Doctor's orders: Get high

A trip into the medical marijuana demimonde smokes out America's confusion about drugs, pleasure and morality.

Published January 31, 2001 8:00PM (EST)

To get pot, you can stand on 16th and Mission and wait for someone to approach you, and wonder if he's a cop, and wonder if he's going to rob you, and wonder if his pot is laced with strychnine. Or you can have a dull pain in your right ear.

In a green box on the back page of the San Francisco Bay Guardian, Dr. R. Stephen Ellis advertises medical marijuana physician evaluations for just about anyone. The ad contains no explicit offers or promises, just a list of symptoms that presumably qualify one for legal pot: "Anorexia ... chronic pain ... arthritis ... migraine, or ANY other condition for which marijuana provides relief." This is from California Health & Safety Code 11362.5, implemented after California passed Proposition 215, also known as the Medical Marijuana/Compassionate Use Act, in 1996.

In case his point is unclear, the ad goes on to interpret "ANY": asthma, neuropathy, HIV discomfort, constipation, old injury pains," etc. At the bottom, boldfaced, underlined, in caps, we're reassured: "It's THE LAW!"

My ear hurts, I tell the assistant over the phone. He tells me to bring $200 cash. No check or credit card? I ask. Cash, he says.

Ellis' office is at the end of a long, dark corridor in a tall building next to a fabric store. The $200 cash does not go toward interior decoration. A cardboard sign with Ellis' name is taped to the glass on the wood door, which appears to be a good 50 years old. This is medical marijuana noir. That Philip Marlowe isn't smoking a cigarette on the other side seems to be a miscalculation on the director's part.

Not that the other side isn't dark. In the grimy waiting room, which is just a little bigger than a glass of whiskey, six tired men in plastic chairs take their eyes off the linoleum only briefly.

"I have an appointment," I say to Ellis' assistant behind the window. He's young, wearing a sweat shirt.

"Have a seat," he says, handing me a clipboard.

There shouldn't be enough room for two camps in the tiny room, but the six patients manage to segregate themselves. To my left are the ill; three men between 35 and 50 sink into their chairs and stare at things in the floor that I can't see. Their eyes are glassy, and two of their heads are chemo-bald. To my right are three young men, none over 22 surely. They slump too, but with attitude, not sickness. They have baggy jeans and each has acne. The young camp looks at its shoes.

The man directly to my left says he has glaucoma. He's grumpy about waiting. The man to his left says he's new to medicinal marijuana and is shaking and giddy. The man to his left sells sports tickets for a living, and is doing so on a cellphone, apparently unfazed by his circumstances. The grump beside me is New Agey and shakes his head whenever the cellphone rings.

To my right are frauds. "I hurt my back playing football," the big one next to me says. He grins conspiratorially, as if he's never touched a football in his stoner life. Across from us a raver taps his toes. He grins, too, when I make eye contact. The surfer next to him grins too. "I better get this before my man Nate's party Friday," he says to no one in particular.

"How long does it take to get the prescription filled?" I ask.

"My other friend got some from a San Francisco dispensary two days after his evaluation," he says.

I wonder how many scammers it would take to undermine the medical marijuana cause. (This line of thinking is a vector from the anti-pot camp's faulty premise; penicillin would never be criminalized just because some people were smoking it on Friday nights.) And while it's entirely possible that none of these guys will leave today with a prescription, the quiet raver does eventually have his appointment and walk out with a thumbs up. He directs the thumbs up at me. It's assumed I'm in the fraud boat too.

To me, it's unclear what boat I'm in. My ear does hurt. I've considered cutting my head off and throwing it in the ocean. The pain is intermittent, and in fact I haven't had any for weeks, but when it's around, I would smoke medicinal crack if it did the trick. Normal doctors and two specialists were no help. It's not an infection, we have determined. I got hit with an oar once, I always offer. The doctors and specialists nod.

So I have chronic pain but not glaucoma and consequently suffer a faker's guilty conscience. Not that fakers are taking pot from the legitimately ill -- there's plenty to go around. Still, I don't know where I belong, waiting room-wise, and keep myself between the ailing and the insincere. Uncertainty emerges later as a motif in the medical marijuana universe, but for now, I'm being called into the examining room.

Ellis joins me in the bare room, slight, friendly and rushed. He seems breakable. He also has the air of celebrity, probably because he's the only man many people know who can legalize pot, albeit one smoker at a time. He talks fast, like someone who either has been in an E.R. for years or has a line of patients out the door, each with a wad of cash. He takes my money and puts it in his pants pocket.

"My ear hurts," I say, and I explain the pain. My honed explication of the problem doesn't seem to interest him. He interrupts after a minute, telling me to take my shirt off so he can use his stethoscope.

