DOCTOR'S ORDERS: GET HIGH

A trip into the medical marijuana demimonde smokes out America's
confusion about drugs, pleasure and morality.

Jan. 31, 2001 | SAN FRANCISCO -- To get pot, you can stand on 16th
and Mission and wait for someone to approach you, and wonder if he's
a cop, and wonder if he's going to rob you, and wonder if his pot is
laced with strychnine. Or you can have a dull pain in your right ear.

In a green box on the back page of the San Francisco Bay Guardian,
Dr. R. Stephen Ellis advertises medical marijuana physician
evaluations for just about anyone. The ad contains no explicit offers
or promises, just a list of symptoms that presumably qualify one for
legal pot: "Anorexia ... chronic pain ... arthritis ... migraine, or
ANY other condition for which marijuana provides relief." This is
from California Health & Safety Code 11362.5, implemented after
California passed Proposition 215, also known as the Medical
Marijuana/Compassionate Use Act, in 1996.

In case his point is unclear, the ad goes on to interpret "ANY":
Asthma, neuropathy, HIV discomfort, constipation, old injury pains,"
etc. At the bottom, boldfaced, underlined, in caps, we're reassured:
"It's THE LAW!"

My ear hurts, I tell the assistant over the phone. He tells me to
bring $200 cash. No check or credit card? I ask. Cash, he says.

Ellis' office is at the end of a long, dark corridor in a tall
building next to a fabric store. The $200 cash does not go toward
interior decoration. A cardboard sign with Ellis' name is taped to
the glass on the wood door, which appears to be a good 50 years old.
This is medical marijuana noir. That Philip Marlowe isn't smoking a
cigarette on the other side seems to be a miscalculation on the
director's part.

Not that the other side isn't dark. In the grimy waiting room, which
is just a little bigger than a glass of whiskey, six tired men in
plastic chairs take their eyes off the linoleum only briefly.

"I have an appointment," I say to Ellis' assistant behind the window.
He's young, wearing a sweatshirt.

"Have a seat," he says, handing me a clipboard.

There shouldn't be enough room for two camps in the tiny room, but
the six patients manage to segregate themselves. To my left are the
ill; three men between 35 and 50 sink into their chairs and stare at
things in the floor that I can't see. Their eyes are glassy, and two
of their heads are chemo-bald. To my right are three young men, none
over 22 surely. They slump too, but with attitude, not sickness. They
have baggy jeans and each has acne. The young camp looks at its shoes.

The man directly to my left says he has glaucoma. He's grumpy about
waiting. The man to his left says he's new to medicinal marijuana and
is shaking and giddy. The man to his left sells sports tickets for a
living, and is doing so on a cellphone, apparently unfazed by his
circumstances. The grump beside me is New Agey and shakes his head
whenever the cellphone rings.

To my right are frauds. "I hurt my back playing football," the big
one next to me says. He grins conspiratorially, like he's never
touched a football in his stoner life. Across from us a raver taps
his toes. He grins, too, when I make eye contact. The surfer next to
him grins too. "I better get this before my man Nate's party Friday,"
he says to no one in particular.

"How long does it take to get the prescription filled?" I ask.

"My other friend got some from a San Francisco dispensary two days
after his evaluation," he says.

I wonder how many scammers it would take to undermine the medical
marijuana cause. (This line of thinking is a vector from the anti-pot
camp's faulty premise; penicillin would never be criminalized just
because some people were smoking it on Friday nights.) And while it's
entirely possible that none of these guys will leave today with a
prescription, the quiet raver does eventually have his appointment
and walk out with a thumbs-up. He directs the thumbs-up at me. It's
assumed I'm in the fraud boat too.

To me, it's unclear what boat I'm in. My ear does hurt. I've
considered cutting my head off and throwing it in the ocean. The pain
is intermittent, and in fact I haven't had any for weeks, but when
it's around, I would smoke medicinal crack if it did the trick.
Normal doctors and two specialists were no help. It's not an
infection, we have determined. I got hit with an oar once, I always
offer. The doctors and specialists nod.

