03/06/19 Mary Lynn Mathre

This week on Century of Lies, medical cannabis in the US and the UK. We talk with the president and co-founder of Patients Out of Time, Mary Lynn Mathre, RN, MSN, CARN, about their national clinical conference coming up April 11-13 in Tampa, Florida; and we hear a UK government minister answering questions in the House of Lords about medicinal cannabis policy.

Century of Lies
Wednesday, March 6, 2019
Mary Lynn Mathre
Patients Out of Time
Download: Audio icon COL030619.mp3




MARCH 6, 2019

DEAN BECKER: The failure of drug war is glaringly obvious to judges, cops, wardens, prosecutors, and millions more now calling for decriminalization, legalization, the end of prohibition. Let us investigate the Century Of Lies.

DOUG MCVAY: Hello, and welcome to Century of Lies. I'm your host Doug McVay, editor of DrugWarFacts.org.

This week, my guest is Mary Lynn Mathre. She’s a Registered Nurse and a Certified Addictions Registered Nurse. She’s also the co-founder and president of Patients Out of Time, which is a 501c3 educational nonprofit that works to educate healthcare professionals, other professionals, patients and the public about medical cannabis.

Full disclosure: I do work part-time for Patients Out of Time, doing website and social media management.

Patients Out of Time conferences, you work along with medical school and professional organizations, and you provide accredited materials. These courses are accredited for continuing education credits, and, I mean, it's -- why is that? Why do you go through the, I know that it's an arduous process getting the accreditation, and getting everything straight, and all the, heck, the paperwork itself. Why do you do that?

MARY LYNN MATHRE, RN, CARN: Yeah, you described it well. It's an arduous process. You know, years back, we actually, my husband and I started out with NORML, the National Organization for the Reform of Marijuana Laws, I'm sure the listeners know, and you know, clearly, at that point, seeing that it definitely should not be prohibited, that the laws were - the punishment was so much greater than the potential harm of the plant.

As we recognized the health benefits, it just became clear that it's very important healthcare professionals understand the safety and the value of this plant, this medicine. And to do that, we felt we had to have accredited conferences. These are conferences that physicians, nurses, pharmacists, can go and get credits. All practicing clinicians need to continually maintain their license by, you know, showing that they are keeping up to date with new science.

Specifically with cannabis, they really need to understand this. So if we have a conference that accredited, that's basically telling them that this has met the criteria. We are going to be presenting scientific information. We're going to have professionals presenting this information.

So there are many hurdles we have to go through, but, that's it. This isn't a business, it's not a cannabis expo, it's not a business meeting designed for industry people. It's clearly designed primarily for healthcare professionals to really understand the endocannabinoid system, and help them understand the risks and benefits of cannabis, how to use cannabis.

Our attendees -- besides healthcare professionals, we often get patients, because, you know, they look to healthcare professionals to get their information, and sadly, most clinicians, because of the prohibition in the United States, they really don't understand how to use it. Oftentimes, the patients are teaching the clinicians.

But a lot of the patients come to our conference wanting to learn more, and simply to get validation, that they, you know, they really are using a medicine. Patients know how they feel, they can tell if they're feeling better, if the medicine's working or not.

But anyway, yeah, accreditation, for us, is basically saying this is a valid conference. The information you're going to get is valid. And along with that, let me just also introduce the fact that on the Eleventh, Thursday April Eleventh, we'll kick off the conference itself with a pre-conference workshop, and this one is literally really designed for the new clinicians that are considering making recommendations for cannabis, called "Integrating Cannabis Into Medical Practice."

We want to let the healthcare professionals be able to answer questions when patients come in and ask them about their use, and if they -- they can make a better decision about is this -- would cannabis be a good option for this patient, and if so, what would be the best route that they should take? How can I make a recommendation that's meaningful for this patient? How should I chart, or document, my interactions with the patient, what should I be looking for, you know, as they use this medicine?

So, it's, again, the preconference workshop is geared especially for clinicians new to this field. It will give you basic answers, and if we've got two, actually three leading clinicians in this. Doctor Sulak is coming down from Maine, excellent clinician. Deb Malka, Deborah Malka, an MD PhD, she's been taking care of patients for decades as well. And then a local physician, Terel Newton, who's been -- has a background in anesthesiology and treating a lot of patients for pain, pain being probably the most common reason patients seek help with cannabis.

