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

PROVIDING MEDICAL MARIJUANA: THE IMPORTANCE OF CANNABIS CLUBS

[continued from part 1]

ACTIVITIES AND SOCIALIZATION WITHIN THE CLUB

Without question, the focal point of the CBCs was the distribution of
medical cannabis. What too often is either understated or ignored is the
variety of ways members utilized the club as a social and recreational
institution. Most of these social activities appear to come about as a
byproduct of the size of the facility and numbers of people in attendance
rather than through formally planned programs. Members and staff found that
marijuana itself produced a sense of well-being and that sharing both the
substance and experiences developed strong bonds of friendship. This became
especially true for members whose daily routines for dealing with their
illnesses had left them isolated, pained, and frequently deeply depressed.
The ways members went about enjoying their socialization varied. Some found
the club simply a sanctuary from loneliness, a place to go and just hang
out. Several respondents compared the cannabis club to the social setting
of the bar, a likely comparison since both served as places of
socialization and as a place where a mood-altering substance could be
purchased and consumed. In contrast to bars, members found the club more
suitable to sustaining friendships. Chuckles, a gay male with HIV/AIDS,
claimed to have found the CBC far superior:

"Oh, yes, there were lots of shared experiences. Lots of new social
contacts that I would not have made or would not have wanted to make in any
other place. The only other place for me to go, as a gay male, was to a
bar, which means drinking, which is much more deleterious to my health and
my behavior than is marijuana."

Kenny compared the relaxed atmosphere of the cannabis club to a bar that
might offer free beer:

"I saw very few problems of members because of marijuana and considering
that it was open to such a wide spectrum of different types of people, I
think that it was amazing that I never saw a fist fight in there. I heard a
few people had to be escorted out at times, but compared to say, a bar, I'd
hate to even think of what it would be like to have a place with free beer
given out to all customers.... Some people talk about being shy going into
a party, walking into a room... I never felt that. I'd go in, and the first
thing, look around the room to see who was there, and say "hi" to this
person and that person. It was very social. I can't stress that enough."

When the SF CBC moved to its larger (four-story) quarters on Market Street,
directly on the main business' and traffic artery in downtown San Francisco
- - and with the ensuing increase in membership and media attention, and the
political move to make medical marijuana legal under Proposition 215 - a
new era began. A sense of excitement and destiny seemed to transform the
club. Historically, it became the facility where former hippie/
radical/marijuana devotees, some of whom were now debilitated with
legitimate medical conditions, blended with the rising number of people who
had never been part of the counter-culture and were, for the most part,
naive and resistant to using marijuana recreationally. With a sense of
"only in San Francisco," the factions came together in a common political
purpose, a satisfaction and relief of finding others in similar medical
situations, and a feeling of safety because the club was protected by the
local authorities. Though the first-time visitor might be wide-eyed, having
what appeared to be legitimate access to marijuana and the ability to
consume it in public without fear, regular members found that their
satisfactions were as much social as medical, maybe even more so. In
reflecting on their use of the club, members overwhelmingly described the
social benefits in glowing terms.

When asked the question, "What did you like best about the club?" almost
without exception respondents answered in one form or another, "the social
life." As with a community center or perhaps a hospice, members could find
or create activities that utilized their skills, abilities, or talents.
Sandy, a small woman who walked with two hand canes, described how she
would teach origami (the Japanese art of folding paper into flowers or
animals), and how her involvement served to improve her physical condition:

"Twice a week I'd go up there. Friday, and then Saturday, Saturday because
of the evening thing. Mainly do origami, the fellowship, and I'd bring a
little weed and everybody'd have a little bit of weed. We'd smoke, but
mainly we'd be sitting there shooting the breeze, folding stuff, singing
along with the radio. Heck, we'd go up and down the elevator, or up and
down the steps. I was walking up and down the steps on a regular basis. I
was. Yes, I was. Now, I'd do the elevator every now and then, you know, but
I was doing steps, man. It was great. It was old home week. You'd walk in
there, and it didn't matter what kind of day you had had. And it wasn't the
pot. If it was only the pot, I wouldn't be there, quite frankly."

For members with limited incomes or the homeless with qualifying illnesses,
the club provided oranges in containers placed strategically throughout the
facility. On weekend days, staff prepared a full home-cooked dinner for
members. Hector explained how he would schedule his visits to coincide with
the meals:

"Well, food. There was a time or two that I went knowing specifically it
was Saturday afternoon and I specifically expected food would be there, and
I was kind of broke, and I thought, I wouldn't wonder whether i'd get a
potato or a cherry pie from the store. I expect there would be something
decent to eat there."

