O’Shaughnessy’s • Autumn 2018 —11— Coming of Age in Sonoma ‘Nursing is the practice of Anthropology’ By Melanie Dreher when you use this substance all the time for From Dreher’s talk to students in the So- several years. noma State University course on The proposed study examined three cul- as Medicine taught by Jeffrey Hergenrath- tures in which was used consis- er, MD, May 2, 2018. tently: Costa Rica, Greece (in the form of I had never thought about being an an- ), and in Jamaica, where it was thropologist, but I was a big fan of the called , a term you’ve probably heard. work of Margaret Mead, and had an oppor- So, after a year of taking courses in an- tunity to work with her at Columbia Uni- thropology, my professor said, “Let’s see if versity in the 1960s. you can cut it. Go to a country or village Margaret Mead asked, “Why are Ameri- that you’ve never lived in before and find cans having such a hard time with adoles- out everything that you can about...” a sub- cents, when adolescence is just an easy stance that carried a two-year mandatory time in other cultures?” prison sentence for possession. She never got tenure at Columbia Uni- I said, “Oh, no problem, I’m on my way.” versity. She had left the traditional path of So in 1969—the same summer as academia, and was writing for Parent Woodstock and the first landing on the Magazine and for the public. Margaret moon—I found myself on a mountain top Mead took anthropology to the public. And with no electricity, no plumbing, no run- the anthropologists at Columbia —stuffy, ning water, no telephone, or transportation. Melanie Dreher old, white men— hated that. So they would I did not know a lot about Jamaica, and I never grant her tenure. But she was head of actually knew nothing about cannabis or a medical anthropological study.” If children drink marijuana tea, the largest natural history museum in the marijuana, because I had never smoked We needed 60 men to go into the hospital world. She had an enormously important anything. And I didn’t actually know all for a period of two weeks each, and be sub- do they actually perform better position. I think when she was much older, that much about anthropology. jected to a number of studies. Everything in school? and they thought they should offer her ten- So I got to this mountain top, and started from a psychological battery to a blood ure, she shrugged and said, “Mm, I don’t thinking, “Wow, an illegal substance—no test, urine test, the whole panorama of really need or want it.” one is going to talk to me about this.” But maicans, speak something called Patois, what’s going on with these guys physiolog- which a combination of Elizabethan Eng- Sometimes you can’t take just the aca- in fact, people did talk to me. I attribute ically. My job was to recruit subjects. demic route. Margaret Mead published in that to my being a nurse. I was used to ask- lish—15th century English— and West Af- Recruiting the users was not a problem. rican. But you can pick it up after a while. academic journals, too, but she felt that if ing about sensitive questions, and getting Finding 30 matching non-users in a coun- Americans need to know more about how answers, and having conversations about They do understand and speak the King’s try in which 85% of the working-class English, and that was what was taught in to handle adolescent behavior, they’re not intimate topics. So I think my nursing males smoked marijuana was really hard. going to read those articles. She needed to skills really helped me in that environment. the schools.... But it helped to explain many of the find- Anyway, that became my dissertation: put it in Parent, for women who are raising I managed to come back with a fair ings in the study. For example, we found children to read, and not to worry about amount of information, about why it was “Is there really an that comparing the users and the nonusers that occurs universally for anyone who tenure, or progression from assistant pro- used and in what kind of context. I discov- using psychological tests, we found that fessor to full professor. ered that it was exclusively men who uses marijuana?” the users were much better adjusted than I studied men who were rural farmwork- I certainly have done the tenure thing, smoked marijuana, and the women were in the nonusers. and was Dean of Nursing at four different charge of the tea. ers and cane workers in three communities, The immediate assumption is, clearly and discovered that actually their use of universities. But my mission, at least in the So here was a substance that not only had there’s correlation between being well-ad- last 15 to 20 years, has been to really in- recreational value for men, but was also a marijuana had no impact on their work justed and adapted to your environment, whatsoever. Even though they would claim form the public of the truth. Margaret very powerful part of the folk pharmaco- and the use of cannabis. But when you Mead’s example reassured me that I’d get peia. It was used for just about everything, that it would make them work harder. I dis- think about it, the non-30 users that I man- covered this by actually measuring the tons along fine without promotion and tenure. from early childhood ­—giving children aged to recruit for the study, there was al- She was an excellent role model, teacher, who were teething an eyedropper full of of cane they cut, which was not hard for me ready something a little weird about them. to do, because the factories, in which they and person. tea or medicine— to mothers who wanted They didn’t gather with the other men in I don’t even know if they assign her in to make sure their children were smart and cut the cane and bring it to the factories, the rum shops after