Smoke and Mirrors

A man preparing for his wedding has a whole lot on his mind. That’s where a medical marijuana license can come in handy. But as a displaced New Yorker exiled in Northern California, I didn’t exactly have the right to avail myself of the state’s loosened marijuana regulations as I prepared for my impending nuptials. The cops in my town kept pulling me over because of my New York plates, telling me I needed to get a California driver’s license. I did. Thus my problem of residency was solved. And I began the journey from criminal smoker of the demon weed to legal “patient.”

Reflections on being a New Yorker stuck inside California (with the medical marijuana blues again)
Marijuana, medical or otherwise, is inescapable in Northern California. People here are obsessed with weed. When they’re not smoking it, they talk about when they’re going to smoke it. Even when they are smoking it, they talk about smoking it. Sometimes, for a change of pace, they talk about growing it.

There are entire communities in Mendocino and Humboldt counties whose economies seem to be based on supplying growers and dispensaries. For some sense of scale, Mendocino alone has 22 hydroponics supply stores and a population just short of 90,000. Nassau and Suffolk counties combined, with a population of more than 2.8 million, have just two hydro stores.

The Laws They Are A-Changin’
Even as 16 states have enacted some sort of medical cannabis law, the federal government is still not a fan. It has stepped up efforts to enforce federal law in the State of California and is constantly threatening legal action against dispensaries and even the landlords who rent to them. In some states, the victory for marijuana smokers is especially hollow, since there are no provisions made for how a patient will get the pot, other than some sort of magical weed fairy. And in others, such as Arizona, the debate still rages over how, or if at all, to implement voter-passed initiatives.

Regardless, to the federal government, the DEA and the DOJ, marijuana is a Schedule I narcotic. This is the strictest classification, and means that the federal government sees marijuana as more dangerous than cocaine or morphine (which are Schedule II drugs). President Obama and Attorney General Eric Holder have held steadfast to the Reefer Madness fairy tale, with neither indicating that the drug war is anything but full speed ahead.
The surge in state-approved medical marijuana (and the tax revenue it might generate) has certainly gotten their attention, though. “Within the past 12 months, several jurisdictions have considered or enacted legislation to authorize multiple large-scale, privately-operated industrial marijuana cultivation centers,” Deputy Attorney General James M. Cole wrote in a menacing June memo that had some large-scale California growers shaking in their Birkenstocks, and sent a wave of fear of an impending crackdown through the dispensaries. “Some of these planned facilities have revenue projections of millions of dollars based on the planned cultivation of tens of thousands of cannabis plants.”

In a memo this past July declining a nine-year-old petition to recognize medical marijuana (the government likes to take its time with these things), DEA Administrator Michele Leonhart wrote: “[T]here are no adequate safety studies; there are no adequate and well-controlled studies proving efficacy; the drug is not accepted by qualified experts; and the scientific evidence is not widely available.”

Apparently, Ms. Leonhart has never met Donald Abrams, MD.

One Was Texas Medicine
Dr. Abrams—Chief of the Hematology-Oncology Division at San Francisco General Hospital and a Professor of Clinical Medicine at the University of California, San Francisco—is every bit the cynical research clinician, and has no political stake in the many studies into the medical efficacy of cannabis that he’s conducted with the support and cooperation of the FDA.

Dr. Abrams’ work began out of desperation when treating patients suffering from rare cancers as the AIDS crisis hit San Francisco General in the early 1990s. His patients related that the only thing that gave them any relief from the pain was puffing on a joint. Ever the buttoned-down clinician, Dr. Abrams began the laborious process of obtaining cannabis from the US government for the purpose of research, which begins by submitting a proposal to the FDA. The FDA will not recognize a study that uses just any street corner chronic—it must be procured from a growing facility at the University of Mississippi regulated by the National Institute on Drug Abuse (NIDA).

After FDA and NIDA approval in 1996 (no small feat), rolled joints came to Dr. Abrams’ offices in what looked like a large coffee tin. The first study merely established the safety of the pot in a controlled setting, including such restrictions as comical dosages per the FDA (every patient took timed inhales, holds and exhales of the exact same number and duration). Everything was measured, including the amount of THC in the pot, which weighed in at a lowly 3.9 percent (pot from medical marijuana dispensaries is typically about 10 to 20 percent). Once he established safety, Dr. Abrams embarked on a rigorous series of studies of everything from marijuana’s effectiveness as a pain reliever to its interactions with other drugs. In the process, Dr. Abrams has provided a wealth of FDA-approved, double-blind, randomized, placebo-controlled clinical trial data—what the FDA refers to as “the gold-standard of clinical research.”

