Like any proud father, George Realmuto has been known to brag about his youngest daughter Kathleen.
“She got very good grades,” he said. “She was athletic. She was in a dance studio and was exceptional. She did well in ballet, lyrical, jazz, tap — her group won a national award one year. She was on the ski team for Armstrong High School. She was a painter. She went to the Minneapolis Institute of Art’s summer program, and they asked her to come back and be a junior instructor.”
Kathleen Realmuto, her father recalled, “had a number of high achieving ways of demonstrating her many talents.”
Since Kathleen died at age 36 as a result of a methamphetamine overdose two years ago, Realmuto, emeritus professor of psychiatry at the University of Minnesota, has been struggling to come to terms with his loss. He blames his daughter’s death on addiction, believing that her use of methamphetamines grew from her chronic teenage use of marijuana.
Realmuto and his ex-wife learned of Kathleen’s drug use 22 years ago, after she and a group of other teenagers were cited for driving under the influence. He discovered then that she’d been smoking pot regularly since age 15. “She would go out onto a little porch outside her bedroom window and smoke,” Realmuto said. “I didn’t know.”
Realmuto believes that all memories — both good and bad — bring him back to this point of loss. “There is no way to make this comfortable,” he said. “It is uncomfortable. It is grief. I lost a daughter. That will remain with me the rest of my life. It will always be uncomfortable.”
Realmuto is now an outspoken advocate for limiting the scope of medical cannabis and for upping the legal age for the drug’s recreational use. Earlier in his career, Realmuto worked as medical director of Minnesota’s Child and Adolescent Behavioral Health Hospital in Willmar, where he treated young patients who had, he said, “persistent psychosis that had been initiated from very high-potency cannabis use.”
[image_caption]George M. Realmuto[/image_caption]
“When your brain is still developing there are consequences for the architecture of the central nervous system going awry,” Realmuto explained.
And while his interest in the issue is professional, he also admits that it’s personal, too, a fact that he mentions in his presentations. “As a child psychiatrist, I’m interested in how cannabis use impacted my daughter,” he said. “I am also interested in how it affects the brain development of all children.”
‘There is no happy ending here’
As Kathleen neared the end of high school, Realmuto recalled witnessing a shift from what he saw as her naturally “independent, creative” spirit to a person who struggled to maintain friendships or complete academic programs. “She talked about people not treating her well. That started in middle school but later it became a regular theme, especially with boyfriends.”
During Kathleen’s senior year, Realmuto said that she spent time with a group of friends who were known to be using drugs. “She was spending less time at school. Her GPA just nose-dived. She was getting offers for colleges and scholarships, and then her senior year in high school was a disaster. She managed to graduate — but it was totally different from her previous three years.”
Realmuto tried to find treatment programs that could help his daughter come to terms with her drug use. He kept running into dead ends, and eventually gave up. “Kathleen had no interest in treatment,” he said. “This was 22 years ago. Treatment programs for cannabis use weren’t all that accessible.”
Over the next few years, Kathleen’s drug use intensified. She moved away for school, found work and eventually gave birth to a daughter, whom she loved deeply. She tried to limit her drug use for the sake of her child, but she struggled, Realmuto said, and the daughter eventually went to live full time with her father.
[image_credit]Supplied[/image_credit][image_caption]Kathleen Realmuto[/image_caption]
One day, Realmuto confronted his daughter. She told him: “‘I use meth every day,’” he recalls. “‘I’ve used it for 10 years.’”
Surprised and scared, he once again tried to convince Kathleen to seek treatment. “She got angry that I was asking about this,” Realmuto said. “She was upset. I said, ‘You need help.’ She said, ‘I don’t need help.’”
“As a problem-solver and a parent that’s what I struggle with. I go over this timeline a million times at three in the morning, trying to figure out how this could’ve been interrupted.”
By the time he learned about her dependence on meth, Realmuto believes that Kathleen was already so far along in her addiction that it would’ve been nearly impossible for him to help change the course of her life.
“I think about the different phases of chemical addiction or substance use,” Realmuto said. “There’s experimentation and recreational use and the time that you’re still functional, and then you begin to have dysfunction, and then you have a terminal phase.” He feared that his daughter had reached the terminal phase of her addiction.
