Expanding the Compassionate Boundaries of Cannabis
As the tumultuous year of 2020 came to a close, news of a COVID-19 vaccine was not the only good news to infuse us with a much-needed sense of optimism for 2021. If you are an advocate for the disenfranchised, a fan of the freedom to choose your own health care path, or an advocate for the right to use cannabis as a medicine, you will be thrilled to learn that a New Mexico state district judge in Albuquerque recently ruled that qualifying patients in the Bernalillo County’s Metropolitan Detention Center have the right to access medical cannabis.
The legal ruling is important because it creates a clear precedent that all patients who qualify, even those incarcerated, should be allowed access to use medical cannabis.
The 2007 New Mexico statute that permitted the implementation of a statewide medical cannabis program, the Medical Cannabis Act, does not discriminate against a patient’s access to medical cannabis-based upon whether the patient is incarcerated or not. Objections to inmates using medical cannabis from Bernalillo County attorneys stemmed from the overused and feeble excuse that because cannabis is still illegal at the federal level, the use of medical marijuana by the inmate [who brought the suit] “was a violation of law contrary to his agreement to comply with all city, county, state, and federal laws and ordinances.”
Once again, the disconnect between federal and state law clashes in the fight to normalize our relationship with Cannabis sativa. This disconnect is the result of the failed war on drugs and the antiquated implementation of the Controlled Substances Act (CSA) of 1970, which makes cannabis, as well as a number of other medicinal plants like mescaline, peyote, and psilocybin illegal. Fortunately, with the recent re-alignment of the Senate, HR 3884, the bill to deschedule cannabis from its current Schedule I designation as per the CSA will be revived in the 116th Congress. In December, the MORE Act (HR 3884) passed in the House but was stalled in the McConnell-led Senate. Now, with a Democrat-controlled Senate, a revised version of HR 3884 will certainly be passed by Congress and signed into law by President-elect Biden.
Why should we care if prisoners have access to medical cannabis? Why should we care about these criminals; faceless individuals in orange jumpsuits, locked away behind tall prison walls topped with swirls of shiny razor wire?
Let me explain.
The Russian novelist, Fyodor Dostoyevsky, wrote, “The degree of civilization in a society can be judged by entering its prisons.”
Accused as a political radical, in 1849 Dostoyevsky was sentenced to death after eight months of interrogation in a St. Petersburg prison. At the last possible moment, with the executioner’s guns pointed at him, the sentence was commuted to a four-year sentence to a Siberian prison camp. The author of Crime and Punishment, Anna Karenina, and Notes from Underground, Dostoyevsky’s experience convinced him that the ultimate purpose of prison was to dehumanize the inmate, restricting their ability to make choices and to eradicate their free will.
Although I am not a rigid law and order proponent, I certainly do not consider myself an anarchist, either. My recent involvement in the Compassion Prison Project (CPP) has opened my eyes to the plight of those incarcerated. The CPP’s mission stems from studies showing that an overwhelming majority of incarcerated individuals (and those who work as guards in prisons) have a significant history of childhood trauma. And this data is not gleaned by some arcane left-wing liberal publication (and even if it was, if the data is accurate, truth is the truth), but from the FBI Law Enforcement Bulletin.
The Substance Abuse and Mental Health Services Administration (SAMHSA) describes adverse childhood events (ACEs) as stressful or traumatic events, including emotional, physical, and sexual abuse, emotional and physical neglect, domestic violence towards either the mother, father (or both), household substance abuse, household mental illness, parental separation or divorce, and having an incarcerated family member.
The effects of ACEs on the individual run deep. ACEs affect the child emotionally, psychologically, and anatomically. The neurological impacts of ACEs are profound, re-shaping and re-wiring a once normal brain and immune system into one maladapted from coping with chronic stress and fear. Adults that carry multiple ACEs have an altered immune system and their hypothalamic-pituitary-adrenal axis (HPA), our neuroendocrine system designed to cope with stress, is also dysfunctional. This stress-induced immune and HPA dysfunction leads to a plethora of neurological and inflammatory autoimmune diseases. ACEs have been clearly shown to affect our brains in a manner that can easily provide some rationale for the psychological and emotional dysfunctions of so many incarcerated individuals. And the severe psychological stress represented by ACEs affects the individual on the molecular level as well. Studies have shown that ACEs are even associated with changes in brain mitochondrial DNA.
Sociologically, ACEs are strongly correlated to incarceration rates. 80% of prisoners score an ACE of four (out of ten) or greater. In comparison, 61% of adults surveyed had at least one ACE, whereas, only 16% of the general population accrued four or more ACEs. ACEs are also solidly associated with the development and prevalence of a wide range of health problems throughout a person’s lifespan like cancer, heart disease, and early death. Perhaps not surprisingly, ACEs are also strongly associated with substance abuse. It’s been suggested that addiction is an adaptive symptom of ACEs, rather than a function of weak moral character.
