* The National Association of Ethnography and Social Policy, Oakland, CA

PROVIDING MEDICAL MARIJUANA: THE IMPORTANCE OF CANNABIS CLUBS

NOTES: The authors would like to thank the Drug Policy Foundation for its
funding, which made this research possible. We would also like to thank
Elena Bridges for her help in arranging interviews with the Flower Therapy
patients.

Please address correspondence and reprint requests to Harvey W. Feldman,
Ph.D., The National Association of Ethnography and Social Policy, 24
Randwick Avenue, Oakland, California 94611.

Abstract - In 1996, shortly after the San Francisco Cannabis Club was
raided and (temporarily) closed by state authorities, the authors conducted
an ethnographic study by interviewing selected former members to ascertain
how they had benefited from the use of medical marijuana and how they had
utilized the clubs. Interviews were augmented by participant observation
techniques. Respondents reported highly positive health benefits from
marijuana itself, and underscored even greater benefits from the social
aspects of the clubs, which they described as providing important emotional
supports. As such, cannabis clubs serve as crucial support
mechanisms/groups for people with a wide variety of serious illnesses and
conditions. The authors concluded that of the various methods so far
proposed, the cannabis clubs afford the best therapeutic setting for
providing medical cannabis and for offering a healing environment composed
of like-minded, sympathetic friends.

Keywords - cannabis clubs, ethnography, medical marijuana, public policy,
social environment

The issue of whether marijuana has medicinal benefits no longer seems to be
in question. Hundreds of scientific studies and thousands of testimonials
from patients have established marijuana's effectiveness in controlling the
nausea of cancer patients undergoing chemotherapy and/ or radiation; in
enhancing appetites for AIDS patients who suffer a wasting syndrome or who
have adverse reactions to their new HAART (highly active antiretroviral
treatment) medications; in reducing intraocular pressure for persons with
glaucoma; in giving relief from spasms of muscular dystrophy; and for
relieving pain from dozens of other serious diseases (Ad Hoc Group of
Experts, National Institutes of Health 1997; Gieringer 1996). Voters in
California and Arizona confirmed their belief in these medical benefits
when they voted overwhelmingly in 1996 to make marijuana legally accessible
to qualified medical patients (in California this was achieved by passing
Proposition 215). Despite federal resistance to recognizing the medical
utility of cannabis, the remaining unresolved question for public policy
debate and scientific exploration is not whether marijuana can be a useful
tool in managing a range of diseases but simply how qualified patients can
acquire a medicine that they and their physicians believe will benefit
their treatment and alleviate suffering.

Of the several ways available for qualified patients to gain access to
medicinal cannabis, a frequent suggestion has been for patients to grow
their own supplies. While highly desirable, only a small minority of
medical marijuana patients have the wherewithal to grow their own plants.
Most city dwellers do not have outdoor yards or balconies; those who do
report greater danger from thieves than from the police. Indoor growing
requires a large initial investment for expensive equipment, which patients
who live on limited or fixed incomes simply cannot afford. Patients must
also be very skilled home gardeners to ensure a sufficient amount with the
proper potency in order not to run short.

Of special importance is knowing how to identify infestation and molds,
which, if inhaled, might exacerbate already compromised health conditions.

Some observers have suggested acquiring cannabis supplies through either
the medical/pharmaceutical professions or from the police. With regard to
the medical and pharmaceutical professions, no specific recommendations
have been forthcoming from either field (beyond limiting cannabis use to
prescribed THC/Marinol). Both professions seem content to allow the matter
of delivery to be settled elsewhere. Our past history of marijuana
prohibition has resulted in physicians seemingly knowing less about smoked
marijuana, the preferred route of ingestion among patients, than the
patients themselves. In California, most physicians who recommend patients
to cannabis clubs appear satisfied with only recommending cannabis and
monitoring patients while allowing cannabis buyers clubs (CBCs) to dispense
it. The problems (especially with regards to available sources, storage,
and assessing potencies) surrounding how pharmacies might dispense cannabis
have not even begun to be speculated upon by the pharmaceutical profession.

Since the passage of Proposition 215 in California, there has been some
discussion, especially in San Mateo County, about the feasibility of the
police providing confiscated marijuana to qualified patients. This new
police function would require a different kind of training for this new
quasi-medical role. From our discussions with CBC members, many would balk
at revealing confidential health information to their local police
departments. Constancy of supply in the San Mateo plan would depend on
police seizure activities. Would police increase their seizures in order to
meet the medical demands of patient consumers if their supplies ran out?
Would they turn away legitimate patients? Or, out of necessity, would the
police grow cannabis, or purchase it from the black market in order to meet
their medical responsibilities? The number of complications inherent in the
police option makes it a choice that offers amusing contradictions, but
given the historical role of police in our series of drug wars, such a plan
would be impractical and unworkable.

