Michelle Newhart Ph.D. & William Dolphin, Author, Educators, Public Speakers
A husband-and-wife team with more than thirty-five years combined experience writing about cannabis,Michelle Newhart, Ph.D. and William Dolphin have contributed to more than two dozen books on the plant, patients, and policies.
Newhart & Dolphin each have long professional histories as writers and editors for a variety of publishers and organizations. They met in 2002 working for Ed Rosenthal's Quick American Publishing, where they were introduced to the world of cannabis activism and its associated legal quandaries.
Newhart & Dolphin have many years of experience as educators and public speakers, teaching at the university level and presenting to diverse audiences.
https://www.newhartdolphin.com/
The Medicalization of Marijuana
EPISODE TRANSCRIPT
[00:00:01] You're listening to Thinking Outside the Bud where we speak with entrepreneurs investors thought leaders researchers advocates and policymakers who are finding new and exciting ways for cannabis to positively impact business society and culture. And now here is your host Business Coach Bruce Eckfeldt.
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[00:01:06] Welcome everyone. This is Thinking Outside the Bud. I'm Bruce Eckfeldt. I'm your host and our guests today are Michelle Newhart and William Dolphin and they are the authors of the medical. Possession of marijuana subtitled legitimacy stigma and the patient experience. And so we're going to have two guests on today because we have two authors of the book and we're going to dig into a little bit of the history of the book why it was written and their involvement in the marijuana cannabis field. And we can talk a little bit about their insights what they've learned about the market and business. We're going to talk a little bit about what the current state of the industry and where it might go. So with that Michel. William welcome to the program. Thank you for having us. Yeah thanks Bruce. So Michel what we start with you. Because my understanding is as you were the original kind of force behind starting the book and doing a lot of the research so I guess why write the book like what was the focus here why did you want to write this book. I know you've been involved in that kind of a space for a long time in terms of publishing and researching. Tell us about this one and what was really driving it.
[00:02:08] Yeah. This book grew out of my work for my dissertation so I have spent my adult life going back and forth between doing sociology in education space and working in publishing. And when I answered an ad in the air right around the turn to 2000 in the newspaper and ended up working for Ed Rosenthal publishing company after a number of years and I left that to go pursue my P.H. Diem and I actually thought at the time I was done doing things about cannabis that nurture your future he was in sociology. It was in sociology That's correct. And I went of all places to Colorado to do my page.
[00:02:56] It's not a good place to go and try to avoid cannabis right now.
[00:03:00] Well yeah exactly. You know a California kind of been the epicenter before that and everything exploded in Colorado when I was there follows you around. Yeah and I really as I was figuring out what I wanted to do.
[00:03:15] You know I'm passing all these green crosses and I'm just I kind of had a moment where I thought well do I want to do this or not. And it kind of ties into the book we talked about this a little bit and the preface of the book. But at the time you know I wanted to use all this pre-existing knowledge that I had built up around understanding what was going on with this and talked about it in a sociological way. But I also worried at the time you know things were shifting over a long period of time and I just thought Man if I do another thing about cannabis after having worked on cannabis books in the publishing industry you know I don't know if I'll ever get a job out of my page. There is no career killer you know. Yeah and especially if if it's multiple things that I've that I've done yeah. And in the end that very thing ended up being important to why I did the project that stigma around cannabis has a long reach and even effects people you know who want to do research about it. And so this ended now being really meaningful project to me and also the point at which I quit apologizing for doing work that was yeah. So it was evidence based was an interview study and it was a great thing to work on for my dissertation because it had meaning beyond just earning the dissertation. You know the stories of patients are powerful and I wanted to get it right. Yeah.
[00:04:46] So well and I think so important to get real research on this. So when Michelle was considering this she called me from Colorado and said What do you think about this idea. And I was like You know what this is this is great. This is so important because at that point I had been working with Americans for Safe Access the patient advocacy group for a decade. And so I'd heard all kinds of anecdotal stories from individuals you know it is heartbreaking and inspiring stories both. But I knew that there was always this sort of dismissal of Well that's one person's story. And so having some kind of systematic look at what it meant to be a patient participating in a state regulated program was just really important. We're how we talk about this with policymakers and and others.