He did find a so-called “side effect.” The FDA worried about reports of mild euphoria. “Euphoria in terminally ill cancer patients is something we can tolerate,” Dr. Abrams remembers thinking.

To conduct medical marijuana studies legally in the US, researchers must jump through a multitude of hoops for what can take many years, and even then there are no guarantees of approval. It’s easier for your average college freshman to get a dime bag than it is for a professional researcher to get marijuana to test its effects on tumors. But there have been countless scientific studies, both in this country and in others, though the vast majority have not gone through the FDA-DEA-NIDA gauntlet. And the results amount to more than 20,000 published peer-reviewed studies.

This January, the American Medical Association published the most recent study to make headlines (predictably, along the lines of, “Scientists Say Weed is Good for You”): A 20-year study conducted by researchers at the University of California, San Francisco, and the University of Alabama at Birmingham concluded that moderate (weekly, and even daily) marijuana use does not cause lung damage and, in fact, might actually improve lung function slightly. The two-decade-long, federally-funded project (by NIDA, no less, which probably anticipated a different outcome), was one of the longest and largest such studies ever done. Maybe someone will forward one of those “Marijuana Smokers Can Breathe Easy” headlines to Ms. Leonhart.

The Other Was Just Railroad Gin
Literally millions of Americans burn the occasional joint without turning into wildebeests hell-bent on destroying the sanctity of life. We can attest to this from personal experience, yet this is where things get a bit cloudy in the marijuana debate. A great deal of what we do know, we know because we smoke the stuff for fun, relaxation and to enhance Pink Floyd laser light shows.

imageStill, the nearly 100-year prohibition on marijuana is not altogether dissimilar from the prohibition against alcohol. Consider that during the 1930s, there were actually prescriptions for “medicinal liquor.”

There is a feeling among advocates that the tide might finally be turning for more than just “medical marijuana,” and that we could be on the cusp of a repeal of prohibition. If so, it’s been a long haul. Consistently, across many polls in the US, around 70 percent of those asked support medical marijuana. And in a Gallup poll last October, a record-high 50 percent of those Americans asked were in favor of full legalization.

“Border violence is a prohibition phenomenon,” Gary Johnson, former Governor of New Mexico and then-Republican candidate for president, told me back in November. (Johnson now intends to seek the Libertarian nomination, which makes sense since he’s always lived up to that party’s classic slash (taxes) and burn (pot) ideal.) In 1999, while in his second term as governor, Johnson shocked many by publicly coming out not just in support of marijuana law reform or even merely medical marijuana, but legalization—one of the highest-ranking government officials ever to do so. As a fiscal conservative, he made the economic argument. “We had an issue with prisons. We had to build new ones, because we were housing prisoners out of state,” at the time in New Mexico, said Johnson. “It was just this simple: Half of law enforcement’s and half of the courts’ resources are directed at drug-related crime. And to what end? The fact is we’re arresting 1.8 million people a year in this country for drug-related offenses—half of those arrests are for marijuana, and half of the overall arrests are for possession only. It just slapped me in the face that this is a waste of money. An absolute waste of money.”

Despite the blowback from the federal government and the serious dent it put in a promising and rising political career, Johnson remains proud of his position and holds to it more staunchly than ever. “What is it we don’t know that we need to know to stop putting people in jail and change the law?” Johnson asks.

Johnny’s In the Basement
Modern medicine is such that the average household has a cabinet full of chemicals for myriad ailments, from anxiety to incontinence to hypertension to erectile dysfunction. But in an age when big pharma has basically defined medicine as anything that makes you happy and centered, my use of marijuana is as legitimate as your use of Zoloft. Certainly it’s healthier than someone who takes a clonazepam and Ambien cocktail every night with a doctor’s prescription, because they might have trouble sleeping.

