The Points Interview: Dan Malleck

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Dan Malleck

Dan Malleck is an Associate Professor of Health Sciences at Brock University in St. Catherines, Ontario. He is the author of Try to Control Yourself: The Regulation of Public Drinking in Post-Prohibition Ontario, 1927-1944 (University of British Colombia Press, 2012) and co-editor, with Cheryl Krasnick Warsh, of Consuming Modernity: Gendered Behaviour and Consumerism Before the Baby Boom (UBC Press, 2014). Try to Control Yourself won the Canadian Historical Association’s Clio Prize for Best Book in Ontario History in 2013, and Malleck’s writing has appeared in news outlets including the Globe and Mail and The National Post. He earned his PhD from Queen’s University in Kingston, ON. Malleck’s most recent book is When Good Drugs Go Bad: Opium, Medicine, and the Origins of Canada’s Drug Laws (UBC Press, 2015), which he discusses below.

Describe your book in terms your bartender could understand.

This book examines the social and cultural forces that combined to encourage the creation of Canada’s drug laws.  It argues that we need to get past the simplistic statement that drug laws were racist reactions to foreigners in our country, and have complex roots.

What do you think a bunch of alcohol and drug historians might find particularly interesting about your book?

The book is not a political history, but it looks at how various cultural, economic, professional and social forces converged in the early 1900s to make it seem necessary to create federal laws restricting opiates and other mind altering drugs.  It takes long time-
line, following the threads of influence as they grew and expanded, gathering energy and cultural currency. I use the metaphor of streams converging into raging river.  

The main question driving the research was “why did we decide that addiction was a problem that needed federal intervention” and “when did it become okay for the government to severely restrict sales of certain substances that were previously generally unrestricted.”  I argue that Canada’s first drug laws were not laws against recreational use, but pharmacy laws that made it restricted certain substances determined to be dangerous. These laws, the results of political lobbying to deal with a social problem, made such restrictions acceptable.  From that point, the definition of “danger” expanded from the potential of death, to the potential for serious damage, to the potential for dependency.  The precedent for national drug regulation, then, was set in the pharmacy acts, which were a combination of professional pressure and social concern over access to poisonous substances.  

whengooddrugsI also challenge a dominant and reductionist narrative that the opium acts of the early 1900s were simply attacks on Chinese people in Canada.  This argument misses the power of the idea that drugs were a problem.  When William Lyon MacKenzie King argued, in his preamble to the 1908 report encouraging parliament to create the Opium Act, that opium’s “baneful influences” were “too well known to require comment” he was channeling that broader concern based upon the familiarity of most Canadians with the challenges of opium as a medicine and a habit-forming drug. He himself had experience of these baneful influences in his personal life, and most Canadians probably knew someone who had an opium habit. Most had probably consumed opium at some point.  To reduce this to an attack on the Chinese is simply a distortion of the past, often for current political reasons.  Moreover, the same session of parliament that passed the Opium Act also passed a Proprietary and Patent Medicines Act, dealing with another significant drug problem.  This book springs from that contention that reducing the drug laws to racist reactionism doesn’t do the story justice, nor does it help us understand the complexity of our drug laws in general, and the challenges of reforming them.

Now that the hard part is over, what is the thing YOU find most interesting about your book?

It’s the same page length as my first book even though it’s much longer, but took less time to write. Figure that out.

Every research project leaves some stones unturned. What stone are you most curious to see turned over soon?

One thing I was never able to do due to the sheer volume of material and time it would take was track the changes in prescribing patterns as different laws came into effect. I have a database of probably hundreds of thousands of prescriptions from pharmacy records that span various provincial and federal law changes, and I wonder if those laws, restricting access to substances like opium, affected the way doctors prescribed, or the way customers purchased (or pharmacists dispensed). I suspect it did, but without a massive team, grant, and hiccup in space/time, I won’t be able to do that.

BONUS QUESTION: In an audio version of this book, who should provide the narration?

Aaron Paul.

 

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THE FUTURE OF UK MEDICAL MARIJUANA REMAINS BLURRY BUT THERE ARE LESSONS TO TAKE AWAY FROM CANADA

Editor’s Note: Today’s post is cross-hosted at Points and Cannabis Life Network. Contact author Lucas Richert at lucasrichert@strath.ac.uk. 

From 2014–2016, Canadian health authorities were forced to address the issue of medical marijuana, even as activist groups and industry sought to influence the decision-making process and its place in the medical marketplace. First, the system was privatized, then issues of use and access, not to mention the full-on legalization of recreational marijuana, dominated headlines.

