway detrimental to these patients.

Sincerely yours,
Lester Grinspoon MD

Dear Dr.Grinspoon,

I have a question on marijuana and weightlifting. I always drink one weekend to relax and unwind but find myself wanting to drink more and more. Alcoholism runs in my family and I don’t want it to get out of control, I’ve tried marijuana recently and found that it relaxes me faster than alcohol without the nasty hangover, plus giving my liver a much-needed rest. Is it any better for bodybuilding gains than alcohol or could it be worse?? 

Thanks,
Bob

Dear Bob,

I have no reason to believe that cannabis has any effect one way or the other on bodybuilding, but if you find, as many others have, that you can substitute it for excessive use of alcohol, your overall health will certainly benefit.

Sincerely yours,
Lester Grinspoon MD

Dear Dr. Grinspoon,

I was locked up in jail in Istanbul in 1977 and now suffer from posttraumatic stress disorder .I find the dream suppression from marijuana essential for my sanity, as I don't get nightmares when I smoke .If I stop smoking, the dreams come back in all their horror .The only other options seem to be sleeping pills, which mess my head up, or alcohol, which I don't have a taste for. Am I at risk by not dreaming as such – i.e. delta and epsilon level sleep? Please let me know your opinion. 

Sincerely,
Mark Heinrich

Dear Mr. Heinrich,

Suppressing such dreams will in no way harm you.

Sincerely yours,
Lester Grinspoon MD

Dear Doctor Grinspoon,

As a medical doctor, how can you recommend the use of vaporizers which have not been properly tested and regulated? I am referring specifically to the link on your website which redirects readers to a site using an air heater for vaporization. The air heaters used are the types found at hardware stores. Because these heaters are not designed for inhalation purposes, they could contain industrial lubricants and parts which would release hazardous chemicals into the air stream. Is this not a serious concern?

Sincerely yours,
Anonymous, M.D.

Dear Doctor,

Yes, this is a valid concern.  The Multidisciplinary Association for Psychedelic Studies and the California chapter of the National Organization for the Reform of Marijuana Laws have conducted research with several vaporizes examining the constituents of the vapor.  The laboratory which did the actual testing is Chemic Laboratory in Canton, Massachusetts. So far, three vaporizers have been tested; the Volcano (www.vapomed.de ), the Vapir (www.air-2.com) and the Volatizer (www.volatizer.com).  The first two vaporizers where tested without any cannabis in them in order to see if the units themselves were releasing hazardous chemicals into the air stream.  Neither of these units was found to add contaminants to the vapor.  So far no studies have been completed with a heat gun unit. However, since the heat gun would be used at a much lower temperature for vaporization than for paint stripping or other purposes, the heat stress on the unit itself is relatively mild for vaporization.  When more funds are available, other units will be tested.

Incidentally, in my view, the best of the vaporizers so far available is the Volcano.  It will be listed as the first choice on this web site as soon as the German manufacturer makes 110 V units available to the American market.

Sincerely yours,
Lester Grinspoon, MD

Dr. Grinspoon,

Thank you very much for your wonderful site. I had a question for you regarding the use of marijuana and Elavil. You have said, on a number of occasions, that you don't know of any interactions between marijuana and psychiatric medications (in the FAQ section of your site). I was wondering specifically about this combination. I found this site that I thought I would pass on to you:

http://nepenthes.lycaeum.org/Drugs/THC/Health/interactions.html

"Interactions can be expected between cannabis and a wide range of drugs. Nortriptyline is a tricyclic antidepressant. Cannabis interacts adversely with tricyclic andidepressants. Cannabis, on its own, produces tachycardia as a side-effect. Tricyclics do the same. Combined, there is an additive effect, with a bigger increase in heart rate. I have seen this with cannabis + doxepin (heart rate 150, as well as BP 99/75, dizziness and severe anxiety). In this case, doxepin's hypotensive (blood pressure-lowering) effect (another common side-effect of tricyclics) was also potentiated. Tricyclic antidepressants have a certain effect on the heart. This effect can be described as cardiotoxicity. In normal dosage, in individuals with no heart disorder, this causes no problems at all. (In overdosage, tricyclics can produce serious cardiac arrhythmias.) I suspect that in the interaction with cannabis, the cardiotoxic effect of tricyclics is somewhat potentiated. (I don't know if this has produced hazardous changes in ECG rhythm.) The effects of cannabis + nortriptyline in particular have been documented."

Do you know how often these types of interactions occur? Is this rare? Can the use of propanalol before marijuana use offset these occurrences?

I would like to try cannabis both for pain relief and for depression treatment yet I take Elavil and am concerned about the interaction. I am curious about your experience. Of course, I do not hold you responsible for my decision at all but I'd like to know approximately how risky this combination is from a medical perspective. The bottom line: Is this type of reaction, in your experience, common and will propranolol mitigate this? Any information you could give me would be very much appreciated. I don't take this as a substitute for my own doctor's opinion, but he does not have your expertise. I should say of all the psychiatrists I have asked so far, none of them see a problem. I just wanted your opinion. Thank you ever so much for your time. I really appreciate it.

Sincerely,
Anonymous 

Dear Anonymous,

Thank you for sharing this site with me. I am sure that I do not need to warn you that very few of these citations are authoritative. But, then, neither is my understanding of the question of the interaction between cannabis and tricyclic antidepressants since it is based primarily on my experience and not on a large methodologically sound study. In other words, like so much of the information concerning cannabis as medicine, it is anecdotal. Having said that, I am glad to share with you my limited experience with patients who have used both cannabis and tricyclic antidepressants simultaneously. I have not observed any of the problems that you have mentioned. Nonetheless, both of these drugs have effects on the heart, and one cannot say with certainty that a particular patient may not experience some untoward, perhaps synergistic, effect.  I have not had any experience, nor do I know of any, with propranolol in this situation.

Sincerely yours,
 Lester Grinspoon MD

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