Part of the charade of the medical marijuana debate is the linguistic dance. I am not a pothead who puffs reefer as I would be in my home state of New York. Here, in California, I am a “patient” who takes “medicine.” Medical marijuana is a term that, while very serious in some circumstances, let’s be honest, is often hard to say with a straight face—like, say, when you are talking to a guy with white-boy dreads wearing a Kottonmouth Kings t-shirt who’s trying to sell you an alien-head bong with which to take your “medicine.”

When I went to one San Francisco “doctor’s office” to get my referral (all they do is hand out medical marijuana evaluations), they gave me a clipboard and a pen, and I sat on a metal folding chair to fill out a questionnaire alongside a handful of other applicants, all sort of staring at the linoleum floor, trying to avoid eye contact. Aside from asking for the usual contact information, the sheets had a checklist of ailments ranging from terminal diseases to headaches. I didn’t see a checkbox for “impending wedding,” so I marked “anxiety.”

I left the spot asking for my primary care physician’s name blank, because, honestly, I couldn’t remember it. A skinny aide in a trendy t-shirt and a trucker hat at the counter said that information needed to be filled out. I explained that the last time I visited a physician I was living in Manhattan and couldn’t remember the name of the office. “How about Manhattan General?” he asked leadingly. “Does that sound like it?” I kind of shrugged and he scribbled in Manhattan General. After about 15 minutes, they called my name and ushered me into a small, dimly-lit room where the doctor (who is, in fact, an MD) sat behind a metal desk that looked like it came right from an office furniture surplus fire sale.

When I mentioned during the precursory interview that I also had back pain (I have two herniated discs from an old injury), the doctor’s face brightened and he said, “We should put that down,” then asked, “Does marijuana help the pain?” That was about the extent of the evaluation. I left the room, paid my 50 bucks and received the laminated card right there. I walked two blocks to a dispensary and showed the card, registered with the cooperative in the nondescript front waiting area, and was then led back through a locked door to a fantasyland with more kinds of pot than I had ever seen in one place (and I went to a state school). Not only were there dozens of strains of marijuana set out carefully in attractive jars to smell and look at, but also a case full of pot brownies, cookies, lollipops, chocolate, energy bars, cannabutter for cooking and gourmet spicy peanuts with more kick than just cayenne.

This shop would actually turn out to be one of the nicer dispensaries I found in my “research.” Brightly lit and clean, it had the vibe of an expensive tea shop. On the way in I passed an old man hobbling out on a cane, clutching his brown paper bag, a huge smile plastered across his face. The poster child for medical marijuana.

At other shops, the décor was far more, shall we say, “dormtastic.” Looking at blacklight posters with bad bar rock blaring on a boombox in the background while buying pot brought back too many memories for me to ascribe a medicinal use to anything the place sold.

At many of these dispensaries, young, attractive women work behind the counter, patiently explaining the difference between sativa and indica and the various hybrids. One suggested I try a sativa-leaning cookie. “It comes on slow so that you can really enjoy your high,” she said. Funny, when I first hurt my back and needed heavy painkillers, I don’t remember my pharmacist instructing me how to enjoy the high when he sold me a bottle of hydrocodone.

If there is a model for what a dispensary can be, I found it in Mendocino at the Leonard Moore Cooperative. If marijuana is going to be brought into the light, this is the type of place that will do it, literally. It was the only dispensary I found that actually had windows, and even looked out into the street. At some, you are made to feel as if you are sneaking into a porn shop or opium den (see also dormtastic, above). For starters, The Leonard Moore Cooperative, which regularly offers its members benefits such as raw cannabis juicing demos and tastings and yoga workshops, has yellow wainscoted walls, is stocked with thoughtful literature on the latest marijuana research (and a couple of couches and coffee tables at which to read), has a display of the different types of soil the plants grow in around the area, and offers a jug full of water with floating cucumbers, the sort you’d see at a spa.

And Then They’ll Say Good Luck
If medical marijuana is ever approved in New York, you’d likely have the full complement. You can easily imagine the Leonard Moore model in the West Village and maybe Sag Harbor. Figure Ronkonkoma for a place that hangs black light posters (see dormtastic, again). Delivery services (now all the rage in San Francisco) would give all those New York bike messengers pedaling pot a legitimate line of work.

