Public Nuisance Or Therapy?

CANNABIS CLUBS

On one side stand the millions of Californians who voted in favor of
Proposition 215, the 1996 referendum that approved the possession and use
of marijuana for gravely ill patients.

The majority of citizens let their consciences speak. They realized the
benefits of medicinal marijuana. They had heard or knew from firsthand
experience that marijuana offers relief for arthritis pain, nausea, muscle
spasms and glaucoma. They saw appetites restored to AIDS and chemotherapy
patients who smoked joints or nibbled on marijuana brownies. Bodies gained
strength. Patients were better able to fight disease.

On the other side stand California's politically ambitious attorney
general, Dan Lungren, and his allies in Washington: Attorney General Janet
Reno, drug czar Barry McCaffrey and President Bill Clinton. Presumably,
these agents of the war on drugs have family members who feel no pain,
whose joints function effortlessly and whose appetites are never ravaged by
serious disease.

Fifty-six percent of California voters approved Proposition 215, but in San
Francisco the numbers reached 78 percent. Within weeks of the vote, more
than 30 cannabis clubs opened to help sick people in need of relief. One
club quickly grew to include 8000 members.

Then the backlash began. Lungren convinced a state judge that cannabis
clubs were a public nuisance. The war-on-drugs crowd noted that marijuana
remained classified by the federal government as a Schedule I drug, meaning
it could not be prescribed because it had no known medical uses. (Cocaine
and morphine are Schedule II drugs, and thus can be prescribed by a
doctor.) Lungren glowed when the courts ruled that, despite the referendum,
cannabis clubs violated state laws against the possession and sale of
cannabis. One judge interpreted Proposition 215 as allowing individuals to
grow marijuana only for personal medical use -- no clubs allowed.

California legislators implored Washington to recognize the voice of the
people. In a letter to Clinton, nearly two dozen lawmakers pleaded: "This
issue won't go away so long as human beings believe they have the right to
attend to their own illnesses, as their doctors recommend, rather than as
government dictates." Californians have rebuffed the feds before: When
evidence showed that intravenous-drug users were spreading HIV by sharing
needles, San Francisco was the first city to supply them with clean
syringes through an exchange program.

Californians invited lawmakers in Washington, D.C. to fly west and
formulate a safe and affordable system for the delivery of medicinal
marijuana, but the feds declined. As Lungren harassed and eventually closed
the most visible cannabis clubs, advocates spoke of reinventing them. They
thought Lungren was riled by the public nature of the clubs -- perhaps the
answer might lie in rerouting medicinal marijuana through the traditional
medical hierarchy. Maybe doctors in white coats would be more acceptable to
the feds than were proprietors in tie-dye and denim.

Disagreements within the medicinal marijuana movement on the value of the
clubs resulted in two distribution models after the passage of Proposition
215. One model is based on the conventional delivery system for medicine: A
patient visits a buyers' club (read: pharmacy), where he or she presents a
note from a physician, certifying that the patient has a condition for
which the physician recommends cannabis (read: prescription). The
proprietor of the club (read: pharmacist) fills the prescription and the
patient leaves to use the medicine, presumably at home.

This model preserves the medical profession's authority to decide who shall
use a medicine and for how long. The pharmacy provides a source -- in this
case a nonprofit one -- for the medicine. If the doctor and the pharmacist
behave ethically, only those who have a medical need for marijuana can
receive it. In turn, patients now have a reliable source for the drug,
relieving them of the stress of buying it on the street or secretly growing
their own.

The Oakland Cannabis Buyers' Cooperative is one of a number of clubs that
conform to this model. Patients enter the cooperative with documentation
from their physicians, purchase the marijuana and leave. The staid setup of
the club and the attitudes of the proprietors make it clear that the
patient is no more expected to use his medicine there than he would be at a
conventional pharmacy. Some clubs, such as the Los Angeles Cannabis
Resource Center in West Hollywood, have a policy of allowing emergency
medical smoking; this takes place in a smoking room, and the sharing of
joints is not allowed. The Santa Clara County Medical Cannabis Center,
which recently shut its doors under pressure from local authorities, did
not allow smoking anywhere on the premises, including in the parking lot;
if a patient violated this rule, his or her membership was revoked.