Others, like Jamie, enjoyed the Saturday night entertainment, which was
provided by volunteer performers or members themselves in a kind of "open
mike" evening:

"I was there Saturday nights. They... had really great music. Saturday
nights they would put on some nice shows, and things like that. Put on some
bad shows, too. Put on shows. It was fun there. It really was."

FINDING SUPPORT GROUPS

When members were asked how they spent their time at the CBC or what they
liked best, the most common and repeated response related less to the
acquisition of cannabis and emphasized the supportive aspect of being with
like-minded people with similar medical conditions. For many of the
members, the clubs provided a kind of generalized support group: the social
interaction that took place was an important and significant component of
their treatment and/ or rehabilitation. For some individuals, the CBCs were
their primary source of socialization. Recently, Lester Grinspoon, the
Harvard psychiatrist and author of Marijuana Reconsidered (1994), one of
the best and most complete discussions of medical marijuana, turned his
attention to the subject of cannabis clubs. In an article which will appear
in the 1998 Summer issue of Playboy (Grinspoon In press), he notes that
recent studies by others have shown that having a social support network is
an essential ingredient for cancer patients and that " .. these kinds of
supports improve the quality of life... and that there is growing evidence
that [they] may also prolong life" [emphasis added]. He notes that in one
study "socially isolated women were found to be at five times higher risk
of death from ovarian and related cancers than the controls," who were not
reported to be isolated. In a second study, he stated, "women with breast
cancer were 50 percent less likely to die in the first months after surgery
if they said they had confidants, i.e. people they were close to."
Grinspoon (1998) goes on to report that the studies showed that patients
"...become less anxious and depressed, make better use of their time, and
are more likely to return to work than similar patients who are given only
standard care." These and several other examples discussed by Dr. Grinspoon
provide strong testimony for the social role that cannabis clubs can and
have provided.

Not all cannabis clubs make a concerted effort to capitalize on this
therapeutic possibility. But it is clear from the interviews that there
were beneficial aspects to mere attendance at the clubs. Seriously ill and
dying people can gather and enjoy the friendship of others in like
situations. They learn how others with similar medical and social
conditions cope. Hector again supplies one of many testimonials to the
therapeutic benefits of his attendance at the SF CBC:

"There's nothing else like it. There's no facility in town that offered a
comfortable social place to hang out and meet other people that are in your
same similar situation facing terminal illness... and trying to cope with
it, both physically and emotionally... Let me put it this way. I think that
depression is a real illness for some people. And as s major branch for
almost all people who suffer from HIV. Once you're facing a terminal
illness, you are bound to have a thousand ways of depression. And I think a
support group, wherever you find it, a fully functioning support group and
facility, is, can be a big booster and counter to serious depression... And
the option of having a place to go that provides medicine in terms of
marijuana but also medicine in terms of a real friendly network and
reliable support group has been really important. And I haven't jumped
into, or found a support group that was as comfortable and attracted to as
l was with the support group I found on a daily basis at that place."

Such sentiments were repeated often both spontaneously and in response to
direct questions regarding what they liked or didn't like about the SF CBC.
Frederick, a regular visitor to the club, actually downplayed the
importance of marijuana and emphasized the social aspects as the club's
primary significance even though he himself seldom used the club in that way:

"I never smoked at the club. I was never a big one to go hang out and
smoke. I would just get my stuff and would leave, which is what I thought
people should do. Although I do, I am aware that people stayed... They hung
out and smoked. I slowly started to see. I was just there Sunday night. I'm
starting more and more to see that the reason they are there isn't just
because, just that they want to sit there and smoke pot. It's because they
know each other. I think marijuana is a secondary issue... It's about
whatever it is that brings them, these people together, which is probably
more their illness itself. Well, they all have illnesses in common, and the
political issues that surround it [their illness]. That's what they are all
always talking about. That's how they became friends... So, the marijuana
itself to me is a small character in all this. Even with me personally, I
don't see marijuana as being the star of the show here."

Given the pervasiveness of terminal illness among the membership, managing
depression and grief was always an issue which arose both from trying to
adjust to having diseases where death was near and in dealing with the loss
of friends. Being an active member of the CBC helped many individuals who
had been living in isolation to reestablish a friendship network. Kendall,
another member with full-blown AIDS, underscored the social role the club
played in introducing him to a new set of friends:

"The mainstay of my friends now are the people that I met through the club.
Some [friends from the club] I've known way back, but a lot of them are
people I just met m the past couple of years. Course, also in the past 10
years 1've had a lot of friends die from AIDS. I could think of a whole
group of people I would have been out with, say, to dinner, or at a bar,
and I am the only one that's alive out of, say seven or eight people in the
group... I find it very hard to gauge how much benefit I should ascribe to
marijuana and how much to the club itself. Because just being around people
has really helped a lot. Like I said, I lost a great portion of my friends
to AIDS. Other people I just drifted apart from. So, this was a way back
into having a close circle of friends"