work, or down at the had a measure for each man and how much anthropology courses anymore, but if you healthy and prepared cannabis tea for them river to have a smoke. They were a little ever have the opportunity to read “Grow- three times a week. cane they cut. odd, and in Jamaica at the time, and still, I found that there was no impact. But ing Up in New Guinea,” and “Coming of You can imagine what would have hap- the belief was that in order to smoke mari- Age in Samoa,” you should. pened to those mothers if they were in this while I was there I noticed that women rou- juana, you had to have the brains for it. tinely gave their families morning teas of Margaret Mead taught me how to do field culture. But in Jamaica, where folk reme- They also imparted the information that work and I tried to use her approach when dies were rampant, people would say to ganja two or three times a week to keep that’s in fact why women couldn’t smoke them healthy and to make them more pro- I had the opportunity to study cannabis use me, “We’ve got a lot of good folk medi- marijuana. They didn’t have the brains to in Jamaica. cines, but ganja is the king of it.” ductive. They believed it made them stron- handle the psychoactive effects. I just sort ger, they ate more. For children especially, I was a first-year doctoral student at Co- Ganja was not indigenous to Jamaica. It of put that in my pocket and dealt with it. lumbia University and my major professor was brought from East India by indentured mothers believed that it helped them con- But you can imagine the tiny percentage of centrate in school. was applying for a research grant from the laborers who worked in the sugar cane in- men who didn’t use it, they just weren’t National Institute for Abuse. There dustry, picking and loading cane. Very So I finished the two-year study, and got part of normal male society. So we should a job after I graduated, and I had a couple was a very enlightened person at NIDA at much like the workers who came to the not be surprised that they didn’t fare as that time, who thought, “What’s going on after the Mexican Revolu- of babies, and decided I needed to continue well in the study. this work. I went back to see if this was with marijuana in the US?” tion in 1910 brought marijuana... So then I figured, “All right, I have to do In the 1960s marijuana was being used by Ganja was an attractive substance with so true: If children drink marijuana tea, do a dissertation on this.” they actually perform better in school? college students and NIDA became inter- many uses that the Rastafarians, who re- At that time, there was a theory about the ested in the impact of chronic use —not jected the white man’s use of alcohol, took I went to a rural community, a different “Amotivational Syndrome” —that once one than I had been in before. I asked one just what happens to you immediately after on ganja as a sacrament. you started cannabis on a regular ingesting marijuana, but what happens Very quickly: Rastafarians believe basis, you would lose your ambition, drop continued on next page that Haile Selassie, who out, not care about succeeding, perhaps not was prince of Ethiopia, is finish college and not be able to find a job, the living God and that at etc. But I had found in that first summer some point in time, all something very interesting: people in Ja- black people would be re- maica were actually smoking marijuana to patriated to Africa, and make them work harder. The sugar cane would be disciples of Haile plantation managers —they called them Selassie, the prince of Ethi- “Bushers”— would come around to see opia. how they were loading the cane and cutting There was a sense of dis- the cane, and in order to make them work continuity between the harder and faster, they would actually dis- working class people and pense ganja for them to smoke. The bush- what was going on at the ers would come around on horseback and highest level of govern- pull out a big thing of cannabis, and give it Undergraduates at Sonoma State University heard the talk ment in Jamaica. to them so they could roll it up and smoke by Melanie Dreher transcribed here. BIOL 385 was a 3-unit So I spent a wonderful it and work harder. upper division course, open to all majors. Basic biology and summer, went back and Student: Was there a language barrier at chemistry courses were prerequisites. The groundbreak- made my report, and was ing SSU course created an odd irony: these college students all? told, “We got funded, so I would know more about cannabis as medicine than most US want you to go back again MD: Jamaicans, especially rural area Ja- physicians. Margaret Mead and recruit the subjects for —12— O’Shaughnessy’s • Autumn 2018

Melanie Dreher from previous page

They saw it as part of their religion, and There was a culture for marijuana. When there is a culture, rules part of Rastafarian culture. are developed by people about who should smoke it, when, where, at So we had a number of women and moth- what age. All these things just emerge from the culture, and that’s ers who were smoking, and I saw it as an interesting phenomenon that I should take how you control a phenomenon culturally. They didn’t need laws, a look at. they didn’t need a two-year mandatory sentence. I was able to get funding from the March of Dimes. The Thalidomide crisis was still favor of the non-exposed babies. That was factors, familial factors, economic factors on everyone’s mind. [A drug taken by not the case. were much more powerful than whether thousands of pregnant women to counter All of these mothers were breastfeeding. they had been exposed prenatally. nausea and morning sickness turned out to We knew that cannabis passes through the So those results were