So I have chronic pain but not glaucoma and consequently suffer a
faker's guilty conscience. Not that fakers are taking pot from the
legitimately ill -- there's plenty to go around. Still, I don't know
where I belong, waiting room-wise, and keep myself between the ailing
and the insincere. Uncertainty emerges later as a motif in the
medical marijuana universe, but for now, I'm being called into the
examining room.

Ellis joins me in the bare room, slight, friendly and rushed. He
seems breakable. He also has the air of celebrity, probably because
he's the only man many people know who can legalize pot, albeit one
smoker at a time. He talks fast, either like someone who's been in an
E.R. for years, or who has a line of patients out the door, each with
a wad of cash. He takes my money and puts it in his pants pocket.

"My ear hurts," I say, and I explain the pain. My honed explication
of the problem doesn't seem to interest him. He interrupts after a
minute, telling me to take my shirt off so he can use his stethoscope.

The check-up is rudimentary. He hears my heart. He takes a peek at
the bad ear. He looks into my eyes. I offer my oar theory. There's a
brief, touching moment where he pats my arm, not weirdly, and then
he's signing his recommendation. For the next 12 months, I'll be a
legal medical marijuana smoker.

I'll be a legal medical marijuana smoker in California, that is.
California may have approved Proposition 215 four years ago, but 215
has yet to be reconciled with federal law, which still classifies
marijuana as an illegal narcotic.

There is no consensus on how to interpret the ambiguity. California's
medicinal marijuana proponents say medicinal marijuana is protected
under law. The police, depending on the county, generally don't
arrest smokers who have a prescription, except when they do. Courts
often drop cases, depending on the judge, or how a jury might respond.

Federal authorities generally say let's wait for the U.S. Supreme
Court. They're referring to the long-anticipated ruling, which will
likely come down this summer. In September 1999, the Ninth U.S.
Circuit Court of Appeals ruled that "medical necessity" justifies
violation of federal distribution charges. The Clinton administration
asked the Supreme Court for an emergency order to stop the Oakland
Cannabis Buyer's Club (OCBC) from selling pot. The order is
temporary, and this summer the court will issue a final ruling on
whether federal law permits the medicinal use of marijuana.

It will be a significant ruling politically -- a verdict against 215
and similar measures would be a verdict against states' rights,
typically a Republican cause -- but the efficacy of any ban on
medical marijuana would be dubious. It can't overturn California's
215, or the medical marijuana laws in the seven other states that
have passed them. Likewise, state and local police can't be forced to
enforce the federal laws.

Discerning any trend in the response to the medical marijuana
question is difficult. In January, charges were dropped against
Robert Voelker, a Marin County man found growing 19 pot plants
adjacent to his trailer home. Marin Superior Judge Verna Adams
ordered the confiscated plants returned to the man, according to the
Marin Independent Journal. Given the physician's recommendation that
Voelker subsequently obtained, it seemed no jury would convict him.

Other "legal" users don't get off as easy, and the pro-pot groups all
have stories of various authorities flagrantly disregarding medical
marijuana legislation. One Web site devoted to Proposition 215
contains a letter sent by senior U.S. Customs inspector Mark A.
Johnson to a marijuana-prescribing doctor in July 1998:

"As a reminder you may want to tell your 'patients' that although
they may have received a 'prescription' for marijuana from your
office it will hold no weight as far as federal or state laws are
concerned. Such was the case a few days ago when we confiscated less
than a gram of marijuana from one of the people who had put their
confidence in you ... This was a stiff $500 lesson for someone who
probably couldn't afford it, but erroneously placed their trust in
you."

There remains confusion at the medical level, too, but nothing like
there used to be. Plenty of doctors maintain that pot's a damaging
and addictive narcotic, but more and more point to studies confirming
its medicinal value. In November, for example, the BBC News reported
that 80 percent of doctors in the United Kingdom would prescribe
medical marijuana to patients with serious illnesses, if they were
allowed to, according to a study by Medix UK, a Web site for doctors.

