11/28/18 Will Dolphin
This week on Century, we talk with William Dolphin and Michelle Newhart about marijuana and their new book, The Medicalization of Marijuana: Legitimacy, Stigma, and the Patient Experience.
This week on Century, we talk with William Dolphin and Michelle Newhart about marijuana and their new book, The Medicalization of Marijuana: Legitimacy, Stigma, and the Patient Experience.
William Dolphin and Michelle Newhart, co authors of "The Medicalization of Marijuana - Legitimacy, stigma and the Patient Experience" , join us live for the full half hour
OCTOBER 17, 2018
DEAN BECKER: I am Dean Becker, your host. Our goal for this program is to expose the fraud, misdirection, and the liars whose support for drug war empowers our terrorist enemies, enriches barbarous cartels, and gives reason for existence to tens of thousands of violent US gangs who profit by selling contaminated drugs to our children. This is Cultural Baggage.
Hi folks, this is Cultural Baggage, and I am Dean Becker, the Reverend Most High. We've got a couple of guests that are in Colorado attending a cannabis conference who have written a new book. Yes, it's true, Canada just legalized cannabis today, but we've got a different focus for this program.
When I showed up today, there was a gentleman showed up, he's named Mark. He works with Ram Shirts. He donated the first of the Conscientious Objector shirts. You've heard me talk a little bit about it. I urge you go to Objectors.info. There, you can see the logo, the logos, it just says Conscientious Objector To Drug War. It's got the words Drug War scratched through with a big red.
You don't have to be a legalizer like me, you don't want to have to legalize heroin and cocaine, whatever, what you could base your conscience around is that you want to stop funding the terrorists who grow flowers that we forbid, and then they sell that, those drugs, and then they buy weapons to kill our soldiers.
Or you could be for ending the barbarism going on south of our border in Mexico, Guatemala, Honduras, El Salvador, where tens of thousands of people are butchered every year, they're butchered on video, put up on the web to show the other gangs how tough they are, and it's driving thousands and thousands of people northward, mothers and children riding on top of trains, coming to our border, trying to seek shelter, and we take the kids and lock them in cages.
So, I guess the whole point I'm trying to get to folks is that we are -- we have to do better. We have to expose this drug war for what it is. Now, today, we're privileged to have two folks with us, they're live, they're at a conference up in Denver, Colorado, where weed is legal, where folks don't get busted for having a bag, and they've written a new book, The Medicalization Of Marijuana: Legitimacy, Stigma, And The Patient Experience.
It's written by Michelle Newhart and the editor of my book, Mister William Dolphin, and we have them with us live now. Can you hear me, William? Michelle?
WILLIAM DOLPHIN: Yes, we can, Dean. Thanks so much for having us on.
DEAN BECKER: Oh, thank you for being with me. It looks like we lost Michelle, we're going to try to get her back, but thank you, William. Tell her we're working on it.
I tell you what, first off, I want you to just tell me why you're in Colorado, what's going on today?
WILLIAM DOLPHIN: Well, yeah, the conference just wrapped up yesterday. This was a medical marijuana for, it was for, rather, a marijuana for medical professionals conference, so, aimed at continuing medical education for nurses and doctors, one of the only ones that really is about trying to educate those professionals on how to use cannabis in therapeutic practice with their patients.
DEAN BECKER: Okeh. And, what's your take? How's it going so far?
WILLIAM DOLPHIN: Well, you know, it was a great conference, and, you know, a lot of really fascinating information about developments in treatment. There's certainly increasingly growing acceptance in the medical profession that this is a valid treatment, and that there's tremendous potential for treating a whole lot of different types of diseases.
In fact, probably the most exciting thing we heard was a conclusion of some researchers that every disease state in man is implicated in your endocannabinoid system's functioning, so cannabinoids may have a direct role in treating almost everything that goes wrong with us.
DEAN BECKER: Well, thank you for that. And, you know, in reading your book, I'm really impressed, William, with the, oh, I don't know, the diversity, the reach, of this book, to delve into all the aspects that influence and many times complicate the use of cannabis. In particular, the stigma, if you will, that reefer madness is still carrying to this day. Right?
WILLIAM DOLPHIN: Well, that's right, and that's what we were presenting on at the conference as well, because it of course affects the willingness of people to seek it out as treatment, or even talk about it with their doctors, and of course it affects the doctors' willingness and ability to talk about it with their patients, too.
So, you know, one of the things that, you know, we were hoping to do with the book is situate the experience of patients in the medical cannabis program in relation to what we know through medical sociology about how people use other medicines, and how this differs or is similar.
And, you know, our basic findings were that, you know, by and large, it looks a lot like other medicines in terms of how people actually use it, the strategies that they develop for managing dosage and side effects.
But the big difference is, of course, the stereotypes and stigma that are still associated with it, and that means that, even though this of course is a drug with fewer side effects than any pharmaceutical available, this is what they get to last, after they've gone through everything else.
DEAN BECKER: Right. And, well, I tell you what, I want to address my next though, I understand we now have Michelle Newhart on the line. Thank you, Michelle, for joining us.
MICHELLE NEWHART: Yes, hi, thanks for having us.