I want to make sure people also know that on April Twelfth, we will be hosting a benefit dinner at the Florida Aquarium, rooftop on the Florida Aquarium. Really excited about that. It's a chance for those who might not -- who come to the conference, they might want to celebrate that Friday evening with us at the benefit dinner, but it's also open, certainly, to the public, a chance to meet the faculty, a chance to just help Patients Out of Time.

This is a fundraiser for us, so we really -- we depend on donations. As Doug said, we're a 501c3. Folks can find more information at either website: PatientsOutOfTime.org or MedicalCannabis.com. PatientsOutOfTime.org will easily get you all the information about the conference, how to register for it, and I'll hope to see some of you there.

Please encourage your own healthcare professional to attend this conference and learn so that they can take better care of you.

This year, we're changing things up a little bit. We always like to have an evening reception on Thursday evening, which is really a time for the faculty to come, and attendees to come and just interact socially with some of the faculty. And this year we've got Rick Doblin, PhD.

Rick is the founder of MAPS, the Multidisciplinary Association for Psychedelic Studies, and he's going to go back and do a little history of this, you know, what all's happened, how cannabis became illegal in the first place, and where are we today. So we're really thrilled to have him.

Again, we hope folks can come and join us. The reception is going to be at Le Meridien Hotel in Tampa. Again, all that information is on our website.

DOUG MCVAY: That was my interview with Mary Lynn Mathre, RN, CARN. She's the co-founder and president of Patients Out of Time. Their conference April 11, 12, and 13 in Tampa, Florida. The websites are MedicalCannabis.com or PatientsOutOfTime.org. Full disclosure: I do work part-time for Patients Out of Time doing website and social media management.

You're listening to Century of Lies. I’m your host Doug McVay, editor of DrugWarFacts.org.

Here's Valery Shuman. She's Senior Director of the Midwest Harm Reduction Institute at the Heartland Alliance. Audio comes to us courtesy of SAMHSA.

VALERY SHUMAN: So, a lot of the work that I do is in trying to change people's minds about harm reduction, to get them to accept it, to adopt it.

And people have a lot of misconceptions about harm reduction. You know, they feel like it's enabling drug users. They feel like it's giving up on people, right, like setting the bar too low. They feel like if they are sensitive to people's pros of using drugs, right, the reasons that they do it, the things that they get out of it, that that's somehow signing on, or agreeing, that it's okeh to do that.

And so a lot of the work that we do is in trying to understand where people are coming from. I think that's one of the most important things when you're engaging with a community, to try and get them to accept harm reduction, is to understand what their beliefs are, their misconceptions are, why they believe them, what their fears are, because it's often fear-based as well, and to help them understand the ways in which they're already doing it.

That's one of the things that I find, is that people are often practicing harm reduction, but they aren't calling it that. They aren't recognizing it as that, and so we do a lot of discussion around, you know, seat belts. Right? And speed limits, and really pragmatic public health strategies that we all use, that we're all engaged in, that are harm reduction, and around eating, and nutrition, like the dietary choices that we make.

There's a really great book that I often reference called Eat This, Not That. It's like, if you go to a fast food restaurant, this is the healthier choice. Totally a harm reduction strategy.

People who are engaged in primary and tertiary -- primary and secondary prevention strategies around substance use often don't recognize that it's harm reduction as well. They think of harm reduction as only tertiary prevention, right, when people are already sort of on death's door. But all of that is harm reduction. We're all on the same team.

So, trying to help people recognize that we are all on the same team, that they're already engaged in some of these practices, can help them to sign on to some of the more overt practices, as well.

So, another thing that's incredibly important when you're engaging communities around harm reduction is to find what the hook is for that particular community. And it's different in every community.

A good example is if you're speaking to legislators or politicians. They can often leverage information about cost savings to convince people to change the laws, and rules. So for example, there's lots of good evidence of cost saving on syringe exchange programs, reducing the incidence of HIV and hepatitis C, which are incredibly expensive for lifetime prevalence.

Similarly with Housing First, there's great data on how much less expensive it is to house people than to let them remain on the street and use expensive services like emergency rooms, like jails, like prisons, and so to arm people with that information, if that's the hook for them.

But it's different for other people. You know, for some people, it might be their religion or their spirituality, or their morality, that you can tap into, that really speaks to harm reduction.