Prior to the passage of Proposition 215 and the advent of cannabis clubs,
all marijuana purchases in California were illegal. Although the black
market is still an option for legitimate patients to acquire cannabis, it
has a number of disadvantages for persons with serious medical conditions.
If other options are not available, it forces patients to risk arrest in
the process of purchasing medicine. Without necessarily defaming street
dealers or impugning their honesty, these illegal transactions seldom
involve discussions about the quality, freshness, purity, or even the
sources of the product. In these furtive sales, consumers might easily be
cheated, or simply sold bogus cannabis. For individuals with
life-threatening diseases, the total interaction of purchasing medicine on
the black market seems unnecessarily risky, inappropriate, and demeaning as
well as especially costly.

Of all the apparent available choices, purchasing marijuana through
cannabis buyers clubs, from the authors' perspective, is clearly the
soundest option. At this juncture, one might ask, "What are cannabis buyers
clubs?" "What functions do they serve?" "How do people get into them?" and
"What do members do there?"

BACKGROUND AND RESEARCH

Despite the media attention devoted to the cannabis clubs, which has
usually emphasized the public smoking aspect, to our knowledge there has
been almost nothing written about them by trained and qualified social
science observers, other than one oral presentation to the American
Anthropological Association (Roberts 1996) and a New York Times Magazine
article (Pollan 1997) which dealt more with the general implementation of
Proposition 215 than with cannabis clubs exclusively. This article is an
attempt to begin filling that gap in knowledge.

Beginning in February 1996, the authors, both experienced drug researchers,
were part of a research group that met biweekly at the San Francisco
Cannabis Buyers Club (SF CBC). The group was started and chaired by Dr. Tod
Mikuriya, who has been a leader in the medical marijuana field since he was
a consulting psychiatrist with the National Institute on Mental Health in
1967. At the end of July 1996, the Drug Policy Foundation awarded our
research group a small grant to analyze the 12,000 or so intake forms the
SF CBC required from all its members, with the goal of determining the
distribution of disease categories and the demographic characteristics of
its members. Less than a week later, however, on August 4, 1996, the
California State Attorney General's Office and agents from the California
Narcotics Enforcement Agency raided the club, shut it down (temporarily, it
tumed out) and removed all the records, which remain under court seal. With
permission from the Drug Policy Foundation, we revised our research plan
and decided to explore the ways members utilized the CBC and the impact of
its closing. Within two months, new but smaller cannabis clubs as well as
other delivery arrangements emerged to fill the void, some lasting only a
short time. The authors associated themselves primarily with Flower
Therapy, one of the new clubs which some of the former SF CBC employees
opened to meet the demand for cannabis of some of the 12,000 members who
were separated from their supply as a result of the Attorney General's raid.

Flower Therapy provided full cooperation with the research by providing a
setting for interviews and observations, and by allowing staff to refer
members to our research. We interviewed as broad a cross-section of the
membership as our budget would allow. Selection of respondents was made to
provide a broad representation of disease categories, gender, age, sexual
orientation, and race/ ethnicity. To assure standardization, we developed
an interview guide. The interviews were opened-ended, lasted between one
and two hours, were tape-recorded, and transcribed. The few interviews not
conducted at Flower Therapy were held in the respondents' residence. Some
of those interviewed had been both member and staff at the SF CBC prior to
the raid; others had been regular members. While the interviews were our
core data, they were backed up with hours of participant observation - the
ethnographer's stock-in-trade - at three clubs: the SF CBC before it was
raided; Flower Therapy over a 16-month period; and the Oakland Cannabis
Buyer's Cooperative.

WHAT ARE CANNABIS CLUBS?

The concept of a cannabis club is the invention of Dennis Peron, a San
Francisco marijuana dealer since 1973 who became converted to the cause of
medical use of cannabis when his gay lover, a young man with AIDS, found
relief from symptoms with regular marijuana use. Peron's concept was to
provide not only a cafeteria of cannabis products - including marijuana of
varying potencies, cannabis pastries, and smoking paraphernalia - but to
create a life space where persons with life-threatening or seriously
debilitating diseases could gather, relax, and consume their medications in
an accepting, friendly, and colorful surrounding. Some critics referred to
Dennis' place as a "circus," but considering that it was both staffed and
utilized by sick and dying people, more sensitive observers might conclude
that he had created a therapeutic atmosphere that encouraged relaxation,
friendly interaction, laughter and healing. It was lively without being
unnecessarily noisy, and had attractive furniture arranged to facilitate
small group conversation and discussion. With this as a model, other clubs
modified one feature or another - e.g., the Oakland club's rental agreement
did not permit smoking on the premises, and Flower Therapy gave more
emphasis to research and structured intervention - but the essential
concept of having a place where members could select from a range of
cannabis products and gather to socialize was Peron's original creation. As
a new social institution, the cannabis club provides a setting that is a
combination of a community center and settlement house (better known in
eastern and midwest cities), a hospice, a friendly cafe, and - given the
illegal nature of it prior to Proposition 215 - a kind of speakeasy which
had the approval and public support of San Francisco's Board of
Supervisors, Mayors Frank Jordan and Willie Brown, its Department of Public
Health, its District Attorney's Office, and the administration of the San
Francisco Police Department.

