GETTING CARDED

One Journalist's Trip Through the Culture of Medical Pot Clubs to a
Pain-Free Life

I'm not sure why it didn't occur to me sooner to treat my condition
with medical marijuana. I have the journalist's disease -- repetitive
strain injury, which results from excessive or nonergonomic typing
and mouse use. When the RSI acts up, my fingers tingle and an
electrical sensation radiates up my arms, causing nagging pain in the
rotator cuff area, prompting me to compulsively poke at the spot.

When the problem was at its worst, in the mid-to late '90s,
California had recently passed Prop. 215 -- the Compassionate Use Act
- -- an epochal measure that legalized marijuana for medical purposes,
but gave no direction on how patients were to obtain it. So the
infirm, doctors and pot growers were on their own. Medical pot
pioneers had set up a few medical marijuana dispensaries even before
Prop. 215 passed in 1996. Federal and state authorities shut them
down often, but the dispensaries blazed the basic path that is
followed to this day.

Reading stories about Dennis Peron's prototype dispensary on Market
Street, the Cannabis Buyers' Club, which went through several
incarnations in an almost Groucho Marxian two-step of eluding law
enforcement, I assumed that only seriously ill people, people with
cancer or AIDS, were entitled to medical marijuana. My RSI was being
treated in traditional ways -- occupational physical therapy,
stretching, attention to proper ergonomics, Tylenol and a few months
of weekly acupuncture.

If someone at the time had suggested I try smoking pot to alleviate
my RSI, I probably would have laughed at him. Smoking pot gets you
high. How could you get any work done stoned? Certainly I couldn't. I
can't even follow street signs when I'm stoned. Pot as medicine just
didn't track for me. I compartmentalized it as something used for
another purpose -- just like alcohol.

At the same time, it seemed beyond absurd that the federal government
was banning pot for medical use. Cannabis is classified as a Schedule
1 drug, meaning the weed is seen as having no medical value. It never
can be prescribed, and anyone using or selling it can go to prison
for years, even for life, depending on quantity. The Schedule 1
category also contains heroin and LSD. Even cocaine and morphine,
classified as Schedule 2, can be prescribed. Yet there are reams of
evidence that cannabis has medicinal value.

Years went by since Prop. 215 passed, and pot clubs were sprouting
like the weed they purveyed. By 2005 there were more than 40
dispensaries in San Francisco. The fact that the feds were busting
clubs regularly didn't seem to slow them down a whit. Politicians
such as Mark Leno, Tom Ammiano and Chris Daly, far from backing down
in the face of federal threats, were becoming more determined to get
medical pot into the hands of people who claimed to need it.

"We have a federal government that is completely disrespectful to the
will of the voters of California but also disrespectful to public
sentiment throughout the country," Leno, now a state assemblyman
representing San Francisco, told me. "Sick people are going to jail
- -- it's shameful. Don't these people have enough meth labs to go bust?"

In the past year, there has been a constant stream of media reports
on medical pot. Federal busts, medical breakthroughs, Supreme Court
decisions, a lawsuit against the government accusing it of lying
about the medical benefits of weed. And since my RSI had been acting
up again, it seemed the right time to find out for myself what was
happening in the world of medical marijuana. Finding a physician to
make a referral is as easy as typing "medical marijuana doctors" into
Google. The Web site for NORML -- the National Organization for the
Reform of Marijuana Laws -- among other sites, has a statewide list
of doctors who give medical cannabis recommendations. About 20
physician groups in Northern California advertise referrals, which
amounts to about 50 doctors. They charge between $100 and $300 for
visits, and usually accept cash only. Visiting individual physician
Web sites, I learned that most doctors require patients to present
medical records from a primary-care physician detailing an existing
medical condition. An exception is the MediCann group, which says its
own doctors will do checkups.

Shopping the NORML list, I found a doctor's group that charged only
$135 for a visit. Called Howard Street Health Options, it turned out
to be an extremely inconspicuous corner clinic on Howard and Eighth
streets in San Francisco. Inside it was bare bones, tidy and
spacious. I filled out my medical history, paid cash and a
receptionist brought me into one of the doctors' offices. The office,
such as it was, was formed by cheap partitions that didn't even meet
the ceiling. I won't name the doctor because I saw him as a private
patient, not as a journalist.

