HIV was a crisis of the magnitude never before seen in America. It was a tangle of issues, many of which were steeped in morality. Everyone seemed to have an answer, from sequestering patients on an island to pressing criminal charges against them (Kirp, 1986).
The national dialogue was a mishmash of feeling. What it wasn’t was an application of what works and what ultimately did work: the knowledge, values, and skills of public health. Eventually, the fringe insanity found its rightful place in the margins of the discussion.
One commonly suggested solution was sexual abstinence (Myhre & Sifris, 2018). On one level, it made perfect sense; if sex was the means of transmission, eliminating it would cauterize the wound. It’s a nice idea, it’s just not at all effective. The plan was missing a key element: humanity. The notion that an entire nation would stop all sexual activity was, and is, absurd. Ultimately, the Surgeon General refined the message to say that “short of abstinence, the safest practice is use of a condom” (NLM, n.d.). To the dismay of control freaks everywhere, it worked.
America is nothing without its evangelical posturing that is hyperfocused on two issues: sex and drugs. The opportunity to control behavior was ultimately squashed by reality. Here we sit with addiction, the gum on the shoe of America, heightened by an overdose problem taking lives at an alarming rate. America’s love affair with control and morality is killing people. Why didn’t we learn from the HIV crisis that criminalizing a health concern has the opposite effect of the stated goal?
Drug policy in America is an abysmal failure by any metric. It has a single-digit rate of success (Glaser, 2015) and a slew of dead bodies to show us that we’re approaching it in completely the wrong way. America is a giant dysfunctional family, both trying to control supply and shame people into one solution: total abstinence. So what of the HIV crisis? Can we take a tip from that playbook and see what worked? Morality failed, shame failed, and health care didn’t “solve” the issue, but it sure helped.
Part of our flawed thinking with drug use is the insistence on total abstinence—anything other than that is seen as failure. But is it? If addiction is a disease, why aren’t we putting our money where our mouth is and treating it as such? Someone with an obesity problem is celebrated if they lose fifty of the one hundred pounds they need to drop. Hypertension can greatly improve with diet and exercise and if it gets better, we cheer and look for other ways to make it better still. But with substance misuse, we shame and publicly flog individuals as selfish, unwilling, and incapable.
How one chooses to recover can bring a whole other level of shame. America not only wants total abstinence, it wants its people to find Jesus as the portal to abstinence. The treatment plan for everyone is largely if not exclusively the same: Twelve Step indoctrination, Twelve Step rehab, Twelve Step forever. That plan might work, but only for some people. The overwhelming majority of people don’t respond to Twelve Step programs and are thus banished from the kingdom of recovery. That’s wrong, plain and simple. Social workers who only present this plan are guilty of malpractice, as they are forgetting or ignoring the foundational tenants of the profession. So what to do?
Enter a new era of decriminalized, medicalized, and adult-use cannabis. For generations, cannabis has been vilified as part of fringe or unacceptable cultures—hippies, degenerates, beatniks, and burnouts—and people who’ve been marginalized as a blight in society. The Nixon administration led a mission to relegate cannabis use to that of a cartoonish cliché of San Francisco hippies and other undesirables, most notably black and brown people (“Top advisor,” 2016). Richard Nixon, a strategic genius, knew that one way to disrupt culture is to criminalize a part of it, lobbing grenades, irrelevant though they may be, to vilify people with whom Nixon had a beef or just didn’t like.
Imagine hating English people for whatever reason. It wouldn’t make sense to honestly state one’s issue, but it might make sense to lie about tea and consumption of tea. Create a lie about tea, stick with the lies, and vilify the culture that consumes tea. Does anyone think the English would eliminate tea from their culture? Effectively, that is the story of cannabis. Lies, distortions, and half-truths based on many factors except the one that matters: honesty.
The truth is that cannabis isn’t without risk. Many things might happen as a result of using it, but most of the negative effects are benign unless the DEA shoots you—that’s pretty much the only way to die using cannabis. There are anecdotal examples and antiweed crusaders who cite the occurrence of accidents suffered by people under the influence of cannabis (Cox, 2015). Of course that happens. It happens with cough syrup too, but we don’t incarcerate people who use cough syrup. Behavior while under the influence of anything, cannabis included, is an issue and nobody is advocating for reckless behavior.
So what’s the truth about it? By any metric, cannabis is the safest form of intoxication and it does have medical applications (Robinson, 2017). As a social worker and mental health practitioner, this is where I get myself into trouble. When people claim that medical cannabis patients just want to get high, my response is, “Yeah, so?”
America loves drugs, and we need to stop hating drug users. “Two glasses of wine after work? They just want to relax and shut down the insatiable demands of the world.” Yes, that’s correct. That’s the human condition. Use of any drug isn’t inherently a crime or a pathology. Fully grown adults in a controlled environment are safe using cannabis—there, I said it.
Personally, I think it’s safer than Doritos.
As the father of teen boys, I deal with a constant barrage of junk food. I try to head it off, but often lose the battle and can very easily end up eating a bag of Doritos and some blue beverage when an apple and a water would do. Is that worse than cannabis? Maybe. The truth is that because of the vilification of cannabis, we don’t empirically know. Let’s reclassify the stuff based on science and common sense and unleash the academics to find out.
