Jeff Jones: Thanks everybody for coming out this morning. I know that we're not listed on the agenda, but we do have some very important things to say, and our panelists want to share the research and their own activities involved in this issue. I speak to you today being involved for over ten years in the medical cannabis movement here in the bay area. I moved here in the early part of 1994, and within a week, walked into the San Francisco Cannabis Buyers Club that was run by Dennis Peron; and knew that I had to change things and what I'd be doing in the near future.

The era, the smell in the air was one of change, but I knew that what was happening in San Francisco may not be able to be replicated in other cities across America. Being from the Midwest, I grew up in South Dakota, I didn't think what Dennis was doing in San Francisco would be able to be done in the Midwest. And I soon embarked on a path that changed my life in Oakland; setting up a dispensary that was a model for being conservative and well run on and focused on a path of changing the way that it's looked at in our local community; and as Ethan (Nadelmann) put it so distinctly, institutionalize what we wanted to see in the future, and what we wanted to create in what our environment and our communities built on. And the panelists that I have here today have looked into that issue, and want to describe in their own ways what it means to them. The first one we have up is Amanda Penick, and she's from UC Berkeley.

Amanda Penick: Hello, my name is Amanda Penick and I'm from UC Berkeley; I'm a PhD candidate in the School of Social Welfare. I'll be actually receiving my PhD three weeks from tomorrow. I'm very excited, I've been in college for ten years, so it's a long time coming, and I decided to do my dissertation research on medical cannabis facilities in the San Francisco Bay Area. And the reason I decided to do that was kind of three fold: I felt like I was really in a unique position to do this kind of research, and as Ethan Nadlemann so eloquently put it before, start to legitimize what was going on with some of these facilities in San Francisco; so that when other states that have passed Medical Marijuana legislation wanted to open up the same kind of facilities to protect their patients from having to go and get their medicine on the black market; we could develop some kind of model of best practice, so that we could take it on the road, so to speak, and start to develop other facilities utilizing and preserving what has really come out of Dennis Peron's movement and the social model club here in San Francisco.

Again the three reasons I decided to get into this was that one I'm a patient myself, moving out here from Chicago in 2002, I was really impressed with what was going on in the movement, and thought it was something that really needed to be shared. I was also kind of tired of the news stories that talked about medical cannabis dispensaries, because they always show the same picture; either a really large bag of weed, or somebody smoking out of the exact same pipe. I think they've been using that same shot and that same pipe for four years, and what I was seeing was very different. I was seeing support, and I was seeing patients who were ill getting a lot of camaraderie from each other. I was seeing products being sold like books, and magazines and T-shirts, and I was seeing activism being generated in these facilities. That's what I wanted to get out to the public, and I thought if we could demystify what was going on really and show the positive things that were coming out of this movement; then maybe when we wanted to go develop a facility system in, say, Montana, or one of the other states that have recently passed legislation. It wouldn't be so scary, and we'd be able to bring this out of a place of legitimate research.

I am a patient. I'm also a researcher, and I'm also a social worker; so I thought that also could kind of give me a unique perspective into some of the social support benefits that go on in facilities.

I'm going to talk a bit about my study; and I'm going to give just a quick bit about the facility history, the medical cannabis facilities, and I use facility and dispensary interchangeably, and theres a reason for that − I did some pre-testing with the surveys I did for my study, and some of the feedback that I got was that some of the facilities/dispensaries prefer to be called facilities, because dispensary might lead to some incriminating activity, so I use facility in my research report, but I mean the same thing.

What was going on in Dennis Peron's home was really more of the social model. Lester Grinspoon kind of coined these terms: of the "social model" and the "pharmacy model" medical cannabis dispensary, and the "social club model" is pretty much what it sounds like: it's really not just about the dispensing of medication, but it's about the social support, and it's about addressing not only the medical needs of the patients, but the social and emotional needs of patients as well. And this is kind of on the other end of the spectrum from the pharmacy model, which is how the medical cannabis system is carried out in Amsterdam; which is really more of a "Walgreen's" style pharmacy: You walk in, you get your medication and you leave. Not the coffee shops, but the medical cannabis dispensing itself. And some people do prefer this, so I think that it's important to study both types of facilities, and kind of figure out what's working and what's not; so that we can offer both types to patients.