published, and we cause deformity and death]. People were mammary gland barriers and that these ba- sent them into NIDA and asled for an ex- very, very interested in the teratogenic ef- bies were getting continued exposure to tension to do the study from ages five to fects of any substance being used through cannabis, and yet they were really very so- ten. That’s when you see something called pregnancy, and what the outcome would be ciably alert, had high neurological scores, “executive function” begin to operate,. neonate. and were doing very well. Would these children be able to actually Cannabis was the third most commonly That was a very hard study to get pub- execute in their academic environment, ac- used substance by pregnant women in the lished, because there was so much resis- complish tasks, become good students? US. So there was a particularly keen inter- tance on the side of editors and so much That’s when I got the call from NIH, say- est in looking at women who were users, bias on the part of editors, that they just ing, “We’re not going to fund you any- and then when they got pregnant, what im- didn’t want to put it in. The study was com- more.” They didn’t like the results of the pact it had on their own prenatal experi- pleted around 1989 or ‘90, and we could study, and said, “Unless you can find some- ence, and their own neonatal experience of not get it published until 1994. Finally, Pe- Worker cutting sugar cane. thing negative or something wrong with the newborn. diatrics, which is a medical journal, pub- cannabis, we can’t fund you, because Con- of the teachers if she could identify for me lished it. And then it sat there. gress will not like your findings, and we which of these children in this school you We followed the women from I thought there would be a response to get our money from Congress. And if you think might be drinking cannabis tea. And the third trimester all the way the article, that people would be writing in, could just find one bad thing about canna- the teachers consistently picked out chil- pediatricians would find it outrgeous… bis and follow that trajectory...” dren who were not doing well in school. through their pregnancy, then we Nothing. There was no public response at And I said, you know, “these are the data. And said, “Okay, probably this one and examined their neonates at one all, I met the terms of my NIH contract, I did this one and this one.” day, three days, and one month. When it went online the American wom- the study, I collected the data, analyzed it. So that was part of my data set, and I en who were interested in the effects of Everything was done very carefully. And I went to each of these families and actually marijuana use during pregnancy found it We used the same model that we used in can’t change the data, these are the facts.” measured the amount of tea they had con- and there was online dialogue. But that was the earlier study. We took 30 women who At that point I said, “Okay, enough. I sumed. When, how often, how much, and it, the only response. It wasn’t until almost were cannabis users and we matched them don’t want to have to fight these battles so forth. And I found that it was actually 15 years later that I was walking into work according to parity —the number of chil- with the federal government.” So I discon- just the opposite. The children who were one day —I was Dean of Nursing at Rush dren they already had, socioeconomic sta- tinued that work for a little bit and thought, drinking cannabis tea, as the parents had University in Chicago— and one of my tus, and age. We had a very nice match “Maybe I’ve done all I can as an individual predicted, were in fact performing at a students rode by on his bike and said, sample from a rural parish in Jamaica, and researcher, maybe someone else can take higher level in school. They were also the “Dean Dreher, your study’s gone viral!” we followed the women from the third tri- this up.” children who came to school most often. Now this is 15 years later when the Ameri- mester all the way through their pregnancy, Cocaine And they were also the children who had can public began to question, “Hmm, is then we examined their neonates at one It was the 1990s. I was still teaching, and clean uniforms and notebooks to write in, this really the problem that it’s purported to day, three days, and one month. was Dean of Nursing at the University of and so forth. be?” Massachusetts. I decided to keep taking So one of the things that I had discovered NIDA funding nursing students to Jamaica where they was that preparation of cannabis tea for In Jamaica we had this wonderful sample could really learn a different kind of nurs- children was part of what I call the “Good of 30 babies who had been exposed to can- ing practice. Mother Syndrome.” If you wanted your nabis and 30 babies who hadn’t been ex- That was a very good thing to do. The children to do well in school, you made posed, and I thought it was time to go to the students came back incontrovertibly sure that they had whatever was necessary, federal government for funding. The Na- changed in their whole way of thinking including shoes to make that long walk of tional Institute on Drug Abuse had funded about patient care. But while I was there, I two-and-a-half miles to school. Had a my pre-doc and my postdoc, and they gave noticed that in Jamaica, cocaine had en- proper breakfast, had lunch at school, and me funding to go back and follow these tered the substance-abuse scene. And this so forth. children post-birth until age five. was very sad. So once I looked at the results of this There was a culture for marijuana. When study and thought, “Hmm, another correla- The environmental factors, fa- there is a