DEAN BECKER: Yes, ma'am. Now, the thing that comes to mind, for me, where the big change, the true change, began, was with Doctor Sanjay Gupta, and his analysis of the situation with the kids with Dravet's Syndrome, the epilepsy, and how the marijuana changed their lives, and is still changing lives.
It was an awakening, was it not?
MICHELLE NEWHART: Well it certainly, especially for the southern states, in treating children.
The book focuses a lot on the expansion of the program in Colorado after the Cole Memo, and just how the program really exponentially grew over a year, where the year before it had only five thousand patients in Colorado's state program over the first eight or nine years of that program, and then in a single year went from 5,000 patients that applied to the program to over 125,000 patients who had applied to that program, just with that small change in the policy that wasn't even a binding change, but was rather a memo sent to the state attorney general -- the state's attorney, asking for the federal system to respect state laws.
And, so, that was where the data from the book came from, was from patients who were at mid-life or older, who had entered that program.
DEAN BECKER: All right. Yeah, and, you know, I've often said, you know, why don't we look at the life history of cannabis users. I've been at it for, what was it I figured out the other day, 54 years, and I'm a relatively healthy individual, had a successful career, so, but that doesn't seem to enter the picture. You need science, you've got to hammer it down, do you not.
MICHELLE NEWHART: Yes.
WILLIAM DOLPHIN: Well, you do, and I think the, you know, the question you asked just before about the Sanjay Gupta piece goes to that as well, because, you know, he is a trusted individual, he is a public figure, and that first special that he did for CNN and he's now, of course, followed up with a couple of others, really provided credible information for people about the possible effectiveness of this.
And, you know, much like Michelle was just describing with the Cole Memo's effect, you know, that special came out and all of a sudden you had parents with sick children pounding on the doors of their statehouses saying, you know, we need access, and, you had this sudden, you know, increase in the number of states that have what we refer to as CBD-only laws, so extremely limited, not really workable programs for a lot of folks, but, you know, at least saying let's get kids this safe, effective, no side effect medication.
And that was some of the most exciting stuff we were hearing, too, during the conference, was just the growing understanding of the remarkable applications for CBD, the non-psychoactive cannabinoid in the plant.
DEAN BECKER: You know, just today, I saw a news story, a gentleman, actually it was a woman, was caught with some cannabis, and she was a medical patient, had her license with her, but the cop who stopped her didn't know the law, put her under arrest, took her to jail, and now the district attorney is considering dropping the charges, but it's, it's just making sure that the word gets out, is part of the problem, is it not?
MICHELLE NEWHART: Well, exactly, and a couple of the points that you're touching on speak directly to this over-arching issue of legitimacy, and the fact that we have uneven laws is not just a signal, but it's a practical risk, and the fact that the law can be interpreted in different ways, if you don't have clear and binding rules that are standard across different scenarios.
And so then it comes to how's any specific law enforcement officer interpreting those laws. That creates a huge environment of uncertainty for a patient.
WILLIAM DOLPHIN: Well, it is, but, you know, here's the issue. They know that. Many of them will respect that, but it comes down to the judgment of the individual officer, just like right now, even if you're in a state where it's legal, you still have some risk with the federal government, you still may have, you know, issues around the custody of your child. Right?
DEAN BECKER: Yeah. Yeah.
WILLIAM DOLPHIN: You know, even if it's legal, that doesn't necessarily mean that it can't be invoked as a way of taking away a professional license, or taking away your children from you, and there have been many great folks in states where it's not legal, another case in Texas, the Zartlers, who have a daughter with severe autism and self injury behavior.
DEAN BECKER: Yeah.
WILLIAM DOLPHIN: And, they were very concerned, because, you know, she needs a custodial guardian, and she turned 18, and they were concerned about what was going to happen.
I mean, fortunately the folks understood what was going on, and they respected that the family was doing everything they could to simply care for this young woman, but, you're at risk, and this was something that all of the patients in our study were acutely aware of, and managing that interpersonal, you know, relationship with everyone they met, whether it's family members, co-workers, law enforcement.
And that is not something that people have to deal with with other medications, and it's of course just an extra stress, an extra problem, and it's a barrier to using it in the first place.
DEAN BECKER: You know, when I mentioned, I do what I can, maybe initially I help with supply, but mostly what I do is convince them that they know someone who can help with that, someone within their family or their, you know, friend, close friends, that they know someone who can help with that assistance.
And so far, it's worked out every time, because, my god, everybody smokes pot. I'm sorry.
WILLIAM DOLPHIN: Well, many people do, and many people understand that it's safe and effective, and that was another of our findings in this, was that the way that patients were finding out about it was not through their doctors, it was through networks of family and friends.
DEAN BECKER: Yeah.
WILLIAM DOLPHIN: And someone, like you, would come to them and say, hey, you've got a condition, I'm pretty sure cannabis can help with this. Maybe you should try it. And some of these people were extremely persistent, you know, like show up at the house, here's some cannabis, I think you should use it right now. Let's see how this works.
DEAN BECKER: Right.
WILLIAM DOLPHIN: And it took that, you know, these are -- these are complicated decisions, and Michelle can speak to this too, but, I mean, always made with family, you know. This is an intimate problem for folks.