The rules as you know vary from city to city; as on the bay area, as far as medical cannabis facilities the three cities in the bay area that I was kind of focusing on were Berkeley, Oakland, and San Francisco, although my study sites were all in Berkeley and San Francisco. And then there's also the question as to what's going on in unincorporated areas. They also don't really know what to do, something that I was also noticing was that there were a lot of moratoriums being issued in unincorporated areas, around the development of medical cannabis dispensaries, and I felt that one of those reasons was because they really didn't know what to do. And it wasn't that they were against it or for it necessarily; but they had a lot of questions, and they didn't know how this was going to fit into their landscape. They're afraid of making bad decisions, and again this is one of the reasons I felt this study was important, because it gives people something to look at. And I also noticed that a lot of the debate around medical cannabis facilities was about the zoning. Is it this close to a school? Will people smoke outside? Should we have parking? Do we need this license or that license? And what was kind of being left out of the discussion was what do the patients want?

You know, when you start a new business or start a medical health service, you want to know who your patients are, who are you serving, what do they like, what do they want, you know, what works best for them. And this was what was kind of being left out of the discussions that were going on in city hall, which is another reason I felt it was important to do this study.

My study was both a description of medical cannabis patients and a description of the facilities. I had a patient based evaluation of services at seven different facilities, and also a description of the service utilization patterns at the facilities. For the description of medical cannabis patients, I looked at 130 anonymous surveys; and God bless them, each survey was twenty pages long and they were really hard to get through, but you know, I was sitting in these facilities for seven, eight hours at a time; we made a day out of it and had a good time, it was a great experience. So I was looking at demographics like gender, ethnicity and income; whether or not patients had health insurance, the length of time of their symptoms, and how long they had been treated. I had a measure of general health status, that covered physical, emotional and overall health; and then I also looked at two issues − one of self-medication and the other of substitution.

There's been some really interesting work by Dr. Mikuriya; around substituting cannabis for alcohol, and also for other drugs, and also the presence of self medication: We covered the spectrum of what is medical, what is not medical; and if I take an aspirin, and I just go decide to take that aspirin, is that self-medication? Well of course it is. I decided to do it . . . if I go have a cup of coffee in the morning, I don't need a doctor's prescription to do so; I decide to do it, and that's self medication as well. So that was another concept that I was interested in.

And then I also had an alcohol treatment component; and the reason I did this was because I noticed there were a lot of similarities between twelve step programs, and the social model of medical cannabis clubs, in that there really wasn't an expert on hand; like there's nobody in the club with like a white coat in there with some sort of stethoscope to administer your medication. And the people who work there mostly are patients, they are people that can relate very well to the people that they're serving. So that was where the alcohol interest came from. So I wanted to know if medical cannabis patients had been previously in alcohol treatment. If they had, was it their choice to go? And then their satisfaction with various types of alcohol treatment, so we could maybe look at some commonalities between alcohol treatment models, such is twelve steps versus like a hospital inpatient program; and different dispensary models, like the social club model versus the pharmacy model.

Besides the 130 patient surveys, I also collected seven manager surveys from each of the seven facilities where I did my research; because I wanted to know a lot about the environmental characteristics. If we know a lot about the patients and what they want, we also need to know what's going on in the building; and what the experiences are of the managers so that we can develop good services.

I asked the managers about how long they had been in service, their hours, square footage, what the I.D. requirements were to enter, rules and regulations in the facility, the staff makeup − so you know, do they have counselors on staff, do they employ legal council, security − what products are offered; and this includes cannabis and non-cannabis products. What services are offered besides the distribution of cannabis, and what the reported political and legal relationship has been like with the medical cannabis facilities and local government and police.