culture, rules are developed by tion between really strong behavior, good people about who should smoke it, when, behavior, positive behavior, and cannabis milial factors, economic factors where, at what age. All these things just use.” But was it really the cannabis use? were much more powerful than emerge from the culture, and that’s how The best we can say about a study like that whether they had been exposed you control a phenomenon culturally. They is what we said about the earlier study. We We used a standardized test that had been prenatally. didn’t need laws, they didn’t need a two- know it doesn’t disadvantage them. developed in the US by the Brazelton Neo- year mandatory sentence. They had their While I was doing that study, I noticed natal Group at Harvard — a famous test for We wanted to look at their readiness for own laws that were well obeyed. So if they that increasing numbers of women were looking into variation in neonatal behavior. school, and to see if their prenatal exposure saw a 12-year-old, an older man in the vil- starting to smoke cannabis in a manner not We discarded the first study — immedi- had any impact on their beginning to be lage would say, “Ey, boy, no, you’re too unlike the way men smoke it. It was the ately after birth through the first 24 hours— ready for school. We found that there was young. Wait five years, then you can be a early 1980s. The women were smoking because there was such variation. Some no impact of the cannabis at all. The real man, then you can do this.” with their friends, they were smoking alone babies we’d catch at three hours and some issues had to do with children who had bet- There were all these things that I had if they had a hard task to do. If they were babies we’d catch at 24, and babies change ter environment for neonatal development been recording and I thought, “Someday, going to the field to pick crops, or even at a lot in the first 24 hours after birth. than other children. The environmental I’m going to write the book on how a cul- home doing laundry, it was not uncommon So we decided to use the three-day mea- ture monitors itself with its substances.” for many of the women—not all of the sure to compare the neonates of these sam- But when cocaine came in, there was just women— to have a ganja cigarette, a spliff. ples, the exposed and non-exposed babies. no culture for cocaine —crack cocaine— And I thought, well this is a change. Things And then we compared them again at one at all. And crack, as you may know, is a are happening. month. highly addictive substance, the most addic- We found that at three days there is very tive form of cocaine. The Rastafarian men really felt little difference between the exposed and What we were seeing was a big rise in that their Rasta Queens had their non-exposed babies. This was a neurobe- prostitution, some serious rises in crime. havioral test, so we would do things like The cocaine was coming in, Jamaica was a right to smoke. drop a Kleenex on their face and see if the trans-shipment port from South America to babies would raise their hand to push it- Louisiana and Miami. So the smugglers The Rastafarian movement had given away. Very simple things, but simple things would get to Jamaica, drop bails off the women a special place in that culture. They a neonate would be capable of. ship, and then the fishermen would go out called the women who were Rastafarian We gave them the test again at one month. to help them bring in these bails of cocaine. the Rasta Queens. The men who were not At one month, we got very different re- Then they would be transported to another Rastafarian, who criticized women when sults. We found that the babies of the moth- place, put on a different ship, and taken they smoked (unless it was in a pre-sexual ers who were smokers did significantly into the United States. context with them) didn’t like it at all when better on every item on the Brazelton Neo- The fishermen and transporters had never women smoked with friends or in a social natal scale. This was completely nonintui- heard of crack or cocaine before. They had manner. tive. We just assumed there would be dif- no idea what it was. But that’s how they But the Rastafarian men really felt that ferences, and the differences would be in their Rasta Queens had their right to smoke. continued on page 39 O’Shaughnessy’s • Autumn 2018 —39—

Melanie Dreher from page 14 were paid ­—in­ cocaine. So everyone had In the US alcohol is allowed for ing labor and delivery that was unauthor- their pound of cocaine to take in. They pregnant mothers. We know the ized, it wasn’t approved, which we didn’t quickly learned from people in other coun- consent to, and they discovered she was tries, entrepreneurs who would come down damaging effects of alcohol. We using cannabis. And the state authorities and show them how to make crack. Soon know them. Yet we can’t find any have removed the baby and put the baby in Kingston and Montego Bay had a real for cannabis and it’s illegal. foster care.” crack cocaine problem. We were seeing in- These are the kinds of stories that have creasing numbers of women using it. put me more into the activist role. Some I went to the State Department and they patients haven’t cured themselves by using are much worse, believe me, where they agreed to fund me to look at substance use cannabis.” actually put the mother in prison. Recently in general through Jamaica. And they said, “Yeah, we’re seeing that, I called the Attorney General of a big mid- I took five anthropology students with but we didn’t prescribe it.” western state, and I didn’t speak to a staff me, put them in different locations through- And I said, “Listen to you: you don’t person and said, “What is the