The checkup is rudimentary. He hears my heart. He takes a peek at the bad ear. He looks into my eyes. I offer my oar theory. There's a brief, touching moment where he pats my arm, not weirdly, and then he's signing his recommendation. For the next 12 months, I'll be a legal medical marijuana smoker.

- - - - - - - - - - - -

I'll be a legal medical marijuana smoker in California, that is. California may have approved Proposition 215 four years ago, but 215 has yet to be reconciled with federal law, which still classifies marijuana as an illegal narcotic.

There is no consensus on how to interpret the ambiguity. California's medicinal marijuana proponents say medicinal marijuana is protected under law. The police, depending on the county, generally don't arrest smokers who have a prescription, except when they do. Courts often drop cases, depending on the judge, or how a jury might respond.

Federal authorities generally say let's wait for the U.S. Supreme Court. They're referring to the long-anticipated ruling, which is likely to come down this summer. In September 1999, the 9th U.S. Circuit Court of Appeals ruled that "medical necessity" justifies violation of federal distribution charges. The Clinton administration asked the Supreme Court for an emergency order to stop the Oakland Cannabis Buyer's Club from selling pot. The order is temporary, and this summer the court will issue a final ruling on whether federal law permits the medicinal use of marijuana.

It will be a significant ruling politically -- a verdict against 215 and similar measures would be a verdict against states' rights, typically a Republican cause -- but the efficacy of any ban on medical marijuana would be dubious. It can't overturn California's 215, or the medical marijuana laws in the seven other states that have passed them. Likewise, state and local police can't be forced to enforce the federal laws.

Discerning any trend in the response to the medical marijuana question is difficult. In January, charges were dropped against Robert Voelker, a Marin County man found growing 19 pot plants adjacent to his trailer home. Marin Superior Court Judge Verna Adams ordered the confiscated plants returned to the man, according to the Marin Independent Journal. Given the physician's recommendation that Voelker subsequently obtained, it seemed no jury would convict him.

Other "legal" users don't get off as easy, and the pro-pot groups all have stories of various authorities flagrantly disregarding medical marijuana legislation. One Web site devoted to Proposition 215 contains a letter sent by senior U.S. Customs inspector Mark Johnson to a marijuana-prescribing doctor in July 1998:

"As a reminder you may want to tell your 'patients' that although they may have received a 'prescription' for marijuana from your office it will hold no weight as far as federal or state laws are concerned. Such was the case a few days ago when we confiscated less than a gram of marijuana from one of the people who had put their confidence in you ... This was a stiff $500 lesson for someone who probably couldn't afford it, but erroneously placed their trust in you."

There remains confusion at the medical level, too, but nothing like there used to be. Plenty of doctors maintain that pot's a damaging and addictive narcotic, but more and more point to studies confirming its medicinal value. In November, for example, BBC News reported that 80 percent of doctors in the United Kingdom would prescribe medical marijuana to patients with serious illnesses if they were allowed to, according to a study by Medix UK, a Web site for doctors.

If statistics like those from the Medix survey are surprising, it's because the evolution of thinking within the medical community has been undermined every step of the way. Even Drug Enforcement Administration administrative law Judge Francis Young's 1988 acknowledgment that pot "has a currently accepted medical use in treatment in the United States for nausea and vomiting resulting from chemotherapy treatments" got buried after a while. And of course marijuana's benefits among AIDS patients -- cannabis can help stimulate appetites, for example -- are obscured regularly by pot prejudice and AIDS prejudice.

As far back as 1982, then Rep. Newt Gingrich wrote to the Journal of the American Medical Association criticizing the "outdated federal prohibition" of medical marijuana, and the "bureaucratic interference" it encounters, as reported by Michelle Malkin in the Seattle Times. Sixteen years later, Malkin pointed out, Gingrich was "Speaker of a House that just declared that marijuana 'contains no plausible medicinal benefits.'" If doctors like Ellis eventually excuse themselves from the medical debate and start furiously signing pot prescriptions, it might be because the medical debate is stuck on repeat.

None of the above -- the legal and the medical disputes -- particularly matters. In the United States, medicinal marijuana still occupies a place far from the realm of reason. The terms of understanding are primitive. We rely on imagery and hysterical association to direct, and then articulate, our support/disdain for the movement. Like all drug debates to emerge in the past 15 years, this one is a closed system, impervious to new information. Progress occurs in spite of the alleged national conversation.

Within the conversation, those opposed to medical marijuana have made little rhetorical progress since 1936's now-camp propaganda film "Reefer Madness." As few researchers will deny the drug's medicinal value, its detractors employ abstract versions of morality (it's "evil") and foresight (it's a gateway drug) to make their case. These tools interact with the presiding convention of all drug debates -- a collective disregard of logic on both sides -- and consequently we no longer ask why pot is evil, or how we can legislate something because it might lead to something worse. (Are forks a gateway weapon?)