Later, when a friend of Kathleen’s called to tell him that he had found her dead in her home from an apparent overdose, Realmuto said he was devastated, but not surprised. The pain still feels fresh. “It is two and a half years ago,” Realmuto said. “It doesn’t change.”
Realmuto suspects he’ll always feel this way. Since Kathleen’s death, he’s been involved in NAMI-Minnesota. He goes to fundraisers and speaks with other parents who’ve also lost their children to addiction, overdose and suicide. He seeks out support and makes connections, but he’s often left with a nagging ache of frustration.
“There is no happy ending here,” Realmuto said. “It’s part of your life and it affects your life. Kathleen died in June. My mood changes in June. My second wife didn’t understand what was going on until I reminded her, ‘I’m not sleeping well. I’m remembering these times I spent with Kathleen.’”
When people talk about finding “closure,” Realmuto often scoffs. He’s not a great believer in happy endings. “There is no closure,” he said. “Your child is gone. That’s just how it is.”
‘I’m not that idealistic’
In the statewide debate over the legalization of marijuana, Realmuto has been front and center. Since 2015, when the push to legalize cannabis took flight, he has joined with other physicians in the state to voice his reservations about the move.
“There was a lot of controversy,” Realmuto said about the eventual move to legalize medical cannabis. “Physicians did not want to have anything to do with prescribing cannabis. We didn’t learn about it in school. We didn’t understand it. We knew it could have negative consequences.”
He’s also concerned that the public doesn’t understand that much of the cannabis available to consumers today has been cultivated to increase its potency and addictive qualities. He tries to make his colleagues and the general public aware that much of what is available for medical and recreational use today is nothing like the marijuana that was available decades ago. While he supports decriminalization and expungement, he’d still like to see some controls.
“I’m working on managing people’s perceptions about the safety of cannabis,” Realmuto said. “When you read what I’ve culled from the literature you can see that it’s not like it was in the past. The potency of cannabis used to be like beer. Now it’s more like Everclear.”
While his argument has its share of detractors, Realmuto and his psychiatric colleagues have also had success in getting their message across. Last December, when Minnesota Department of Health Commissioner Jan Malcolm announced that the state would not add anxiety disorders to the list of qualifying conditions for treatment with medical cannabis, Realmuto felt like she’d read the position paper that the Minnesota Psychiatric Society had sent to her office.
“When the commissioner made this statement,” Realmuto said, “four of the five points she made were points we made in our letter.”
[image_caption]Dr. Alik Widge[/image_caption]
Realmuto, Widge added, is, “trying to do what he thinks is genuinely right for his patients. He’s following the ethical perspective of, ‘First, do no harm.’”
Kaz Nelson, associate professor of psychiatry, likewise emphasized Realmuto’s long-standing commitment to his young patients. “I think he recognizes that he’s in a position of privilege and would not dream of squandering that when he could be using his in-depth understanding of the psychiatric health of children and adolescents. There is a mission driving his desire. He’s really an advocate for kids.”
[image_caption]Dr. Kaz Nelson[/image_caption]
“I do this work because it is very interesting in itself,” he said. “If I were to think about, ‘I’m saving other kids,’ it would be a trigger for my own grief. That’s a hard place to be.”
He admits that he struggled about whether to talk about his daughter for this story. “I knew I’d be uncomfortable,” he said, but he decided that the experience of speaking at length about Kathleen might, at least for a moment, make him feel the way he felt right after he gave her eulogy.
“I was almost free for 20 minutes,” he recalled. “I told 50 people about what she meant to me and they had to sit there while I went through my stories. It was so liberating.”
All I can say is that psychiatry is a branch of medicine that relies almost exclusively on prescribing medication, and almost all of the medications prescribed have side effects and potentially dangerous outcomes. So let’s not pretend that everything else psychiatrists prescribe is perfectly harmless and effective or that no other psychiatric medications can be addictive or abused. let’s not pretend good outcomes are guaranteed with other medications.
For instance a significant number of psych patients commit suicide, and many do so by over-dosing their prescribed meds. Then we could discuss the pharma research and experimental regimes that psychiatrists design and implement. So the: “do no harm” thing can get a little dodgy in normal psychiatric practice, you don’t have to delve into cannabis to find those concerns.