If statistics like those from the Medix survey are surprising, it's
because the evolution of thinking within the medical community has
been undermined every step of the way. Even Drug Enforcement
Administration administrative law judge Francis Young's 1988
acknowledgement that pot "has a currently accepted medical use in
treatment in the United States for nausea and vomiting resulting from
chemotherapy treatments" got buried after a while. And of course
marijuana's benefits among AIDS patients -- cannabis can help
stimulate appetites, for example -- are obscured regularly by pot
prejudice and AIDS prejudice.

As far back as 1982, then-Rep. Newt Gingrich wrote to the Journal of
the American Medical Association criticizing the "outdated federal
prohibition" of medical marijuana, and the "bureaucratic
interference" it encounters, as reported by Michelle Malkin in the
Seattle Times. Sixteen years later, Malkin pointed out, Gingrich was
"Speaker of a House that just declared that marijuana 'contains no
plausible medicinal benefits.'" If doctors like Ellis eventually
excuse themselves from the medical debate and start furiously signing
pot prescriptions, it might be because the medical debate is stuck on
repeat.

None of the above -- the legal and the medical disputes --
particularly matters. In the U.S., medicinal marijuana still occupies
a place far from the realm of reason. The terms of understanding are
primitive. We rely on imagery and hysterical association to direct,
and then articulate, our support/disdain for the movement. Like all
drug debates to emerge in the last 15 years, this one is a closed
system, impervious to new information. Progress occurs in spite of
the alleged national conversation.

Within the conversation, those opposed to medical marijuana have made
little rhetorical progress since 1936's now-camp propaganda film,
"Reefer Madness." As few researchers will deny the drug's medicinal
value, its detractors employ abstract versions of morality (it's
"evil") and foresight (it's a gateway drug) to make their case. These
tools interact with the presiding convention of all drug debates -- a
collective disregard of logic on both sides -- and consequently we no
longer ask why pot is evil, or how we can legislate something because
it might lead to something worse. (Are forks a gateway weapon?)

Those leading the medical marijuana charge can be dismissed, too:
They're potheads. If there's a single obstacle to the acceptance of
the drug's medicinal virtue, it's that it's fun, too. The high that
accompanies the pain relief is the unspoken doozie conservatives
can't surmount. That medical marijuana users experience this -- and
perhaps even enjoy it -- diminishes their credibility.

The high is distilled subversion. What else could it represent? Like
sex, religion and the Red Menace, its threat lies in its utter
ungovernability. Transcendent or faux-transcendent experiences aren't
only dismissed because they're hokey -- to some, they seem to be
downright unpatriotic.

Still, in spite of the noise and in between the zealots, attitudes
are quietly changing. If polls are any indication, the average
American is more open to the idea of medical marijuana than ever
before. The dialogue has never broken free from the larger drug war
discussion, but it's cooled off some. On a case-by-case basis, we
seem to be remembering that we don't want our loved ones'
chemotherapy worse than it has to be, and that in fact we, or our
friend, or our aunt, have smoked quite a bit of pot for quite a long
time, and nothing bad has happened yet.

Getting a physician's recommendation from Ellis may have been easy,
but getting him on the phone for an interview is another story. It
isn't until a month after my visit that he agrees to talk.

"What were you doing before this?" I ask.

"I was at emergency rooms," he says.

"Which ones?"

"Various emergency rooms in the Bay Area," he says.

He won't say how many patients he's seen since opening the office in
July -- "let's say several hundred," he finally tells me -- nor will
he say how many are ultimately granted recommendations. I get the
impression most walk away satisfied.

"What about fakers?" I want to know.

Ellis assures me that fakers don't make it to the examination room.