“We have a way forward to how we might get to a majority of states that have legal medical marijuana in just a couple of years,” said Rob Kampia, co-founder and Executive Director of MPP (Marijuana Policy Project). By the end of 2014, Kampia estimated that more than half the states in the country, including New York, will have medical marijuana legislation. With at least 26 states on its side, MPP thinks it can launch a legal challenge in federal court to overturn the national prohibition on marijuana. “It’s not a guaranteed victory at all, but we need at least 26 to have a shot,” he said.

New York may be the last holdout in the region, though. You’ll likely be watching your friends from New Jersey, Connecticut and Massachusetts walk into medical marijuana dispensaries long before you can.

The New Jersey legislature passed a bill allowing for medical marijuana in January 2010, but Governor Chris Christie has blocked its implementation, so the future for potential dispensaries remains unclear. The Connecticut House passed a bill decriminalizing possession of less than half of an ounce of marijuana at the very end of the 2011 session. Though a full medical marijuana bill stalled on the floor, Connecticut is expected to pass one this year. Vermont passed a bill in August 2011 allowing medical marijuana that contained provisions for dispensaries. The Massachusetts legislature debated medical marijuana bills in 2010 and 2011 and currently has a bill on the floor that would regulate and tax marijuana. There is also a good chance that Massachusetts voters may pass a proposed ballot initiative approving medical marijuana in elections this November.

There are no bills being considered in New York, and it’s unlikely one will be introduced this year. New York is different than California and Massachusetts in that our state does not have ballot initiatives or voter referendums on issues, so it’s all up to Albany to do the will of people. If you’re familiar with Albany, that can’t be a very comforting thought. While 50 percent of the people in this country are for major marijuana law reform, fewer than 1 percent of politicians are.

The large Empire State has a dramatic split, making it almost two separate states. And New York has some thorny issues, with the upstate-downstate dichotomy coming into especially sharp relief. While Manhattan and Long Island might be for changing the law, large swaths of red-meat conservatives Upstate depend on the prison system for jobs, census representation (prisoners are counted as living in the counties where they are incarcerated) and more.

But New York will soon be squeezed on all sides by medical marijuana states. Could leadership possibly come from the top on this? Governor Andrew Cuomo has given little indication that he’s ready to pull a Gary Johnson, but one DC reform lobbyist told me stranger things have happened, characterizing Cuomo as “mercurial.” When asked by Pulse, Governor Cuomo left his options open, declining to comment.

If New York does eventually join what is looking more and more like an inevitable green tide, Cuomo can expect some positive cash flow, as well as some smiling constituents. For starters, the state would be replacing court and law enforcement expenditures with tax revenue. And such a move would surely create jobs and business opportunities, as it has in states such as California and Colorado. The impact would not be immediate, but you could see Mendocino-like growing communities pop up in, for instance, the North Fork, where conditions are right. Throughout the state of California, businesses have developed—not just dispensaries, but lawyers’ offices specializing in compliance, training academies and programs, cooking specialists and more.

Oh, Mama, Can This Really Be The End?
Marijuana reform advocates trot out the most extreme cases for obvious reasons. Nobody in good conscience would try to deny an Iraq War veteran haunted by PTSD something that provides him a degree of comfort. What kind of sadistic monster would tell an AIDS patient wasting away that he can’t smoke pot to increase his appetite and put a few pounds back on? (Dr. Abrams conducted research on this in San Francisco and pot did help.) However, take an ordinary person who smokes a joint to unwind and you don’t get the same response as you do using cancer patients.

Sipping “decompression elixirs” at cocktail hour has long been a socially acceptable practice, however, the same rules don’t apply to marijuana just yet (despite the public polling numbers to the contrary). There is no “Vapor Room” with happy hour pricing to cure what ails ya—well, in San Francisco there is (and it’s called that), but you get the point.

In moderation, even the demon weed can have its place. In New York you can probably get a prescription for Valium or trazodone because you are having nightmares about your impending nuptials. You’d have to be in California or one of the other medical marijuana states to have access to the arguably safer MJ alternative.

Speaking of my wedding: That went off without a hitch (other than the intended, of course). But the mother of the groom did get the giggles after scarfing a handful of peanuts she found in an unmarked jar on one of the tables.

When Prop 215, the ballot initiative that made it legal in the state of California for a patient to possess marijuana for medicinal use with a valid doctor’s prescription, passed in 1996, more people voted yes on it in San Francisco than voted for Bill Clinton.