[00:05:34] So who is your audience for the book are you are you primarily focused on people that are already in the industry where you're looking at people that were users of cannabis. People that are thinking about coming users of cannabis. How did you define your kind of target in terms of readers.
[00:05:46] Well initially the goal was to write something that was academically rigorous so it could be used to teach college courses and would be appropriate to that audience. But I also wanted it to be accessible enough that advocates or policymakers or other people interested medical professionals people who wanted to know more about this issue. This could be a point of entry to understand the you know the behavioral side of what's going on around this issue. And we see there's more research and important research that's going on that's clinical about you know what we can do with cannabis but it's important to also see how people behave around it and especially in how they use it as a medicine. So I really wanted to write about that part and we focused on people who were at midlife or older. So everybody all the patients in the book are 30 and older and that was important too because historically when we talk about cannabis we don't necessarily. There wasn't an age gradation about how it was discussed but really a lot of what the literature talked about was adolescent cannabis use and the outcomes from that. But the biggest growing group of medical users are people in their 40s and older you know. So I really want to focus on the group that was this growing population that was just entering this space to use medical cannabis and see and I really felt like it was important to highlight age and how we've discussed age and in some ways that led to this overall idea that the book presents about that we call it the single story that cannabis had a single story for most of the 20th century and this story was enforced by authority and it basically said cannabis is for is one thing.
[00:07:39] First of all it has one use for intoxication. Every uses the same no matter how much or how little you use. And you know basically making every user kind of fit a stereotype. And so with medical cannabis it really kind of drives a wedge in this idea. And I mean we know there's been contention all along as we've had this story that goes along with prohibition about abuse. But what medical does is it says we'll know there are other levels of use other age groups age makes a difference. Your purpose for using it makes a difference. And we start seeing this disintegration of the single story into you know a multi form use where we we acknowledge that there are differences in how people use it as it's really kind of a deconstruction of that of that history or that that single story.
[00:08:31] I'm curious from a from a research point of view I mean you know on the on the clinical side you know obviously we've had the strength of researchers because of the legal situation.
[00:08:40] I guess how much did the lack of other clinical scientific research but the lack of that on the political side did that impact either your process or your thinking or your ability to put together the behavioral research.
[00:08:54] Well you know on some level of course it does. I mean we see these limitations across the board. But the thing that we do have a lot of information about is how people use medicines you know so medical sociology has looked at this in depth and and so there is a literature about other substances and the behaviors around that. And one of the things that's very interesting in that we do in the book is to consider well how does medical cannabis use differ from or resemble what folks do with other medicines. And the answer is you know it looks really similar. People largely adopt similar strategies for using cannabis medically as they use with pharmaceuticals. The idea that we use is when established by other writers which is a Mini Mac strategy that patients are interested in minimizing the amount of medication and the symptoms that they're experiencing while maximizing their ability to function. And so they're undergoing this sort of balancing act at all times of trying to make sure that they can you know fulfill their roles in life. That's what people are concerned with and that's obviously quite different from the purpose of you know if we will if you will a recreational use your own right. You're not trying to just get high you're trying to you're trying to be good you're trying to be able to function as effectively as possible.
[00:10:13] Yeah no there's there's definitely a target a purpose that you're you're driving towards and the use that as you know sort of measurable in that sense or at least quantifiable in terms of housing or alleviate the symptoms that you're trying to address.
[00:10:27] Talk to me a little bit about the research and the writing.
[00:10:29] Process What roles did you each play and how did you collaborate. How did you kind of work together to create this book.
[00:10:36] Well and the other thing I would say about what you were just saying to just put a point on it is social science often studies things where there may be uncertainty or controversy around that thing and your job is not to prove that it's it has efficacy or that is clinically relevant or not. I mean a lot of times you just sort of bracket that question because what you're interested in is how people are using it or talking about it.