In light of last week’s shocking medical marijuana report, the policy debate will certainly grow more heated here in the UK. The All Party Parliamentary Group on Drug Policy Reform stated there is “good evidence” cannabis can help alleviate the symptoms of several health conditions, including chronic pain and anxiety. According to Prof Mike Barnes, a leading consultant neurologist who contributed to the report, “We must legalise access to medical cannabis as a matter of urgency.”

In a recently co-edited series on Canadian cannabis called Waiting to Inhale, it became clear that medical marijuana was a supremely complex policy issue. Some of the questions included, but were not limited to, the tenuous balance between consumers and regulators, Canadian physicians as unwanted gatekeepers, marijuana as a measure (and potential leveller) of inequities, and the major struggles between Big Cannabis and craft cannabis.

Looking ahead, the UK can learn lessons from other countries, including Canada.

Background: Canadian medical cannabis

Medical marijuana has been available in Canada since 2001, after the Canadian Court of Appeal declared that sufferers from epilepsy, AIDS, cancer and other ailments had a constitutional right to light up. Prohibition of this “medicine” was, in short, unconstitutional.

The original regulation that allowed patients to access medical marijuana in Canada was enacted in 2001 and called the Marihuana Medical Access Regulations (MMAR). It allowed patients to possess dried marijuana flower/bud with a license issued by the government, provided that the application was signed off by a physician.

One strain of medicine was available for purchase from one single government supplier, Prairie Plant Systems, but optional licenses were available for patients to grow their own plants or to designate a grower to supply medicine to them.

The MMAR was repealed and replaced by the Marihuana for Medical Purposes Regulations (MMPR), enacted on Apr. 1, 2014. With this, medical marijuana was officially opened for business. And the new rules generated a craze as dozens of new entrants jumped into the marketplace.

As of Aug. 24, 2016 the MMPR was replaced with the Access to Cannabis for Medical Purposes Regulation (ACMPR). These new regulations included legislation that satisfied the latest Supreme Court decision to allow patients who possess a prescription from a doctor to grow their own medicine.

During this period, certain problems have hindered the medical marijuana industry’s growth in Canada, and Britain could learn from these.

Dispensaries vs. Big Cannabis

These stores and clubs are illegal because they procure and sell their products outside the federal medical marijuana system, which was overhauled and expanded last year to allow industrial-scale production of pot products that are mailed directly to licensed patients.

The pushback against dispensaries has come from national and local law enforcement as well as the Canadian Medical Cannabis Industry Association. Yet, the Cannabis Growers of Canada, a trade association representing “unlicensed” growers and dispensaries, have fought to be included at the table. Along with several other organizations, the CGC has lobbied the government to be included in the new legal regime.

As the New York Times put it, “a lobbying battle is raging between the new entrepreneurs and the licensed medical marijuana producers, who were the only ones allowed to grow and provide the plant under the old regulations. One side complains about being shut out by a politically connected cartel, while the other complains about unfair and damaging competition from those who are breaking the law.”

Physicians

Medical marijuana has not approved as a medicine by Health Canada, although there is a growing body of clinical evidence regarding its pain-alleviating effects.

As such, physicians in Canada have struggled with the science and ethics of medical marijuana. At the 147th annual meeting of the Canadian Medical Association in Ottawa last August, many doctors expressed serious reservations about prescribing marijuana.

Some doctors said they felt threatened or intimidated into signing prescriptions, whereas others felt as though patients were shopping for doctors. Worst of all, there were reported cases of malfeasance, where doctors charged their patients for a prescription.

The result is that the CMA remains divided on, if not outright opposed to, being the gatekeepers of medical marijuana.

Workplace Safety and Performance

With more relaxed rules around medical marijuana (along with federal legislation looking to legalize cannabis),employers are wondering whether this will grow as an issue when it comes to pre-employment or on-the-job testing.

Aside from certain industries, such as transportation, most provinces don’t have clear policies or precedents for dealing with medical marijuana.

Besides that, workplace screening of marijuana is a mediocre indicator of performance in the workplace as it doesn’t actually test for impairment. Rather, it tests for by-products excreted from the body after the drug’s been ingested.

Looking ahead, human resource departments will be forced to develop a raft of new policies.

Veterans

The core problem rests with the amount of cannabis veterans are authorized to take. In 2014, Veterans Affairs doubled the amount to 10 grams per day for eligible veterans. Yet, this is twice the amount Health Canada considers safe.