So,with the patient based evaluation of services, I really just wanted to know how satisfied patients were with the services they were receiving at the facilities − these were across four different dimensions: general satisfaction, access, interpersonal, and privacy. I used a standardized test in order to gather this. Privacy, I added on my own, and then service utilization after I went to each facility and had managers fill out surveys and tell me what services they offered, I then developed site specific patient surveys; so that when I went back to the facility to give the patient survey, they were only asked about services that facility offered. That way, I figured it wouldn't be as confusing. And I wanted to look at the social model, and the wide variety of services that are offered.

My methods were an exploratory, cross-sexual survey design. I had a hundred and thirty patient surveys at seven study sites; two in Berkeley, five in San Francisco. At the facility level and patient level data, I collected the data myself. All the surveys were anonymous, and I had people fill out surveys at the facilities themselves, so that they could capture the satisfaction.

The measures I used: I designed my own survey, I also had two standardized pieces: I used the Rand 36 item health survey in order to capture health status, and the patient satisfaction questionnaire three in order to capture satisfaction data. So how did I go about collecting this? Well, I basically just went to a facility, I got a list off the internet from the California NORML website; and identified a few in several areas of San Francisco I wanted to cover, and I just went and I brought my little Berkeley business cards and my little "human subjects have approved this study" form; and I just asked them if they wanted to participate. I said all patients would be completely anonymous, and then I explained the purpose, in that I really wanted to take what was going on here and start publishing it in social work journals and in public health journals and public policy journals; and I wanted people from other states to be able to read this information, and to use this information. People were really, for the most part, very supportive. I sampled from inside the facility. Some surveys were self administered; however, if there was a vision problem or literacy problem, I administered the survey, and I just asked everyone that came in if they wanted to participate. And I stayed at each place for about four hours or so, then I would just visit them at various times during the week.

First I'm going to talk about patient satisfaction; and I think that this is really important. As some of my other activist friends have told me this is what's going to be the sound bite. I don't have the comparison data, but the sample of two thousand medical patients that the patient satisfaction questionnaire was normed on; meaning that they gave it to two thousand people to see what the general feeling of satisfaction was in the country around medical services, and it's significantly lower than the satisfaction reported by medical cannabis patients. The scores − if one is a perfect score for satisfaction for medical cannabis patients ranged from .77 to .87, and for the national average is .5 to .65. So I think that that's showing that in addition to just dispensing cannabis, there's something going on that patients are really responding to.

And another question I felt it was important to ask was; "Why did you choose this facility today?", because I think it's important to know what patients deem important when choosing what facility to go to. So I had all these different reasons, and they could rate it on a scale of one to ten, each one with ten being the most important reason and one being the least important reason; and facility familiarity, comfort and security, and the staff were the three highest rated reasons why someone would choose a facility which really speaks, I think, to what we've heard all along: That patients really appreciate that the staff knows them, and that they know the other people there, and that they know what's going to happen when they come into a facility. They know what to expect. They know what kind of ID they need. They know what the process is going to be like. I think that's something that we've developed well in California, because people are really very loyal to their facilities. I know I am, I only go to one; and even if I'm not close to that one, I'll go to that one the next day, because I know the people there, and I feel really comfortable.

Some of the results of the organizational data: The seven facilities have been open ranging from 30 to 150 months. The range of patients seen is between 200 to 525 per week, and the number of services offered ranges from 0; which is the pharmacy model dispensary, to 17 services in addition to dispensing marijuana. The documentation needed for entry: Most dispensaries you just need your medical marijuana I.D. card; however it was observed that some of the dispensaries, if it's the first time you visit, you also need to provide a state I.D.

Other rules I looked at included whether you were allowed to use cannabis on site at all; and at only one out of the seven you were not. And that was the pharmacy model − whether you could use inside; whether there was a time limit on how long people could stay; whether there was a limit on the type of use that could be approved − vaporizing versus smoking; and whether or not tobacco was allowed.

Some of the cannabis and non-cannabis products −(and this is some of the information that I feel is really important to get out to the general population, especially when they have this narrow minded view of what goes on in medical cannabis dispensaries), because of course there's the buds/flowers, and the edibles; but there's also tincture, which people mix in tea; salve which is topical, butter, peanut butter, hash, and kif. And then non-cannabis products like coffee and snacks; and paraphernalia, t-shirts and books and games and then food and meals and stuff like that.