He spent about 15 seconds looking over my application, asked no
questions and gave me my recommendation, which was specified to
expire in three months. That's because it was going to take a while
for Kaiser Permanente to dig out my medical records and fax them
over. The doctor said that when the records came through, I could
return and get a new recommendation good for a year. At that point,
he said, I could use the referral to apply for an official medical
marijuana state ID card. Meanwhile, he said, most dispensaries would
let me in with the referral.

The state cards are part of the medical pot mechanisms spelled out in
the appropriately named state Senate Bill 420, passed in January
2004. The bill's key provisions:

. Ordered California counties to administer a state ID card
enrollment program for patients and their designated caregivers.

. Specified limits on how much pot patients could possess and how
many plants they could grow.

. Suggested a rough model for how medical pot providers should
organize as nonprofit enterprises.

I decided to try to apply for the state card with the temporary
referral. The San Francisco Health Department processes applications
for cards at a small, semi-private desk area partitioned off from the
bustling main lobby at San Francisco General Hospital. A clerk
snapped my photo and accepted a $46 processing fee -- $13 for the
state and $33 for the county. My card -- good for one year, after
which it must be renewed by a new doctor's referral -- would be ready
in about seven days, she said. So much for the three-month doctor's note.

The clerk was harried, because in February the state had announced
that on March 1 it was raising the card fee to $142, causing a run on
applications. However, after an outcry in the medical pot community,
Leno persuaded the state health department to reduce the fee hike to
$66, which went into effect April 1.

The state had proposed the initial increase because the
card-registration program -- mandated by SB420 to be revenue neutral,
meaning the program has to be funded only by the fees -- has run way
under budget. Only 10,979 cards in the entire state have been issued
- -- almost half in San Francisco alone -- and that's because only 25
counties out of the state's 58 have chosen to follow SB420 and
administer medical cannabis programs. Before SB420, when San
Francisco was issuing its own cards out of the Health Department at
101 Grove St., around 4,000 patients a year snapped them up.

According to Dr. Josh Bamberger, the Health Department official who
administers San Francisco's card applications, the disparity could
reflect a greater trust in the city than the state when it comes to
patient confidentiality. However, Bamberger insists the state program
is completely confidential. "Each person brings their letter from the
doctor to the General, my staff calls the doctor for confirmation and
if the doctor says yes, we check off a box and return all the
paperwork to the patient. That makes the medical marijuana user happy."

With at least a week to wait before my card was to come through, I
set out with my doctor's recommendation. Some clubs I visited as a
patient, others I made appointments with as a Chronicle reporter. Of
the clubs I visited anonymously, all except two -- the Purple Heart
Center in Oakland, and the Love Shack in San Francisco's Mission
District -- let me in with the letter. The door watcher at the Love
Shack informed me that the club was membership-only and their limited
spots were taken, so they couldn't welcome people off the street.

Entering my first medical marijuana club, the Bernal Heights
Dispensary, I experienced a bit of sensory overload. Nothing fancy
about this place, a single room fronted by a beefy security guard who
checked my doctor's referral, asked for a driver's license and
invited me in. The smell of the place was the first thing that hit me
- -- not marijuana smoke, which is commonplace on the streets, but the
sweet, sharp scent of ripe buds.

And there the buds were, arrayed in 1/8-ounce bags in a large
counter, dozens of bags, about a dozen varieties, averaging $50 a
bag. And that was just the pot. There also was a selection of
hashish, tinctures, oils and edible products like cookies, brownies
and butters. Quite astonishing, really. It dawned on me that a person
driving all this stuff in the trunk of a car most places in the
country could get pulled over by a law officer and end up serving 10
years in prison for possession with intent to sell. And, indeed,
there was nothing stopping Drug Enforcement Administration agents
from raiding the dispensary and prosecuting its staff.

This is what it must have been like in a speakeasy during
Prohibition, I thought. The atmosphere was genial, with six or seven
well-dressed customers, about half of them white and half of them
African American, perusing the wares. A bit disoriented, I decided to
leave without buying anything for my RSI.

What I found out after visiting more clubs was that the Bernal
Heights store was a fairly basic operation. The selection was
average, and they asked nothing of customers other than ID. Other
places were more ambitious, and more outwardly concerned about
behaving in a way that their owners believed could help ensure the
dispensaries' survival.

Many of the 31 clubs that exist in San Francisco will not survive --
possibly not past July 1. That's the deadline set by San Francisco in
the Medical Cannabis Act, passed by the Board of Supervisors in
December 2005, for dispensaries to conform to a strict set of rules
before getting permits. Each club has to pay a $6,669 application fee
and submit to vetting by the planning, health, fire and police
departments, plus meet not only Americans With Disability Act
standards but also stricter ADA standards for new construction.

