April 22, 2007
David Rubien, San Francisco Chronicle Magazine
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.