An internal Health Canada document showed that more than five grams has the potential to increase risks to the cardiovascular, pulmonary and immune systems, as well as psychomotor performance and has a chance of increasing the risk of drug dependence.

Ferguson’s office could not find any evidence to support this decision to increase the threshold. Veterans Affairs Minister Kent Hehr expressed shock in March that his department lacked an “informed policy” on the use of medical cannabis, even as the number of claims by veterans for medical marijuana grew more than tenfold over the past two years.

Vaping

The intersection of vaping and medical marijuana has also caused tension. As vaping has moved from a niche presence to mainstream practice, its unregulated nature – at the federal level – poses problems to policy-makers.

For example, the Ontario government exempted medical marijuana users in mid-November from a law that bans the use of e-cigarettes anywhere regular cigarettes are prohibited. These regulations were set to come into effect Jan. 1. This exemption meant medical marijuana users could vape in restaurants, at work or on playgrounds. However, Ontario’s associate health minister Dipika Damerla stated that the government would remove the exemption.

Local governments in various cities recently voted to implement a vaping bans in public spaces, with only a vape shop exemption predicated on “safety” concerns, specifically for the uninitiated e-cigarette user who doesn’t know how to install batteries in the device. But it was also predicated on the notion that buyers should be able to see what they’re getting, which is the same argument made by authorized medical cannabis users about the value of a local pot dispensary.

The Future

Marijuana remains a highly contested medicine for various scientific, political and social reasons. That is obvious.

Policy makers from government, industry leaders, and physicians will face considerable question marks. Cutting through all the haze won’t be an easy task, yet all participants, including the public, would be wise to use recent examples from Canada to light the way.

Conference Summary: “I’ve Been to Dwight,” July 14-18, 2016, Dwight, IL

Editor’s Note: This conference summary is brought to you by David Korostyshevsky, a doctoral student in the History of Science, Technology, and Medicine at the University of Minnesota. He traveled to Dwight, Illinois, in mid-July to attend the ADHS off-year “I’ve Been to Dwight” conference, and has provided this account of his time there. Thanks David!

On July 14-18, 2016, a group of international alcohol and drug historians descended upon the village of Dwight, Illinois, for an ADHS off-year conference. Conference organizers selected Dwight because 2016 marks the 50th anniversary of the closing of the Keeley Institute.

Founded by Leslie E. Keeley in 1879 (and operating until 1966), the Keeley Institute offered treatment options to patients with addiction, usually alcoholism, including Keeley’s Gold Cure. “I’ve Been to Dwight,” the conference title, references “a catchphrase” former Keeley Institute patients “used to explain their sobriety.”

Keeley

To make it easier to read, this summary is organized thematically. You can see the full conference program here.

I live-tweeted the conference as @rndmhistorian under the hashtag #IBTD16. Also, Janet Olson, volunteer archivist at the Frances Willard Historical Association wrote a blog post about the conference.

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Fiction Points: Sarah Gerard

SarahbyDavidSarah Gerard is the author of a novel, Binary Star (2015); two chapbooks, BFF (2015)  and Things I Told My Mother (2013); and a forthcoming collection of essays, Sunshine State, centered on her childhood in Florida, the home state she shares with PointsShe also writes a monthly column on artists’ notebooks, “Paper Trail” for Hazlitt. Gerard’s chapbooks garnered praise from tastemakers such as Hobart and The Rumpus, and Binary Star received glowing reviews from, among other publications, The Huffington Post, The New York Times, NPR, Vanity Fair, and The Los Angeles Times, which chose the book as a finalist for its Art Seidenbaum Award for First Fiction.  Buzzfeed, Flavorwire, Largehearted Boy, NPR, and Vanity Fair put Gerard’s debut novel on their 2015 year-end lists. Her short stories, essays, and criticism have appeared in venues including BOMB Magazine, The Los Angeles Review of Books, The New York Times, New York Magazine’s “The Cut,” The Paris Review Daily, and Vice, as well as in anthologies for Joyland and The Saturday Evening Post. She teaches writing in New York City and has been a visiting writer at the University of Maine, The New School, Pratt, and other institutions.

Two nuns and a penguin approach you at a bar, and you tell them you’re a writer. When they ask you what you write about, how do you answer?

I write about the intersection of arctic birds and religion. Can I interview you?