DEAN BECKER: Well, let me address a question to Michelle. By the way folks, we're speaking with, that was William Dolphin, and Michelle Newhart, the co-authors of The Medicalization Of Marijuana: Legitimacy, Stigma, And The Patient Experience.
And, Michelle, let me address this to you. In one of your chapters here you talk about modeling doctor-patient interactions. And, I'm aware in California it got to be where there were certain doctors who were just, come in for five minutes and we'll write you a recommendation, that became their whole exclusive trade, or profession, if you will.
But what we need is more, to make this more available, or what's the word I'm looking for, where any and every doctor would maybe consider making that recommendation, because the truth is so evident. Your response there, Michelle.
MICHELLE NEWHART: Sure. We definitely find that policies matter for how doctors handle this interaction, and, you know, those policies have changed in the states that allow that, in terms of trying to close any loopholes that people sense as ways that people can get into the medical system illegitimately.
But, lots of times, the doctor-patient interaction around a cannabis recommendation is not the same as going in to get diagnosed. Often you already have your diagnosis. It's just about whether this treatment is an appropriate treatment for this, and because patients may not know their doctors opinions about that, it creates a sense or uncertainty in bringing it up with doctors who also can have very biased, pro or con, opinions about medical cannabis.
And so that can create uncertainty for everybody in that interaction.
DEAN BECKER: I have seen this. I have seen the instant relief that can come to those, I saw a lady in a wheelchair, I think she had MS. She was in a rally in Austin, the day wore her out, it was hot, it was tiring, and we went behind the capitol, and she smoked a couple of hits and you could see the relief come over her. She was able to actually formulate and speak her words better.
There is legitimacy, and we have been fooled by these lying weasels for a hundred years, and it's time to step up, to take control of this, to grab the moral high ground. To demand they defend this policy that has never achieved any of its stated goals.
We're back with Michelle Newhart and William Dolphin, the medical -- the authors of The Medicalization Of Marijuana: Legitimacy, Stigma, And The Patient Experience.
Well, either one of you can jump in on this. After your presentation, what were some of the responses, some of the questions you might have received.
WILLIAM DOLPHIN: Well, you know, yeah, you know, part of what we were talking about again was, you know, how this issue of the stigma, and the stereotypes that patients experience affect their interactions with doctors, so, you know, the gist of what we were talking to these doctors and nurses about was that folks won't necessarily tell you about what they're up to, because they're worried about the interaction.
And so, you know, it's really important for doctors and nurses to educate themselves, and unfortunately, you know, we're in a position where there's still no medical training on cannabinoid medicines, so these are things that folks have to go out, like, attend this conference, and do the education on their own.
So, you know, a lot of concern for that, you know. You mentioned the sort of doctor-mill docs, where you come in, you've got a five minute "appointment," quote unquote, no exam, no real history, and you walk out with a recommendation.
Well, a lot of concerns among physicians about that type of practice, because, as you can imagine, you might miss an underlying medical problem that could be directly treated, and the cannabis can treat a lot of things directly, but it can also be a great palliative. Right? I mean, you can just ease symptoms without necessarily under, you know, addressing the underlying problem.
So, you know, if you've got -- if you've got some sort of serious, you know, bone cancer going on, you don't want to just mask that pain, you want to figure that out.
DEAN BECKER: Yeah.
WILLIAM DOLPHIN: And that requires a certain amount of testing. So, you know, there were some questions about how to get past that, and how to deal with that, and, you know, some of that is, of course, on patients to be honest, and if you've got a medical problem, you want to tell your doctor what you're up to.
But, you know, our research showed that doctors say some crazy things to people around this, you know. We had one patient who, you know, we talked to, had a rare form of multiple sclerosis, went to her doctor about it, and he was like, well, you might as well just drill a hole in your head, like they did in the middle ages.
You know? And she had to be persistent, but, you know, she kept going back, kept going back, and said hey, you know what? I'm trying this, it's working, you need to educate yourself, and he came around in the end.
MICHELLE NEWHART: We had other doctors that we know are out there who support the use of medical cannabis for their patients, for their patients who may have known conditions for which medical cannabis is helpful, and, but they're prevented from making the recommendation because of bureaucratic limitations, federal money, or DEA licensure, keeps them from actually being the one to sign the recommendation form.
So, even though informally they'll give the thumbs up, they aren't the ones who could sign it. And we've seen the laws change around, sort of how loose it is to go in for a recommendation, what evidence you need to provide, whether you have to give ongoing care to those patients or not.
But, another way to see the doctor-mill of doctors, so to speak, is that they've played an important role overall in the medicalization of marijuana, and that's because you had to have doctors willing to sign those recommendations to have a functioning program.
DEAN BECKER: Right.
MICHELLE NEWHART: So, you know, without someone willing to sign those papers, you don't have a program that's working.
DEAN BECKER: Right. You know, I knew one doctor, a California doctor very well, Doctor Tom O'Connell, and he took the time. He evaluated his patients, he kept a lot of notes, he did some of his own studies, analysis of who was coming to see him and why, and so forth.
And, you know, Doctor Tom has passed on now, but they weren't all that nefarious, or what you might say, out in California.