Another thing that I think is really interesting, is who's on staff at these facilities. The facilities I sampled had social workers, counselors, record keepers, legal council, security, cooks, and groundskeepers all working on staff. I know a lot of other facilities have masseuses, and acupuncturists that work on staff − a lot volunteer their time. And these are the services offered. Again, this is another thing I think is important to get out to the public; because other than cannabis, there is a myriad of services offered, and there's some research on coping styles: When people have chronic illness, there's basically two types of coping styles. There's the style where people really talk out their illness and really share and vent, and it really surrounds what they're going through. And then there's the coping style where they don't want to think about it. They're tired of thinking about how sick they are. They just want to have fun. They just want to relax; they want their minds to be on something else for a little while. And one of the things I noticed was that the cannabis facilities really represent both styles of coping strategies, because you have groups that are centered around certain illnesses, or for certain populations with an illness, such as women or men or veterans. There's groups surrounding issues of addiction, such as AA or NA; but then there's also groups like writer's groups, and quilter's groups. I went to bingo and it was so much fun! Open mike nights and poetry readings − There's cannabis related services; like classes on how to grow, classes on how to protect yourself legally, vaporizer lessons. There's social services like housing help, food, hospice delivery, referrals, and there's community events. One of the facilities I went to in San Francisco organized clothing drives for the community.

And then there's things like doggie day care, which is just a really cute service. But if you have a lot of medical appointments, or you have to go to work; you can drop your dog off, and pick them up when you're done.

So what's next? Well, lots of publishing, I hope; but I'd also like to take a look at this data and compare it to some of the national data which I've already done in satisfaction. But are also kind of looking at the issue of substituting cannabis for other drugs and self medication.

I also think it would be great to develop a best practice model of service delivery, so that other states can start medical cannabis facilities and in-depth studies of innovative facilities; such as the Berkeley Patient's Group, which I know has just opened a new health center nearby, where they offer yoga and all kinds of extra services. So I think maybe looking at one club really in-depth, and providing an evaluation type report would also be helpful.

And I think there's lessons for service integration for other health and social services. Coming from a social work background, I know that service integration is something we've struggled with forever; and providing a continuum of care where people go to get their food stamps, are also getting their substance abuse counseling, and they're also getting their welfare counseling, and they're also getting their job training all in the same building. And I think that a lot of that is going on in these cannabis facilities. And people go to get their medicine, and they stay because they feel supported; and they feel like they're getting something out of it besides just the cannabis. And that's what I really want to get into academia, that's what I really want to get into the journals, And that's what I really want to get out to the public. Because once the public sees the benefits of these facilities, and what's really going on, then it's not only going to benefit the medical cannabis community; but it's going to benefit the rest of the health and social service community, because we can learn from each other. So thank you, and I'll take any questions if we have any time.

Jeff Jones: Thank you Amanda, for coming and talking and presenting your important work. I hope that you continue it. Work like this helps to explain what's happening inside of these places not seen by most of America. I host UC Berkeley Political Science class once a semester, that comes to my office and has visited there, what, eight − nine years. It's called "Unseen America" and it's one of the most popular site visits that the class takes. We used to actually tour them through our dispensary and show them live plants and what it looked like. Since then, word has gotten out and now every semester, they have renewed their visit with me. It just goes to show you that there are interested minds out there that don't know very much about this, and want to be educated. And it's work like that, that helps educate them and spin them in the right direction. That this is something that is going to be different from what you thought it was.

We're going to move right into Martin Martinez, who is a patient advocate from Washington State area, and he's going to talk about his activities up there.

