04.16.26: The Weed Issue, News
Despite Massachusetts legalizing marijuana more than a decade ago, it remains prohibited on Harvard’s campus, highlighting a disconnect between state law and university policy as national attitudes become increasingly positive. An addiction specialist at Massachusetts General Hospital and an Instructor in Medicine at Harvard Medical School, Dr. Peter Grinspoon has used medical cannabis in treating patients for approximately 25 years.
Grinspoon is the son of Dr. Lester Grinspoon ’55, Harvard psychiatry professor and advocate for marijuana legalization. Grinspoon’s interest in studying the effects of marijuana comes not only from his father’s academic legacy but is also deeply rooted in personal experience; when Grinspoon was eight years old, his older brother passed away from childhood leukemia, but was illegally using medical cannabis to relieve some of his symptoms. “I grew up with the idea that cannabis is a helpful medicine, not the satanic weed,” Grinspoon said in an interview with the “Harvard Independent.”
Medical cannabis was first legalized in California in 1996; many states followed suit in the subsequent years, including Massachusetts in 2012. Now, 47 states allow cannabis use for medical purposes, excluding Idaho, Kansas, and Nebraska. Despite most states adopting policies that allow for medical usage, under U.S. federal law, cannabis is classified as a Schedule I drug—along with heroin, lysergic acid diethylamide (LSD), and others that are classified as having a high potential for abuse. While legal in Massachusetts, marijuana and cannabis are federally illegal, a legacy of President Nixon’s war on drugs.
“Right now, it’s state by state. There’s a lot of variability in the quality of the regulation and the labeling—it just creates a lot of chaos and confusion,” Grinspoon said. “It’s just incoherent because it’s legal in Massachusetts and it’s legal in Vermont, but it’s not legal to drive over the border from Massachusetts to Vermont because the borders are federal.”
In 2023, the Department of Health and Human Services proposed that marijuana be lowered from a Schedule I classification to a Schedule III classification by the Drug Enforcement Administration. If approved by the Drug Enforcement Administration (DEA), the change would reclassify cannabis and acknowledge medical use in the United States.
“Legalization helps make people feel more comfortable asking about [cannabis]. It helps lessen the stigma, and it also provides a sort of ratification for patients who are already using it,” Grinspoon said. The medical properties of cannabis have been used for centuries, with use becoming popularized in the U.S. and England in the 1800s. The shift in perception coincided with changes in drug legislation and was later accelerated by the War on Drugs.
For Grinspoon, federal legalization opens doors for greater research on its medicinal properties and social destigmatization: “We can educate people about the harms, and that would open the way for neutral research … does it harm? Does it help? What are the harms? What are the benefits? What doses? What are the most effective things?” Grinspoon stated, citing Canada’s recent legalization of cannabis as a model for what future legislation could look like in the United States. “I think federal legalization really opened the floodgates to better communication, better regulation, and better research.”
While recreational and medical marijuana are growing in popularity, they still have addictive qualities, most notably the psychoactive ingredient: THC. “It can be addictive, and the addiction is serious. It needs to be treated with compassion and empathy … that said, it’s not as addictive as alcohol or tobacco,” Grinspoon addressed. Marijuana use can affect adolescent brain development before full maturity around 25 years of age. The legal recreational age of both alcohol and cannabis is 21 and unlikely to change. In some states, including Massachusetts, medical cannabis is available with a doctor’s recommendation at 18. “I usually pick 18, because most of the potential damage is in kids that are 14, 15, 16. Kids are more susceptible to [the effects of cannabis] than adults,” Grinspoon said.
Grinspoon attests that some of the misconceptions and anxiety surrounding cannabis use and legalization stem from inflated data around addiction. There are 11 criteria for substance use disorders, two of which have to be met—including tolerance and withdrawal—to be diagnosed by an addiction psychiatrist with a use disorder. “With cannabis, every patient has tolerance and withdrawal. That’s true for opiates or benzodiazepines, or selective serotonin reuptake inhibitors (SSRIs), for that matter,” Grinspoon pointed out.
Certain drugs used as pain relievers are excluded from this criterion, yet medical cannabis is commonly used in chronic pain treatments. As a result, estimates that approximately 30% of cannabis users are likely to become addicted are inflated. “Everybody uses opiates for pain. Everybody gets tolerance and withdrawal. So there’s an opiate exclusion in the definition of addiction for opiates, which is, if you just have tolerance and withdrawal, you’re not addicted, because just having tolerance and withdrawal doesn’t make you addicted,” Grinspoon said. Because cannabis does not have the same exclusion as opioids, it can overstate true addiction statistics, an oversight which Grinspoon attributes to a lingering drug war mentality.
One of the first steps in destigmatization is education, especially in how to get started using cannabis responsibly. Grinspoon calls these patients “canna-curious.”
“Start low and go slow,” Grinspoon emphasized. “Take a very small dose of an edible or tincture under the tongue. Some of the topicals are really helpful if you have arthritis … Don’t take the 20 mg edible your kid gives you because that’s what they take recreationally.” He strongly recommends against smoking marijuana because of its harmful effects on the lungs.
According to Grinspoon, discussions about the limits and uses of medical cannabis start in hospitals and medical offices, which in turn influence research and public education. “The only problem is, doctors are often significantly undereducated about anything helpful having to do with cannabis; most doctors can’t really advise their patients sensibly how to use it … The solution to this, of course, is to educate doctors and patients,” Grinspoon said.
“It also helps the patients who are kind of curious, because instead of hiding and getting their information from dubious sources, now they feel more comfortable saying ‘Hey, doctor, hey nurse practitioner, what do you think about medical cannabis?’”
As Grinspoon continues his research and treatments with cannabis, the conversation around proper usage, destigmatization, and legalization continues to expand. This dialogue extends across generations; college student usage is notably on the rise, but Grinspoon claims the most rapidly growing demographic of cannabis users is people over 65.
In Massachusetts, over 37% of residents have reported using cannabis in the last year, and nearly half the population has used marijuana at some point in their lives. The number of cannabis users continues to grow, and so does the research on its potential health benefits.
“I think we’re going to be using it earlier and more consistently in our treatment algorithms. I don’t think it’s going to be a last resort. I think it’s going to move up as more physicians appreciate what many patients have already figured out; that cannabis is generally well tolerated and generally quite effective for many conditions,” Grinspoon concluded.
Grinspoon’s latest book, “Aging Well with Cannabis,” further explores the harms and benefits of medical cannabis use.
Sophia Gonzalez ’28 (sophiagonzalez@college.harvard.edu) is canna-curious for the possibilities of future medicine.
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