Born in Minnesota to a family of educators, registered nurse and addiction specialist Mary Lynn Mathre has long been a key player in the medical-marijuana movement. Though she didn’t enter nursing with the intent to become involved in the national debate, several incidents steered her toward learning about therapeutic cannabis and she eventually served on NORML’s board of directors for several years during the early 1990s. She subsequently cofounded I CARE, the International Cannabis Alliance of Researchers and Educators, with her husband, Al Byrne, also a former NORML board member, to develop educational tools related to cannabis as medicine. Their first project was a 17-minute video called Marijuana as Medicine; their second is a new book, Cannabis in Medical Practice: A Legal, Historical and Pharmacological Overview of the Therapeutic Use of Marijuana (McFarland and Company; North Carolina and London). Both are available through I CARE at 1472 Fishpond Rd., Howardsville, VA 24562.
HIGH TIMES: How did you decide to become an addiction specialist?
Mary Lynn Mathre: I got into it in about 1985, probably because I’d seen so many patients in different hospitals where I’d worked who had alcohol and tobacco-related problems. I think alcohol was the wake-up call, seeing them and not knowing what to do with them. We’d just patch them up and send them out, and nobody said anything about the drinking.
Were they being treated for alcohol abuse?
No. I was seeing them for pancreatitis, motor-vehicle accidents, liver failure, trauma, all sorts of different problems, but not specifically alcoholism. Sometimes we didn’t even mention alcohol, even though we knew that was the primary thing that brought them in.
So back then I was fairly clueless as to what treatment was. I knew they went to some center and something happened there, but I didn’t know what it was.
What was the treatment at that time?
Most of the centers in the early ’80s had a standard 28 or 30-day treatment program of complete abstinence. The person would come into the treatment program and agree to the abstinence, and if they couldn’t do it, they failed, not the treatment program.
Has treatment changed?
Yes, there are fewer 30-day treatment programs where one size fits all. It’s now more individualized, recognizing that some people may have a problem with one drug and not another and need to change that behavior. There is also more acceptance that some people just need education. In the old days there was a lot of feeling that if you use certain drugs you’re an addict and we’re going to throw you into treatment, but we’ve come to realize that use doesn’t equal abuse or addiction.
We’ve also learned a lot more about neurochemistry in the last 10 or 15 years, so I think there’s a lot more understanding that some people, to some extent, are trying to self-medicate because they do have chemical imbalances. And for them it’s a matter of trying to help them get a better balance.
Unfortunately, the bad news with treatment is that it’s harder to get. That’s the saddest part of treatment: There’s less and less money for it.
Where did you start working in treatment?
After I got my master’s I came to the University of Virginia and began teaching, and after a couple of years I decided to move into treatment. My role when I entered it was management—I’d had years of experience running different units—but part of that was the day-to-day management level, so I was also part of treatment.
What kind of program?
It was a 20-bed program at the University of Virginia and it was one of those 28-day programs, but I’d say the good part about it was that it was nurse-run. All the patients were voluntary. We’d screen them and they had to want to come. If they said “the court said I had to come,” we’d say we didn’t think they belonged. I mean, if it was somebody who was selling, it would be someone who in our minds didn’t have a drug problem, they had a drug-law problem.
So we were fairly standard, but because it was more nurse-run, it gave it more of a holistic picture than programs run by recovering counselors with a psychiatrist or psychologist heading them. We had a psychiatrist who was in charge of the program too, but the nurses did the screening, the detox management and most of the education. We viewed it as a health problem.
Did you find that those who sought help got it?
We never did scientific follow-ups, so while I certainly think a number were helped, I can’t give you a number. I think a lot were helped even if they didn’t stop using; they might have learned something or changed their behavior of use.
You note that bed space is down. Are there statistics concerning what happens to those who look for rehab beds and are turned away while they are waiting to get admitted?