Surprisingly, as of June 2020, the United States had the highest number of incarcerated individuals worldwide, with more than 2.12 million men and women in prison. The United States was followed by China, Brazil, the Russian Federation, and India. The CPP is shedding light that the United States’ correctional system is taking some of our most traumatized citizens, locking them up, isolating and dehumanizing them, essentially suffocating an inmate's ability to reform and return to society as a productive citizen.
The current broken system often deprives inmates opportunities to be educated, rehabilitated, and healed from the childhood trauma that most incarcerated individuals have endured. The present prison-industrial complex keeps millions of mothers and fathers, brothers and sisters, locked behind concrete walls and iron bars that keep them safely away from those on the other side. An alternative approach to the present incarceration system embraced by the CPP includes identifying appropriate inmates and incorporating them into supervised programs intended to return them to their communities in an effort to help heal the cycles of neighborhood and generational trauma that affected them.
Do not citizens who commit crimes deserve punishment?
Indeed, they do . . . but, in a compassionate society, as Dostoyevsky suggests, inmates also deserve an opportunity to be healed from the traumas that were inflicted upon them as once-innocent children. Inmates deserve a shot at a more humane way to repay their debt to society by contributing back to the communities in which they lived, rather than rotting behind the fortified walls of the prison. They also deserve a compassionate standard of medical care that those not incarcerated enjoy and expect. And if that standard of care includes medical cannabis, which has been reported as a reasonable alternative treatment for such trauma-related psychological disorders like PTSD and addiction, why should inmates not be given access to such treatments?
As an emergency physician, I have witnessed, in silent horror, egregious medical treatment of those incarcerated. Shackled inmates have confided to me that when they suffer from a medical problem, they are lucky to be seen by a competent medical professional, be it a nurse or physician. They tell me it is common to wait hours or days before their complaints are taken seriously enough by prison staff to transfer them for medical evaluation at the prison infirmary.
I have personally witnessed medical care deliberately withheld from inmates who complain of pain, fever, or other symptoms; their complaints are often marginalized. A case that will haunt me forever involved a male prisoner who complained of a priapism (an abnormal erection lasting longer than four hours, and a well-known complication of the prescription drug he was taking). The medical staff at the facility dismissed his complaint until it was too late. The inmate’s ignored priapism caused irreversible damage and left him impotent for life, a permanent handicap that could have been easily remedied had he received timely medical care. In another example, at a prison facility near a hospital in which I work, 189 of the 225 inmates in the facility tested positive for COVID-19. Does not our Constitution say something about “cruel and unusual” punishment?
If Dostoyevsky is right, surely the United States can do better. Americans can insist that our society is both compassionate and civilized by changing our prison system to a place of personal rehabilitation, rather than an institution of dehumanization. A step in that direction might be other states following the lead of New Mexico, allowing access to medical cannabis to appropriate inmates, just like any other citizen.
Without a doubt, we live in chaotic times. The Centers for Disease Control and Prevention have ACE data that confirm Americans live in a traumatized society. What else can we do as a hurting and grieving society to make our country more compassionately civilized? There are concrete steps we all can take today to work toward a more tolerant and kind society. Please watch the six and a half minute video showcasing the amazing work of CPP: Step Inside the Circle. Consider volunteering or donating to CPP.
Also, please contact your Congressional representatives and ask them to support legislation to declassify cannabis from its present Schedule I designation, like HR 3884 proposed. Ask them to sponsor and support legislation that expunges criminal records of individuals with non-violent, marijuana-related crimes. Legislation should also decriminalize non-violent marijuana-related infractions.
Ask your representatives to embrace legislative measures that eliminate mandatory sentencing laws, such as the ‘Three Strikes’ statute (Violent Crime Control and Law Enforcement Act of 1994), that provides for mandatory life imprisonment for a variety of offenses.
These are times of both radical change and opportunity. As a nation, we find ourselves with unprecedented opportunities for societal enlightenment. Science is dispelling myths and fictions that have handcuffed our vision of reality. Research has demonstratively shown that cannabis can be used effectively as a medicine, and is not the Devil’s weed.
This same science has also shown that most criminal behavior is not a function of immorality, rather, it is often the result of heartbreaking childhood trauma, as evidenced by ACEs. Groups like the CPP have shown that approaching inmates with compassion and a willingness to address long-ignored childhood trauma, and removing the shame associated with them, can provide a path for inmates (and our society) to begin a journey of both emotional and spiritual recovery. Cannabis can expand the boundaries of compassion and be an instrument to this healing.
Michael Geci, MD is the author of the recently published memoir, Pot Doc: A Physician’s Search for the Holy Grail of Medical Marijuana. Practicing medicine since 1996, Dr. Geci’s long-time love of plants and his interest in botanical medicine precipitated an interest in cannabis. In 2009, he founded Montana Botanical Analysis, one of the first analytical laboratories in the United States devoted to the quantitative analysis of medical marijuana. Dr. Geci continues to practice emergency and integrative medicine. He lives in upstate New York.