The second distribution model resembles a social club more than it does a
pharmacy. The dispensing area is plastered with menus offering types,
grades and prices. Large rooms are filled with brightly colored posters,
lounge chairs and sofas, tables, magazines and newspapers. While some
people remain only long enough to buy their medicine, most stay to smoke
and talk. There are animated conversations, laughter, music and the
pervasive, pungent odor of reefer.

The atmosphere is informal, welcoming and warm, providing support for
patients who may be socially isolated and have little opportunity to share
concerns and feelings about their illnesses. This type of club is a blend
of Amsterdam-style coffeehouse, American bar and support group. The model
was epitomized by the San Francisco Cannabis Cultivators' Club, which was
shut down by sheriff's deputies following local and federal court rulings.

Until some kind of legal accommodation makes it possible for patients to
receive marijuana without violating the law, buyers' clubs are the best
approach to the problem. Yet the government, including the White House, the
Drug Enforcement Administration and law enforcement at all levels, remains
opposed to the idea. While the feds are retreating somewhat from their
position that marijuana has no therapeutic value, they are still working
diligently to close cannabis clubs. Many if not most advocates who
recognize the importance of buyers' clubs believe that the model
exemplified by the Oakland, Santa Clara and Los Angeles clubs is preferable
to that represented in San Francisco. The former are more businesslike,
conform more closely with the pharmacy model and at least appear to be more
vigilant about checking the documentation of people who present themselves
as patients. The San Francisco club, largely because of the on-site
cannabis smoking and its relaxed atmosphere, appeared to be more casual in
its commitment to confirming medical need, which made even the supporters
of buyers' clubs a little nervous.

Yet the importance of the social aspect of buyers' clubs cannot be
underestimated. It is becoming increasingly clear that emotional support --
contacts with and help from friends, family, co-workers and others -- plays
a salutary role in battling many illnesses. This kind of support improves
the quality of life, and there is growing evidence that it may even prolong
life. In one study, socially isolated women were found to be five times
more likely to die from ovarian and related cancers than women with
networks of friends and families. In another study, women with breast
cancer were found to be 50 percent less likely to die in the first few
months after surgery if they had confidants. In a four-year study of 133
breast cancer patients, married women had a longer average survival time.

Researchers have consistently found that support groups are effective for
patients with a variety of cancers. Participants become less anxious and
depressed, make better use of their time and are more likely to return to
work than patients who are given only standard care, regardless of whether
they have serious psychiatric symptoms. There is evidence that even brief
supportive therapy can have benefits that last for months. Some researchers
have made the controversial claim that mere participation in support groups
can keep cancer patients alive.

The San Francisco buyers' club functioned very much as an informal support
group. It was not designed by psychiatrists and social scientists to
provide supportive group therapy, but there's reason to believe it did. One
of the properties of marijuana may have contributed to its effectiveness:
When people use cannabis, they tend to be more sociable and find it easier
to share difficult thoughts and feelings. If there is even a kernel of
truth to the idea that talking about the stress, setbacks and triumphs in
the battle against an illness can help a patient cope and recover, it is
clear that the San Francisco model provides the best environment for the
dispensing of medicinal marijuana.

Unfortunately, we live in a culture that considers such a facility a public
nuisance and criminalizes a compassionate form of caring out of loyalty to
a symbolic war on drugs.

The contentious legal battle continues. This past summer Oakland designated
the employees of the local cannabis club as officers of the city. This
inspired political move uses a section of the Federal Controlled Substances
Act and grants buyers for the cannabis cooperative the same protection as
undercover narcs (who buy and sell drugs as part of investigations) have
from possible prosecution. The club remains open in defiance of a federal
judge's order to close.

Copyright ©1998 Playboy Enterprises, Inc.

Checked-by: Richard Lake