MICHELLE NEWHART: Exactly.
DEAN BECKER: And, so --
MICHELLE NEWHART: Exactly. There's plenty of legitimate doctors who are -- do sign papers, but some doctors that do end up with limitations, either in what they believe or in the limitations that they find from being tied to federal money in some way, or federal licensure in some way, that means that they're not going to sign papers.
But we found also patients wanted legitimacy, and they gauge that legitimacy by how that legitimate that doctor recommendation interaction was. And they themselves may keep paperwork on their use, and just keep track of their own regimen for use in order to support that medical use of marijuana as well.
DEAN BECKER: It's time to play Name That Drug By Its Side Effects! Loss of personal freedom, family, and possessions, ineligible for government funding, education, licensing, housing or employment, loss of aggressive mindset in a dangerous world. This drug's peaceful easy feeling may be habit forming. Time's up! The answer: doobie, jimmy, joint, reefer, spliff, jibber, jay, biffa, jazz, blunt, steege, greener, cracker, hogger, bone, carrot, maryjane, marijuana, cannabis sativa. Made by God. Prohibited by man.
All right, we're back with the authors of The Medicalization Of Marijuana, Michelle and William. I want to first, I had a page, I was going to reference something here. This is part of your introduction:
"Our focus on patient experience contrasts with how cannabis use has been commonly considered: as a manifestation of criminality or addiction." And that's, well, hell, that's most of the problem, isn't It?
WILLIAM DOLPHIN: So it is. It's the core of it, you know, and we've, as you said, and I just want to just add here, too, I mean, you have done such amazing work on spreading the truth about this, and I want to, you know, help you encourage everybody to support this program, but, yeah, you know, we have a long history of lies around this, and criminalizing what is otherwise harmless behavior with people, and that has had a profound impact on where we've ended up with this.
And, you know, sociology has had plenty of time to look at cannabis use. One of things that's different about our book is it's the first time that anybody has looked at it as a positive behavior, a therapeutic behavior. Everything else has been a matter of dealing with it as a criminal or a deviant matter.
And that's part of the stereotype and stigma, of course, that patients have to deal with. It's not just the kind of funny Cheech and Chong stuff. It's, you know, what kind of person are you? You know, you've got an attorney general right now who says, you know, good people do not smoke marijuana. You know? And that's just outrageous.
DEAN BECKER: Well, and then, I keep seeing rumors that Trump's going to legalize weed right after the midterms, and I'm 70 years old, and I've heard this BS before, from, all the way back to, what, Jimmy Carter?
WILLIAM DOLPHIN: Carter. Carter promised it.
DEAN BECKER: Carter promised it, and I don't know, the, somebody who worked with NORML got caught doing cocaine at the White House or something. Anyway --
MICHELLE NEWHART: One of the things we talk about at beginning of the book, too, is that we chose to name the book Medicalization Of Marijuana, as opposed to any other term we might use, to, because marijuana is the social construction of cannabis.
DEAN BECKER: Yeah.
MICHELLE NEWHART: And we argue that, in some ways, it may be the most consequential social construction of the twentieth century. I mean, the drug war, and its affects, reach everyone, whether you used cannabis or not, it had a huge impact on our society over the twentieth century.
And, so we felt like that was very important to lay out, and we feel like that's largely a result of what we call a single story that's been enforced by authority throughout the twentieth century as the only interpretation of cannabis use being one for intoxication, that all use is equivalent, no matter your age, no matter how much or how little you use, no matter in what context you use it.
And that's part of what medicalization starts to break down. It drives a wedge into this idea of having just one interpretation of use.
DEAN BECKER: I have interviewed, I guess, a hundred and fifty authors of drug reform type books, and I can tell you this, this one delves deep. This one reaches why. This one gives you the information you need to help educate your doctor or your family or friends to the legitimacy, to the reality, of this situation, and I urge you to pick up a copy, The Medicalization Of Marijuana: Legitimacy, Stigma, And The Patient Experience.
I'm going to give you guys a couple of minutes to, you know, close it out here, to tell folks of your own experience, perhaps, and you know, how we should move forward. Do you want to go first, William?
WILLIAM DOLPHIN: Sure, I will, yeah. You know, I mean, I, everybody has a story about how they became interested in this, how they became attached to the issue, and mine was very personal, with a dear friend who was dying, who was finding relief but was scared to death of the consequences of getting caught using cannabis instead of the opiates he was being prescribed.
Right now in America we've got an opioid epidemic, you know, thousands and thousands of people are dying every year. One of the things we were hearing at this conference was the very clear, compelling evidence that cannabis, CBD, THC, isolated or together, provides a really viable alternative to this, that not only can be used instead of it, but even for people who've got really severe pain, a little bit helps, you know, potentiate, make that opioid work a lot better so you can lower the dosage, lower the side effects, lower the risk for people.
And at the end of the day, that should be what public health and public policy is about, is keeping folks safe. And, you know, the current policy is do exactly the opposite, endanger folks, and in a lot of ways that we may not even see. You know, the drug war takes resources out of the police that could be used to help stop real crimes that affect people's person and property.
DEAN BECKER: Yeah.