I don’t know of any stats on it, but I do know that our program had at times a three-month waiting list. And in some cases, particularly with cocaine where people are getting off and can’t get treatment, there are suicides because they feel so desperate. And I’m sure that there are lots of people—again, I don’t have the numbers—who are arrested for drug use while on rehab waiting lists. And there’s no shortage of beds in jail. It’s pathetic.
My job now is finding programs for people. And it’s rare that I can get people into a treatment program right away. If a patient is very wealthy they can go to a private clinic; if they’re very poor they probably can find someplace. But if they’re in the middle they’re stuck, because most insurance won’t cover it.
What’s considered success in treatment?
Good question. Are you successful with an alcohol abuser only if the person remains abstinent or would you call it a success if they drank but didn’t have a problem?
There is a lot of literature out there comparing treatment programs, trying to find out which ones are more helpful compared to other programs. In California there was a study—I think it was a Medicaid study—which found that for every dollar spent on treatment, they saved seven dollars on health care in the long run. So cost-effectively, treatment makes sense. Locking people up for having an abuse problem when they haven’t done anything violent is like punishing someone who’s already suffering.
In all the time that you ran the treatment center at UVA, how many patients were admitted who had marijuana as their primary drug of addiction?
One, for sure. A man came in who only smoked marijuana and he felt he had a problem with it. Another one put marijuana right up there. Those are the two people who came in for marijuana abuse.
Out of how many patients?
We screened thousands. So it’s really a miniscule amount.
There was a study done recently which compared the addictive qualities of several substances. Are you aware of it?
Yes. In 1994 Dr. Jack Henningfield from NIDA—I think he’s the head of their pharmacology area—and Dr. Neal Benowitz of the University of California rated six drugs for addictive qualities: nicotine, heroin, cocaine, alcohol, caffeine and marijuana. They disagree a little, but both agree that marijuana produces the lowest level of withdrawal symptoms, the lowest levels of reinforcement, the lowest tolerance—needing higher and higher doses to achieve the desired effect—the lowest dependence factor and the lowest addiction potential. The only category for which marijuana didn’t have the lowest rating was intoxication; both caffeine and nicotine rated lower there. Of course, the most addictive drug rating goes to nicotine, followed by heroin, cocaine, alcohol, caffeine and marijuana.
How did you move into the field of therapeutic cannabis use?
First, just to get it done with, let’s just say that, like most Americans, I’ve tried it. And then secondly, let me say that when I was in the military there was a time when some nurses wouldn’t even say the word marijuana.
What do you mean?
Here’s a story: When I got out of the service, my husband, Al, was stationed in Washington state and I was at a small hospital there when an elderly patient was being admitted. It turned out he was part of the University of Washington in Seattle’s program of using a synthetic THC—it wasn’t Marinol then—for his cancer. And our director of nurses was not going to let him into the hospital. She came to me and explained that we had a patient who had—and she spelled it out, she wouldn’t say the word—marijuana and what were we going to do? Well, I said let him in and bring his medicine.
That was probably the first medical thought I had about marijuana that was kind of curious. Of course it turned out the patient was no problem, and his grown kids talked about how that was the first time their dad’s weight stabilized and he seemed to be doing OK.
And about that same time, somehow I got a mailing from Robert Randall—the first person to receive a federal supply of marijuana— from the Alliance for Cannabis Therapeutics. I think it was just sent to the hospital and was given to me. Also about that time, ’81 or ’82, Al had his first piss test in the Navy. The military had already been giving them for enlisted men and they were just beginning to give them to officers. So we had a heightened awareness of what was going on with marijuana.
How did he do?
He passed and he was pissed. He fought it, saying he’d do it if he was ordered—which he was—but didn’t think it was appropriate. We actually contacted NORML for legal advice on it because Al was quite vocal on the issue of saying that that was not the way to solve the problem of drug use. So we thought the military might be trying to make an example of him. But he came out negative, so nothing came of it. And when Al left the Navy we ended up in Cleveland, where I did graduate work at Case Western, and there I did my thesis on “Marijuana Disclosure and Health-Care Professionals.”