problem? out Jamaica, and did a study of all sub- want to prescribe something that is very ef- What problem are you trying to solve stance use. fective, pretty inexpensive compared to here?” I was very nice, I wasn’t trying to you’re studying, is that you go through From the time that the fisherman put the what else there is, and you would rather see be confrontational, I just said, “Just explain several trials of trust. I was a nurse, that bail in his boat that cocaine would be the pharmaceutical companies come up to me.” helped a lot. I delivered a lot of babies touched 30 times before it got to the even- with very expensive, synthetic products And they said, “Well frankly, we do not when I was in Jamaica. Once someone de- tual user. That’s 30 people who derived an that only rich people will be able to afford, believe that a child is safe in a house where livers your baby, you feel pretty comfort- income from that crack cocaine. It was and that the taxpayers will pick up the bill there is cannabis. Where marijuana is pres- able. I have a lot of godchildren who are amazingly lucrative for some people. For for, when poor people need to have this an- ent.” now big adults, older than you. It was a others, it was just a way of making a living tidote to opioid addiction.” And I said, “Really? But your gun laws useful skill set to have, to be able to treat in an impoverished third world country And that’s sort of where we are right now say that anybody can have a gun. You don’t peoples’ problems. that didn’t have many ways of making a on this whole issue, take a baby out of a house where there’s a Studying behavior in context is really im- living. So as I’ve shifted from saying, “I did the gun, or dishwasher detergent. Or a bottle of portant. The studies that have come out in I had a meeting with the chief of police in research, here are my findings, and it’s up asprin, or any of the other things that can the US on marijuana use during pregnancy, Jamaica, and he understood that I was do- to you policymakers, you clinicians, or you kill children and babies. Why are you so are usually done by a questionnaire, a re- ing this work. He said, “Can you tell us educators, to take those findings and get focused on this?” search schedule that people can respond to: where these crack houses are?” And I had them out to everybody.” Now I’m saying They don’t have an answer, but they re- “I do,” “I don’t,” “I do sometimes,” or students who are working in these crack that I have to be part of that group that is ally feel like they’re doing the right thing. “this is how many times...” houses, collecting data there. I said “No.” out there spreading the word and helping It’s astounding. But we have classic, But to actually be in a place where you He said, “I know some of your students people understand what a profound sub- wrenching stories of women who have can observe people’s behavior makes a are working in these crack houses.” And I stance this is. And that if it were discovered been imprisoned right after the birth of huge difference. You can relate it to other said, “That’s right, they are. Our students today, it would be considered a miracle their child, without even the proper cloth- behaviors. I could understand which wom- have been here for five weeks. Your police drug. ing or services needed for a woman who’s en were going to become the marijuana have been here for years. And I bet your But because it has this long history, in a just given birth. These letters keep coming. smokers, because they were usually wom- police officers know where every crack fear-driven society, we are reluctant to use We really have a problem, and it’s not go- en who were independent of their men. station in Kingston or Montego Bay is.” what is there, what is available, what is the ing to go away unless we become activists They could take a chance, use when they The police were very heavily involved in cheapest, most effective we have for a seri- and do something. wanted, and many women in our study this. They always have been. Less so in ous addiction problem. JYH: In the Jamaican study were all the whose children were exposed prenatally ganja. They were obviously being paid off Student: You talked about the farm pregnant women smoking or were some were also vendors. So one of the things in the crack cocaine industry. workers and how they use ganja. What just drinking tea? they could do that other mothers couldn’t The kind of heroes of that war between about other occupations, like doctors and MD: We had women who smoked daily, do was stay at home, have their home- crack and ganja were the Rastafarians, who teachers? several times a day. They were categorized based cottage industry, preparing and sell- wouldn’t touch crack cocaine. Marijuana MD: There was a wonderful physician in as heavy users. And then we had women ing cannabis, and have their baby with was their substance. And they feel that it this village who was absolutely fine with who were in the middle, who tend to just them at home. So they developed a unique gave them the protection against crack co- cannabis. He didn’t use it himself, but he smoke recreationally or socially, on the environment for neonatals, in which they caine. And I thought, “Well, that’s pretty had no problem with his patients using it. weekends, and use cannabis tea during the were with their babies constantly. interesting,” so I got the State Department He had trained in England as a physician week. And then we had the third group, Have there been any other studies like to fund a study of sex workers in Kingston- and then went to the University of Minne- who were pretty serious cannabis tea drink- that? No, and it’s unfortunate, because Jamaica, who were crack cocaine