WILLIAM DOLPHIN: So, you know, we're hoping that this book will help shed some light on that, and I thank you for your kind words about it. We've tried to take a comprehensive look at it, so, if you're reading it, you don't just get a sense of what these patients are dealing with, but sort of what we all deal with, the history of how we got here, and, you know, potentially the way forward.
Because, you know, it's not just a matter of turning it over to the pharmaceutical companies. We need targeted drugs developed that can do specialized things, but the whole plant is safe, and patients want access to it, and they want options, and that's the sort of thing we should see develope.
DEAN BECKER: Right. And, Michelle, do you have some closing thoughts?
MICHELLE NEWHART: Sure, I just, I mean, in the course of writing this book, we got the chance to talk to so many patients, and I just applaud them for their bravery. I think that this issue never would have gotten anywhere without the grassroots efforts of just so many people who have pushed on this issue to get it where it is, and we certainly appreciated the ones who participated in the book and all those out there who are trying to change the laws, and get this more evidence based and in line with what this plant actually can do for us.
DEAN BECKER: All right. Well, I want to thank you both. I want to tell the audience one more time the name of the book: The Medicalization Of Marijuana: Legitimacy, Stigma, And The Patient Experience. Our guests have been Michelle Newhart, and William Dolphin. I want to thank you both.
WILLIAM DOLPHIN: Thank you, Dean.
MICHELLE NEWHART: Thank you.
WILLIAM DOLPHIN: It's been such a pleasure, and an honor, and I just want to encourage everybody to support Dean and this program. It makes a difference.
DEAN BECKER: You know, it's been a long time since I had a guest or a couple of guests on for the whole program, but, I felt that their book was very important to helping change America's attitude. Anyway, again, I remind you, because of prohibition you don't know what's in that bag. Please, be careful.
To the Drug Truth Network listeners around the world, this is Dean Becker for Cultural Baggage and the unvarnished truth. Cultural Baggage is a production of the Pacifica Radio Network, archives are permanently stored at the James A. Baker III Institute for Public Policy, and we are all still tap dancing on the edge of an abyss.
CENTURY OF LIES
NOVEMBER 28, 2018
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 on Century, we're going to hear from Michelle Newhart and William Dolphin. They're the authors of a new book, The Medicalization Of Marijuana: Legitimacy, Stigma, And The Patient Experience. It's just out from Routledge Press.
So, could you tell our listeners a little bit about yourselves first?
WILLIAM DOLPHIN: Sure. Well, so, I am William Dolphin, and I've been working on medical cannabis related issues since about 2001, 2002, first with Ed Rosenthal's federal trial in San Francisco, and then since then with a variety of patient advocacy organizations, including Americans for Safe Access. If you get the monthly newsletter from ASA, you know me because I'm the one who sends it out.
But, I'm also a teacher of writing at the University of Redlands, I've been at other places too, and Michelle and I have known each other for quite a long time around this, back in the Ed Rosenthal days.
MICHELLE NEWHART: Yes. And now we're married.
WILLIAM DOLPHIN: Now we're married, that's right, in part thanks to all this, I guess, yes.
MICHELLE NEWHART: And I'm Michelle Newhart, I have my PhD in sociology from the University of Colorado at Boulder, and prior to graduate school, I worked as an editor for Ed Rosenthal's publishing company for about eight years, doing research and writing about cannabis and medical cannabis since about 1999.
DOUG MCVAY: Now, Michelle, you write in the book, in the forward, you know, the preface, I guess, whatever it's called. Forward? Preface? You write in the book that marijuana chose you. Now, I think I know what you mean, but could you explain that for the listeners?
MICHELLE NEWHART: I guess what I meant by that is, it's the thing that found me, I didn't go looking for cannabis. I became a sociologist, and I ended working in cannabis initially with Ed because I literally cold answered an ad in the newspaper, and then when I left from working for Ed, I went to graduate school in Colorado thinking my days of working on cannabis were done, and lo and behold, everything blew up in Colorado while I was in graduate school, so I found myself working on that issue again.
DOUG MCVAY: Let's talk first about stigma, if that's all right, because, I mean, I talk about stigma on this show quite a lot. We talk about stigma a lot in drug policy reform and harm reduction in general, but, tell me about stigma in the context of the general social use of marijuana.
WILLIAM DOLPHIN: Well, stigma attaches to cannabis use, period. Right? And we see that in all aspects of it, and it doesn't matter where you are. At the point where you identify as a cannabis user, you're open to being stigmatized, and the point we make in the book is that the most consequential social construction of the twentieth century is cannabis.
Medical marijuana has driven a wedge into that, because it differentiates the use. Right? I mean, there's a sort of single story about what it means to be a marijuana user, and what marijuana is, and that's a drug of abuse that's only purpose is intoxication, in some problematic way. And of course medical cannabis use is entirely different, and that is the transition that it's going through.
But even with all of the many states that have enacted programs, and the growing body of research about it, and the growing public acceptance of it. As you know, Doug, the public opinion polls, 86 percent of Americans think you should have legal access if your doctor recommends it to you.
But nonetheless, people are super sensitive to being stereotyped around it, and that affects everything. That affects how they interact with their families, with their colleagues at work, and with their doctors.
