Ugly Disparities Among My Patients Demand Marijuana Racial Justice

    As a doctor in a harm reduction clinic, the racist applications of our marijuana laws are regularly apparent to me. While white patients are typically given second chances, patients of color are frequently criminalized and their families torn apart. Legalization, my experiences show me, is essential. But it isn’t enough: We need legalization measures that directly address racial injustice.

    Legislators in my state of New York are currently considering a marijuana legalization bill designed to do exactly that. The stories of two of my patients illustrate why we desperately need it.



    Henry*, a black man in his 40s, went to high school with me. Unlike me, he knew what he wanted to do after graduation: He wanted to be a chef. A giant at 6 feet 7, he has an unfailingly outgoing and kind demeanor. He used to get off the bus from the high school culinary program and divvy up fresh pies and cakes amongst eager adolescent recipients.

    A few years after college, Henry took a bad fall down a flight of icy stairs and landed with a crunch on his neck. Combined with a mild congenital spinal deformity, this injury has resulted in 20 years of chronic, unremitting pain and arm tingling.

    When he came to the REACH office in Ithaca, we hadn’t seen each other in 20 years. Henry had lost so much weight that I hardly recognized himuntil, that is, he performed an impression of his high-school self in the waiting room. He had just consulted with local neurosurgeons to discuss treatment options and left their office determined to avoid surgery or prescription opioidshe had seen their use go south for too many people to want to try them.

    Other medications like amitriptyline and cyclobenzaprine left him groggy, so he turned them back to his doctor. Staying active and social has long been his main recourse. For years, he did regular physical therapy, lap swimming, stimulating electrode therapy, massages (when he could afford them) and yoga. He also took enough ibuprofen to tear up his stomach, all without enough relief to let him stand and cook in a kitchen for more than an hour.

    “Suddenly, I wasn’t [seen as] an active single father who helped with homework and baseball practice, I was a lazy black dude who lay around smoking weed.”

    Henry lives downtown in subsidized housing with his son. He recently got approved for SSI (supplemental security income), as he hasn’t been able to work due to pain.

    In the evenings, he smokes marijuana to ease his pain while playing video games. He finds that it calms his mind and lets him get recuperative sleep. Marijuana has helped him to deal with anxiety, and to make peace with a life that hasn’t aligned with the one he envisioned.   

    He came to REACH to request certification for medical marijuana, which we completed that day. Despite the much higher out-of-pocket expense, he wanted to obtain marijuana legally to avoid further trouble.

    Henry’s son is now in high school. Years ago, when Henry and his white girlfriend broke up, they endured custody hearings together. During proceedings, she reported to the judge that he “smokes marijuana and plays video games.”

    “Just the mention of it changed everything in that courtroom,” Henry told me. “They immediately decided to take my custody. I didn’t have any charges!” The judge’s sudden shift in tone made him feel he was being seen as “that stereotype of a neglectful black dad smoking away my days and ignoring my child.”

    “That couldn’t have been farther from the truth,” he pointed out. “At that point I hadn’t had any interruption in my employment and my resume was impeccablebut they couldn’t see that. I wasn’t an active single father who helped with homework and baseball practice, I was a lazy black dude who lay around smoking weed.”

    His full custody was reduced to visitation every other weekend, until he had completed drug and alcohol counseling. He eventually got full custody back. Scarred by this experience, he is acutely aware of how high the stakes would be for him if he were found using marijuana from an illegal source.  



    Amelia* is a laid-back, intensely smart white kid with academic parents and a social justice heart. I saw her at my previous practice five years ago for her 16-year-old physical. Besides a meningitis vaccine, our agenda was to catch up and have the requisite talk about sex and drugs.  

    Amelia then shared with me that, though she didn’t smoke marijuana more than a few times a year, the prior spring she had sold $20 of marijuana to a friend on school grounds.

    Someone had told the police, and she had been arrested and charged with a felony for selling to a minor. She was expelled from her school district for a year; her family hired a lawyer and paid a $5,000 fine.

    After stressful hearings, mandated community service (which she totally enjoyed) and repeated urine testing, the judge made his decision. He told Amelia that, because she was “such a promising young woman,” he was able to seal the felony under “youthful offender status.”

    When I spoke with Amelia, she was a devoted Political Science student and serious rower. She joked, with a grimace of white guilt, that unless she wants to join the FBI, her marijuana incident won’t get in the way of her goals. Besides the worry heaped on her parents, she noted, the worst part was her acute awareness that “such a promising young woman” felt like code for “good white kid.” Had she been a woman or color or less well connected, her education and employment future would have looked dramatically different.

    “If this happened to one of my black friends, it would be a totally different story.”

    Two years later, at her pre-college physical, Amelia gave me her update. She had gotten into a great university in the Midwest and was in an awesome relationship, but was again feeling guilty about “something stupid” she had done.