In keeping with the way the clubs provide a healing atmosphere, Jamie noted
how the social relations he had developed over time allowed him and others
to manage the grief associated with the death of close friends and helped
him find a new set of associates whose concerns he valued:

"We had wakes there. We had a wake for Jimmy when he died. Jimmy was one of
the original people from before it was Church Street... That's how long
Jimmy was a member... He was one of the original I'd say 10 people in the
beginning. And when he died, they had a wake... I've been a part of the
club because I was there everyday. I became a part of the

club, one of the faces that belongs there. When 1 went away for a week,
everybody said, "Where'd you go?" It's a social thing to do, every day of
your life. Well, almost everyday.

THE ETHOS OF "LOVE AND COMPASSION"

One of the remarkable consequences of having established the clubs as a
place where members could expect help was the way the notion of helping
others permeated member interaction, so that group esteem and status was
often connected to performing kind, compassionate acts. One might say that
there emerged an unstated expectation that rewards and recognition could be
accrued through acts of helping other members. As a result, several
respondents reported how they consciously set out to be of service to other
members, which they viewed as being consistent with the club's mantra and
slogan of "love and compassion." This aspect of helping was a route to both
recognition and acceptance. Sidney, whose medical diagnosis did not include
physical infirmities, explained how he created a helping role for himself
in an attempt to become an official volunteer:

"I hung around every day that I could because I wanted to help people who
had problems with neuropathy, palsy, sclerosis, dystrophy. They can't roll
[joints]; they can't clean [remove stems and seeds from marijuana]. They're
shaking, trembling... A friend of mine has glaucoma and also has spasticity
and arthritis. She'll come in and literally hand me her bag [of marijuana],
and I would sit and roll her entire bag. And she would hand me a cigarette.
And I would say, "No, thanks." And she would say, "Okay, just light it.""

For Marie, a 40-year-old African-American women who was wheelchair bound
because of muscular dystrophy, and a lifetime resident of San Francisco
before moving to an adjacent county when special housing for her medical
condition became available, her three visits a week to the club were her
rationale for leaving her apartment. As a knowledgeable observer of San
Francisco scenes while growing up in the Haight-Ashbury district, and as a
child seeing the development of the counter-culture during its heyday in
the mid-sixties, she summed up her view of the SF CBC by putting it in the
context of San Francisco as a city of civility:

Marie: I went Mondays, Wednesdays, and Fridays.

HWF: Did you go there only to buy or did you hang around?

Marie: I went there to buy but I'd always run into someone I knew who I'd
sit around and smoke a joint with and talk about how cool it [the club] was
.. The club was life! The club was what San Francisco was all about. People
were there sharing, talking, loving, just having a good time. And it was
all kinds of people from all walks of life... It reinforced what San
Francisco was all about I looked forward to it. Wednesdays is Farmer's
Market Day [on Market Street near the SF CBC]. It was perfect. I could go
to the club and then get my fruits and vegetables on my trip to the city.

SUMMARY AND CONCLUSIONS

Our approach in assessing the functions of cannabis clubs, particularly
what was formerly called the San Francisco Cannabis Buyers Club, was an
ethnographic examination of how members themselves perceived the benefits
of their membership. While the acquisition of medical marijuana for
specific diseases (as recommended by their physicians) was the members'
major rationale for seeking membership, almost without exception they
expressed greater satisfaction in the social interaction and activities
they found. Most of the members learned of the club through friends or
acquaintances who were either members themselves or who knew of the club
through other friends. Without advertisement or recruitment, members heard
through word-of-mouth that Dennis Peron had created a facility where
persons with serious and/or terminal illnesses could purchase and smoke
marijuana. With the apparent success of Dennis' place, others with
imagination and administrative skills opened similar, if somewhat unique,
clubs throughout the state - in Marin, Eureka, San Jose, Oakland, Hayward,
Los Angeles, Orange County, and other areas - after becoming acquainted
with the SF CBC. Each may have had a somewhat original twist, but the
notion of having a facility where cannabis could be purchased (and
sometimes ingested onsite) was patterned after the original club created by
Dennis Peron.

Members who probably would have been content to find only a legitimate
source of medical marijuana were even more pleased to discover that the
setting itself served therapeutic purposes for them by providing a natural
environment in which to socialize with others who were struggling not only
with serious disease but who were frequently isolated, frightened, and
depressed. As a result, members often stated that the socialization they
encountered and the friends they made at the clubs were health producing.
Most frequently members referred to these friendship circles as "support
groups" because they offered mutual help in a number of critical emotional
areas: adjusting to a terminal illness, or managing the grief which
accompanies the many deaths an epidemic like HIV/AIDS leaves in its wake.