We did a survey through NORML—which drew about 900 responses— asking primarily whether people were asked about marijuana use when they went to a doctor or nurse. And if they were asked, would they tell the truth? We also asked if they had any health concerns about marijuana, and if they did, what were they?
And that got us more aligned with NORML and taught us a lot more about the Drug War. Kevin Zeese was the national director at the time, and he and Jon Gettman were a great help.
What were the survey responses?
Interestingly, most people said they were not asked, but if they were, more than half said they would disclose use because their doctor might need to know.
The other part of the survey responses that was interesting related to the health concerns people had about marijuana. Quite a number of people wrote in that they had no health concerns because they were using marijuana as medicine—people with migraines, paraplegia, multiple sclerosis, cancer and so forth.
Was the medical use an eye-opener for you at the time?
Yes. I’d gotten my clue with that patient in Washington and I’d since learned that some people used it as medicine, but the survey gave me an idea of how many people were using it medically and for how many different ailments.
I had assumed that most people associated with NORML—it was their membership that was surveyed—were recreational users, but it was a surprise to see how many responded that they were patients who were using cannabis medically. So it was pretty much doing that thesis and following up on people who used cannabis medically that got me interested in medical marijuana.
During the early 1990s you founded I CARE, the International Cannabis Alliance of Researchers and Educators. Tell us about that.
Well, sometime during the late 1980s, I ended up getting on the board of NORML, and a few years later Al also joined the board. And one of the things we were focusing on was medical marijuana. We were trying to get health-care professionals to come out for it, but they are traditionally afraid of NORML, because a lot of people think it’s just for pot-smoking hippies. So in 1992, Al and I founded I CARE—which is a business, not a nonprofit—to make products that we could get into the hands of health-care professionals to educate them to marijuana’s medical potential.
Our first project was a 17-minute video, Marijuana as Medicine, which features the first five recipients of federal marijuana: Robert Randall, Elvy Musikka and Corrine Millet, who receive it for glaucoma; and George McMahon and Irving Rosenfeld, who both have rare disorders and use cannabis for pain management. The video let people see how marijuana is helpful from the patient’s perspective, and we did it hoping that both the public and health-care professionals would see what cannabis as a medicine is all about.
Our new book, Cannabis in Medical Practice, has the same focus. We wanted to put together an accessible book about marijuana as medicine. We decided that instead of just writing one ourselves, we would prefer to have multiple authors with expertise in various areas give an idea of the current situation with medical marijuana: That it’s been used safely as medicine for thousands of years, but it’s illegal. We’ve got 17 authors, including a physician from Jamaica; a psychiatrist and pharmacologist from Sao Paulo, Brazil; and an author from the Netherlands.
There have been several outstanding books on medical marijuana printed during the past 20 years, almost all of which were completely ignored by the major press. What can you expect for your new book?
We don’t know. In terms of getting reviews, medical marijuana remains a sensitive topic. But I think that the recent editorial in the New England Journal of Medicine, in which they say that marijuana is medicine and the prohibition of it as such is solely political and inhumane, should help open the eyes of health-care workers to talking about it now. But the use of cannabis as medicine is certainly something that people want silenced. And our book, as with others on the subject, is intended to help end the silence. It’s written in layman’s terms, so that patients, their families and regular people can understand it. And then the book goes beyond the medicinal uses of marijuana to cover the nutritional value of the seeds and the ecological value of the hemp plant.
You had a hand in getting the Virginia Nurses Association, as well as several other health-care associations, to pass resolutions calling for the availability of medicinal cannabis. How did that come about?
Well, in 1993 or 1994 our local chapter of the Virginia Nurses Society on Addictions passed a resolution I initiated on access to therapeutic cannabis. The issue was that as addiction nurses, we understood that addiction is about people having problems with drug use. And medical use of a drug is different than recreational use. Clearly, if it weren’t, we wouldn’t have codeine, Demerol, morphine or Valium available to patients. So we said that as nurses, we understand that medical use of cannabis is a completely separate issue from the War on Drugs, despite the government wanting to blur that distinction.