Those leading the medical marijuana charge can be dismissed, too: They're potheads. If there's a single obstacle to the acceptance of the drug's medicinal virtue, it's that it's fun, too. The high that accompanies the pain relief is the unspoken doozy conservatives can't surmount. That medical marijuana users experience this -- and perhaps even enjoy it -- diminishes their credibility.

The high is distilled subversion. What else could it represent? Like sex, religion and the red menace, its threat lies in its utter ungovernability. Transcendent or faux-transcendent experiences aren't only dismissed because they're hokey -- to some, they seem to be downright unpatriotic.

Still, in spite of the noise and in between the zealots, attitudes are quietly changing. If polls are any indication, the average American is more open to the idea of medical marijuana than ever before. The dialogue has never broken free from the larger drug war discussion, but it has cooled off some. On a case-by-case basis, we seem to be remembering that we don't want our loved ones' chemotherapy worse than it has to be, and that in fact we, or our friend, or our aunt, has smoked quite a bit of pot for quite a long time, and nothing bad has happened yet.

Getting a physician's recommendation from Ellis may have been easy, but getting him on the phone for an interview is another story. It isn't until a month after my visit that he agrees to talk.

"What were you doing before this?" I ask.

"I was at emergency rooms," he says.

"Which ones?"

"Various emergency rooms in the Bay Area," he says.

He won't say how many patients he's seen since opening the office in July -- "let's say several hundred," he finally tells me. Nor will he say how many are ultimately granted recommendations. I get the impression most walk away satisfied.

"What about fakers?" I want to know.

Ellis assures me that fakers don't make it to the examination room.

"They realize it's a legitimate medical setting and go home," he says. "They can't get in without supporting documentation." I tell Ellis that I was not asked for supporting documentation. He says he has since changed that policy, though I sense that he did so reluctantly.

"We don't [require supporting documentation] in the E.R.," he says. "People come in complaining of a headache, we go over to an open cabinet and they leave with a shot of Demerol in their butt."

"And that's unfair?" I ask.

"Marijuana is much more benign than conventional narcotics," he says.

We talk about his history. Ellis graduated from the University of Illinois medical school at Chicago in 1978, he says. His work as an emergency physician exposed him to "a real need" for better pain management strategies. A few seminars on medical marijuana persuaded him to look into alternative treatments.

If Ellis was uneasy at the beginning of our conversation, he's in a gallop by the end. I ask why so few California doctors are recommending marijuana for pain four years after the passage of 215.

"They're afraid," he says. "They're afraid of the [California] Medical Board, and of their peers, and possibly of potential legal ramifications ... even though they're clearly protected by the law."

It's the California Medical Board that gets Ellis fired up.

"They've been officially silent [on medical marijuana], but behind closed doors they've been harassing physicians," he says. "That's the bottleneck on 215. Patients can't get their docs to prescribe medicinal marijuana, even though the law allows for this. In California, you might find 1 in 1,000 doctors" who would.

Ron Joseph, the board's executive director, calls Ellis' charges ridiculous.

"It's a nice fallback," Joseph says, "but I defy him to cite one case where the board has harassed a single doctor."

As Joseph tells it, it's not the board's policy to have an official position on medical marijuana -- it would just as soon have a position on X-rays.

"We don't say whether it's good or bad, appropriate or inappropriate," he says. "We simply ask, 'Has the physician applied good judgment?'"

Because the board's procedure is simply to investigate a "physician's actions as they're brought to our attention [by a patient]," he says, it has no incentive to bother doctors who are prescribing marijuana.

So why aren't more doctors prescribing marijuana? Joseph blames the government.

"The chilling effect has come from federal [agencies]," he says. "Doctors might be afraid of losing their DEA permit" (which allows them to prescribe controlled substances).

As for Ellis' objection to the liberal distribution of Demerol in the E.R., compared with the paucity of marijuana presciptions in the doctor's office, Joseph says an E.R. deserves its own standards.

"It's a much different situation," he says. "There's little time to make the diagnosis [in the E.R.]. This is not the case in an office visit where the patient has the opportunity to explain his medical history."

- - - - - - - - - - - -

If a patient is able to obtain a physician's recommendation, he or she must next join a buyer's club. The Oakland Cannabis Buyer's Club is a mile from my house, so I swing by on a Saturday. Like Ellis' office, the OCBC is also low-rent, but it makes up for it in atmosphere. If Ellis' operation was film noir, the "Co-op" is Cheech & Chong plus "Beaches." The store mixes earnest compassion for the ill with a healthy appreciation for fat, leafy weed. Inside, past the pipes and bongs and vaguely pornographic poster of a luscious green bud, a woman at a counter sorts membership files. (The club has roughly 4,000 members, executive director Jeffrey Jones tells me later, but it's hard to count. Why? I ask. "We don't know how many are dead," he replies.)

