Sunil Kumar Aggarwal's Doctoral Dissertation
"The Medical Geography of Cannabinoid Botanicals in Washington State: Access,
Delivery, and Distress"
A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy University of Washington, 2008 Program Authorized to Offer Degree: Geography,University of Washington
Abstract: The Medical Geography of Cannabinoid Botanicals in Washington State: Access, Delivery, and Distress
Sunil Kumar Aggarwal, Chair of the Supervisory Committee: Professor Jonathan Mayer, Geography
Though rendered dormant by a post-1937 Cannabis sativa L. prohibition, the emerging field of cannabinoid medicine is growing in the United States as ever greater numbers of physicians become educated about the physiologic importance of the endogenous cannabinoid system and about the wide safety margins and broad clinical efficacies of cannabinoid drugs, available in both purely botanical and purely chemical varieties and useful for managing pain and other conditions in the growing chronically and critically ill patient population.
Research presented here is focused on medical access and delivery of cannabinoid botanicals in Washington State and seeks to map the geography of this developing cannabinoid medical care system by taking medical geographic “snapshots” of two purposefully chosen locations: a rural clinic site in Washington State where patients currently access cannabinoid botanicals for medical use in the treatment of chronic pain syndromes with acceptable safety under medical supervision and another site where qualifying patients are delivered environmentally culled cannabinoid botanicals. At the former site, retrospective chart reviews were conducted with 139 patients with chronic pain, and at the latter site, a convenience sample of 37 qualifying patients delivered a monoclonal lot of cannabinoid botanical medicine were prospectively studied using standard and tailored survey instruments.
A political ecology of disease approach was employed to rationalize and depathologize patients’ mental distress at potentially facing possession-related legal problems due to their consumption of the still-contraband biota. Results provide quantitative and qualitative insight into the frail health status in both samples of qualifying patients and give a grounded understanding of the lengths that patients and care providers go, despite multiple hurdles, to access and deliver treatment with cannabinoid botanicals that relieves patients’ diverse symptoms and improves their health-related quality-of- life.