Points is a blog primarily for drug and alcohol historians. What do you think this audience would find most interesting about your work?

Well, the protagonist of Binary Star is anorexic and addicted to diet pills. Her boyfriend is an alcoholic and takes his psychiatric medication not exactly as prescribed. So, they may find that interesting. I write about drugs and alcohol in a rather different way in my essay collection, which I’m finishing now. I kind of toy with the boundaries of what is a drug: alcohol is a drug, ecstasy is a drug, but is religion also a drug? Is capitalism? Is success? Also, I don’t like to categorically vilify drugs and alcohol. Sometimes recreational drugs are a lot of fun, and sometimes they’re used as medication when another isn’t available. Read More »

Fiction Points: Elissa Washuta

elissawashutapicElissa Washuta is the author of Starvation Mode: A Memoir of Food, Consumption, and Control (2015) and My Body is a Book of Rules (2014), the latter of which was a finalist for the Washington State Book Award. Washuta has received fellowships and awards from Artist Trust, 4Culture, Potlatch Fund, and Hugo House. Her essays have appeared in Buzzfeed, The Chronicle of Higher Education, Literary HubSalon, Third Coast, and elsewhere. Washuta is a member of the Cowlitz Indian Tribe and teaches nonfiction in the Institute for American Indian Arts’ MFA program, where she is also the faculty advisor for Mud City Journal. Additionally, she serves as the undergraduate advisor for the Department of American Indian Studies at the University of Washington, from which she earned her MFA. She lives outside Seattle.

Two nuns and a penguin approach you at a bar, and you tell them you’re a writer. When they ask you what you write about, how do you answer?

Differently than I would answer almost anyone else, probably, because my first book, My Body Is a Book of Rules, is about sex, (psych) drugs, violence, alcohol, Indigenous identity, and the nuns who tried to teach me how to live. I might whisper to the penguin that I still have all the issues of Cosmopolitan from December 2007 to May 2011 that I used to create a quote-comparison of the magazine’s sex tips and text from The Catechism of the Catholic Church.

Points is a blog primarily for drug and alcohol historians. What do you think this audience would find most interesting about your work?

Prescribing Information,” one of the chapters in My Body Is a Book of Rules, takes the form of a list of the prescription drugs for bipolar disorder I used and, occasionally, abused between 2006 and 2009. The voice is inspired by that of the information pharmacies dispense alongside prescription drugs. Throughout the book, I write about the effects—helpful and harmful—of those drugs, including Seroquel, Abilify, Xanax, Ativan, and lithium.Read More »

Will I Be A Dope Doctor When I Grow Up?

EDITOR’S NOTE: Points is delighted to welcome Kim Sue, a previous contributor (check out her earlier posts here and here), medical anthropologist, and dual degree MD/PhD candidate at Harvard University. On the heels of Points’ recent posts about the difficulties of reconciling clinical and scholarly perspectives on addiction treatment and the media frenzy about the recent prescription opioid epidemic, Sue offers a historical and ethical reflection on having the power to dispense prescriptions.

I first met Anita in the Boston jail where she was doing time for passing bad checks related to a prescription opioid addiction. She had first been introduced to opioids after giving birth to her first child several years earlier. “I was prescribed percs [percocets] for pain related to the delivery,” Anita explained. “I just remember taking them and being high and cleaning … I took four or five at a time.” Anita’s drug use spiraled out of control, as her physiological tolerance to the opioids increased and she needed to buy more and more pills to get the same effect. One day, Anita’s dealer offered her heroin, and off she went.

Ethnographers and historians of drug use are all too familiar with stories that resemble Anita’s. As an anthropologist who studies prisons and addiction treatment, I find it relatively easy to point the finger at doctors for their professional complicity in “epidemics” of opioid addiction.

But as a medical student in my final year, destined to start residency in July in an internal medicine-primary care program, I also worry I won’t be able to refuse prescriptions for opioids for patients presenting to me in distress and pain.

Historians of medicine and drug use have detailed how physicians—whether they wanted to or not—became central to the distribution and administration of opioids in the United States. In the wake of the Harrison Narcotics Act, addicts had to obtain prescriptions for their drugs, and so-called “dope doctors” would provide them for cash. The alternative to the dope doctor was the street druggist, the so-called “pusher.”

