10/17/18 William Dolphin

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

Program: 
Cultural Baggage Radio Show
Date: 
Wednesday, October 17, 2018
Guest: 
William Dolphin
Michelle Newhart
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CULTURAL BAGGAGE

OCTOBER 17, 2018

TRANSCRIPT

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.