We also have to contend with the existence of an addiction/recovery industry that will seek to protect is own interests, that’s a whole nuther thing that always plays a role in these discussions. There are a myriad of reasons different actors may want to keep as much cannabis use as possible classified as “abuse”.
As for adolescent brains, let’s remember this a profession that started dumping stimulants into kids brains to treat ADD back in the 90s without any pharma research to support it’s safety or effectiveness beyond anecdotal observations. So when we talk about Doctor Realmutto’s research in this regard I think one or two citations from peer reviewed literature should be called for as well as some analysis of that work.
None of this is suggest that Doctor Realmutto’s concerns aren’t legitimate or sincere, but this is an incredibly complex issue that defies simple abuse/recovery analysis. I’m not saying cannabis should be prescribed for anxiety, but I’ve seen what the anti-anxiety drugs currently prescribed can do and anyone who tells you those drugs carry no risks or potential for abuse is not being honest.
Altruism? That would seem to be about the last thing motivating this guy. I would call him sadistic and cruel, denying people relief because his adult daughter overdosed on meth.
The cannabis his daughter used wasn’t legal, but still readily available to her. Denying people access to legal cannabis, only means denying them access to regulated products where the potency is controlled. If potent cannabis is the problem, then Realmuto is actually hurting people.
Shame on Minnpost for giving this guy any time. This isn’r rational analysis – this is a guy driven by his daughter’s addiction (to an entirely different drug) and death.
The man – I use the term loosely, as no man worth the epithet would do what he’s done – is standing on his daughter’s grave to push his agenda. Despicable beyond belief.
I cannot fathom the amount of loss this man has experienced, but I cannot also fathom how he feels he can offer a clinical analysis of this situation WITHOUT that loss coloring that analysis. He’s a clinical psychiatrist, yet assumes no other factors for his own child’s decline but marijuana. His daughter began using drugs at 15, but the drug was the problem. He mentions his daughters high achievement, but nothing about the affects of the stress of that high achievement on her mental health. I do not intend to conflate the two issues in any way but how the argument sounds, but it reminds me of the subset of anti-vax parents who assume their children’s autism MUST be caused by vaccine exposure, there can be no other source. I feel terrible having to say it, but it sounds like excuse making, reducing what was in all likelihood a complex issue of mental deterioration, fueled in no small part by self medication to address some unaddressed need, to a simple problem, with a simple fix. Beyond that example, its depriving others, in entirely different circumstances, the ability to decide for themselves the proper course.
No admission either of the possibility that his punitive parenting strategy might have alienated his daughter and made her reluctant to seek his assistance later with any of her mental health or substance abuse struggles. It was a dramatic and overly clinical response to suggest his kid needs treatment for a common rite of passage. Would he have done the same if he’d found out she’d been drinking Mike’s Hard on occasion with friends?
She needed an understanding parent to open up to with trust, not a clinical psychiatrist who would send her away from home if she admitted to a perceived, wrong behavior
I won’t make that leap, as I only feel comfortable in commenting on the information presented.
This, entirely. The reasons a child/adolescent might use a drug are often very different from adult recreational use. Dr. Realmuto is mistaking correlation with causation, which is poor scientific practice. There are lots of signs that he’s ignoring the real cause in favor of the correlation – early drug use, hanging out with “the wrong crowd,” etc. There are lots of signs that the cannabis was a coping mechanism for something else, which something else was never addressed, or it wouldn’t have lead to meth use. Pat has provided a source based on actual evidence that cannabis is unlikely to actually be a “gateway drug.” All of this shows that Dr. Realmuto is not an appropriate source for what the public should know about cannabis, and he’s misusing his degree as an appeal to authority.
Well said, especially “it sounds like excuse making, reducing what was in all likelihood a complex issue of mental deterioration, fueled in no small part by self medication to address some unaddressed need, to a simple problem, with a simple fix. Beyond that example, its depriving others, in entirely different circumstances, the ability to decide for themselves the proper course.”