    Now 18, she had been pulled over for using her phone while driving. The officer discovered 10 ounces of weed and $2,000 in cash. She had been charged with possession with intent to sell,  forfeited her car, and felt sure this was a death-knell for her life plans.

    But once again, the judge had gone to bat for her, handing her a five-year conditional discharge. This meant only that if she got in trouble again, she could be retried for the earlier offense. The judge also sealed this charge under “youthful offender status,” even though most don’t get that reprieve the second time around.  

    She was even more certain than before that the leniency she experienced was due to her privilege. “If this happened to one of my black friends, it would be a totally different story.”

    Amelia is now a semester away from graduating, debt-free. She doesn’t miss smoking weed, is bringing her boyfriend home for Christmas, and is busy with interviews for left-leaning think tanks. The leniency she was shown is clearly good news for her, for her family, and for her ability to contribute to society. The problem is the racial chasm it illustrates.


    New York’s Marijuana Regulation and Taxation Act

    Currently about a million New Yorkers have had criminal justice contact because of marijuana charges. Black and Latinx people make up 80 percent of those affected—despite using marijuana at similar rates to whites and constituting only 32 percent of the state’s population.

    New York’s 800,000 arrests for small-scale marijuana possession in the past two decades have played out in individual pieces of suffering—custody loss, incarceration and the resultant family separation, and loss of life opportunities—that have devastated families and communities of color.

    We now have hope. There is a New York State bill in the Senate and Assembly (S03040-C Krueger, A03506-C Peoples-Stokes) that can begin to ameliorate this shameful disparityif it is passed without removal of its critical racial justice provisions.

    The Marijuana Regulation and Taxation Act (MRTA) will reduce or eliminate many prior marijuana offensesclearing records for acts which are no longer crimes, and reducing barriers to work, custody and housing.

    Critically, it will also lower legal and financial barriers to entry into the legal marijuana industryparticularly important for people of color who have been excessively harmed in economic ways, as well as so many others. It will create a micro-licensing program like that for New York’s thriving microbrewery industry, facilitating gainful employment and enterprise for people without substantial savings.

    Half of all tax revenues will be committed to a Community Grants Reinvestment Fund.

    The expected tax revenue is largethe state comptroller’s 2013 study put it at $400 million annually at leastand MRTA demands that a substantial portion of these funds be directed toward repairing racial injustice.

    Half of all tax revenues will be committed to a Community Grants Reinvestment Fund, which will include, according to the Drug Policy Alliance “funding for community-based projects including adult education services, job training, the expansion of afterschool programs, re-entry services, and other community-centered projects.”

    Further, “25 percent of the revenue [will support] the state department of education to keep public schools open and provide a quality education to New York’s children. The final 25 percent … will be directed to funding drug treatment programs and public education campaigns geared toward preventing drug misuse, reducing opioid overdoses, and saving lives.”  

    It’s wonderful that New York could soon become the 11th state to legalize marijuana. But equally importantly, this bill can provide a powerful example of how to go about undoing some of the ongoing harms to communities of color rendered by the War on Drugs.


    The Responsibility of Unearned Power

    “The crack epidemic was like Raid in a bottle,” Henry recalled during our discussion. “What do you do when you see roaches? You spray it all over them. Just like cops and crack back then. The punishment hits everyone and gets deep in the bloodline of families. You can’t get it out. [Marijuana enforcement] is the same.”

    As a 1995 Los Angeles Times articles reported, “Whites are more likely than any other racial group to use crack, according to surveys by the National Institute on Drug Abuse. But the US Sentencing Commission reports that about 96% of the crack defendants in federal court are nonwhite. And, records show, the majority are low-level dealers, lookouts and couriers rather than drug kingpins.”

    In this ugly context, it’s little wonder that when we discussed marijuana legalization, Henry said, “I’m all for it.  

    “White supremacy takes away the ability to see someone else’s pain.”

    As a white physician without an arrest record, living and working in an 80 percent white city, I am both obliged and honored to use my unearned power to listen to, learn from, speak out with, reach out to, and fight for my sisters and brothers with far less privilege.

    Kassandra Frederique, New York state director for the Drug Policy Alliance, has said, “White supremacy takes away the ability to see someone else’s pain … It takes compassion away.”  If we are to right the wrongs of our collective past, if we are to bring justice and health equity to our state, we must summon our compassion now and pass legislation to explicitly benefit those most harmed by our racist past and our racist present.

    Governor Cuomo, you have more power than anyone to make this right for New York. Use that voter-elected, wealthy, white, male, educated power. Prioritize passage of the MRTA in January without removing its strong provisions for racial justice.

    *Names and some identifying details have been changed; subjects gave permission for their stories to be used.

    Image via The Tornado Times.

    • Dr. Ryan is a family physician and former associate medical director at REACH Medical, PLLC in Ithaca, NY. She has worked as adjunct faculty at SUNY Upstate School of Medicine and served on the Public Health Commission for the New York State Academy of Family Physicians. She grew up in Ithaca.

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