At the time of this writing, two legal actions are underway in attempts to
close the clubs: (a) action by the California State Attorney General's
Office, which claims that cannabis clubs do not qualify as primary
caregivers under their interpretation of Proposition 215; and (b) a federal
civil suit against six California clubs - including the San Francisco
Cannabis Cultivators' Cooperative, Flower Therapy (which closed because of
federal action against the club's landlord), and the Oakland Cannabis
Buyers' Cooperative. The federal case seems the simplest since it drew on
the Controlled Substances Act of 1972, which classified marijuana as a
Schedule I drug (a classification specifying that marijuana has no
legitimate medical use).

The federal action - taken by the Drug Enforcement Administration (DEA)
under the Department of Justice - simply does not recognize the many
studies and reports on marijuana which have demonstrated its medicinal
usefulness. Perhaps the anticipated report from the Institute on Medicine
(whose members visited the Bay Area cannabis clubs in December, 1997) on
its investigation of possible medical uses for marijuana will help bring
the Department of Justice and the DEA more into line with the available
scientific evidence. At the moment, the DEA simply ignores all scientific
and medical evidence, and with apparent blindness continues to argue that
marijuana has no legitimate medical use. With that as their foundation for
determining public policy, from the DEA's perspective all marijuana use
remains illegal. And they saw fit to take civil - not criminal action -
against six of the better known clubs. The remedy for the federal position,
which in all likelihood is forthcoming, is to reschedule cannabis and
recognize what thousands of Americans and hundreds of physicians already
know - that cannabis is a remarkable, naturally grown substance with wide
utility in the treatment of a variety of diseases. The authors concur with
the New England Journal of Medicine, which stated in its editorial of
January 30, 1997 (Kassirer 1997) that "...a federal policy that prohibits
physicians from alleviating suffering by prescribing marijuana for
seriously ill patients is misguided, heavy-handed, and inhumane."

The California Attorney General's case is somewhat different, since under
Proposition 215 the use and recommendation of cannabis for severe medical
conditions is legal. In California, the suit against the SF CBC attempts to
clarify Proposition 215 by implying that the law does not authorize or
consider the role of cannabis clubs in providing marijuana to legitimate
patients. While the Attorney General's Office has not developed its own
plan for distribution, it does seem to support the police option suggested
in San Mateo County, which (as discussed earlier) would blur the lines
between law enforcement functions and medical practice. Having the police
as distributors of medical cannabis would have a chilling effect on how
medical patients, fully aware of how police departments in the past viewed
marijuana consumers, might utilize or abuse this new distribution route.

After almost two years of investigation into the functions of cannabis
clubs, witnessing how members participate in the socialization that takes
place in them, and formally interviewing a selected sample of patients, as
social scientists the authors conclude that the cannabis clubs are not only
a desirable method but a preferred method for the distribution of medical
marijuana. Without question, of the available ways of providing cannabis,
the CBCs provide the safest and least expensive commercial method for
patients to purchase medical marijuana. Moreover, the existing
relationships are trusting ones that have been developed over the years,
and they would be difficult to transfer. Of greatest importance is that the
clubs provide a therapeutic setting which patients themselves find
gratifying, socially supportive, and congenial.

Rather than attempting to shut down cannabis clubs, public policy makers at
the federal and state level should move toward supporting the clubs'
existence, and thus function the way the health, law enforcement, and
elected political officials in San Francisco have done over the past six
years. As a new and promising strategy, the cannabis club concept is boldly
imaginative and; according to our investigations, highly effective in
providing its sick and terminally ill members both a medicine and a social
setting which has improved the quality of their lives.

REFERENCES

Ad Hoc Group of Experts, National Institutes of Health. 1997. Report to the
Director: Workshop on the Medical Utility of Marijuana. February 19-20.
Available on the Internet at www.nih.gov/news/medmarijuana/MedicalMarijuana.

Gieringer, D. 1996. Review of Human Studies on Medical Use of Marijuana.
San Francisco: California NORML.

Grinspoon, L. In press. A perspective on buyers' clubs. Playboy.

Grinspoon, L 1998. Personal communication.

Grinspoon. L. 1977 (1971). Marihuana Reconsidered. Cambridge,
Massachusetts: Harvard University Press.

Kassirer. J. 1997. Federal foolishness and marijuana. [Editorial] New
England Journal of Medicine 336 (5): 366-67.

Pollan, M. 1997. Just say "sometimes." New York Times Magazine July 20: 21-48.

Roberts, T. 1996. Life crises create situations for communitas. Paper
presented at the Annual Meeting of the American Anthropological
Association, San Francisco, November 22.

Checked-by: Mike Gogulski