Dr. Realmuto makes some excellent points. To me, the most important point is that there is so much we don’t know about the impact of cannabis – particularly its impact on the developing brain. Once we legalize it for open use, there is no turning back. We need more information before we make this huge policy decision. What I said in a 2019 StarTrib commentary is still true. https://www.startribune.com/legalized-marijuana-in-minnesota-for-medical-use-yes-for-open-adult-use-not-yet/506462572/
No, what you said then is just as cruel, illogical and ignorant as it is now. The only issue now is whether we going to tax and regulate it, or keep it on the streets and disproportionately arrest Black people for using it.
I agree on both points. The irony here is that Dr. Realmuto’s is essentially saying that the student’s he prepares for a career in psychiatry are not competent to diagnose and prescribe drugs and governmental limits need to be put in place to control their professional performance..
As a shop teacher in the late 70s I did find the occasional sternum woodpecker as an effective behavior management tool that is no longer allowed in current practice. Maybe good, maybe bad…
A significant portion of our lack of knowledge is the direct result of overly-criminalizing it in the first place.
Adam, I totally agree. Decriminalizing should have happened long ago.
Would you also agree that there is no scientific support for the claim that Cannabis is a gateway drug? That blaming the death of his adult meth-addict daughter on teenage Cannabis use is not supported by the evidence, and should not be a basis for his advocacy and teaching? As a doctor, I would hope that you find what Realmuto is doing to be grotesque.
We do, however, know the impact of criminalization and the fact that the majority of people who go into our prison system come out as either hardened criminals or permanently damaged, dysfunctional citizens. That is the real choice we have made with criminalizing selected drug use.
Exactly. When we talk about crime and criminal justice reform, we need to acknowledge the incredible harm drug prohibition causes. At some point people like Realmuto and Ehlinger need to be held accountable.
I’m very sorry for his loss, but do not really understand what his daughter’s meth addiction has to do with cannabis prohibition and policy.
I have re-read this piece, and it may be the worst piece of reporting I have ever seen on Minnpost. Just a journalistic shambles. What this guy is saying and doing raises numerous red flags, and there is no pushback at all. This is dangerous and irresponsible.
The idea that his work is driven by the death of his daughter is horribly problematic. How can he have any objectivity at all? The U of M should immediately pull this guy out of the classroom and reexamine all his work. Even his colleagues quoted seem uncomfortable with what he is doing and reference his good intentions.
All of this seems driven by the fact that his 36-year old daughter, who was a decade-long meth addict, smoked some weed and had trouble in high school. Realmuto claims to be driven by science, but the claim that his daughter’s meth addiction was caused by her teenage cannabis use isn’t supported by science at all.
“In reality, no credible evidence shows that pot makes people more inclined to use other drugs. That, at least, was the conclusion of an exhaustive 96-page inquiry by the Justice Department and the Library of Congress in 2018. “No causal link between cannabis use and the use of other illicit drugs can be claimed at this time,” the authors wrote.”
https://www.washingtonpost.com/outlook/five-myths/five-myths-about-marijuana/2021/07/14/7cc2046a-e426-11eb-8aa5-5662858b696e_story.html
Realmuto’s entire agenda is based on a lie. Its a scapegoat for his daughter’s meth addiction and death.
It is always important to know who is funding these advocates, and what groups do they belong too. Much of the anti-Cannabis legalization funding comes from opioid manufacturers and alcohol trade groups.
https://www.usnews.com/news/articles/2016-09-08/fentanyl-maker-donates-big-to-campaign-opposing-pot-legalization
https://theintercept.com/2016/09/14/beer-pot-ballot/
Finally, I want to take issue with Dr. Widge’s claim that Realmuto is doing not harm. He is doing lots of harm. Cannabis wasn’t legal anywhere when his daughter starting using it, and keeping it illegal now isn’t going to stop any other kids from using it. It still isnt’t legal for kids. What it does is prevent people who don’t have easy access to cannabis getting it to treat their conditions. It means that the cannabis they do get isn’t measured and regulated and tailored to their needs. It means that lives ate still being ruined by criminal convictions for cannabis use, and those convictions have historically disproportionately affected BIPOC.
Pat, I suspect Dr. Realmuto is a tenured professor so removing him for writing this article is not an option. But dude, seriously, can’t you disagree with a person without launching such personal attacks? Demanding his removal from the U and/or banishment from the pages of Minnpost?