MICHELLE NEWHART: Well, and as we know, that stigma is, in large part, by design. It was structured into how the laws work, and stigma and legitimacy can be seen as two ends of a pole of how we understand this issue.
And, it's also a behavioral stigma, so, like other behaviors, it's something that is in a moment and can be hidden or disclosed, and that makes it a special type of stigma, and so public identification becomes a very important part of understanding how that stigma works.
DOUG MCVAY: More specifically toward medical, now, I live in Portland, Oregon. That's the home of the National College of Naturopathic Medicine [sic: National University of Naturopathic Medicine, the name was changed in June 2016]. You don't have to live -- in fact we have more naturopaths in the state of Oregon and in this area than pretty much any other state in the country -- you don't have to live here though to know that alternative therapies and complimentary and alternative therapies have been growing in popularity for the past few decades.
In spite of the growing acceptance and use of complimentary and alternative therapies -- I prefer CAT to CAM, partly because I like cats, but also because when people think medicines they think drugs, and when people think acupuncture and the like, therapies might be a more inclusive word, so that's why, but in your book you refer to them as CAM -- but anyway, in spite of that growing acceptance and use of these complimentary and alternative therapies, there are still a lot of medical doctors who are, to say the least, skeptical.
So much so that a lot of people just lie to their doctors about their use of these therapies. Now, so, talk to me for a moment about the stigma around that, around the use of, generally, of complimentary and alternative therapies or medicines.
MICHELLE NEWHART: Well, when I decided to write about this, I was already writing about complimentary and alternative therapies, and thinking about how those were affected by the changes in the law that allowed nutritional supplements to market directly to consumers, and those laws changed in 1996, the same year that we got our first medical cannabis laws in California.
And, I started asking people when we did interviews about how they saw cannabis fitting with other complimentary and alternative medicines, and I expected people to see them as similar, but it was interesting that most medical cannabis patients didn't see them in the same category.
Yet, from the physician side, I think you're right, I think we've seen developments in integrative care since that, over the last couple of decades since that time, and we've certainly seen some changes in the language that's used around complimentary and alternative therapies.
But, even the latest study that just came out, Elin Kondrad and colleagues in 2018 interviewed primary care physicians and their patients about the various medical therapies that they used, including cannabis and differentiating whether it was medical cannabis use or not, and it was clear that about half of them who reported using medical cannabis did not tell their primary care physician that they were doing so.
So, even, you know -- you know, that's a very contemporary study, and still showing that there's communication problems between doctors and patients around things outside of biomedicine.
WILLIAM DOLPHIN: Well, and as you can imagine, you know, there's concern for what are called stereotype threats, just how people are going to categorize you based on disclosure. You know, it applies to all kinds of folks and no less doctors.
You know, doctors are authority figures. People are very concerned, and sociology would describe this in the context of other kinds of doctor-patient interactions as well, that people are trying to manage those relationships, and disclosing sensitive information that may lead to being treated like you're, you know, less of a person, or the wrong kind of person, may be hidden, for sure.
And, you know, the consequence of that, on the one hand may not seem like much, but one of the things that came out of that Kondrad study, it was a dual survey and both the doctors and the patients separately, was that the doctors identified that nineteen percent of their patients had conditions that they felt cannabis use might be contraindicated for.
So, not disclosing to the doctor what you're using it for can end up masking some more important problem that might be addressed through an alternative therapy than with cannabis use, so, you know, enabling solid communication between doctors and patients is important, and doctor education's the most important part of that.
So we're seeing more development of CME, continuing medical education credits, for doctors, but it focused on endocannaboid science and cannabinoid science, but there's still, to my knowledge, no medical school in the United States that's teaching.
DOUG MCVAY: Interesting. I'm intrigued, when you say that the patients didn't necessarily view -- did I get that right? You said that patients don't necessarily view medical cannabis, medical marijuana, I prefer marijuana, actually I call it weed myself, but never mind, that patients don't necessarily view that as a part of complementary and alternative? Or did I misunderstand?
WILLIAM DOLPHIN: Well, no, they do, they do see it that way, I mean, they see it as part of their medical regimen. All that the patients interviewed for this book are participating in a state program, and certainly viewed use through the lens of medicine.
Did they explicitly think of it as complementary and alternative medicine? No. And the classification of that comes more I think from the institutional medicine side, for instance the National Cancer Institute lists cannabis as a CAM, as a complementary and alternative medicine, so, that's more sort of the issue of the transition that it's undergoing, as it's gaining more institutional acceptance, and the institutions wouldn't matter if you're trying to figure out how to classify it and where to put it.
MICHELLE NEWHART: I expected patients who were interviewed to make that connection very readily. Many of them had disorders for which they'd been treated over a long period of time, they'd tried many pharmaceuticals, many of them had, and had tried various forms of complementary therapy.
But, when I asked them directly if they saw that connected to medical cannabis, they were ambivalent about that categorization.
DOUG MCVAY: You mentioned the patient interviews, you have quite a few in the book, and there's a theme around midlife patients. Tell me about cannabis use among these midlife patients. What kind of characteristics did you find in common?