users. I sota where he got a degree in public health. ers, and occasional smokers. It might have that’s the only way you can study women wanted to see how they were using it, how He was well known and liked. been two or three times a month. They had and children. often, under what conditions, what context, On one of the articles, he’s the second au- to be smokers, they had to smoke cannabis The other reason why Jamaica is the kind and how that linked to what they were do- thor. He found that it was a very helpful at some point. But again, we really could of place to do this work is because until re- ing with marijuana. substance to people, and they should be not find a difference among the three cently, you did not have multiple drug us- That study was really enlightening for encouraged to drink the tea, and saw noth- groups, in terms of neonatal outcomes at ers. Women who used cannabis were high- me, One of the things it made clear is that ing wrong with it at all. all. Nor could we see any differences at age ly unlikely to use any other substance. marijuana is not a precondition to crack co- A Jamaican doctor named Manley West two, using the McCarthy scales, and then Maybe an occasional beer, and since ciga- caine use, it is not a gateway drug. Most of observed that ganja smokers have no glau- at age five. There was just no evidence of rettes in the area were sold one cigarette at the women had never smoked ganja — coma. He and hiis colleagues developed a any impact at all. a time, they might on a Saturday night to crack cocaine was the first substance they medication called Cannisol —eye drops Student: How many journalists turned look cool, buy a cigarette and smoke it. So smoked. When they were given what they for glaucoma— that never got to the US you down before Pediatrics published your we essentially had an opportunity to study called a “season spliff” — a ganja cigarette but sells very well in South America. papaer in 1995? the actual divorced that has been laced with cocaine— they Teachers, no. I found that teachers were MD: Interestingly, all the nursing jour- from any other substance use. found just by trial and error, that they did really struggling to move from what might nals turned me down. The issue was, “what Some of the NIH critics of the study not immediately want more. have been the working class to middle does this have to do with nursing?” Seri- would say, “Well you know, that works in They would say, “When I smoke crack class. And they were divesting themselves ously, the third most commonly used sub- Jamaica, but I don’t think the data would cocaine, it feels great, and then I have this of anything that might speak to a working stance in the United States! “What does apply here in the US.” And in fact, you sudden drop, and then I feel really bad, like class behavior. Even though they may have this have to do with nursing?” I just find it can’t do that study here in the US because I need to have something right away.” ingested it themselves as children, been astounding that a profession could be so there is so much multi-drug use in the US. Whereas when they smoked the seasoned given it by their mothers, they just wanted narrow-minded. Pharmaceutical are so widely used spliff they didn’t feel the need to have an- to separate themselves from what was a The nursing profession has many subspe- that to tease out the specific effects of can- other dose of crack immediately. So some working-class phenomenon. cialty organizations. One is addiction nurs- nabis is very hard to do here. of the women started looking at this as a One of the things about being an anthro- ing, and cannabis use is considered an ad- Every society, every culture, has its sub- way of relinquishing their crack cocaine pologist, working in the community, living diction. Cannabis is not addictive... stances that it approves, and its substances habit. in the community with the people whom Student: The dogma in America is that it that it doesn’t approve. In the US, alcohol I found that people were doing this in doesn’t make you productive, it makes you is allowed for pregnant mothers.We know Brazil as well, getting off of crack cocaine lazy and all that stuff. the damaging effects of alcohol. We know by using marijuana in some way. MD: Right. That’s the sort of cultural them. We can’t find any damaging effects Today, when I see what’s going on with folklore. And the cultural folklore around for cannabis and yet it’s illegal! the opioid epidemic, I think, “This is ex- cannabis use in Jamaica is that when you actly what’s happening. People are using smoke cannabis it goes right to the brain, marijuana to get off opioids.” “...the state authorities have re- and it has a psychoactive effect. They don’t In Illinois, with the dispensaries that are moved the baby and put the baby use the term psychoactive, but it affects now open, they estimate a third to a half of in foster care.” how you think. And cannabis, when it’s the people they are seeing in the dispensa- consumed as an infusion, when it’s drunk, ries are there to relinquish their opioid ad- it goes into your blood. This is the folk I have made many court appearances in diction, and doing so really successfully. explanation for it. It makes you healthy and response to heartbreaking stories. I get a I sit on the Chicago Board of Health,. strong, and gives you protection for the fu- desperate letter from a family that says There are four physicians and they’re all in ture. You don’t feel the effects right away. something like, “My wife was having her internal and primary care. I said, “Come on he author in amaica It’s for prevention, it’s a strength-inducing, T J with two study sub- first baby, they did a hair-sample test dur- guys, you can’t tell me that some of your jects, WHAT YEAR› continued on next page —40— O’Shaughnessy’s • Autumn 2018