ROUTES OF ENTRY

The development of the SF CBC is attributable to three underlying currents
that seem peculiar to San Francisco: (1) its history of progressive
political activism, (2) its reputation for innovation, and (3) its
relatively small population, which allows for information to be
disseminated quietly and quickly by word-of-mouth.

The political background which brought like-minded people together in the
medical marijuana movement was given a substantial boost with Proposition
P, a local ordinance the San Francisco Board of Supervisors passed in 1992
that directed the San Francisco police department to make marijuana arrests
its lowest priority. This ordinance allowed Peron to come out of the
shadows and become more public in using his private residence for
commercial marijuana sales, and eventually to become the central San
Francisco figure around whom others gathered in order to advance the cause
of marijuana both as a political rallying point and as a legitimate
medicine. Dec, the fictitious name for one of the early recruits, explained
how her contacts with Peron introduced her to both the medical and
political aspects of marijuana:

"Oh, when I met Dennis, we'd sit around his living room and plan it
[organizing for the passage of Proposition P, a San Francisco initiative
requesting that police lower the priority of marijuana arrests]. I met him
almost six years ago through my ex-husband... I met him and I knew from the
minute I met him that he was coming from the heart as far as helping sick
people get marijuana. We just connected. And the second time I went to his
house, he just grabbed me and hugged me and kissed me and said, "Welcome
back." And I was a regular at his house from 1992 on, even though I had to
drive back and forth from Bakersfield... And then in 1994 my friends were
worried that I was dying (from multiple sclerosis). I was wheel-chair bound
and weighed about 100 pounds. I had gone to Los Angeles for a Medical
Marijuana Day in 1994, and they all saw me and realized how critically ill
I was. And they moved me to Santa Cruz and then I got moved to San
Francisco with Dennis' help."

Others came to the club through other word-of-mouth referrals; one, an
elderly woman with both glaucoma and breast cancer, was referred by a
member of the San Francisco Board of Supervisors:

HWF: How did you initially learn about the club?

Hortense: From A [the elected Supervisor] sending me that note. I didn't
even know it existed before then.

HWF: How did you go about becoming a member?

Hortence; I just made a nuisance of myself. I went every week on Fridays
and Saturdays and talked to people. Then I decided my role was to listen,
and I did that for quite awhile. And then in July, Dennis asked if I would
do intake. There wasn't a lot of intake. We only had a hundred members or
something like that.

Regarding the original club, located on Church Street in much smaller
quarters than the one which has received national and international
attention, others heard from friends about a unique place where marijuana
could be openly purchased and consumed. While the early members joined
because they were personal acquaintances of Peron, a critical mass
developed so that word-of-mouth became the most common route into the club:

JM: How did you learn about the club?

Hector: The club? A friend of mine told me about it because access [to
medical marijuana] after HIV was still often awkward and expensive. Some
people you buy from have minimum amounts that you have to meet. Like an
eighth [ounce] for $60 or more. And limited hours. You don't know when they
are going to be home, or when it's going to be available. So when you run
out and when you want it, there was no guarantee that you were going to
have enough money or that it would be easily accessible. A friend of mine
knew about the club on Church Street, and took me, and introduced me. I had
my proper paper work.

HWF: How did you hear about the club?

Marie: From a care-giver. 1 was in the hospital, and I wanted to get out.
[A friend] told me about it.

HWF: Where was the club then?

Marie: On Market Street. And I couldn't believe it. It was like a piece of
heaven.... I went with my doctor's letter. I knew what I had to bring. I
was prepared. They walked me through it and introduced me around. It was
just wonderful.

JM: When did you first get involved in the club?

James: Way in the beginning because I had a low number [cell count]. At the
club on Church Street.

SM: How did you gravitate there?

James: My boss at the time brought me in because at the time you had to
have a member bring you in was the way it worked. You couldn't just walk in.

HWF: How did you initially learn about the club?

Donald: A good question. Hmmmm? I guess a friend told me about it.... That
there was a marijuana buyer's club that was right down the street from me.
At that point I was HIV-positive so 1 could become a member.

HWF: So, it was described to you as... ?

Donald: As a place to buy marijuana for people with AIDS.

HWF: Was it exclusively AIDS in the early days?

Donald: It wasn't. No, because Hortense had glaucoma. No, but that's what
they told me. Once I went, I found out it was for AIDS, cancer, glaucoma.

Checked-by: Mike Gogulski