MCJ Interviews Mary Lynn Mathre

By Mark Pedersen: Editor Medical Cannabis Journal. (Virginia)

11-14-2011

MCJ Interviews Mary Lynn Mathre
Mark Pedersen rev 10/19/2011

This interview was conducted in April of 2011 at the Fish Pond Plantation, Howardsville,
Virginia.

MCJ - Why don't you introduce yourself and tell us a little about your organization.
Mathre - My name is Mary Lynn Mathre.
I have been a registered Nurse for over 35 years. I began in medical/surgical adult care -
nursing and the hospital system. Along the way, I learned about patients using cannabis.
I have a Masters prepared background in medical/surgical nursing.
In the early 80’s, I was a supervising nurse in a small hospital in Washington State.
Our Director of Nursing was quite concerned because an elderly patient was coming in with
what she called a “marijuana pill.
This was during the time when Marinol was undergoing clinical trials at the University of
Washington.
So I thought, we’ll just lock it (the cannabis pills) up in the narcotics closet with the other
medications - there shouldn't be a problem.
I talked to the man and learned that he was a cancer patient and that his adult son and daughter
were there with him. They told me how he was actually gaining weight with it and it was really
helping. That caught my interest.
Al (Mary Lynn's husband) was still in the military and his last duty station was Cleveland Ohio.
That was where I went to grad school. So I decided to do my thesis on cannabis. I just
wanted to ask people about disclosure; when they (cannabis users) go to their physician, does
the nurse or physician ask them about your cannabis use?
Since cannabis is the most used illicit drug in the United States and since this information
affects a patient' health Care, they really should know about it.
So I arranged for a survey. It worked out that NORML (National Organization for the Reform of
Marijuana Laws) was willing to put the survey in their leaflet to distribute to their membership.
It was kind of a nice agreement that we had. I would give them the report when I was finished
and in return I got a big sample population of patients who probably used cannabis from their
membership rolls.
I got a great response - over 800 respondents and that was just general demographics; " How
old are you? What's your occupation? etc.")
I got a wide assortment - from 18 years olds, all the way to those into their 70’s. Every
occupation you can think of - Priests, housewives, physicians, nurses, truck drivers, students.
Their income and education varied greatly.
I asked questions about their use - how often they used, how much they used. Then it got
to the meat of it. Have they ever been asked about their use by healthcare professionals?
Amazingly, most of them had never been asked if they used cannabis.
The other questions were, "If you were asked, would you admit to your use?"
Not that I was surprised, but I was pleased to find that most would admit to using cannabis.
They said, "Well, it's a drug. Maybe they should know. So they were willing to answer.
My next question was, "Would you be more willing to tell a physician or a nurse?"
To my dismay, they were more willing to tell a physician. I was frustrated. I thought they’d be
more willing to talk to a nurse; because of the trust issue. But most patients understand the
patient-confidentiality with physicians, so that was why they answered that way.
Then there were questions like, "Why would you not tell them? Fear of losing your job?
Concern about what the doctor would think: Would it affect their care negatively)?. So they
had real concerns.
The final questions were, "What are your health care concerns? And, "Are you worried about
how it will affect your heart?...Your lungs?"
For a woman, "If you were pregnant, would you be concerned for the fetus?".
Then I listed “Other ”. And this at the end was kind of the surprise result of the whole survey..
A Lot of people started writing in, “I use it to help with my migraines.”, or, “I'm a spinal cord
injury patient and I use it for spasticity.”.
That was a real awakening for me. My goodness, people are using this as medicine.
The research that I conducted for my thesis, in association with NORML, really got me into
the issue in a serious way. I started working with NORML as Director for their Counsel of
Marijuana and Health. It was an informal organization of healthcare professionals. When a
report regarding cannabis came in, we would look at it and let the NORML staff know if it was a
real health concern or was the study flawed, etc.
I worked there for several years and later served on the NORML Board.
Probably one of my greatest achievements, besides getting that thesis finished, was to bring
the 5 surviving Federal legal patients together for one of our conferences.
Back in the early 90's, the Federal government allowed patients to receive free, legal
cannabis through the FDA with what they called the "Compassionate Investigational New Drug
Program, or Compassionate IND program.
A physician would basically say, "My patient has this condition, the medications aren’t working,
cannabis might help..." and the patient could apply for the program.
If they got access, then they’d have a stable supply. It was supposed to be in a research
program.
There's a long history to that program - the first patient being Robert Randall who used it
for glaucoma. He had to win a legal case to be a part of the program. Bob is clearly the
forerunner of our current day medical marijuana movement.
He started the Alliance for Cannabis Therapeutics to let people know that cannabis helped his
glaucoma and that it may help other patients.
" It shouldn't be just about me. It should be available to everyone." He said.
Through his efforts he was educating people.
In 1990, there were ONLY 5 patients in the United States that received cannabis from the