"They realize it's a legitimate medical setting and go home," he
says. "They can't get in without supporting documentation." I tell
Ellis that I was not asked for supporting documentation. He says he's
since changed that policy, though I sense that he did so reluctantly.

"We don't [require supporting documentation] in the E.R.," he says.
"People come in complaining of a headache, we go over to an open
cabinet and they leave with a shot of Demerol in their butt."

"And that's unfair?" I ask.

"Marijuana is much more benign than conventional narcotics," he says.

We talk about his history. Ellis graduated from the University of
Illinois medical school at Chicago in 1978, he says. His work as an
emergency physician exposed him to "a real need" for better pain
management strategies. A few seminars on medical marijuana convinced
him to look into alternative treatments.

If Ellis was uneasy at the beginning of our conversation, he's in a
gallop by the end. I ask why so few California doctors are
recommending marijuana for pain four years after the passage of 215.

"They're afraid," he says. "They're afraid of the [California]
Medical Board, and of their peers, and possibly of potential legal
ramifications ... even though they're clearly protected by the law."

It's the California Medical Board that gets Ellis fired up.

"They've been officially silent [on medical marijuana], but behind
closed doors they've been harassing physicians," he says. "That's the
bottleneck on 215. Patients can't get their docs to prescribe
medicinal marijuana, even though the law allows for this. In
California, you might find 1 in 1,000 doctors [who would]."

Ron Joseph, the board's executive director, calls Ellis' charges ridiculous.

"It's a nice fallback," Joseph says, "but I defy him to cite one case
where the board has harassed a single doctor."

As Joseph tells it, it's not the board's policy to have an official
position on medical marijuana -- it would just as soon have a
position on X-rays.

"We don't say whether it's good or bad, appropriate or
inappropriate," he says. "We simply ask, 'Has the physician applied
good judgment?'"

Because the board's procedure is simply to investigate a "physician's
actions as they're brought to our attention [by a patient]," he says,
it has no incentive to bother doctors who are prescribing marijuana.

So why aren't more doctors prescribing marijuana? Joseph blames the government.

"The chilling effect has come from federal [agencies]," he says.
"Doctors might be afraid of losing their DEA permit [which allows
them to prescribe controlled substances]."

As for Ellis' objection to the liberal distribution of Demerol in the
E.R., compared to the paucity of marijuana presciptions in the
doctor's office, Joseph says an E.R. deserves its own standards.

"It's a much different situation," he says. "There's little time to
make the diagnosis [in the E.R.]. This is not the case in an office
visit where the patient has the opportunity to explain his medical
history."

If a patient is able to obtain a physician's recommendation, he or
she must next join a buyer's club. The OCBC is a mile from my house,
so I swing by on a Saturday. Like Ellis' office, the OCBC is also
low-rent, but they make up for it in atmosphere. If Ellis' operation
was film noir, the "Co-op" is Cheech & Chong plus "Beaches." The
store mixes earnest compassion for the ill with a healthy
appreciation for fat, leafy weed. Inside, past the pipes and bongs
and vaguely pornographic poster of a luscious green bud, a woman at a
counter sorts membership files. (The club has roughly 4,000 members,
executive director Jeffrey Jones tells me later, but it's hard to
count. Why? I ask. "We don't know how many are dead," he replies.)

The woman at the counter gives me paperwork and takes my physician
recommendation, a copy of which I'd already faxed in for approval. I
do the paperwork and pose for my photo and pay the fee. My $21.95
entitles me to a list of active dispensaries, support in the event of
police trouble, free massages and regular cultivation seminars.
Cultivation? I ask. I can grow up to 48 plants, they say -- beyond
that it's risky.

My new member ID is my "shield." If a cop stops me for possession, I
need only flash the card. If that doesn't work, the officer is to
call the 24-hour phone number on the back, and the club will vouch
for me.

"But this is legal, right?" I ask.

"Well," they reply, "yes. But call if there's a problem."

