From Demon Weed to Wellness Darling: How Cannabis Got a Medical Makeover

“We know that stigma is really hard to get rid of,” Professor Kisha Lashley says. “But a takeaway from our research is that it can be done.”

Kisha Lashley

By Caroline Kettlewell

How did pot go legit?

That’s the focus of a research study co-authored by McIntire Professor Kisha Lashley, recently published in the journal Administrative Science Quarterly. Once decried as the “evil weed,” thief of motivation, and gateway drug to a life of slacker indolence, marijuana has undergone a remarkable rehab in the past few decades.

As recently as 1989—the year then-President George H.W. Bush escalated the “war on drugs”—more than 80% of Americans opposed legalization of marijuana. But today, even as cannabis remains an illegal drug under federal law, more than two-thirds of Americans support legalization, and some form of cannabis product use is legal in all but three states. Lashley and co-author Timothy G. Pollock of The University of Tennessee, Knoxville present the case that this shift was achieved through a protracted, complex, and often contentious process by which marijuana was decoupled from its associations with black market criminality and recreational drug use and realigned instead with a legitimate enterprise: the medical and health and wellness industries.

From Medicine to Reefer Madness
Marijuana, the researchers note, was available medicinally in this country into the early 20th century. But the establishment in 1930 of the Federal Bureau of Narcotics (now the Drug Enforcement Agency) saw the beginning of federal efforts to stigmatize cannabis, which was increasingly characterized as a dangerous drug associated with physical ruin, violent criminal behavior, and the corruption of children. By the 1950s and ’60s, the growing incidence of recreational marijuana use among college and university students contributed to an expanding moral panic about pot. Finally, in 1970, cannabis was federally classified as a Schedule 1 drug, along with the likes of heroin and LSD, which the DEA still defines as having “no currently accepted medical use…and a high potential for abuse.”

The result? The marijuana business was not only made illegal but also endowed with a “core stigma,” the authors explain, in which the very nature of the enterprise itself is delegitimized and any individuals or activities connected with it are stigmatized by association.

The (Re)birth of “Medical Marijuana”
Yet almost as soon as the marijuana industry was freighted with core stigma, events began to unfold that would offer a path back towards legitimacy. The groundwork was laid in a 1978 Supreme Court ruling allowing a private citizen to grow marijuana for use in treating his glaucoma, which the researchers mark as the first recorded use of the term “medical marijuana.”

From there, Lashley and Pollock propose a process of three overlapping phases by which “the poisonous weed which maddens the sense and emaciates the body,” as a 1934 New York Times article characterized it, rebranded itself as “medical cannabis,” succor for the suffering.

The attitude shift took place over time, with the AIDS epidemic serving as the catalyst for the first phase, “initiating a moral agenda.” In the face of a debilitating and deadly disease, “activists crusaded for AIDS patients’ rights to use cannabis for medical purposes,” write the authors.

The focus on the relief of suffering for the gravely ill helped link marijuana to the positive values of patient rights and compassion and “a moral agenda centered on healing.” Making common cause with other patient rights groups furthered this moral realignment; the authors note that a television ad featuring the wife of a cancer patient helped propel the ultimately successful effort to make California the first state to legalize medical marijuana in 1996.

In the second phase, “moral prototyping,” a stigmatized industry actively disidentifies itself with negative associations while identifying itself with positive ones. In this stage, “medical marijuana” emerged as a distinct category associated with healing and the alleviation of suffering rather than recreational drug use. Attending industry conferences as part of her research, Lashley found that participants actively policed and constructed the language of this new category, replacing words like “user” and “toking” with “patient” and “medicating.”

The third phase, “morality infusion,” might be called the “good citizen” phase, when industry players seek to project a “squeaky-clean image,” as the authors describe it. Spotless dispensaries telegraph the look and feel of a doctor’s office or a high-end spa. Products are packaged to emphasize associations with purity, health, and wellness. And dispensary owners present themselves as model community members—professionals who attend church, join the PTA, and engage in “highly visible acts of philanthropy,” the authors write.

Front-Stage Image, Backstage Reality
Complicating these efforts, however, has been marijuana’s continued status as an illegal Schedule 1 drug. The medical marijuana industry might seek to distinguish itself from black market drug trafficking, but federal law makes no distinction. As the authors put it plainly, “Imagine starting a business when the federal government has declared your product or service illegal, banks will not let you open a checking account, you cannot deduct your business expenses or pay your taxes through conventional means, you are forced to pay your employees in cash…and many of your customers do not want to admit they use your product or service.”

This conundrum results in an unfortunate conflict between image and reality: For all their above-board, “clean” business trappings and purposes, dispensary owners and medical cannabis entrepreneurs are often forced to survive by engaging in “backstage” activities like sourcing products from the black market or continuing to serve a customer base of purely recreational users. (Nor have all industry actors been on board with repudiating marijuana’s recreational associations, and the authors note that “messy” internal discord within the industry has on occasion played out on a “side stage” in partial public view.)

Yet the shift in public opinion, the growing state-level trend towards full legalization, and the normalizing and mainstreaming of cannabis use all attest to the remarkable success the industry has managed in destigmatizing itself and a still-illegal drug that will still get you high. For Lashley and Pollock, that success offers an intriguing new perspective on the nature of core stigma.

“We know that stigma is really hard to get rid of,” Lashley says. “But a takeaway from our research is that it can be done.”

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