Federal Government. We thought, We need to get these patients together."
It made sense from a nursing standpoint, since they didn’t know each other.
It worked out beautifully. We brought them together in a conference in Washington D.C.
Robert Randall was the moderator of a panel. Each patient was allowed to tell their story.
We were very fortunate to have C-Span pick up the story and it was carried throughout the
United States and repeated over and over for people around the country. Viewers realized that
cannabis patients were regular looking people, as opposed to the young "stoner" that the media
would portray. Just regular people with serious conditions using this as medicine. They got to
see how it changed their lives; how it helped them.
That was the starting point for Al and I in terms of seeing how important it was for patients
to have the support of each other, how compelling their story was, and how unfair the whole
situation was. It just didn't make sense if it’ not available to others.
As time went on, the program became all too well known. The AIDS epidemic was alive and
well, so to speak. So most of the applications were HIV positive patients. Because of that, the
government literally just shut the program down in '92.
At that time, there were 15 patients who still were getting their medicine from the Federal
government. About 30 were approved but didn't get their medicine. The other applications
weren't even looked at. They (the government) just closed the program and let the 15 who
were still receiving it continue to get it.
As things went on, we were seeing the desperate need. Now, the only access left for the
patients had been closed in their faces. This gave us the urgency to start our own organization.
We knew so many patients that were suffering terribly and risking a great deal; to use their
medicine, to find their medicine, or get it for someone they cared about - whatever it was. Just
getting medicine and having a safe supply was a clear issue that just shouldn’t have to happen,
especially since cannabis is such a safe medication.
So when Al came up with the name "Patients Out of Time", everything just clicked.
We could see that the Federal Government was just sitting back, hoping that the 15 remaining
patients would remain quiet and die, so that they wouldn't have to admit that they actually gave
cannabis to patients.
Here we are today and only 4 of those patients are left alive. The leader, Bob Randall died, but
before he did, he recognized what we were doing and kind of passed the baton - to continue
the patient effort.
Bob's organization, The Alliance for Cannabis Therapeutics, focused on getting patients
into the IND program. Since it was closed, we focused our efforts on educating the public,
and particularly, healthcare professionals, so that they would understand that cannabis is a
really good medicine, a really safe medicine. And, as healthcare professionals, they should be
advocating for it instead of putting their head in the sand, saying, "It's illegal. There's nothing I
can do about it."
To me, there's an ethical issue here that they are running away from. They aren’t really fulfilling
their ethical duties to their patients.
The mission for Patients Out of Time is simple: educate healthcare professionals and the public
about the therapeutic use of cannabis. We don’t look at ourselves as activists as much as
advocates. We just want to advocate something that’s very safe, something that works in a wide
array of conditions and something that should just be available. Cannabis should be back in the
pharmacopoeia.
MCJ- You were talking about the IND program. You mentioned that research was the
intent of that program. What came of that?
Mathre - Good point. For patients to get their medicine, their physicians had to file for
acceptance to the program on their behalf. They were supposed to keep records on this and
every year send in reports to the Federal Government. We, meaning the patients and their
physicians, assumed this was being looked at and were doing something with it.
Soon the physicians learned that the government didn't even care if they sent in the report or
not. They didn't want the information. As far as we know, nothing happened to it. It just went
into limbo.
This was wrong. Where are the results? As far as the government was concerned, there wasn't
going to be any.
Doctor Ethan Russo, a neurologist from Montana who had been working with us, recognized
the same thing. Here were patients who were being supplied cannabis - not from the street -
government issued. So we could look back and know what they had been taking for 20+ years.
Why don’t we look at them - really closely?
So we did our own study; a very in-depth study of 4 of the patients. We called it the "Missoula
Study" for short, because it was conducted in Missoula, Montana.
We looked at these patients in depth; blood-work to check all sorts of different functions, a
full array of pulmonary function tests to see how well their lungs functioned; x-rays, cat-scans,
neuro-psychological testing (written exams to see how clearly they are thinking; how good their
memory was - a thorough physical, obviously.
They were run through the mill; test after test. The results literally showed that these patients,
in spite of their illnesses, were doing remarkably well for their age; better than others in their
age group who dealt with these diseases, with the exception of maybe minor bronchitis.
MCJ- what kind of ailments are we talking about?
Mathre- We had some rare disorders. Irv Rosenfeld, the longest patient in the study; the one
who had received cannabis the longest, had Multiple Congenital Cartilaginous Exostoses -
a long name for a genetic disease.
Literally, it means that he had tumors that grew at the end of his long bones. They were rough
and would tear at his joints when he moved. He had to have multiple surgeries to remove the