Martin Martinez: Thank you Jeff. I have been a patient since 1996, when I was hit by a car while riding a motorcycle in Los Angeles − Orange County − and so technically I am a California medical marijuana patient originally, but I've spent most of my time in Seattle. Most of my life in Seattle. I was arrested in '96, just before Prop. 215, and I presented a medical necessity defense. Over the course of two years I had a trial, and a couple of arrests. We developed the medical marijuana law in Washington partially through my ordeal. It was a testimate as to what is wrong with the prevailing picture at the time. At that time, after I was released from my legal obligations, I had been involved with the Green Cross Patient Co-op, quite a bit there at that time, but I left Washington and became a member of the Oakland group, with Jeff Jones. I was one of the fourteen patients who asked for permission from the high and mighty Supreme Court if we could please stay alive a little longer. Now we have Angel with the same, though a little bit more refined, arguments. And we're still here hoping that we ultimately prevail in the Supreme Court in the United States. If not that, we're hopefully going to get congress to do their job and represent the people who support medical marijuana which is apparently vast. I have some experience with the co-ops and the patient dispensaries but my experience is a little more specific. What we have here with the co-op situation is a group of people who support each other. The information that we've just seen shows a vast range of the applications of people who are providing cannabis and all of its associated features and applications and there's a great social network here in California which is very refreshing. In Washington, society is a little bit less open about this subject, obviously. I spent about four years here in the Bay Area and worked with Jeff a little bit, then returned to Washington around 2000, just before the Supreme Court pointed their fingers at us and said "No no no." And things have gone a bit downhill from there.

Politically, unfortunately, a lot of people from my experience officials, administrators have taken the news blips as policy flags and where there was a growing openness in Washington, during the prevailing Bush years, earlier conservatives have had a much greater voice in policy I think. However Green Cross, where it is not technically legal under state law to dispense marijuana from one person to another, Green Cross is tolerated. Green Cross has boasted two-three thousand patients at least, it's hard to say. It's a large group-affiliated network.

The word co-op, of course, cooperative comes from farming where farmers joined together to market and share their products. But in Washington, this is technically not allowable, even though it's tolerated. Instead when I returned to Washington, I decided that we were going to have a medical marijuana group where it would be entirely legal under the existing state law. There are flaws in the law, which I don't need to go into right now, except as contrast. But the real contrast I want to show here is the difference between a cooperative, which is a buyer's and seller's technically network, and cooperative, which is also a word derived from farming, but in a cooperative... excuse me a collective, people don't join together to market their wares, they actually farm together. And so what we have with a collective is a bunch of patients who are trying to help each other, and our motto has been "patients helping patients" since about the year 2000, with the Lifevine group in Washington.

The social services offered that we're seeing in Amanda's information is wonderful, and again it's refreshing that there's such a great social network, however the practical fact of trying to be a self-sustaining group of medical marijuana patients without non-patients involved is quite a work-intensive ordeal. Let me explain also that the medical marijuana law in Washington is a bit more specific and limited than here in the state of California. In Washington, the list is short, and not very sweet, if you're on the medical marijuana list in Washington you're probably very, very ill. And this of course leaves out a great deal of the people who are less sick, here in California who are patients, but are not necessarily terminally or severely, intractably ill who are able to perform a lot of the functions which we simply don't have in the pool of patients in Washington. The people are generally very ill − cancer and AIDS of course, and intractable pain is technically unrelieved by other medications. That means you are very, very ill. So we have a more difficult time providing for the group and therefore Lifevine itself is vastly smaller than any of the major 219 groups you have here in California. It's just not possible from my experience to have a self-sustaining medical marijuana group without a lot of strong healthy people to do a lot of the work. There's a lot of dirt to mix, we're not hydroponic for the quality reasons − we find better quality with soil, but of course it's a lot of work, and the problem is that people are sick, and when patients are trying to help patients, there's a lot of people who just can't make it. Great intentions are often not enough. Someone's got to water the plants every day, someone's got to do all of the work that it takes to do that and so what happened in about the year 2001 was the Green Cross coop had received an order from the Seattle Police Department to "Cease and Desist." They had been operating out of a residence and had received hundreds of complaints from the neighborhood, and they were forced to shut down for a month or so. At that time, my fledgling Lifevine group exploded to over 400 patients. Which is not much of course, compared to the Oakland group, but it's an awful lot for the small staff that we had.