"I think this is cause for alarm," says Shona Gochenaur, who runs the
Sanctuary dispensary in the Tenderloin and a patient advocacy group
called Axis of Love. "We're in danger of losing 90 percent of our
collectives that follow a compassionate model for our patients. Only
six dispensaries will be able to come up to the construction standards."

Other dispensary proprietors are hopeful the city will bend the rules
a bit and extend the deadline. But the likely scenario is that
several clubs will be culled. As of press time, 25 clubs had applied
for permits and only two -- the HopeNet Co-Op and the Good Fellows
Smoke Shop -- had received them, pending police review.

Those two dispensaries represent polar opposites of the dispensary
spectrum. HopeNet is deeply committed to the compassionate model
alluded to by Gochenaur, while Good Fellows is a head shop that added
pot to its inventory. So at this point, compassion and charity don't
seem to be criteria that the city agencies are giving due
consideration, although according to Matt Kumin, a San Francisco
attorney who represents and advises dispensaries, such criteria will
be crucial to the long-term health of the medical marijuana movement.

"The co-ops that survive will be the ones that have alliances with
health care providers, law enforcement, scientists doing studies, the
ones that bring in service providers," Kumin says, adding that
dispensaries "must operate as nonprofits, because that's what's
spelled out in SB420. If you're in it for big bucks, you'll fail."

For HopeNet, things are falling into place. You couldn't say that in
September 2005, when the DEA raided the gritty club on Ninth Street.
No one was arrested, but the feds cleaned the place out. The club was
able to reopen within a week.

"The community brought us back," says Cathy Smith, who owns the
dispensary with her husband, Steve. "We filled an entire block in a
storm that was sideways." Like all medical marijuana dispensary
owners and workers, the Smiths are registered patients themselves,
which keeps things legal under SB420.

Though HopeNet has its permit -- "after sinking almost 10 grand into
getting the place to code," Cathy Smith says -- she worries that most
dispensaries will have to close, making San Francisco more like
Oakland, which allows only four clubs.

On a weekday afternoon, HopeNet was teeming with patients, many
smoking samples of bud that employees fetched from jars. The place
almost had the feel of a rec center. The dispensary gives medical pot
away to more than 100 severely ill patients, Smith says. Patients
with active HIV and veterans get medicine at cost, and everyone else
foots the bill with their purchases.

When I told Smith that I wanted something not too strong for my RSI,
she suggested sativa, as opposed to indica. Those are the two major
strains of cannabis. Sativa, she said, doesn't hit the body or the
head as hard, but still has an analgesic effect. I told her I'd try
it and get back to her.

Good Fellows, the other permited club (pending police approval), is
in the Lower Haight, which claims three dispensaries, making the
neighborhood one of the most pot-concentrated in the city. But
there's a world of difference between the clubs.

Three blocks up from Good Fellows is the Vapor Room, which embraces a
model of compassionate care for the gravely ill and destitute even as
it lures the average patient with a funky lounge ambience, high-tech
smokeless vaporizers and an impressive selection of customized
strains of herb, balms, teas and edibles. Martin Olive says he and
co-owner Nicky Strand are dedicated to meshing positively with the
community, which entails "handing out community-conduct rules to new
customers, donating to local services and monitoring the area for
undesirables."

There's a place for the hip and the downtrodden at the Vapor Room,
the former paying for the goods while the latter often get them for
free. "It's part of our multilevel compassion program," Olive says.
"We provide the really sick patient with high-grade medicine here for
free. Load up a bowl or roll a joint, and you can medicate right
here. That eliminates the possibility of resale." Olive says he has
about 75 members who are terminally ill or long-term disabled whom he
supplies with free medical marijuana.

The Vapor Room was doing brisk business on a weekday afternoon -- as
opposed to its Lower Haight competition, the Good Fellas and
Alternative Herbal Health Services, which projects an unfriendly
vibe. Busy and fun, the Vapor Room seems to be the model to which
cannabis dispensaries should aspire.

But not every Lower Haight resident is crazy about the idea of having
three dispensaries in the vicinity, and the Vapor Room -- ironically
- -- could be a victim of its own success. It's the go-to dispensary
for people who want to feel comfortable.

Olive doesn't see a problem with sharing a neighborhood with two
other clubs. "We're really close to a Muni hub, hospitals and social
services -- it's convenient for patients," he says. "They might go to
Good Fellas to get their medicine, then come to the Vapor Room to
kick back with it."