tumors but they would come back. This is a childhood illness. Devastating.
George McMahon had another rare disorder called Nail-Patella Syndrome. . The name comes
from the lack of normal nail beds in a patient's finger and toe nails. The kneecap patella doesn't
form right, either. This condition also caused muscle spasticity, nausea and vomiting.
George told us that since his physicians did not adequately understand his illness, they would
often exacerbate his condition with wrong treatments. Western medicine was doing more
harm to him than good Cannabis allowed him to move around more freely and made it more
comfortable for him.
Then we had Elvy Musikka who used it for glaucoma and Barbara Douglass who used it for
Multiple Sclerosis.
These were some really sick patients.
We clearly wanted a look at what they were getting from the Federal Government. In fact,
what they were getting was freeze dried , low-grade cannabis.
Just to be objective about the whole thing, we had one of the patients open two of the cigarettes
that the government had sent to see the contents. You could tell that it was very dry and you
could see seeds and stems in it. We documented that.
Medicinal grade cannabis should not have seeds and stems. That doesn't add any medicinal
value and they pop when they try to smoke it.
It was so dry that Elvy would put it in the refrigerator with some lettuce to put some moisture
back into it.
Elvy also didn’t want to smoke. She had a history of tobacco smoking. Cannabis helped her get
off of it. She chose to consume her cannabis in cookies or other baked goods.
But like I said, it was a harsh cannabis, and it was sometimes very old.
Sometimes when they received it, it would be a couple years old, then other times, as much as
10-14 years old.
You'd never find herbal medicine in stores over 5 years old. I’m sure you’ve noticed that all
our medicines have expiration dates because they lose their potency and their effectiveness
over time. But the government chose to give them (IND patients) old, low-grade cannabis with
seeds and stems in it.
MCJ- If these are the only people who are receiving it legally, why is the tins of cannabis
so old? Why do they wait so long to issue it to them?
Mathre- That's a good question. The farm at the University of Mississippi where they grow their
cannabis is also where they grow the cannabis for NIDA research.
The NIDA's primary goal is to do research on the drugs of abuse; to find all the negative effects
of it. It's not really grown for medicinal use, so a lot of the cannabis they get is actually grown
for other studies.
The questions that they (NIDA) was looking to answer were: "How carcinogenic is it? How is it
going to mess with someone's immune system?"
So I don’t know. Are the patients just low on the totem pole? Good question. Don’t know.
They should have been getting fresh (cannabis). When it's given to patients for patient use, as
opposed to animals in studies, you'd think that they’d get the best. But I don’t know.
Most recently, the patients have been saying that they think it's getting a little better. I believe
a lot of that has been since we published the fact that they (FDA) were giving the patients
poor quality cannabis. It was an embarrassment. More or less shamed them into helping the
patients get better medicine.
MCJ- You called cannabis the “exit drug”. Please explain.
Mathre- Lets go back. We call it cannabis. Let's start with that. cannabis versus marijuana.
When you go back in history you don’t find much about "marijuana". That’s because cannabis
is the proper name for the plant . It's been used historically since the beginning of time as a
medicine. It's a wonderful medicine.
It was actually used at times to help people with drug problems. I have a little bottle from the
early 1900’s that has on its label "...for habits of morphine or chlorylhydrate".
It was used to help patients with withdrawal, delirium tremors, and DT’s from alcohol withdrawal.
Today, with some states having medical cannabis programs, dispensaries and caregivers are
hearing many patient stories about how they have used cannabis as an "exit drug".
The government keeps saying that cannabis is the gateway drug. That's the "stepping stone
theory". They imply that if you use cannabis, it will lead to harder drugs and eventually you will
be shooting up heroin. That's just not true.
You could almost say sugar is the "gateway drug"...or caffeine. There have been enough
studies that have looked at that.
The Institute of Medicine looked into it - whether or not cannabis was a "gateway drug". They
determined that there was nothing chemically about it that would compel you to use harder
drugs.
The fact is the black market forces people to purchase cannabis from people who deal in other
illicit drugs. If that person doesn't have cannabis for him, well, hey "I've got some cocaine"..
or.."I've got some of this for you" or "This will be out of your urine in a short period of time if you
should get drug tested".
There isn't anything intrinsic to cannabis that leads to harder drugs. But, on the other hand,
many addicts get into trouble with alcohol, cocaine, morphine, Oxycodone, Vicodin, you name
it. What a lot of these drug addicts have found is that cannabis helps them get off the addictive
drugs.
Melanie Dreher did research on women and their children in Jamaica. (http://
www.druglibrary.org/schaffer/hemp/medical/can-babies.htm)
Cocaine was not a drug that was particularly popular except in Kingston, but it's use was
becoming an epidemic among prostitutes there. These Jamaican women didn't fit in with their
culture.
Dreher found that these women learned to use cannabis, or as they called it, ganja, to get
off the cocaine that was devastating their lives.
They had become addicted very quickly and their lives were focused on just getting more and
more cocaine.