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Laudanum (image via Science & Society Picture Library/Getty Images)

 

Doctors and opiates have a long, complex history. In the era of magical formulations, Dr. Thomas Syndenham compounded laudanum by mixing “two ounces of opium and one ounce of saffron dissolved in a pint of Canary or sherry wine” with a “drachm of cinnamon powder and of cloves powder,” as historian Richard Davenport-Hines noted in his history of the subject. At the time, opiates (plus or minus alcohol) were among the few medicines that were actually effective pain relievers (working at the μ pain receptors in the brain). They were instrumental in bolstering the medical profession’s emerging reputation for dispensing effective interventions rather than simply bearing witness to suffering. Indeed, enterprising pharmacists and doctors alike created their own patented formulations of various narcotics marketed as cure-alls– a mix of magic, profiteering, and chemistry.

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Recent News Round-Up: Hoarders Edition

A few months ago, I was packing for my fifth move since 2008. I emptied every closet, box, and drawer. With every move, I’d shed belongings— a full twelve boxes of books in move number four— so why, I wondered, am I still knee-deep in useless things?

The answer was that, in true academic fashion, I’d redefined “useless.”  Turns out “keep,” “store,” and “toss” are unstable categories: I classified our household belongings entirely differently after reading the New York Times article on Marie Kondo, a home organization expert with a devoted global following.

Kondo has a best-selling book and a robust media presence, but her most famous piece of advice could be summed up in a tweet: Touch every item you own; if something doesn’t “spark joy,” discard it. I applied this method to my packing process, and a lot of things I’d been storing went out the door. (I also made a few personal archival discoveries— see below).

My "Just Say No" buttons from elementary school. Joy!
My “Just Say No” buttons from elementary school. Joy!

The process got me thinking about Americans’ warped relationship with material possessions, an entanglement that has grown more dysfunctional over the past several decades. Even as the middle class flounders, easy credit, cheap foreign labor, and larger home sizes have made it easier than ever for the average American to acquire far more possessions than he needs or can use. Since excessive, compulsive consumption factors into most definitions of addiction, it’s unsurprising that Americans’ increasingly acquisitive habits have led to cultural anxieties about purchasing (and hoarding) behavior.

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The Value of Propaganda as Historical Evidence: Anslinger’s Gore File as Source Material

Editor’s Note: This week, Bob Beach follows up on an earlier post about the Harry J. Anslinger papers. Today, Bob shares some of his findings from the infamous “gore file.”

In roughly four years, between 1933 to 1937, Harry Anslinger led a policy push to marginalize and strictly regulate the use of marijuana in the United States. His victory, the Marihuana Tax Act of 1937, was the culmination of bureaucratic maneuvering, public lobbying, and the use of extreme, sensationalist propaganda. These facts are not in doubt.

But what of propaganda? What is it? Where does it come from? There is no doubt that propaganda can be completely fabricated. But the most effective propaganda is rooted in some form of truth: cultural anxieties, social tensions, economic hardship. Indeed, all three of these were factors during the 1930s and it seemed like each of these elements found their way into the moral panic that was reefer madness.Read More »

Breast or Bottle: La Leche League and Alcoholics Anonymous as Lay Health Movements

Editor’s Note: This post is from Contributing Editor Michelle McClellan.

I’ll begin with two anecdotes, the first of which is probably familiar to most Points readers. In 1935, a stockbroker named Bill Wilson found himself in Akron, Ohio for a business deal. When it fell through and Wilson felt the urge to drink again after a period of sobriety, he reached out through area ministers and was put in touch with a woman who arranged a conversation between him and Dr. Robert Smith, a local physician who also struggled with his drinking. Their conversation is now recognized as the genesis moment of Alcoholics Anonymous (AA).

bill wilson

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Drugs, Demons, and Fiends: “I Can’t Breathe” (Guest Post)

EDITOR’S NOTE: Today’s post is by Suzanna Reiss, an Associate Professor of History at the University of Hawai’i and author of the recently published book, We Sell Drugs: The Alchemy of US Empire (University of California Press, 2014). Reiss offers a timely meditation on the legacy of the Harrison Narcotics Act, which turned one hundred yesterday. 

As we confront the hundredth anniversary of the passage of the first US federal drug control law, it is difficult not to be haunted by current events. What is happening today in contemporary policing reflects the legacies produced by drug control and its origins in the deep racial animosities and inequities that contributed to the passage of the Harrison Narcotics Act in 1914. This centennial commemoration should provoke national soul-searching about the drug war’s contribution to racialized policing and its ties to economic inequality in American society. It certainly is not cause for celebration.

Listen to two accounts – separated by a hundred years, sharing too much.

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