Olive also recommended sativa for my RSI, but I told him I tried the
bud from HopeNet and found it to be too strong. It may be fun to
chill with on a Saturday night, when I don't notice the arm pain so
much anyway, but it wouldn't do me any good during the workweek.

"Try some tea, then," he said, offering me a selection of varieties
from one of his edibles bins. "It's very light on THC."

Saturday rolled around, and I brewed up a cup and drank it. In a few
minutes, I felt suffused with a sensation of well-being I would
almost call narcotic, but my head was clear. I picked up a magazine
and read it with no loss of comprehension. And -- voila -- the
nagging pain in my shoulder was almost gone.

Amazing. Then I laughed, thinking how absurd it was that I could be
arrested by the feds for this. HISTORY

The medical benefits of cannabis have been described as far back as
the beginning of the A.D. calendar, when a Chinese pharmacopoeia
called the Shen-Nung Pen-Tshao Ching listed more than 100 ailments
for which marijuana was a treatment, including rheumatism, digestive
disorders and malaria. In 19th century Britain and the United States,
marijuana was in common use for a variety of ailments, and recognized
as an effective anesthesia for surgeries.

The tide began to turn around the beginning of the 20th century when
new drugs like aspirin and morphine came into use. Temperance
promoters, citing the psychoactive effects of pot, led to the banning
of the drug with the Marijuana Tax Act of 1937.

That was further hardened in 1970 with the Controlled Substances Act,
which classified marijuana as a Schedule 1 drug, which, according to
the DEA, means it has a high potential for abuse, has no currently
accepted medical use in treatment in the United States, and has no
accepted safety for use under medical supervision.

Other countries followed the U.S. lead in banning the drug, although
some permitted medical uses and research. As a result much current
science is based on foreign research.

Despite U.S. drug laws, the federal government has maintained a small
farm at the University of Mississippi in Oxford, Miss., to grow
low-potency marijuana for research and to treat a handful of
patients. However, researchers claim that the Federal Drug
Administration erects too many hurdles to pass to acquire marijuana
for studies.

"It hasn't been easy to do research on marijuana," says UCSF
oncologist Donald Abrams, who has managed to procure federal cannabis
for a few major studies.

Last year he completed a study that determined that marijuana
significantly relieves nerve pain in the feet of AIDS patients who
were not helped by any established pain-relieving drugs. The study
was a randomized clinical trial, and the results were published in a
respected journal, Neurology.

In a previous AIDS study, Abrams showed that cannabis has no negative
impact on patients taking protease inhibitors.

Most other research has not reached the standard of clinical trials,
or has been done on animals.

Here are examples:

Researchers in Madrid and at the Scripps Research Institute in La
Jolla found that THC inhibited growth of Alzheimer's disease cells.

Studies in Madrid and Milan showed that cannabis inhibited growth of
cancer cells in the brain.

Several studies have demonstrated the effectiveness of cannabis in
relieving nausea in radiation and chemotherapy patients.

A British controlled trial with rheumatoid arthritis patients found
that cannabis significantly relieved pain and inflammation and
improved quality of sleep.

Several studies have demonstrated relief in multiple sclerosis patients.

A UCLA study found that smoking marijuana leads to no increased risk
of lung cancer, and may actually reduce the risk of lung cancer in
cigarette smokers.

[sidebars]

D.R. THE WAR ON POT

Despite the best efforts of law enforcement to eradicate marijuana
and to convict and imprison users and traffickers, the plant reigns
as the No. 1 cash crop in the country, according to a study by
marijuana reform activist Jon Gettman, published in December 2006's
Bulletin of Cannabis Reform.

The study conservatively estimated the value of the annual marijuana
harvest at $35 billion -- more than corn and wheat combined.

California is responsible for more than a third of the harvest, the
report stated.

Coincidentally, $35 billion is approximately what the United States
spends annually on the war on drugs, according to an analysis of FBI
data by the Sentencing Project. Of that, $4 billion is spent on
arresting and prosecuting marijuana crimes.

Approximately 180,000 people nationwide are serving prison sentences
for marijuana-related crimes, according to the Department of Justice.

A Marijuana Policy Project study of the budgetary implications of
legalizing pot found that taxing the drug would net $7.7 billion a
year for federal and state government.

PUBLIC OPINION

In national surveys conducted since 2001, approximately 75 percent of
respondents believe patients should have access to marijuana for
medical purposes.

SOURCE: www.norml.org/index.cfm?Group_ID392