[00:11:00] So you know regardless of what clinical science finds or interest in the story of people and how they're interacting and what they know or don't know about this thing how they're using it.
[00:11:12] So does that mean that social science you know a judge really jump in on that because you're one of the things we found is that the patients who participate in the study there were 40 in-depth interviews and they all knew a lot more than the general public about cannabis in its therapeutic uses but they all had something significantly wrong about it and that kind of goes to this problem we have about who counts as an expert and who do I trust your information. Obviously we can't go to the FDA to get information about this right. That's who would normally trust our information. And so there's this this matter of the each individual has to sort of take on for themselves both understanding it finding out about it making decisions about it as we describe in the book creating legitimacy around the use. But that's also again back to our purpose you know illuminating this is is critical to helping people better understand it and establishing work that has some degree of expertise is is really important. But back to how we did it.
[00:12:17] Yeah well so you mentioned you had 40. You did 40 interviews and in-depth interviews. Talk to me about your roles and talk to me about the process and the interviews themselves. How did you structure things.
[00:12:26] Sure well I mean the interviews I collected in the course of doing my dissertation. So that research was passed through an IAB review at a university which you know means it's taking into consideration the ethics and the methods by which you're collecting that information. It also included attending a lot of things related to organizing medical patients or medical advocacy in the state related to policy and then I also did a set of unstructured interviews with people throughout the state of Colorado who were in various roles in relation to patients. So it may have been somebody who was working at the Colorado Department of Public Health and Environment. You know this EDP A.G. or you know people in different towns who you know I talked to some growers I talked to people who were already dispensaries are running at this because he organizations in a lot of that was just to get the pulse of what was happening because everything was going so fast that there was no literature you could look to you had to just talk to people who were affected by policies are being implemented in different ways and and figure out what's going on in that part of her. Now that was at heart. I'm curious from those people.
[00:13:43] Given that things were moving so quickly what did that that that make the kind of doing the research more problematic in terms of it was kind of a moving target or that you know as as time went on you know that the changing context and the changing environment would change the nature of the interviews or or the content of the interviews in some way.
[00:14:01] Well I don't think anything happened that significantly changed the kind of responses I got from patients and the book overall is really about about them. I think there's kind of two pieces to the book. On one hand I feel like it if it feels a need to talk a little more comprehensively about what is this trend that is happening right now with the adoption of both medical laws and with adult use laws. But of course our book focuses on this medical information process in which you move something that was previously considered deviant or handled through your criminal justice system into a medical space and you know that means that it's within medical institutions. Culturally we accept it as being within medicine but that process is incomplete and that means that the legitimacy that comes with calling it a medicine is also incomplete and that means that people are always trying to construct that legitimacy. And it's complicated by the fact that you also have recreational use running alongside that which is you know a different narrative to tell about about use and complicates the story around whether it's medical or not. And so this puts a lot of pressure on patients to figure out how to be legitimate quote unquote legitimate you know medical cannabis patients and a lot of that comes down to creating that legitimacy in. Actions with people and so a big piece of that. You know there's there's a lot of things that are there about theorizing about what that means and those things are very enduring. I think that part of the book will have you know a long life on the other hand. I think it also captures a moment that happened in Colorado and some those things you know about about how stigma operates with with cannabis and these type of things. It's going to really become evident how that was also a point in time. Yeah. Yeah.
[00:16:01] And likewise with the risks because you know we talk a bit about the risks that individuals face when they make the decision to enroll in a program and you know those are multiple you know you've got direct legal risks are you compliant or are you not compliant. What happens when you deal with a compliance check at your house and how are the police going to treat you and we've got some fairly horrifying stories and hear from the patients but also things around you know what's your professional role is that threatened by it. How about your parental role you know are you going to have that come under question. Are you fit to handle children and things like that. And you know it's that's an ongoing process. And you know it's probably going to be a while before we fully resolve it. But yeah I think it is important to people understand just what all is at stake for the individuals who are actually using it.