MICHELLE NEWHART: Well, sure. Midlife was of interest because that is the largest growing population who signs up for medical cannabis patient programs, and the patterns of the majority were what you might expect. It was -- many had tried it in adolescence, and then as they took on more adult responsibilities, had kids, got more serious jobs and so forth, and moved into midlife, it had been a number of years since they had used cannabis. It kind of fell along the wayside somewhere in there.
And then, they tried it again through the medical lens in midlife, and so, that was a common trajectory that we saw. But there were also a minority who had never tried it, and there were a minority who had tried it in adolescence, liked it a lot, and continued using throughout adult life, on and off, or fairly consistently, across adult life.
So, we saw all three of those patterns. But by far, the most common one was trying it in adolescence, maybe using it for some time during adolescence, and then desisting use over adult life, and then deciding to try it again medically in midlife.
WILLIAM DOLPHIN: One of the interesting things that we found as well was that, you know, while they may have had a basis of experience as young people, the idea of using it medically tended to come from family and friends.
There was some type of intervention that was pretty commonly described, where basically these were folks who may have exhausted all the conventional medical remedies. This was medicine of last resort, and somebody came to them and said, hey, look, you know, I'm pretty sure, based on what I've heard, that this is going to work for you, sometimes very assertively, and convinced them to try it.
Once they did embark on using it medically, one of the things that's super interesting is the degree to which it matches the way folks use other medications. There is an existing body of literature that has examined, you know, through research methods, how folks use medicines, and it matches up pretty darned well, you know, and the term for it that we used it Min/Max Strategy.
So, trying to minimize the amount of medicine being used and the side effects of the medicine, and maximize the ability to function in their lives. And again, this is common with pharmaceuticals. Everybody knows that, you know, sometimes people follow exactly what the doctor directs with the medication, but a lot of times there's some experimentation in terms of dosage and frequency, because everybody's trying to get that sweet spot of being able to be as functional as possible, and that was true with cannabis as well.
MICHELLE NEWHART: It was also interesting because, we opened the book with two stories that we juxtaposed, one of Karen and one of Dale, and Karen was an example of that pattern we expect to see, where she was, you know, had used it in adolescence and then had children, and got married, had a job, you know, was like a PTA mom and active in her church, and all this kind of stuff.
And then she, actually, she came to it through her husband, who was in a car accident that left him with chronic pain issues, and she herself had migraines, and after his success with medical cannabis, she ended up trying and finding it successful for her migraine.
Then the other story about Dale is, he had been a, you know, kind of a juvenile delinquent who'd grown up using all kinds of recreational substances, including alcohol and cigarettes, and many different types of drugs across his adult life. But not very much cannabis, because that would get him caught on the drug test, and he needed to be able to pass drug tests for the type of work that he did.
So, the interesting thing is that neither one came to it thinking that cannabis was going to be legitimately medical, and so it was interesting to me that despite whatever recreational background the patient had, often they weren't really convinced of its medical efficacy until they experienced it themselves or saw somebody very close to them experience it in that way.
WILLIAM DOLPHIN: Yeah. They, I mean, really, it was such that regardless of experience, that single story, the stereotype about cannabis use and cannabis itself, was really powerful. And so even if there was a lot of direct experience, there was still deep skepticism about medical utility.
DOUG MCVAY: This is an interview with William Dolphin and Michelle Newhart, they're the authors of The Medicalization of Marijuana: Legitimacy, Stigma, and the Patient Experience. You're listening to Century of Lies, I'm your host Doug McVay.
Fifteen years ago, ten years ago, the number of people who used for chronic pain was used by -- you know, large number of people using medical cannabis for chronic and severe pain, and yet those numbers were being used by opponents to try and claim that medical marijuana wasn't -- was illegitimate because oh, pain, anybody can say.
Now, we have, in the context of an opioid overdose crisis, we have people I think starting to see pain relief and medical cannabis for pain relief as more than just legitimate, it's being seen as one way to relieve the overdose crisis. How has the perception of pain and the condition of pain, how do you think that's played into all this?
WILLIAM DOLPHIN: Well, I think you're exactly right, that there's growing awareness of the problems around treatment. Pain is the number one reason that people go to doctors for treatment, and it's the thing they're most likely to say they're dissatisfied with the treatment they're receiving.
And, you know, the US Pain Foundation estimates we've got a hundred million Americans with some kind of, you know, chronic pain syndrome. So, yeah, it's a significant problem, and opioids are in many respects, you know, a useful tool, but they come with severe side effects, and as long term treatments they're extremely problematic, as we've seen, you know, in the US, with the epidemic problem.
Now, another thing that's happening recently is that you have an increasing body of research about the combination therapies, that a little bit of cannabis goes a long way toward maximizing effective use of opioids. So, and many people report using it as a substitute, one for the other, as well.
But, we're understanding better the biology of how the synergism between those two drugs, classes of drugs really, work, but, you know, more importantly, you know, folks are recognizing that there's a different safety profile.
You know, there is no medicine with a better safety profile than cannabis, and so, I mean, I think the real challenge here is again moving it from a medicine of last resort to more of a frontline, first line sort of alternative, and, you know, we'll see about that. Again, it's, some of the doctors are generally skeptical about it, you know, patient experience is different.
