What is a Medical Cannabis Dispensing Collective? The majority of medical cannabis patients cannot cultivate their medicine for themselves. Most of California's estimated 75,000 patients obtain their medicine from a dispensing collective, often referred to as a cannabis club. There are more than 100 of these operating in California as of late 2004. Dispensing collectives require that patients register as members before receiving medication. The staff can then verify the patient's doctor's recommendation and provide legal patients with their legal medicine in a safe environment. How does the passage of SB 420 impact our community in terms of dispensaries? The state legislature passed SB 420 in 2003 in order to clarify the Compassionate Use Act (CUA), noting that problems and uncertainties in the act have prevented qualified patients and designated primary caregivers from obtaining the protections afforded by the act. It clarifies that primary caregivers may receive compensation for providing a qualified patient with medical cannabis. The CUA defines a primary caregiver as someone who has "consistently assumed responsibility for the housing, safety, or welfare of the patient." Dispensing collectives may be designated as the members' primary caregiver as they protect the patients' safety and welfare by providing medicine in a safe and reliable setting. Another provision of SB 420 states that an individual who has been designated as a primary caregiver by more than one qualified patient must reside in the same city or county as the patients. Therefore, under this law, dispensing collectives are necessary in every county in which patients require access to a dispensing collective as their primary caregiver. Cities and counties are compelled to implement ways in which qualified patients and designated primary caregivers can obtain the full protections afforded by the act. Should patients be allowed to medicate with cannabis on-site? Yes, for a few important reasons. First is that the dispensing collectives that encourage members to linger and use their medicine have positive psychosocial health benefits for chronically ill people. Lester Grinspoon of the Harvard Medical School observed the medical cannabis dispensaries in San Francisco in which patients were welcome to medicate on-site. He concluded that, The importance of the social aspect of buyers’ clubs cannot be underestimated. It is becoming increasingly clear that emotional support—contacts with and help from friends, family, coworkers and others—plays a salutary role in battling many illnesses. This kind of support improves the quality of life, and there is growing evidence that it may even prolong life. In one study, socially isolated women were found to be five times more likely to die from ovarian and related cancers than women with networks of friends and families. Researchers have consistently found that support groups are effective for patients with a variety of cancers. Participants become less anxious and depressed, make better use of their time and are more likely to return to work than patients who are given only standard care, regardless of whether they have serious psychiatric symptoms. The San Francisco buyers’ club functioned very much as an informal support group. If there is even a kernel of truth to the idea that talking about the stress, setbacks and triumphs in the battle against an illness can help a patient cope and recover, it is clear that the San Francisco

model provides the best environment for the dispensing of medicinal marijuana. (Playboy, November 1, 1998.) Second, many medical cannabis patients have to medicate as often as every 2 hours to alleviate their symptoms. Allowing patients to medicate on-site lessens the risk that patients will medicate before they get home and reduces the risk of open-air cannabis use outside the collective. Third, dispensing collectives who allow patients to medicate on-site are better positioned to provide other health services, such as peer counseling, massage, 12 step programs, and acupuncture. Another health service they may provide is the use of a vaporizer, a cannabis delivery device that delivers inhaled cannabinoids while avoiding the respiratory hazards of smoking, but is prohibitively expensive for most individual patients. How many dispensing collectives should be allowed in our area? Generally, no more dispensaries will successfully operate than there are patients who need them. The ones that provide better services for their members tend to flourish, and the ones that provide less eventually fail. Dispensaries have different atmospheres that patients respond to differently. Like pharmacies or coffee shops, patients like to have choices; therefore it is preferable to allow for a greater number of small ones to operate, rather than a small number of large ones. The number of residents who may require cannabis at some point in their life is surprisingly large. One out of four Californians, for example, will treat cancer in their lifetime, and may well find cannabis the only treatment that helps. Does the U.S. Supreme Court decision Gonzales v. Raich affect medical marijuana dispensing? While a June 6, 2005 U.S. Supreme Court ruling in Gonzales v. Raich (Raich) authorizes federal law enforcement officials to prosecute patients, California’s medical marijuana law remains intact. The decision does not say that the laws of California (or any other medical marijuana state) are unconstitutional and does not invalidate them in any way. Also, the decision does not say that federal officials must prosecute patients, leaving the discretion open to the federal government. The Court also indicated that Congress and the Food and Drug Administration should work to resolve this issue. The same day of the ruling, California Attorney General Bill Lockyer issued a statement affirming the state’s medical marijuana law. Lockyer followed up with two bulletins to all California law enforcement agencies issued on June 9 & 22, 2005, to be absolutely clear. Since the decision did not overturn state law, conduct currently protected under California’s medical marijuana law will continue to be enforced in the manner it has been. Despite the Raich decision, twenty-two cities and counties have accepted responsibility for ensuring safe access to medical marijuana by establishing regulations allowing for and protecting dispensing. There are also a number of localities that are currently addressing the issue of collective and cooperative dispensary regulation. Many current moratoriums have been adopted to ban the establishment of such facilities until the impact of the Raich decision can be assessed. While it is reasonable to allow time for the development of sensible and fair policies, it is unacceptable to use the Raich decision to stall implementation of or ban collective and cooperative dispensaries, as those actions would be contrary to the spirit and intent of the CUA and SB 420. Since the ruling does not say anything about the legality, regulation or operation of medical marijuana cooperatives and collectives, City Councils and Boards of Supervisors are still bound to uphold and enforce California law and must act expeditiously to develop and implement reasonable and sensible policies.