Agree or disagree this article is food for thought and as such doesn’t bother me by simply existing. Is this perspective potentially harmful? Maybe, it’s worth discussing. The possibility that the current addiction/recovery regime might be harming those it seeks to treat has been bouncing around for a couple decades. Will THIS article harm anyone? Or put another way- would anyone be safer if this article were never published… doubtful to say the least.
There is nothing personal about it. This guy is an unprofessional liar doing harm to other people. He claims to be driven by science, but he lies about the actual science. This guy should not be treating patients or teaching students. He is a very bad person, and Minnpost wrote a puff piece about him.
“He is a very bad person…”
Pat, this is the very definition of a personal attack. Minnpost shouldn’t blindly publish your comments.
Not true at all. My criticisms of Realmuto – including calling him a bad person – are based on his actions. I have explained my criticisms of him in detail, and have included links explaining why basically everything he stands for is based on lies.
Would it be a personal attack to call Derek Chauvin a bad person for murdering George Floyd in the street? Would it be a personal attack to call the people who stormed the Capitol last January 6th bad people?
This is a guy who is a crusader against legal cannabis, and his motivation is the false idea that his adult meth-addict daughter was destroyed by smoking weed in high school. Cannabis prohibition has caused real harm to many people.
Minnpost doesn’t blindly publish my comments. Sometimes they do get censored. But when I make substantive arguments and support my positions, they get published, even when I draw a negative (but obvious) conclusion.
Pat, just because you have a reason for your personal attacks doesn’t mean they’re not personal attacks. By the way, you don’t get to decide how to classify your own behavior, other observers will draw their own conclusions.
Sure, you can draw whatever conclusion you want. And Minnpost can decide whether my comments are appropriate. They won’t censor them, though, because they aren’t personal attacks.
You say a lot of similar things about people with whom you disagree. I wouldn’t call them personal attacks. You said that Jacob Frey should lose his job because of his actions. I think that Realmuto should lose his job because of his actions. Do you think the cop who shot Amir Locke should be fired (I do FWIW)? Would that be a personal attack?
Like me, you seem to disagree with Realmuto. Its just a matter of degree. I think he is a dangerous, dishonest man who is abusing his position and hurting people as a result.
The only real personal attack here is the comment suggesting that Realmuto’s approach to drug use and poor parenting may have contributed to his daughter’s death. And while that may well be true, I won’t speculate about it.
But I will talk about how using his daughter’s death and lying about the actual science to guide his agenda does not belong at the U or at Minnpost.
Responding to Mr. Ehlinger’s point, regarding the “unknown” effects of cannabis and the addiction/recovery industry’s habitual support for prohibition there a couple observations that always need to be made.
First, it can be observed that human beings have far more experience with cannabis than any other drug or medication they may currently have in their medicine cabinet. We can easily venture to say that most people are far more familiar with the effects and side effects of smoking pot than they are Adderall, or Metformin, or benzodiazepines. Human beings actually have thousands of years of experience with cannabis even if we don’t have MRI’s or PET scans documenting the effects on teenage brains. That doesn’t mean pot can’t be abused, but it’s kind of silly to claim we’re not familiar with it.
Furthermore, we always need to note that these recommendations typically flow out of an addiction/recovery industry that has a weird claim of expertise. There are few other disciplines wherein frequent and catastrophic failures (such as the tragic example of Dr. Realmutto’s daughter) are used to establish “expertise”. The entire field is actually prone to recidivism. Typically if we want to find the best advise we turn to people who have unusually high levels of success dealing the subject. I have noted that this column rarely if ever discusses the fact that addiction/recovery is one of the few health care scenarios wherein outcome and treatment actually share an extremely tenuous relationship.
Point being, are these REALLY the people we need to make good policy in this regard? I’m just asking.
We also need to note that the prohibition model of harm reduction or management in-and-of itself can be a dodgy proposition. Why is if for instance that prohibition is the best approach to managing the possible harm of cannabis use but can’t be considered for Oxycontin or Ativan? Not to mention the obvious fact that if prohibition actually worked… we wouldn’t have such a huge addiction/recovery industry in the first place.