“Isn’t it a gateway drug?” That’s question I get often. The short answer is “No.” Most people who have severe substance use disorders will tell you they have smoked weed. They will also tell you they had peanut butter and jelly in second grade. Post hoc, ergo prompter hoc. The rooster does crow at dawn, but does it cause the sun to rise? Millions of people try cannabis, don’t like it, and never use it again. Millions more try it and become unimpaired recreational users. Others try it, like the medical applications, and use it that way. A very small percentage try it and start using heroin (NIDA, 2018).
So does cannabis start the ball rolling to addiction? It could be part of the story, but not the whole story, and it certainly isn’t causal. If we want to talk about first exposure to substances, we have to talk about beer. Somehow, sneaking beer as a teenager is as wholesome as an episode of Happy Days, but maybe that’s the culprit. Maybe the first exposure to withdrawal and craving is sugar.
One of the results of criminalizing and vilifying drug users is a lack of research about addiction. Our current drug policy would be like shooting people for eating Skittles because a small percentage of the population has diabetes and can’t metabolize them.
“My nephew got schizophrenia from smoking weed!” That’s another line that’s popular among Twelve Step zealots. No, he didn’t. That reminds me of “My son listened to Iron Maiden and then killed himself” back in the 1980s. Maybe people have a negative response to cannabis and aren’t good candidates for use, but they didn’t “become schizophrenic” any more than a normal healthy child “becomes autistic” from an inoculation. Maybe it contributed to the complex process of descent into severe mental illness, but schizophrenia as a light switch turned on by smoking cannabis at a party is a falsehood.
Cannabis can’t really fit into recovery, can it? Of course it can. The notion that the only definition of success for a substance misuse issue is cessation of all drugs is wrong. Substance misuse is complex, intersecting with organic mental health, culture, family, race, and gender. There are many variables and it’s as individual as a thumbprint. The notion that all people have the same solution is absurd. The metrics for success need to include many things: family life improvement, relationship improvement, employment, civic responsibility, community participation, and disentangling from court systems.
There are many ways to look at “success” beyond the binary “clean” or “dirty” urine screen. A recent client was a seventy-three-year-old male whose wife had passed away from breast cancer. He was a retired lawyer living alone, fractured, isolated, alienating his family, and severely alcoholic. He fell at a family gathering and knocked over the baby’s high chair while inebriated. Frustrated, hurt, and angry, his daughter forced him into a Twelve Step indoctrination rehab because that’s what she was told to do. Her research revealed hopeless statistics and that hanging in is an act of providence. The client walked out on day two and somehow found his way to me.
We engaged with him, led with compassion and understanding, and started the process. It took being honest about his health, the mess he had made of his family, and the dire condition in which he found himself. He was resistant to cannabis replacement, but liked the idea better than Alcoholics Anonymous (AA) and abstinence. He said, “I’m not some goddamn hippie,” to which I responded with, “You can go home and drink yourself to death too. That’s not illegal, 88,000 Americans do it annually and there’s no reason to believe you won’t be one of them.”
After thirty days off scotch, he lost twenty-five pounds and his blood pressure improved dramatically. We started him on a simple walking program. He started to talk a bit about grief, loss, aging, and other issues he faced. He began to have hope for the future, even expressing a desire to take his grandsons to a Giants game.
According to AA, we failed because he is not “drug free.” After a day of therapy and movement practice, he uses a vape pen. In simplest terms, he likes to watch The Rockford Files and get stoned. Is the demand for abstinence the nemesis of improvement? It would be easy to see this client acquiesce to a Twelve Step treatment experience, then go home and hit the scotch hard.
Our work continues. The client has agreed to sell his large home with steep stairs and move into a manageable condo in a high-rise. He has agreed to get thrice-weekly help with chores of daily living, cleaning, cooking, and medication organization. He has kept up with his walking and he will talk to a male therapist, but “none of that goddamn group crap.”
He is still himself. We didn’t correct or fix him. We supported him in finding a better path.
Cox, J. (2015). Number of deaths caused by marijuana much more than zero. Retrieved from https://familycouncil.org/?p=11795
Glaser, G. (2015). The irrationality of Alcoholics Anonymous. The Atlantic. Retrieved from https://www.theatlantic.com/magazine/archive/2015/04/the-irrationality-of-alcoholics-anonymous/386255/
Kirp, D. L. (1986). LaRouche turns to AIDs politics. The New York Times. Retrieved from https://www.nytimes.com/1986/09/11/opinion/larouche-turns-to-aids-politics.html
Myhre, J, & Sifris, D. (2018). Does abstinence education work? Texas legislature puts abstinence education back in the spotlight. Retrieved from https://www.verywellhealth.com/does-abstinence-education-work-49142
National Institute on Drug Abuse (NIDA). (2018). Marijuana: Is marijuana a gateway drug? Retrieved from https://www.drugabuse.gov/publications/research-reports/marijuana/marijuana-gateway-drug
Robinson, M. (2017). Here’s how much marijuana it would take to kill you. Retrieved from https://www.independent.co.uk/news/health/how-much-marijuana-take-to-kill-you-fatal-weed-a8043856.html
“Top advisor to Richard Nixon admitted that ‘war on drugs’ was policy tool to go after antiwar protesters and ‘black people.’” (2016). Retrieved from http://www.drugpolicy.org/press-release/2016/03/top-adviser-richard-nixon-admitted-war-drugs-was-policy-tool-go-after-anti
US National Library of Medicine (NLM). (n.d.). The C. Everett Koop Papers: AIDS, the Surgeon General, and the politics of public health. Retrieved from https://profiles.nlm.nih.gov/ps/retrieve/Narrative/QQ/p-nid/87