[00:16:53] Yeah. Jessica what are we all on that a little because I think I think sometimes people don't appreciate or really consider from a user point of view from a consumer point of view. You know patient point of view what what the spheres of impact or the spheres of consideration that come up and when we mentioned the the legal side it's like OK well what am I exposing myself to kind of you know legal risks you know compliance issues you know with the law with regulation there is social aspect. So you know friends how is this going to come up there. You mentioned a family both parents children things like that. Professional. Like is this going to impact my professional credibility or reputation. Were those the major spheres or what how did you see patients or what's what spheres Did you see patients kind of grappling with when it came to you know the use or the consideration of use of cannabis.
[00:17:42] Well one thing is that I think you're touching on here is a you know it isn't all said and done just because you pass a law at the state level. It allows people to access to you know part of the stigma around cannabis is not just a negative judgment but it's also it's also the way it gets made into a joke or made light of go for you know made humorous. And what's this dismissive innocence of some of the risks that people take on.
[00:18:12] And even though some of those you know that risk is is variable we're seeing changes. There are a lot of other aspects to it in terms of how it affects your rights. It isn't just whether you know whether there's a state program but also how does your you know how does that affect employment. How does it affect your your parent and like parenting rights how does it affect your other medical rights. You know in some states you can't own a gun. How it affects your driving rights if they set specific DUI laws related to it. So you know it can affect a lot of other rights and not all of that has been teased out yet.
[00:18:52] Yeah yeah I've heard a lot of stories of like employment situations where particularly where there's you know people are are employed in a different state than they live and they have a medical card for one day. But then in the other state it's illegal and the employer has certain policies around you know use of things or drug tests and things like that and like all the confusion and the drama and certainly a lot of things about parental rights you know protective services coming in on situations and stuff. So yeah it's not. I mean just. Just because you kind of pass this legislation saying we're authorizing medical use it doesn't fix all those things.
[00:19:24] That's right and there's also a concern for judgment. So even if there's not a direct lethal consequence right. It's like how are people gonna see me how am I going to be judge what's my boss going to think if I disclose this even if I'm not using it anywhere near work or working hours it can still you know it carries a stigma.
[00:19:42] And so you know this is good. And we have to remember that this is a double stigma because if you are using medical cannabis it means you have a medical condition which may also mean you have to establish the legitimacy of your medical need.
[00:19:57] So to reduce the one you're saying. Yeah yeah. That's interesting. I had thought it that way. It's like kind of you know the address or solve one stigma. You've got to suffer another stigma.
[00:20:08] That's right. And you're expected to have some rights around that of confidentiality about your health. So it gets a little sticky because you shouldn't have to disclose certain health conditions to your employer for instance. But you know this gets tied up in that. And then that can bring in you know we have a few stories in the book. People talked about not wanting to disclose their medical condition and not being tied to not wanting to disclose medical cannabis use because they were afraid that when would impact their ability to be promoted. Yeah yeah sure. So.
[00:20:42] And what we know is that when individuals are faced with the threat of being stigmatized you know the more vulnerable you are to being stereotyped. The more sensitive you are. So you know we have stories in the book from patients where there's like well you know I feel like I can be an outspoken advocate on this and tell people because I am completely a normal middle class contributing member of society otherwise nobody can say anything bad about me except this. So I feel safer talking about it. But if you have any other characteristic that might be stigmatizing then you're just compounding matters by adding in more whether it's your health condition or you know other factors in real life.
[00:21:26] So a lot of sensitivity around me that can be out of your control in the sense that some diseases we treat as more legitimate than others.
[00:21:34] So give me an example. Is there an example of Wow.