For other people it's about bodily autonomy, so, trying to figure out what's important to the people, the audience that you're talking to and finding what the hook is for them.

DOUG MCVAY: That was Valery Shuman, Senior Director of the Midwest Harm Reduction Institute at the Heartland Alliance. You’re listening to Century of Lies. I’m your host Doug McVay, editor of DrugWarFacts.org.

On Monday, March 4, in the UK Parliament’s House of Lords, a government minister answered questions about the government’s plans to make medicinal cannabis available on prescription.

The questioning is opened by The Baroness Meacher, Molly Christine Meacher, a Crossbench member of the House of Lords and Co-Chair of the All Party Parliamentary Group for Drug Policy Reform. The Minister responding to questions is The Baroness Blackwood of North Oxford, Nicola Claire Blackwood. Baroness Blackwood is the Parliamentary Under-Secretary for Health and Social Care.

Other Members of the Lords follow with questions. I’ll give you the list at the end.

BARONESS MEACHER: I beg leave to ask the question standing in my name on the order paper.

BARONESS BLACKWOOD: My Lords, government officials have been working with colleagues across healthcare and the wider system to ensure that where appropriate patients can access ?medicinal cannabis.

Clinical guidance has been issued by the Royal College of Physicians, the British Pediatric Neurology Association, and the Association of British Neurologists. Specialist doctors will consider this before prescribing, but we are clear that the decision to prescribe should be one for individual clinicians to make in partnership with patients and their families.

BARONESS MEACHER: I thank the Minister for her reply. The Minister will be aware, of course, that only about four people have received a prescription of medical cannabis since it became legal on the First of November last year.

Doctors have had no training in prescribing cannabis. They need to know the contents, the dosages, the side-effects, and everything else about medical cannabis products. And the pressure on doctors with desperate patients whose standard medications are not working or are causing unacceptable side-effects is intense, and doctors do need government help, urgently.

Will the Minister ensure that the NHS [National Health Service] medical director makes specialist doctors aware of the new guidelines to be launched later this month by the Medical Cannabis Clinicians’ Society, and also to make doctors aware of the twelve module online training course already available from the Academy of Medical Cannabis?

BARONESS BLACKWOOD: Well, I thank the noble Baroness for her question. This is a challenging area, and the evidence base is still developing.

But the Government is working hard to ensure that awareness is increasing. This is why we have asked NICE [National Institute for Clinical Excellence] to develop guidance which will be released later this year. We've asked HEE [Health Education England] to develop a training package to increase knowledge and awareness among health professionals.

And it's also why officials are working closely with suppliers and importers to ensure that when prescriptions are given, they are filled. But we do understand that there is work to do on this and we will continue to work on this issue.

BARONESS MEACHER: My Lords, following the -- following the --

LORD HOWARTH: Will the noble Lady comment on the issues illustrated in the predicament of a person who has been prescribed the cannabinoid Dronabinol, branded as Bedrocan, which is the only medication that has proved effective for her following the failure of 35 different medications previously prescribed to relieve her chronic pain from cervical and lumbar spondylosis?

Given that it was last summer that the Chief Medical Officer stated that there is conclusive evidence that cannabis-based products are effective for certain medical conditions, why is this patient still forced to travel to Holland every three months to obtain the medication which her consultant considers essential for her, and why does confusion still reign over licensing procedures?

Will the noble Lady, the Minister, meet with me and the person I've mentioned to see if she can introduce some more sense into these arrangements?

BARONESS BLACKWOOD: I thank the noble Lord for his question, and I am very sorry to hear about the situation that he raises. I am of course very happy to meet with him. What I would say is that there should be no reason, as I can see, for the situation that he has outlined. It is up to clinicians to prescribe as they see fit under the guidelines which have been put out, and I'm very sorry to hear of the situation that he's raised.

BARONESS WALMSLEY: Lords, when the Chief Medical Officer recommended that cannabis medicines be rescheduled, she produced a report which showed that the most rigorous regulatory authorities in the world -- those in the US, Australia and Ireland, and indeed the World Health Organization -- had strong evidence of the benefits of cannabis-based medicines for people with epilepsy.

In light of that, surely four licences is completely unacceptable. Why are UK patients being deprived of these safe and effective medicines which have actually fewer side-effects than some licensed pharmaceuticals, such as sodium valproate?