The woman at the counter gives me paperwork and takes my physician recommendation, a copy of which I'd already faxed in for approval. I do the paperwork and pose for my photo and pay the fee. My $21.95 entitles me to a list of active dispensaries, support in the event of police trouble, free massages and regular cultivation seminars. Cultivation? I ask. I can grow up to 48 plants, they say -- beyond that it's risky.

My new member I.D. is my "shield." If a cop stops me for possession, I need only flash the card. If that doesn't work, the officer is to call the 24-hour phone number on the back, and the club will vouch for me.

"But this is legal, right?" I ask.

"Well," they reply, "yes. But call if there's a problem."

I'm out in 10 minutes, but still without pot. This is because an injunction keeps the club from selling it. When the government went after buyer's clubs in 1998, it went after the six biggest. No attempt has been made to close the others that sprang up subsequently, Jones tells me. And nothing keeps the OCBC from directing me to an active dispensary two blocks away.

"Why did the government pick on some pot clubs and not others?" I ask Jones. Surely it knows about the other dispensaries.

"Who knows?" he says. "Maybe they wanted a martyr."

"But nobody's going to respond to martyrdom when it comes to getting marijuana," I say.

"Then maybe we were doing too good a job helping people," he says.

The unmarked dispensary two blocks away is to pharmacy as Bates Motel is to Ritz-Carlton. Metal gratings cover the windows of the old building, which begs for a paint job or some dynamite work. A guard stands out front and thoroughly inspects my paperwork before sending me inside to the next guard, who also thoroughly inspects my paperwork. Then I'm sent to a desk, where I fill out more paperwork, show my OCBC card, put a dollar in a jar and gain access to the next room.

The next room is un-American. It's how Amsterdam is described among teenagers, a perversely legal assortment of illegal things: pot plants, pot brownies, pot cookies, pot seeds and, of course, pot. Half a mile from the Oakland Police Department, two glass counters full of dope and a promising back room await anyone with an OCBC card and some cash. There is no catch. I experience the brief heartbreak of poorly timed access -- this kind of opportunity would've been great back when I liked pot -- but mainly I'm glad people who need it can get it.

I buy an eighth of an ounce of the good stuff, not the great stuff. It's $45. The guy behind the counter is nice like a nurse. The place isn't a neighborhood drugstore -- no matter how medicinal your marijuana, it's still pot, and pot culture is irrepressible -- but there's no Pink Floyd or opium-den decadence, either. On the wall is a mural of a sunny Oakland park, full of relaxed people in various stages of illness. They appear positively pain-free.

- - - - - - - - - - - -

The night I begin writing this article, I turn my head and the old ear pain shoots back. It's mild at first, then heavier. The pain isn't really inside the ear, but rather right where my ear hits my head. It hurts when I push on it and when I move. I decide it's time to take my medicine.

I don't really get high anymore. Back when I did, I never experimented with pot's medical potential. I dig out a pipe and get to work. The first thing I do is underestimate how strong it is. I take two big hits, then sort of walk around, then take two more. The high is always indistinguishable from the ritual in the first three minutes, so it's a while before I know what's what. I sit and begin writing. I get up and look for something. I find incense in a drawer and light that. I sit and write some more. The pot is strong. My head is light, or heavy. I get up and put the incense out. A piece rolls behind the couch, still burning, and the house almost burns down. I find the piece. I sit down to write again and then remember to see if my ear hurts.

It does. But not as much. I think. Does marijuana just make you too stoned to evaluate pain? This would be dumb. I consider Ellis. It's hard to conclude anything about him, for he's as ambiguous as every other element of the medical marijuana question. In a city of either conservative or craven doctors, he's taking a chance. Those who take chances to improve the lives of the sick and dying are heroic. But at the same time, it wasn't just the sick and dying in that waiting room.

Ellis, like many medical marijuana advocates, is breathless on the subject. He perceives an injustice perpetrated by the medical establishment and by the federal government. If he's occasionally quixotic on the issue -- the executive director of the California Medical Board can't imagine what Ellis is tilting at -- one can infer that he's either dramatic or tired of seeing people in pain.

Finally, what will happen to a doctor in a tiny office who flouts federal law on the back page of the San Francisco Bay Guardian? Is he in danger?

"I don't know," Jones from the OCBC had said. "Is a bug that flies into the light in danger?"

Because he's working with other information, or because he's blinded by the light, Ellis himself isn't scared.

"They'd be crazy if they bothered me," he'd told me, before getting off the phone to see another patient.

By Chris Colin

Chris Colin is the author most recently of "Blindsight," published by the Atavist.

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