I'm out in 10 minutes, but still no pot. This is because an
injunction keeps them from selling. When the government went after
buyers' clubs in 1998, they went after the six biggest. No attempt
has been made to close the others that sprang up subsequently, Jones
tells me. Nothing keeps the OCBC from directing me to an active
dispensary two blocks away.

Why did they pick on some pot clubs and not others? I ask Jones.
Surely they know about the other dispensaries.

"Who knows?" he says. "Maybe they wanted a martyr."

"But nobody's going to respond to martyrdom when it comes to getting
marijuana," I say.

"Then maybe we were doing too good a job helping people," he says.

The unmarked dispensary two blocks away is to pharmacy as Bates Motel
is to Ritz-Carlton. Metal gratings cover the windows of the old
building, which begs for a paint job or some dynamite work. A guard
stands out front and thoroughly inspects my paperwork before sending
me inside to the next guard, who also thoroughly inspects my
paperwork. Then I'm sent to a desk, where I fill out more paperwork,
show my OCBC card, put a dollar in a jar and gain access to the next
room.

The next room is unAmerican. It's how Amsterdam is described among
teenagers, a perversely legal assortment of illegal things: pot
plants, pot brownies, pot cookies, pot seeds and, of course, pot.
Half a mile from the Oakland Police Department, two glass counters
full of dope and a promising back room await anyone with an OCBC card
and some cash. There is no catch. I experience the brief heartbreak
of poorly timed access -- this kind of opportunity would've been
great back when I liked pot -- but mainly I'm glad people who need it
can get it.

I buy an eighth of an ounce of the good stuff, not the great stuff.
It's $45. The guy behind the counter is nice like a nurse. The place
isn't a neighborhood drugstore -- no matter how medicinal your
marijuana, it's still pot, and pot culture is irrepressible -- but
there's no Pink Floyd or opium-den decadence, either. On the wall is
a mural of a sunny Oakland park, full of relaxed people in various
stages of illness. They appear positively pain-free.

The night I begin writing this article, I turn my head and the old
ear pain shoots back. It's mild at first, then heavier. The pain
isn't really inside the ear, but rather right where my ear hits my
head. It hurts when I push on it and when I move. I decide it's time
to take my medicine.

I don't really get high anymore. Back when I did, I never
experimented with pot's medical potential. I dig out a pipe and get
to work. The first thing I do is underestimate how strong it is. I
take two big hits, then sort of walk around, then take two more. The
high is always indistinguishable from the ritual in the first three
minutes, so it's a while before I know what's what. I sit and begin
writing. I get up and look for something. I find incense in a drawer
and light that. I sit and write some more. The pot is strong. My head
is light, or heavy. I get up and put the incense out. A piece rolls
behind the couch, still burning, and the house almost burns down. I
find the piece. I sit down to write again and then remember to see if
my ear hurts.

It does. But not as much. I think. Does marijuana just make you too
stoned to evaluate pain? This would be dumb. I consider Ellis. It's
hard to conclude anything about him, for he's as ambiguous as every
other element of the medical marijuana question. In a city of either
conservative or craven doctors, he's taking a chance. Those who take
chances to improve the lives of the sick and dying are heroic. But at
the same time, it wasn't just the sick and dying in that waiting room.

Ellis, like many medical marijuana advocates, is breathless on the
subject. He perceives an injustice perpetrated by the medical
establishment, and by the federal government. If he's occasionally
quixotic on the issue -- the executive director of the California
Medical Board can't imagine what Ellis is tilting at -- one can infer
that he's either dramatic or tired of seeing people in pain.

Finally, what will happen to a doctor in a tiny office who flouts
federal law on the back page of the San Francisco Bay Guardian? Is he
in danger?

"I don't know," Jones, from the OCBC, had said. "Is a bug that flies
into the light in danger?"

Because he's working with other information, or because he's blinded
by the light, Ellis himself isn't scared.

"They'd be crazy if they bothered me," he'd told me, before getting
off the phone to see another patient.

About the writer Chris Colin is the associate People editor at Salon.