A Green Education
A reporter gets schooled in the realities of medical marijuana
When Californians passed Proposition 215 in 1996, effectively legalizing marijuana for people with chronic pain or wasting diseases, it all seemed, well, so California. The seriousness of the compassionate-use movement soon melted away, and in the decade that followed, Californians saw the rise of dispensaries as pharmacy/weed-boutique hybrids, medical clinics that existed solely to legitimize patients' marijuana use and the near full acceptance of marijuana as a major agricultural crop. The Golden State was first among more than a dozen states to legally reinvent the herb as medicine, and yet, almost 15 years later, medical marijuana remains not quite legal, caught somewhere between Western medicine and Californication.
The North Bay is not completely unaffected by the commercialization trend, but despite its spot smack between Oaksterdam and Humboldt, area communities have remained somewhat resistant to the invasive weed. An exception is the medical-marijuana clinic in downtown Santa Rosa. It sits discreetly in a single-story building across from the library, next to a real estate office.
A small paper sign reading Compassionate Health Options marks the spot, yet the name is somewhat misleading considering that most people visit the clinic with just one health option in mind: medical marijuana. For a cash fee and a good tale, the story goes, anyone can get a doctor's recommendation for marijuana. Patients with everything from AIDS to ADHD are treating their symptoms with the weed, and a person need look no further than a weekly paper in any town to find a list of doctors competing to write recommendations.
It's a familiar business model to be sure. Clinics operate with low overhead and have a ready-made remedy to offer patients, no matter the etiology of a symptom. Dr. Hanya Barth is a doctor specializing in medical-marijuana recommendations, but she doesn't want to be confused with the so-called prescription mills, despite her enthusiasm for the herb. Barth recognizes the potential for marijuana to be misused, but says that shouldn't detract from its usefulness.
"It's really not the medicine that's the problem," Barth says. " It's a great healing plant, but it can be abused. If I do a good job medically and someone does something inappropriate after I recommend marijuana, that's something I don't have any control over."
Barth is petite with long, gray-white hair and light-colored eyes obscured by a pair of wire-rimmed glasses. She doesn't fit any stereotype about what a marijuana doctor should be. Barth is a mother of seven, as she readily points out, and a grandmother to seven more. Though she doesn't use marijuana herself, Barth say she's constantly amazed at the range of illnesses it can treat, and that, not the money, is what drives her to open more clinics.
"The thing that surprises me every single day," Barth says, "is that this simple plant, that's considered by some to be a weed, can be so healing, physically and mentally."
Barth started her business five years ago, a modest one-woman operation where she answered phones, filed paperwork and saw patients herself. Today, she owns a chain of eight medical-marijuana clinics around the Bay Area and Northern California. The newest members of her green empire opened in Santa Cruz and San Jose last month, and there are already plans for a ninth clinic.
If it seems backward for patients to seek doctors based on the medicine they want to receive, rather than having a doctor diagnose a problem and prescribe a treatment based on medical expertise, that's because it is. But it's not exactly uncommon. Consider the way pharmaceuticals are marketed in magazines and on TV, where we see happy people run through green fields or play with puppies while a voiceover advises, "Ask your doctor about [insert drug name with side effects here]." There could come a day when big drug companies market marijuana, too, listing side effects such as dry mouth, forgetfulness and a strange compulsion for Doritos.
The California Medical Association, which represents more than 35,000 physicians in the state, has publicly supported doctors' right to recommend marijuana, and advocated the need for more research, calling restrictions on such research "failed policy." Still, the federal DEA compares the use of marijuana as medicine to using opium medicinally. Why, the DEA asks, would a doctor prescribe opium when there is a pharmaceutical version called morphine? And why would patients smoke marijuana, a controlled substance, when there is Marinol, a synthetic THC with side effects that don't include getting high?
The answers could be as simple as availability and cost. According to DEA estimates, marijuana is the largest cash crop in California, and it can be grown at little cost by anyone with a doctor's note. But how easy is it, really, to get the recommendation?
Compassionate Health Options' website has a list outlining the kinds of infirmity that a person might treat with marijuana. I'm young and healthy, but I cross-referenced the list and settled on a compilation of true-to-life symptoms. Insomnia, hyperactivity, anxiety—sure, I have these things. So with a cheerful stride and a pocket full of the Bohemian editor's cash, I headed toward the clinic and a greener future.
Inside, the office was clean and vaguely medical with white walls and the soothing music of Jon Bon Jovi. Across from the check-in desk was a waiting room with surprisingly ethnic magazines: Latina, Black Enterprise and, of course, Health. The intake form was six pages long and wanted information ranging from the quality of my relationship to my parents to my drug-use history. A quick screening and blood-pressure check by the receptionist confirmed that I was healthy. Then on to the doctor, a short man wearing jeans and an orange turtleneck under a blue flannel shirt.
Much to my surprise, he wouldn't diagnose me with ADHD or social anxiety disorder, or anything that could secure me a legal right to smoke weed. I had already handed over the cash! He did give me a temporary recommendation, good for two months, so I could try to treat myself while I looked for another doctor who would help me get a diagnosis. All of which raises the question: Why wouldn't a person just ask their regular doctor about marijuana?
Barth says that many people are still uncomfortable with asking their primary-care physician to recommend the same stuff they used to covertly smoke behind the high school gym. Many doctors are also uncomfortable recommending the drug, despite endorsements from organizations like the California Medical Association. To top it off, insurance companies refuse to cover marijuana purchases in the same way they cover pharmaceutical prescriptions or trips to a clinic like one of Barth's, which, she says, is one of the reasons she only accepts cash. It's like a vicious circle that keeps the herb from being truly accepted as medicine. The fact that many dispensaries or co-ops severely blur the line between pharmacy and weed exchange doesn't help either.
I felt compelled, despite the fact that I have too much anxiety to actually smoke marijuana, to visit a local medical-marijuana co-op. Before a person can even get close to the door at one of these places, there are several obstacles: identification, doctor's recommendation, light weapons check. No phones allowed, no cameras, no electronic devices, all to protect patient identity. It's a strange stance to take, considering that patients are presumably acting within the law, and it's an attitude that, again, conflicts with the idea that marijuana is medical.
Nonetheless, I passed security and headed to the intake desk for what was a surprisingly traditional medical experience—except for the magazine selection, which included West Coast Cannabis, a publication "for hemp enthusiasts everywhere!" and also, I gather, for people who like to look at really big pictures of marijuana buds. Black Enterprise was conspicuously absent.
My recommendation was deemed legitimate, so I headed into the showroom, where I felt the way a lot of people my parents' age feel about technology—overwhelmed by the options. It turns out there is a lot more to know about consuming marijuana than which side of the Zig-Zag to lick. Glass cases displayed more than pot; there were pills, salves, edibles, resins, dusts and even a few live plants. And the prices? Well, they were not how I remembered them. I left empty-handed, slightly offended at being offered a joint of shake for $10.
More striking than the price was the evidence that there is no typical medical-marijuana user. Some people in Barth's office or the marijuana co-op were visibly unwell, but otherwise there was no indication in any of the patients' appearances that they were a certain type—a marijuana-smoking type. Maybe it's just a California thing.
By Kylie Mendonca
april 21 2010
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