Melanie Dreher from previous page appetite inducing substance. taken Ritalin as children, who were identi- Courage is greatly lacking in Melanie Dreher, Ph.D., RN, FAAN has Appetite is very important in Jamaica. fied with this problem as children, because our culture today. served as the dean of four Schools of Nurs- They do not like skinny people. They find it continues into adulthood. ing. While at the University of Iowa Col- it unattractive. So losing your appetite is MD: I don’t hold any rancor for them at lege of Nursing she established a Masters not a good thing in Jamaica. But those psy- I never saw dementia in Jamai- all. People and organizations act in their in Nursing and Health Care Practice de- choactive effects, when you ask farmers self interest. It’s just a fact. And I can un- gree, which became the national model for and cane workers, or women who are home ca. They live longer than we do, derstand, if I was head of NIDA and I professional nursing education. The author attending to their gardens, cleaning their and I never saw a hint of demen- thought that my budget was going to drop of books, articles and reports, her research house, where they have a lot to do, and I tia there. as a result of this person’s work, or the interests include cross-cultural studies of found this in pregnant women who consis- funding of this particular scientist, I’d have the health care systems and financing of tently said, “It just gives me the energy I In addition to Attention Deficit Disorder, to think twice. But what I think NIDA community health care. need to do all the tasks I have to perform.” I think something can be done with very should do, and what NIH should do and The study we did with children was very elderly people. I never saw dementia in Ja- doesn’t, is to actually go to Congress and interesting for me because, one, it showed maica. They live longer than we do, and I have an audience with them and tell them what good parenting was about. These never saw a hint of dementia there. I’m “We have some really interesting findings. schools in Jamaica are likely to have 50 in sure there were some, but in all the villages You need to be informed so that you can a classroom, with four children squeezed I lived, in Kingston and wherever, it just inform your constituents.” into a desk about this size. Lots of noise, wasn’t there. So I think it’s worth really ex- Courage is greatly lacking in our culture lots of things going on, and for a child to amining the role of this substance in brain today. If we’re really serious about health- concentrate in that kind of environment is functioning in much older people. care in the US, we can’t just look at the really difficult. Student: Do you have any idea how the same science that has guided us forever ganja-using children turned out? and ever. We have to step outside those MD: In 2000 I got a tiny grant from the boundaries and look at other ways of doing Ruth Landes Field Study Fund, Research things, other ways of thinking and learn- Institute for the Study of Man and I went ing. back to look at these kids, who were then between 18 and 20. We didn’t have a lot of time, but we found 14 of them just by go- ing around the villages and asking where The War on Mothers they were. It was so much fun! We’d pull 1. “Perinatal Marijuana Use and the up to the house, and look. “Miss Mel, it’s ing for developing children also should be Developing Child” was published by you?” advised to maintain abstinence. Treatment JAMA July 16. Lead author Lauren Janson We asked what they were doing now. programs for women with CUD should is in the Department of Pediatrics at Johns Many of them had gone on to college — be available and accessible, and gender Hopkins. Co-author Chloe Jordan, PhD, is meaning high school in Kingston— and and culturally specific, particularly during with the National Institute of Drug Abuse. then went on to do professions like ac- pregnancy and postpartum periods.” Their fear is that “Expanding use of can- counting, nursing, teaching, which I 2. “Association of Nausea and Vomit- nabis among pregnant and lactating wom- thought was pretty good. These were all ing in Pregnancy with Prenatal Mari- en (as likely will occur with legalization) the using children. But since I didn’t have juana Use” ran in JAMA online as a re- may lead to increased risk from fetal and the whole sample, and couldn’t do a com- search letter August 20. The authors are child exposures if the teratogenic potential Parents believe that the ganja tea helps parison, I just didn’t think it was yet wor- with Kaiser Permanente’s Northern Cali- of cannabis remains underappreciated.” them concentrate in that kind of environ- thy of publication. But it was gratifying to fornia Division of Research. In response to The neoprobes’ goal —summed up in the ment. And they would go without ganja see these kids, who were allegedly doomed more pregnant women using cannabis as an quote highlighted by the JAMA editors and themselves, if their supply was low, so the by nurses and teachers to not succeed, in antiemetic, Kaiser records were analyzed reprinted below— is to suppress dissent children could have their tea. fact succeeded quite nicely in a country in to find a correlation between marijuana use among physicians. Student: Why just two or three days of which it’s quite difficult to succeed. and nausea and vomiting during pregnancy the week, if it’s so effective? Why not ev- (NVP, also known as “morning sickness”). ery morning? Valuing anthropological evidence They found, unsurprisingly, that the more MD: Because they have a range of other It’s very hard