It was too much. We couldn't really sustain the number of people without a large group of non-patients helping and we were trying to remain strictly self-supportive so over the course of a few years, the group has shrunk in size however the people who are involved in our Lifevine group are . . . I won't say desperate, but that is the underlying factor for people who cannot grow for themselves. The theory of the Washington State Law, of course, is that patients are allowed to grow for themselves. But giving someone the freedom and a couple of seeds does not allow them to get up out of a wheelchair or whatever their medical disability may be, and perform all the physical operations required to produce marijuana. So therefore, it's a balance, it's a difficult situation. We need more people to help, but we do have the law which is always a factor we always have to conform to.

I wrote a book called "The New Prescription − Marijuana As Medicine" Which outlines a lot of the science for medical marijuana up until the year 2000 when it was published. We're going to revise this book, it should be out in a year or so. But the medical editor on this first edition, Dr. Francis Podrebarac, was a patient also. He helped establish the Lifevine group originally, he always said that he would never stop his work until he could get marijuana from the pharmacy on the corner. And that's knowable. And there are great advances happening here in California to help not just legitimize, but institutionalize, integrate the medical marijuana dispensaries in society, and I'm all for that. However there's a broad range of motivations behind what we're doing here.

For me personally, it's also about freedom. Freedom from the pharmaceutical industries and freedom from the pharmacies. And therefore the law that we have in Washington may be very difficult for dispensaries to operate as they do in California, yet it does offer the freedom. Washington State does uphold individual rights of freedom in a substantial way, which is why I live there. And we have this freedom if we can manage to do the work to produce the medicine. The small group of patients who are helping each other is surviving and we do really appreciate the great margin of spectrum who are doing the works here in California because it sets a great example for us who are just a few people who are trying to struggle through. But we're networking, and we.re duplicating and we also provide lessons, and we provide information, and we provide lighting equipment and other supplies.

We're trying to also provide information because the biggest problem is that no one knows how to grow marijuana − it is an art that you learn over the course of experience. I'm trying to learn how to teach people to take care of themselves. Of course we all know the cliché "If you feed someone, you feed them for a day, but if you teach them how to farm, you feed them for life". I'm offering a DVD series which is in development now, this is the first disc, which is called "The Miracles of Marijuana", and it outlines some factors of patient use, which are very important these days in negotiations with authorities over cultivation amounts, which is the big bone of contention I've spent a lot of time in courtrooms, both for myself and for other people, about the amount of marijuana involved. That's the big scare factor is that you're allowing people to manufacture drugs in their own homes. Of course it's okay for the microbreweries, which are a big part of society in Seattle, but opening it up for marijuana has been harder. We're trying. We have a little store that we're opening up, but the problem is again the difference between the patients and the recreational users who are a bit jealous, but no one wants to pretend to be severely ill to get this right, but the police are a problem because they are always trying to catch us. I've been under surveillance, at my office for months at a time, Green Cross is inspected every month. They don't want to lose control of us. So it's a delicate balance and we're trying to learn and we're trying to stay alive, that's our main motivation. We really appreciate all the support, and I'm hoping we'll hear from some of you folks, at CannabisMD.org. We need to hear about the news from all over California, and all over the state, and stay in touch, and work together. We're doing great works, all of us, and I thank you. We're going to keep pushing. Thanks all.
Jeff Jones:Thank you Martin. Our next speaker is an inspiration to activists everywhere. His name is Don Duncan, and I hope that he brings some interesting things into your day.

Don Duncan: Thank you Jeff, thank you to the other panelists who brought us such good information. My name is Don Duncan. I'm on the board of directors of Americans for Safe Access, and I'm also part of the team that operates three medical cannabis dispensing collectives; one here in Berkeley, one in West Hollywood, and one just now opened in the heart of Hollywood in Los Angeles itself. In that capacity, with ASA and as a dispensary operator, I've had the opportunity to work with cities and counties all over the State of California on implementation issues, and I can tell you across the state, local governments are grappling on what to do with medical cannabis dispensaries. It's unprecedented in American law on how to handle an institution that is illegal under federal law, is very vaguely legal under state law, and has no local guidelines whatsoever to start with. I am happy to say that if you can measure the success of Proposition 215 and of our medical cannabis movement here in California by the expansion of safe access, then it's been a tremendous success. We've gone from one dispensary in San Francisco, to over 200 state wide. And I'm especially encouraged that we are now seeing a long awaited proliferation of dispensaries in Southern California, in Los Angeles, and the inland empire east of Los Angeles County. Even in San Diego, which is arguably the most hostile Jurisdiction in the Southern bit of California for medical cannabis right now. And that's encouraging. I remember for the longest time there were only dispensaries in Northern California, and it seemed like L.A. never would come along. And now it feels crowded in L.A., and so I think that's a tremendous success. And I don't just mean the traffic either.