That's a very good definition of an addiction. Your life starts revolving around a drug and you
want to continue using it despite all the problems it causes. Continued use of a drug despite
the problems it causes in life.
Cannabis helped them get off the cocaine.
In compassion clubs in the "medical" states, they are finding that alcoholics are saying that it
helps them stay away from drinking.
I worked a number of years at the University of Virginia as the Addictions Consult Nurse.. I
would go around the hospital and see patients.
A prime example of someone I would see would be someone there for a liver transplant. And
very often it was because of alcohol.
They had Sclerosis of the liver because of the alcohol and needed a transplant, but no one
wanted to give them a liver transplant if they were going to still drink. So they’d call me in.
It was kind of ridiculous, really, because I couldn't really make a prediction, but they wanted me
to assess whether or not it was worth giving them the transplant.
A lot of the patients that I talked with about this told me, "When l use cannabis, it helps me stay
away from alcohol."
I'd basically just counsel them so that they understood that it was illegal there in Virginia and
that if they were going to use it, they would need to make sure that they get a clean supply and
that they get it safely.
Then I would have a conversation with their physicians. I would tell them, "I think they will stay
away from alcohol since they were using cannabis. I didn't think that it would be a problem for
them. And to their credit, the hospital would go ahead and put them on the list.
Years later, I was accepted as the director of a Methadone clinic.
You know, in the big cities, it (Methadone) is usually for treating heroin addicts. In
Charlottesville, it just happened that most of our patients were opiate addicts. Prescription
opiates...Oxycontin was a big one, but we would also see those addicted to morphine, Dilaudid,
Percocet - any of the usual pain killers.
Patients would get into really big trouble - "doctor hopping" - doing whatever they can...to keep
their supply from running out.
We would bring them into the clinic and put them on methadone. That's a very long acting
opiate. It would stabilize their system so they could literally feel normal again. Which was
obviously very important for them.
Once addicted to opiates, it's a very tough addiction. A patient literally needs the drug to feel
normal. And, over time, needs more and more of it.
So, methadone being long-acting, they can actually have a life. But to an extent, they are
dependent on this medication. It's very strong and it can kill. It kills a lot of patients.
When I applied for the job at the Methadone clinic, I let them know initially that I ran a not-forprofit
called Patients Out of Time, that advocates the medicinal use of cannabis. I just asked
them, "Is there an issue with that?"
The person interviewing me had been in the substance abuse field for a long time. He dealt
most of his career with hardcore heroin addicts and some really serious addictions.
He said, "No problem at all."
He understood the disease of addiction well. He also understood the laws. It was not legally
necessary to test for cannabis at the Methadone clinic. By law, we had to do drug tests
on the patients when they came in;...We had to test for other opiates...We had to test for
benzodiazepine...drugs like Ativan, Valium, Xanax,.. And we had to test for barbiturates, cause
if the patient were to use those with the Methadone, it could be lethal. It's a safety issue.
But with cannabis, there's no reason to test for it. A lot of clinics do and if a patient is using it,
they kick 'em out of the clinic.
But the owner of the clinic where I worked was great. We could work together, because there
was no need to test for cannabis. We didn't need to know.
Methadone is a very scary medication to use because of its long half-life. Patients don't feel the
effects very quickly. So they want to take more. And the problem is that it's slowly going up but
it is far from reaching its peak. They take another dose and pretty soon its overdose time.
During induction is the worst time, when we're trying to get the right dose. You can't give them
a lot because you don't know. When a patient comes in who is an opiate addict, you really don't
know for sure what they have been taking. You want to try to match it, but you don't want to kill
them either.
We would start at a dose that was just high enough to keep their symptoms at bay, but it's not
going to be the same. Since it's an outpatient clinic, they come in, they get checked over, they
get a low dose, and they go home. Then they come back the next day - we evaluate them, and
give them another low dose.
It takes weeks...sometimes months, to hit the right dose. If patients go home and they don't feel
good, they go find a drug. If they find Valium, it could lead to death. If they find faster working
opiates, which peaks while the Methadone is still going up, it could result in death.
If they use cannabis, it doesn't harm them. It's not a risk. They feel better. There's not the risk
of them taking those other illicit drugs. So in terms of a safety issue, from a nurse's perspective,
I felt much safer if they were using cannabis.
Another thing we found was that patients didn't want to stay on Methadone. Many would tell me
that they would work themselves off the Methadone through the use of cannabis.
So I have seen it in the clinic. The big dispensaries have seen it, too. Patients getting off
medications, off drugs, It is clearly more of an "exit drug" than a "gateway drug"... It's such an
important issue.

 

PLEASE SEE THE ENTIRE INTERVIEW IN OR NEXT ISSUE THIS SPRING.

© This article is copyrighted by Medical Cannabis Journal 11-14-2011

medical cannabis patients time medical cannabis journal ML Mathre  

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