Policing Patients or Providing Care? The Medical Cannabis Certification Process and the Production of Physician Authority

• In Event: 30210 - Shifting Contexts of Clinical Work

Abstract

Social science scholarship has examined the institutional structures, practices, and consequences of medical and physician authority. Medical expertise, diagnostic capability, treatment discretion, and prescriptive control have been identified as integral components of the constitution and exercise of physician authority. With the legalization of medical cannabis in the US over the past three decades—with 39 states allowing medical cannabis—these foundational components have been significantly challenged. In most licit states, medical cannabis (1) patients are ‘certified’ for, not prescribed, medical cannabis by physicians; (2) access is delimited to patients diagnosed with one of a legislated list of qualifying conditions, rather than physicians’ treatment discretion; (3) dosing and frequency of use is determined by patients, not physicians; (4) patients are often certified by physicians other than those who diagnosed them; and (5) patients tend to have more knowledge about cannabis’ medical uses than physicians. Given this unique array of challenges to physician authority, how is physician authority produced in this context—and with what consequences for patients and physicians? Drawing on four years of research into Minnesota’s medical cannabis program—including a survey of healthcare providers (N=1183) and in-depth interviews with patients (N=27)—this paper examines the medical cannabis certification process to answer these questions. With insights from Deleuze and Guattari’s emergentist ontology, I analyze how bodies are transformed into hierarchically-arranged ‘medical cannabis certifiers’ and ‘patients’—whereby the former are positioned to authoritatively mediate the latter’s access to cannabis—through the certification process, tracing each’s emergent capacities and a/effects to the intensive and extensive relations that constitute the program. I show how authority emerges through an assemblage of medical and non-medical actors, institutional processes, and laws that position state-licensed healthcare providers to mediate (and, thereby, police) access to licit cannabis through the certification process on an annual basis.

Author

• Ryan T. Steel, Miami University