In the end the rationale’s behind arguments like Mr. Ehlinger’s tend to end up in a circular struggle for coherence. We can’t use pot because pot is illegal and we can’t legalize because don’t how legalizing it works… because it’s not legal. As long as pot remains illegal robust research on it’s safety and effectiveness can’t be conducted, so you just go round and round.
Meanwhile I’m not sure most people who don’t or haven’t worked in the health care/medical profession realize how weird it actually is for practitioners in one silo to step so far outside their silos and dictate treatment options to other docs. Any doc with a license to practice can prescribe almost any medication they want for whatever they want (i.e. off label) without any special permission or authorization. It’s also important to note that chemical dependency is just one psychiatric diagnosis among hundreds that psychiatrists treat, and few psychiatrists specialize in chemical dependency. I would venture a guess that more psychiatrists actually specialize or treat anxiety disorders than chemical dependency for instance on a regular basis. Most psychiatrists refer their CD patients to treatment programs. Point being- it’s kind of weird to see docs from another field telling docs in a different field or silo how to treat their patients i.e. “don’t use this to treat anxiety”. And again, we can talk about the “dangers” of cannabis but we then also have to about the risks involved with all the treatment options and medications. And if you want to claim that Ativan is “safer” than cannabis you need to do the research, not just point to tragic stories of drug related suffering and death… and there’s the catch.
Thank you for your comments. We all need to point out the hypocrisy in this field.
Granting Realmuto slight credibility because of his loss, which could easily be diagnosed as the result of poor, distracted parenting, I would recommend that anyone taking his opinions seriously read “Chasing the Scream: The First and Last Days of the War on Drugs” by Johann Hari. Countries that have abandoned the misguided punishment based drug policies of the US are have far better outcomes than this country. Treatment for addiction and other mental illness is more humane, economically rational, and based on better science. The fact that the overwhelming majority of people are able to take any drug currently available without becoming addicted or dysfunctional proves that our current system uses the same rationale as punishing everyone for the transgressions of a few.
US psychologists dole out “kiddy meth” and anti-depressants like candy, as if they are a magical cure for a variety of environmentally-induced problems. As long as this group of wannabe-professionals continue to ignore outcomes and responsibility for their drug peddling, they are not going to be useful in problem solving.
So, after starting out drinking milk, she moved on to a downer, marijuana, and that caused her to want uppers, and because she had to buy them on the street, that ended in a fatal overdose, so, therefore, marijuana caused it all and cannot ever be made legal? It looks to me like milk is the real villain here.
Aside from casting blame hither and yon, why have so few stepped back and noticed that our War on Drugs isn’t working? It’s killing people both here and abroad, and it’s pumping a large amount of money to less than reputable people.
And of course then we have this, a cure for cancer and of course Cannabis no less!
https://www.jpost.com/health-and-wellness/article-689554
So now what, Killer weed or life saving weed! I be the later not the prior.
what a hodgepodge of opinion and information. it’s interesting that the only references offered are in the opinion responses, not in the piece itself.
We can always find another perspective to suit our own preformed beliefs. Seems MinnPost earlier ran a piece that outlined Dr Scott Jensen’s opinion that recreational weed should be legalized. I welcomed his opinion then, now, not so much.
It’s true that the cascade of drug use that led to her death probably began before her pot use, likely from pinching her parents liquor or tobacco . And she possibly did’t die from a meth od, but from the fentanyl that was unknowingly included in her meth.
I don’t see rec/pot ever being legal in MN; well, maybe dead last. Then it will be more expensive than blackmarket sources.
I find it disappointing that many like to point to pot for drug issues while totally ignoring the devastation caused by alcohol. Truth is that excessive use of anything is not good.
I turned 80 on the 24th. I’ve used cbd to help me relax at night, sleep and to reduce the pain we suffer from as we age, but one has to understand that one must control the use of almost anything and that includes food.
We could invest in affordable health and mental care to help our people, but one repub party…absolutely refuses. We could also invest in our people with affordable life, but again one repub party refuses. It disappoints me how this repub party that claims Christian values, ignores Christ’s message to love all and to help the needy. Repubs are a vast disappointment.