BARONESS BLACKWOOD: Well, I don't accept the characterization which the noble Baroness has just given. UK patients are not being denied access to these medications. They are able to access medications via prescription from a doctor who is on the specialist medical register.

And, the Government has acted fast on -- with the review of the best clinical evidence and are going further with a NICE guideline which will come forward, and also with, further, a Health Education England training package to raise even more awareness.

BARONESS THORNTON: What troubles me, my Lords, about the noble Lady's answer, is that -- I've looked on NHS England’s guidance, and it said that medical cannabis can only be provided only where all “other treatment options have been exhausted," and where there is, “published evidence of benefit”.

Well, we've heard lots of evidence of the benefit here, just this afternoon. What, I think, we're right to be worried about is, what is the research that's allowing that to happen? Why is it not happening quickly enough? And I think the thing that underlies this is, can the noble Lady describe what level of opiate addiction and which severe side-effects of other medication can be tolerated before medical cannabis is prescribed?

BARONESS BLACKWOOD: Well, the evidence base for the quality and effectiveness of these products is limited, and it is developing. But this is why the Government has asked the MHRA [Medicines and Healthcare Products Regulatory Agency] to call for a proposal to enhance our knowledge of these medications.

However, we have not waited to do this. We have introduced a route via the unlicensed medications, which allows for doctors who are on the specialist register to prescribe for patients.

This is the right route because these are the doctors who will understand the conditions which are mostly likely to benefit from prescription, and they are the ones who are able to make a judgment about the safety and efficacy of medicinal cannabis.

And, it is the route which is usually used for unlicensed medications, and is the one which the MHRA has set up already. We want to see more licensed products in this route already, though, so we do also call upon industry to invest in more trials and publish the results and the full underpinning data to build our knowledge in this space so that more patients are able to benefit.

LORD WEST: My Lords, the majority of those guilty of violent terrorist crimes in this country, we have found are heavy users of cannabis. When one looks at violent crime outside of terrorism, again, and I don't know the details of this, but it does seem that very often the people involved are heavy users of cannabis. Skunk, not the ?stuff we're talking about, the liquid stuff.

Could I ask the noble Lady Minister, is the Government actually looking at the relationship between use of these really strong types of cannabis and violent crime, to see if anything should be done about it?

BARONESS BLACKWOOD: Well, the types of medicines that we're speaking about are not skunk. And he is right that all medicines carry risk, but they can also be beneficial.

That is why we have introduced a route to allow medicinal cannabis to be used for those conditions where it will be beneficial. But the change in the law allows strict access by specialist doctors who, in making the decisions to prescribe, can ensure that the benefit outweighs the harm to the patients and that restrictions are line with the advice from the ACMD [Advisory Council on Misuse of Drugs].

Any further concerns around the kinds of drugs which he is talking about are still strictly controlled by the Home Office and policing.

DOUG MCVAY: You just heard The Baroness Blackwood, the UK Government’s Parliamentary Under-Secretary for Health and Social Care, answering questions in the House of Lords on March 4 about the Government's plans for access to medicinal cannabis on prescription.

The other members of the Lords you heard in that segment, in order, were:

The Baroness Meacher, Molly Christine Meacher - Baroness Meacher is Co-Chair of the All Party Parliamentary Group for Drug Policy Reform;
The Right Honorable the Lord Howarth of Newport CBE, Alan Thomas Howarth;
The Baroness Walmsley, Joan Margaret Walmsley - Baroness Walmsley is Co-Deputy Leader of the Liberal Democrat Peers;
The Baroness Thornton, Dorothea Glenys Thornton – Baroness Thornton is Labour Party Shadow Spokesperson for Health;
and the final question was put by what I can only describe as the living caricature of an ill-informed patrician politician, The Right Honorable the Lord West of Spithead GCB DSC, Alan William John West.

You're listening to Century of Lies. I'm your host Doug McVay, editor of DrugWarFacts.org.

Here’s Valery Shuman once again. She’s Senior Director of the Midwest Harm Reduction Institute at the Heartland Alliance. This audio comes to us courtesy of the Substance Abuse and Mental Health Services Administration.

VALERY SHUMAN: I think it's really important for people to shift the culture around drug use and drug users in general, really recognize the importance of drug users in taking care of one another, and that they can and they do already, and we can give them some tools, we can use them to help avoid overdoses with others in their community, to educate one another.

So, naloxone is really important, and it's really important to get it into the hands directly of drug users and the people that love them, but there's a lot of other strategies that we can implement as well.