to understand any kind of severe her nausea, the more likely it is that teas that they drink, to give to their chil- human behavior when you take it out of the a woman will use marijuana. dren. For example, WHAT if they have context in which it occurs and put it into a “In a large, diverse sample of pregnant worms and need to be evacuated on a regu- laboratory or test tube and try to figure out females from 2009 to 2016 who underwent universal marijuana screening in California, lar basis. Thyme tea, and then just a choco- what’s going on. Or even to do a question- The authors cite numerous published al- late tea once a week. So the try to mix it up naire or a survey. But when you can actu- those with severe NVP had nearly 4 times legations of harm and then express dismay greater odds of prenatal marijuana use, and and not give their children the same tea ally witness this behavior as it occurs, it’s that many clinicians do not consider these those with mild NVP had more than 2 times every time. intelligible, you can understand it. And allegations conclusive. greater odds of prenatal marijuana use than They always gave them cannabis tea the that’s the real value of social science. “...Despite these risks, it appears that females without NVP. Although results are morning of exams. I don’t know if any of you are consider- clinicians are not addressing cannabis use consistent with the hypothesis that women Student: How did you know that? ing a career in social science, but I would during pregnancy or lactation; in one study use marijuana to self-medicate for NVP, MD: I lived in the community, so I’d go say we add an enormous amount. What we of 74 lactation professionals, 85% encour- marijuana use may also contribute to NVP, and meet with the mothers every day. There don’t do is double-blind studies that have aged breastfeeding among marijuana-us- or clinicians may diagnose NVP more fre- were only 28 children in that study. So I clearly formulated hypotheses. What we ing mothers. Most national breastfeeding quently among women who report using would go to the mothers, I’d give them a do do very well is record and compare hu- guidelines (eg, the American Academy of marijuana to treat it.” sheet to fill out, I’d go and talk to them, and man behavior. And that in itself can be ex- Pediatrics and the American College of The authors conclude with a reminder tha this is the value of living where you do traordinarily enlightening, and enriching Obstetricians and Gynecologists) have re- “national guidelines” promote abstinence. your research, because they trust you and for people to help them understand their mained steadfast in recommending against They advocate drug-testing for the moth- they tell you the truth. own culture as well. cannabis use during lactation. However, ers-to-be! The children who were getting the ganja the Academy of Breastfeeding Medicine “The health effects of prenatal marijuana tea did very well. They were the leaders in What I’ve found is that nursing has changed guidelines (2009 and 2015) to use are unclear, and national guidelines their class. They had their little notebooks, is the practice of anthropology. allow the potential use of cannabis during recommend that pregnant women discon- their sharp pencil, we’re talking primitive lactation, citing “data...not strong enough tinue use. Patients with NVP should be things, fresh uniforms. How much is attrib- to recommend not breastfeeding with any screened for marijuana use and educated utable to the ganja? It’s hard to say. But I Anybody in nursing? (A hand goes up) Great, is there a program here at Sonoma marijuana use” despite urging caution due about effective and safe NVP treatments.” think one of the areas of research where it’s to “possible long-term neurobehavioral ef- really going to be important in the future, is State? And where are you along in your course? fects.” looking at the significance of ganja prepa- The failure of the Academy of Breatfeed- rations, or cannabis preparations, for chil- Student: I’m still in pre-nursing, so I’ll start applying next year. ing Medicine to remain “steadfast” upsets dren who are easily distracted. the authors, who want doctors to propel the I think we’re missing a big opportunity MD: It’s a really great career. Sometimes people will say to me, “Hmm, nursing and cannabis-using mothers into treatment. for these kids who have attention deficit “The medical community should advise disorders. I’m not recommending that they anthropology, that’s a kind of interesting mix.” But what I’ve found is that nursing is pregnant women to avoid perinatal THC all go out and smoke marijuana, but it exposure and intervene for women need- seems to me that we should be identifying the practice of anthropology. I’m not sure why they don’t require anthropology the ing treatment, for children at risk for neu- some sort of therapeutic substance that robiological and developmental problems, children with ADD can have. way they require pathophysiology in nurs- ing. Because nursing is all about human or for dyads at risk for negative outcomes Ritalin is a terrible drug. If you can really associated with an untreated substance use get kids on something that is harmless, yet behavior in context, and comparisons. So each patient you have, you compare with disorder. does the trick to get them focused, that’s “Advice from medical professionals phenomenal. I think the problem is we the patient you just had. Student: Do you think of yourself as should be consistent: pregnant and lac- can’t experiment with children. Maybe the tating women should be advised to avoid best we could do is to get adults who had having been blackballed by the medical journals? cannabis use, and women (and men) car-