There may be a whole range of reasons why dispensaries are proliferating so quickly, and perhaps the most important is because it's just an idea whose time has come. It's time in this process for these dispensaries, but of course the factor that's driving the increase in Southern California, in the rural areas, is the increase of new patients. We have perhaps a hundred thousand patients, estimates vary. At the conference in Santa Barbara two weeks ago, there was an estimate of somewhere between a hundred thirty to three hundred, thirty-eight thousand patients in California. Only about twenty-five percent of whom have safe access to medical cannabis at this time, so this huge number of patients is driving the proliferation of dispensaries in areas where previously, the communities were not so supportive.

There are also other factors that I think are also relevant to the capacity of the dispensary to serve their patients, and one I think is dissatisfaction. And I don't necessarily mean that in the harshest sense of the word, but a dissatisfaction amongst the patients with what they have. There are some dispensaries, some patients, which are dissatisfied with the services and with the medicine that they can find in the dispensaries; and that will often lead them to strike out on their own. And one of the exciting trends we're seeing now is that individual patients, people who are receiving services are getting educated, they're getting motivated, and opening their own dispensaries. And that is a wonderful step forward.

I talk to at least three or four people every week who want to do that, and we've come now to the point where those people have actually opened up and are operating; and now they are helping to train new dispensary operators from their patient base to open new dispensaries. And that is grassroots organizing in its purest form, I think, people just going out, taking the initiative, and doing it.

Of course, driving that proliferation of dispensaries is financial opportunity. And that's both perceived and real financial opportunity. There's a common misconception that anyone who opens up their doors as a dispensary will be a millionaire by the next week, and of course that is not the case. And yet medical cannabis is a growth industry in California right now. There are people making a lot of money at it, and that perception of financial opportunity I think is also driving the new dispensaries to open. And especially these areas where they've traditionally been less welcome. So the good news about the proliferation of these dispensaries is that having new dispensaries open, over 200 and growing here in California, remember these are only the 219 that we know about. There are plenty more that we don't know about yet.

This means that we're taking medical cannabis and Proposition 215 and making it a reality every single day, in the lives of tens of thousands of patients. That's no small thing. California's medical cannabis law is not theoretical or hypothetical. It's real every day in the patients. lives. And that's something to be proud of, and that's something to strive for in the other states. I know we're seeing inklings of that all up and down the West Coast and Colorado, and even on the East Coast now, and it's a trend I think we should encourage and support, because those new dispensaries in the other states are going to bring that same safe access and that same reality to those patients, and they're going to take the heat off of California. We could really use that.

Now, the bad news about this proliferation of dispensaries is that as the number of dispensaries grows; the challenges facing the local communities, the City Councils and Board of Supervisors, are also going to grow. And with the proliferation of dispensaries comes a proliferation of non-compliant, and perhaps less desirable dispensaries as well. Sometimes, this is the result of ignorance, about how best to operate; and sometimes just carelessness. But local cities and counties are now dealing with the issue of how to regulate their dispensing collectives and cooperatives. And they're not going to get any leadership from Sacramento on this issue. And so city by city, and county by county we're going to have to sort that out in a way that's relevant to those communities, that respects the values of those communities, and hopefully in a way that actually protects the patients as well as the neighborhoods in dealing with medical cannabis.

The problem with dispensaries that are raising concerns and are generating controversy in the community, isn't just for the immediate neighbors, the perception that dispensaries are problematic and that they bring criminal activity and nuisance behavior to neighborhoods jeopardizes the credibility of our cannabis movement here in California. It's very, very important for these dispensaries to be good neighbors and good citizens in their communities so that we can facilitate this growth and safe access.