MICHELLE NEWHART: Well, you bring up something that is very sociologically relevant, so, there were forty patients interviewed in the study, and ninety percent qualified under a pain condition, but, you know, the other conditions in Colorado can be more objective conditions, things like HIV or having a cancer diagnosis.
And patients such as Brett in our study, that, you know, I would qualify under the name of my condition if that were a condition that you could qualify under, but since it isn't listed as one of the qualifying conditions, many people qualify under pain, and conditions are not exclusive, so you can qualify under more than one condition, so it doesn't necessarily add up to one hundred percent. It wasn't everything else ten percent, but most had as their primary condition, pain.
WILLIAM DOLPHIN: Which can of course be a symptom of, you know, the other condition that you've got, that it's a good catch-all for a lot of folks in terms of qualifying, and of course, you know, medical cannabis laws, medical marijuana laws, are different than other types of medical practice because we generally trust doctors to make the determination about appropriate treatments, and when folks, you know, use drugs off-label, we don't usually get too concerned about it.
But, you know, with marijuana, we've got a situation where we list, it's like these are the only things that you can prescribe or recommend this for, and that's a little bit different.
MICHELLE NEWHART: One of the other aspects of that, too, and it plays -- it has to do with framing, so I think part of what you're bringing up is, you know, there's a period of time in which the media and the public presentation of this issue really was skeptical as well, and wondering if medical programs were simply a ruse for recreational users to find a legal way to use cannabis.
And I think we've seen some of that shift in terms of how it's being framed, with the opioid crisis, and it provides us a different way of understanding that, and may take some of that pressure away from that way of framing it.
But, I think pain is a subjective condition, and whether you're treating it with cannabis or opioids, I think it's problem area for doctor-patient relationships generally because it it subjective, and so this is, you know, reported also, if you look at other types of treatment for pain, it's concern, and part of the reason why, as William said, that cannabis provides a possible relief for the opioid crisis is its amazing safety profile, so there's more room for user error.
WILLIAM DOLPHIN: And from the transition point of view, the best clinical evidence is around pain. We have more clinical trials showing efficacy of cannabis for managing pain than for any other condition. So if you're an evidence based physician, as they mostly are and should be, that's what you have the most confidence in recommending for.
DOUG MCVAY: Again, folks, I'm speaking with Michelle Newhart and William Dolphin. Their new book is The Medicalization of Marijuana: Legitimacy, Stigma, and the Patient Experience.
What do you hope, when they read your book, what are you hoping will be the big takeaways?
WILLIAM DOLPHIN: Well, it depends on who you are, really.
DOUG MCVAY: That's fair.
WILLIAM DOLPHIN: Well, you know, we have tried to do several things at once with this, you know, that may be more or less successful depending on who you are, but, you know, first and foremost this is an academic study, and there's a concern for legitimacy around the science side of this. Behavioral science is neglected, looking at medical cannabis use.
There are certainly some studies that are out there, but there's been very little, most have looked at it, again, as a deviant behavior, not as a positive or therapeutic use, so, you know, kind of broadening the conversation on the academic side to say this is legitimate, and it's a legitimate subject of study.
And in fact, you know, we're twenty years into this social experiment of medical marijuana access. We really should take a look at what patients are actually doing, what they actually need, as we're making decisions about it.
So, you know, so an academic researcher can look at it and say, well, here's a really cool, qualitative study that's going to give you some insight into a particular population that's understudied.
If you're a policymaker, you should be able to look at it and say, I can make a much better set of decisions understanding what it is that people are actually doing and who these folks are.
And if you are a patient yourself, or you have a family member who you think might be helped my medical marijuana, in some sense, I hope that it provides a little bit of, if not a road map, at least something's that's a way of having a touchstone into, this is kind of what the experience is about. We organized the book in the order in which people encounter the issues, the decisions that they have to make, so there's a sense of I'm not in this alone.
And again, because this is a concealable behavior, and because of the stigma and stereotype, a lot of people hide it, or they hide their concerns. They don't know who to ask about it, and our hope is that this is a book that will help folks break down some of those barriers.
MICHELLE NEWHART: You know, at best, I hope that it offers them new ways to think about it and to frame the issue, so the overarching theme of the book is medicalization, an medicalization is a process that's been studied in sociology since the '70s. And also, our argument that, you know, marijuana's undergoing medicalization but that process is as of yet incomplete.
And since it is in progress and it's not necessarily a linear progress, there's no guarantee that it will be completed. But we can look at various things that are happening, socially and policy-wise, and think about how does that fit with this framing of understanding what's happening. And I think that's just one, I think we offer several other things of that type throughout the book, depending on which part you look at.
We talk about risks to patients, and we talk about stigma management. We talk about how patients form a thought community, and use similar strategies to manage stigma, and so, these just give a different place to hang your hat and think about the issue overall, and how different things fit within that.
DOUG MCVAY: That was my interview with Michelle Newhart and William Dolphin. They're the authors of a new book from Routledge Press, The Medicalization of Marijuana: Legitimacy, Stigma, and the Patient Experience.
And well, that's it for this week. 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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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.