Then, in 1994 I went to the Virginia Nurses Association with the same resolution and they passed it. And after we passed those resolutions Al and I realized that this was the way to go. Individuals are often too afraid to do anything, but if we could educate the organizations, it would give every individual member the freedom to talk about and support the issue, without feeling they were singling themselves out.
And the Virginia Nurses Association resolution gave us the idea of starting Patients Out of Time, a nonprofit organization which basically has the goal of educating health-care professionals, the public and everyone else about therapeutic cannabis use, with the push that patients are out of time. They need the medicine now.
And with that we’ve gone and gotten a great list of organizations backing medical marijuana.
Who makes up Patients Out of Time?
Primarily it’s people receiving medical marijuana from the federal government: Barbara Douglas, who’s receiving marijuana for multiple sclerosis; Corrine Millet and George McMahon are on the board of directors; Irving Rosenfeld and Elvy Musikka are spokespersons for us; and Bob Randall acts as an advisor and spokesperson. My position is president and cofounder, and Al is on the board of directors, secretary, treasurer and cofounder.
We’re not a member organization. We’re just trying to be a small nonprofit that will educate and offer tools and advice on the topic of medical marijuana. We really think that it takes just one member of any organization to educate the entire organization. It’s hard to do it from the outside. I was able to change the Virginia Nurses Association’s position and get the National Nurses Society on Addictions to pass a position paper on medical marijuana; I introduced the American Public Health Association’s resolution, and that was a huge win. It’s the leading and oldest public-health professional association in the United States.
What are some of the other organizations that have signed similar resolutions?
We’ve got the New York, California, Colorado, Mississippi and North Carolina Nurses Associations. And the Congress of Nursing Practice passed a motion that urges the education of all nurses about therapeutic use of marijuana. Then we’ve got nurses in Washington, Oregon, Texas, Arizona and Alaska who are thinking about signing the resolution, and the American Holistic Nurses Association will be meeting in early summer with one of the points on their agenda being a consideration of a resolution to back medical marijuana.
What do you think about our Drug Czar, General McCaffrey, continually saying is that no real health-care society in the USA supports medical marijuana?
Well, it’s a lie. But he says it and nobody challenges him. We keep sending letters to the editors of newspapers about this, and we send the list of organizations that have passed therapeutic cannabis resolutions to the press, challenging him. But most people still buy the lie because the press allows McCaffrey to get away with his nonsense.
He simply misses the whole point of medical cannabis in his fear of rising adolescent recreational use, doesn’t he?
You know, when California and Arizona passed their new laws he said something like “Oh, great, that’s all we need. Now we’re convincing people that drugs are medicine. It’s like telling them, here, take this. It’s medicine. It’s good for you.”
And that was his whole worry about the new laws. And I was thinking that has nothing to do with kids trying a drug. You don’t tell kids to take insulin or Digoxin because it’s a medicine. It’s for sick people! If your child happens to be sick and may benefit, that’s one thing, but it has nothing to do with adolescents smoking marijuana. But he says it and everyone nods their heads and says, yeah, yeah. It’s crazy.
What do you see for medical marijuana in the near future?
I see more talk about medical marijuana, and more public discussion can only lead to positive results. California and Arizona caused a lot of issues to be raised, one of which was that there are a lot of physicians and nurses who still have it in their heads that patients can get marijuana if they need it. A lot of them don’t even realize that the Compassionate IND program, which was providing marijuana to just over a dozen people, was closed down five years ago. So I hope I’m seeing positive change through education. And as more people make the effort to get the word out—as more books are written and as the hemp issue becomes more mainstream—that helps people understand the usefulness of this plant, and all of it combined is having a tremendous effect in educating a wider and wider public—a public which does care about the environment, better products and safer medicine.
But everyone in this War is important, whether it be a patient, a family member of a patient, a person who’s been busted, whatever, everyone’s important and everyone has something to say and different opportunities to influence people. And it’s the masses that will end this war. I don’t think it will be a single person, a hero. It’s going to be a lot of people who wake up others to what’s going on.