Some of the more interesting and unique things that are coming up right now is DanceSafe and some of the drug users unions have begun experimenting with fentanyl test strips, which were originally made for urinalysis to detect fentanyl in a drug, but they've found that they're actually pretty sensitive if you dilute a little bit of the drug and then dip the test strip in it, and they're detecting fentanyl.

And there's been a small pilot study in Canada, where they've discovered that folks using these, they're actually making different choices with regard to their drug use once they know that fentanyl is present in their drugs.

So that's a really important one.

Other really pragmatic things that people are doing are encouraging people to avoid using alone, you know, to have somebody else there so that they can intervene in the case of an overdose.

To go really slow with their injections, so that they can feel the drug at the beginning, they're not, like, slamming it in really quickly and then they've got all of it in their system, you can't go back.

To avoid mixing with other depressants, because that raises people's incidence of overdose.

Educating people about their overdose risk, things like, if you've had an overdose before, you're more likely to have one again.

People are using social media to share when there's so-called bad batches around, if they know, for example, in Chicago, there was a couple of things on social media about this person, this black Prius, is in this neighborhood handing out drugs and it's, people are overdosing, it's incredibly strong. So using social media.

And then just really importantly encouraging drug users to work with their community and take care of one another, and recognize their ability to do so.

I think that there's a lot of misconceptions about what drug users are capable of. Right? People assume if they're putting this thing in their body they must not care about themselves, they must not care about others. But what you often find when you talk to people about what they're experiences, and what they're already doing, they're already employing a lot of strategies to keep themselves and others safe.

DOUG MCVAY: That was Valery Shuman with the Midwest Harm Reduction Institute. All right, now, let's hear from Dan Bigg, co-founder of the Chicago Recovery Alliance.

DAN BIGG: Well, for the past 27 years, we have operated what we call harm reduction outreach, and that is, we, our philosophy is simply to assist any positive change, as a person defines it for him or herself.

So instead of having chaotic, out of control addiction on the one hand, and abstinence on the other, and saying these are the only two choices, we've said there's a huge productive middle ground, any positive change, and any improvement.

So we try to operationalize any positive change. You would define it for yourself, I would define it for myself, and then we as an organization would provide the most cost-effective and scientifically proven means to accomplish those things. But the choice is yours, both to what and intensity.

So for almost forty years I've been an addictions counselor, and the focus has been on struggling between those two poles, chaotic out of control addiction and abstinence. And the idea was to migrate people who are chaotic and out of control in their drug use to people who are abstinent. That is the traditional model of addiction treatment.

Unfortunately, it's inconsistent with human behavior, human condition. And there's a huge fertile field between the two that would be called improvements. In other words, using in a way that -- separating drinking and driving, for example. Hugely successful public health intervention.

It's not that we stopped drinking. It's not that we stopped driving. It's that we began to develop mechanisms for separating the two. You see them most on New Years, things like this, where, you know, where there's a designated driver, or cabs that are, or CTA, the trains, are offering free rides, and so forth. We realize there's a danger to that, and so we separate the two.

It's not that we're prohibiting one or the other. We could, but we don't, because we know it wouldn't work.

So, and that's basically all harm reduction says, is public health is the most important thing. The health of your children, the health of my children, the health of the community. That has to be first. We have to put in the background moralism, condemnation, one's perception of how one should be.

And so what we're talking about, for the first time, is affirming and even rejoicing in improvement. Not perfection, improvement. And humans are really good at improvement. We are not so good at perfection.

DOUG MCVAY: That was Dan Bigg, co-founder of the Chicago Recovery Alliance. He was speaking on a video recorded by SAMHSA that was released just a few months before Dan sadly passed away.

He was a legend in harm reduction. He was a pioneer in the distribution of naloxone. And he is sorely missed.

And for now, that's it. I want to thank you for joining us. You have been listening to Century of Lies. We're a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at DrugTruth.net. I’m your host Doug McVay, editor of DrugWarFacts.org.

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We'll be back in a week with thirty more minutes of news and information about drug policy reform and the failed war on drugs. For now, for the Drug Truth Network, this is Doug McVay saying so long. So long!

For the Drug Truth Network, this is Doug McVay asking you to examine our policy of drug prohibition: the century of lies. Drug Truth Network programs archived at the James A. Baker III Institute for Public Policy.