[00:21:36] So if you have HIV or cancer or something that's objectively diagnosable people are going to have a lot less questions about your generous use for medicine. But if you just have chronic pain as we all know that's incredibly subjective. It's not only with medical cannabis. I mean there's a lot going on with opiate crisis about how much pain meds can people get before that's considered you know beyond what they should be given. You know so but but this creates a double legitimacy problem because if you are if you don't have a legitimate condition how are you using cannabis medically in a legitimate way. You must be using it recreationally under the cover other guys.
[00:22:17] Well that's I mean and I mean I guess there is certainly a segment of the population who you know have been able have done that to some extent. You know how do you in your research how have you found that has kind of impacted things. I mean in terms of you know you've got an existing cannabis use culture cannabis use population it now goes medical and you know people using the medical cover for continued recreational use. Is that something you found or is that something you either focused on or didn't focus on specifically how did that come up.
[00:22:51] Well in the course of recruitment for interviews I certainly worded things such that no matter what your reason was for using it you know I was interested in interviewing you. And so I did get the maximum variation I could for her among people who volunteered at the same time you know people who volunteered were probably more likely to feel justified in what they were doing and there's no way around that those people were more likely to volunteer to be interviewed. We did have a handful of people who said that their main reason for getting their medical card was not medical but everybody in the study actually qualified under a legitimate medical condition. So that was kind of an interesting piece in that you know it wasn't that the people who said they were using it didn't have a reason that would qualify under the high they did a lot.
[00:23:46] So they were sort of seeing differences and legitimacy even within the patient population.
[00:23:52] So they the alternative to say it's not for me to judge. But at the same time you could acknowledge that somebody who is you know really seriously chronically ill that it didn't matter what the circumstance they were in you know they could be at a party. They could be wherever and whatever they were doing with cannabis was obviously part of their their medical treatment. And others you know who felt like perhaps. Well I have alternatives or you know I'm not necessarily in 24/7 need then it seemed to be a little bit fuzzier to them. And that's one of the issues around that you know policy in law draws a bright line between these but for individuals it's it's a much more porous situation.
[00:24:38] So let's talk about that a little bit because we end up talking about. I mean it's a lot about gatekeeping. Right.
[00:24:45] So you know whether it's welfare getting qualified for welfare benefits or for qualifying for disability or qualifying for medical care is you have to ask or what do you get if you get through that gate and what are you what are the possible repercussions if you don't.
[00:25:02] And you know as we have more adult you states the difference between people who get get a medical card and those who don't you know it's less it becomes less consequential to them and isn't so stark like either you go to jail for this or you have the right to use it. And so I think that's an important thing is just thinking about like what what are the incentives to get. Get access. Yeah. We're not through this particular avenue and if you lower the stakes for people you see less of that. But we didn't go into it trying to say OK why do people you know how many cheaters are there and why do we have you know why we have cheaters or whatever.
[00:25:44] We really went in to say OK how are people using this. Yeah when they are medical cannabis patients when they're designated as medical cannabis patients and even then we touch on that. It wasn't the primary question that we asked.
[00:25:58] Yeah. So good segway into this kind of next question I have around how what you've learned from this research in terms of seeing how this kind of how this industry is playing out and where it might go or how the future might unfold on some of the stuff I guess you know different states are doing different things some are you know launching medical programs first and some people are doing combined programs at the same time in different states even the medical side is quite different in terms of what you know conditions are being authorized and what or not. I mean how in terms of the insights you've had on the medical use side how do you see this kind of impacting the development of the industry of regulations of policy like how does this impact the industry.
[00:26:46] Well I think that we can see pretty clearly again that there's there's a distinction to be made between folks who are using it therapeutically and folks are using it for nonmedical purposes.
[00:26:55] And this of course has been a debate to states that have medical programs have you know implemented adult use policies as like well how different does that look if at all.
[00:27:08] And there have been suggestions in some states and say well if you have an adult use Access program well we can dispense with this others and you know from what we've seen and heard you know that's that's a mistake. There are different needs people who are using it medically have frequently very particular products or as you know varietals of cannabis that are helpful to them and they need consistent access to them in ways that just aren't quite the same for other folks. So you know I think that's going to be a continuing thing and of course the development of individual options you know as we learn more and more about the constituent components of the plant you know as Michelle said earlier it's not just one thing. Yeah and cannabis that's developed for nonmedical purposes is frequently very different characteristics than things that are developed for health or medical use and with medical conditions right. They just have different cannabinoid profiles different Turpin profiles as well as the kind of products that are derived from them.
[00:28:10] Are there any any suggestions on areas that the kind of medical programs areas that can be improved upon either kind of generally or specifically based on the insights that you found in collecting the research around the use.
[00:28:24] Well yeah I mean yeah good as we know we are married by the way. I was kind of a giveaway there and so yeah.
[00:28:36] No. Absolutely. They can be. I mean you mentioned that condition lists. Right. I mean do you establish in the state law these are the qualifying conditions for using medical cannabis or is that something a little bit broader than that and we allow doctors and patients to make that determination on their own and as we would frequently with other things and the you know the other is that you know there are obviously the things we talked about with risk are you going to have civil protections for using your medicine you know will you be fireable if you test positive on a drug test even if it's you know a medical program in your state. And we've seen that and in some states and there are big differences from state to state and in part as Michelle mentions because of incomplete medical ization at the point where it's fully incorporated then you don't worry if you're a doctor about your patient testing positive for this medication some other doctor prescribed when you're considering a transplant. But right now in many states if you test positive for medical cannabis you can be denied a transplant because there's a drug abuser and drug users are not compliant patients so they're not good candidates for transplants is the thinking however headed. So we've got some got some work to do still.
[00:29:58] Yeah good research so we're going to we're going to hit time here in a second if people want to find out more about the research you've done about the book the work you doing. What's the best way to get a hold of that information.
[00:30:08] We have a Web site that's just https://www.newhartdolphin.com/. And through there you can order book directly through the publisher Routledge or you can go on Amazon and look up our book. It's there as well. And now we also have a book page on Facebook. That's mad MJ book. And now we post lots of things about the social science side at cannabis in society and behavior. Cannabis awesome.
[00:30:38] I will make sure that those links are in the show notes so people can click through and get those.
[00:30:43] Any any work coming up anything that your doing or speaking about that is you know of of note or interesting for you folks.
[00:30:52] Oh my yes.
[00:30:54] Yeah we're we're working on several things. Most immediately we're working on a chapter for an edited volume that's gonna be a social science research about cannabis and we're taking a look at the various state laws and programs medical cannabis programs and analyzing them in terms of how much they look at it in terms of it being a matter of medical necessity for folks or whether it looks like some sort of a hazard that we need to be careful around and try to create barriers to prevent people from using. Michelle has been working on a much larger project as well.
[00:31:28] Not sure if she's quite ready to talk about the exciting.
[00:31:31] Yeah I would just say we're also working on things that have to do with looking at what's happening with the science around cannabis right.
[00:31:40] Oh good. Thank you.
[00:31:42] Scientists are doing what they're what the kind of frontier of the research is looking like right now.
[00:31:48] Yes almost the research on the research like figuring out. Yes.
[00:31:51] Yeah yeah. In the tradition of you know science and technology studies.
[00:31:56] I guess you know what I'm excited about that I'll look forward to when you're ready we'll do we'll do another episode on that because I think that's a a much needed and a fascinating kind of aspect of this industry as the research side. So thank you so much. Michelle William This has been great. I really appreciate the time. I appreciate the insights. I've learned a lot and I think our our listeners have have as well so I really appreciate it.
[00:32:19] Thank you Bruce. It's been a pleasure. Thanks so much for having us.
[00:32:23] You've been listening to Thinking Outside the Bud with Business Coach Bruce Eckfeldt to find a full list of podcast episodes. Download the tools and worksheets and access other great content. Visit the Web site at thinkingoutsidethebud.com. And don't forget to sign up for the free newsletter at thinkingoutsidethebud.com/newsletter.