The concern that local governments have when I talk to them, the city councils and boards of supervisors, are not the big issues. They're not concerned about the Supreme Court case. They're curious, but they're not really hung up on it. They're not concerned about Federal Law and the larger issues of ethics or morals around self medication. They're worried about smoking outside, they're worried about litter and graffiti and parking, and the other types of nuisance activities that cause their constituents to call and complain about medical cannabis dispensaries. And what we need to focus on in regulation I think is the nuts and bolts operation that is going to make these dispensaries good neighbors, and be sure to protect that safe access.

There are two aspects, and of course I could go on all day but I'm going to focus on just two aspects of medical cannabis dispensing collectives that I think would go a long way to shoring up that credibility, and preventing that kind of nuisance behavior that leads to complaints and to problems in communities. One is the organization of the dispensaries themselves, their sort of legal or structural organization, and the other is what I call the good neighbor policy.

Under our State Law, there's no explicit protection for a medical cannabis dispensary. It was not anticipated under Proposition 215, or at least it wasn't addressed under Proposition 215, and it's absent from SB 420 explicitly. However SB 420 does make a space for collectives and cooperatives of patients. And it's a small step from the collective and cooperative of patients to the dispensing collective, where a group of patients and caregivers join together to produce medical cannabis, to package it, to label it, and to provide it back. And in that model, patients would provide to that dispensing collective their excess medication, which would then be provided to the other members who cannot or will not grow their own medicine. And that model, that is membership based, and exclusively supplied by patients and caregivers who are members, I think is one that makes local government and neighbors very comfortable. They don't like the idea of "Wal-Marts of Cannabis". They're uncomfortable with that, but the idea of a group of patients working together, as a closed circuit, isolated from the illicit market seems to satisfy the mandates of SB 420 and allay the concerns of consumers.

One of the things we've been working hard to define is what a dispensing collective is under SB 420. And this is a work in progress. The information you'll find on this page about medical cannabis dispensing collectives was adapted from a return of property motion, filed in a case with an L.A. dispensary that was shut down. And the attorneys set out to identify what a collective or cooperative was in terms of State Law. This very wordy and not terribly elegant adaptation of that return of property motion, talks about a collective in which it is made up entirely of patients and caregivers, that's membership based with a closed membership, just to their registered members, where all the supply is internal. That I believe is the sort of legal organization that's going to lead us forward and allay those concerns, at least until a time that there can be some meaningful regulations from the State Government or a significant change in Federal Government.

Besides being legitimately organized, though, I think we have a behavioral issue that's perhaps even more significant with dispensing collectives and cooperatives. And that is what we talk about as our good neighbor policy.

You'll find a very short booklet called "Medical Cannabis and Our Community". This booklet was developed to talk to neighbors about dispensaries, because we were finding that the same questions were coming up again and again: What is a dispensary? Who are the patients? Are they safe? And are they legal? And that's what this booklet deals with, it's a layman's discussion, and it really is only the starting point of a conversation - not an authoritative treatise.

I want to talk just briefly about the good neighbor policy, which I think is so important because virtually all of the problems that I have witnessed in dispensaries in California were not from Federal Law but from local complaints. And unfortunately some of those local complaints, because of the values and policies of local police departments, turned into problems with the Federal Government; when the local law enforcement would contact the D.E.A., and bring them in and bust the dispensary, because they didn't feel like they had the tools available to deal with the complaints they were getting. A good neighbor policy starts with I think that legal integrity, being legally organized, restricting your membership to only those that are qualified, and taking very real steps to prevent diversion. We can't just pay lip service to legitimacy. We have to be sure that as the dispensaries operate, they're only providing medicine to their members, and that they are not allowing through lack of oversight, members to divert medicine into the illicit market. I personally wish there was no illicit market, that cannabis could just be legal, but then, of course, that wouldn't be an issue. But until it is, we have to have a line of which dispensaries do not cross.

In addition to maintaining that legal integrity, being a good neighbor has to do with providing adequate security that your community requires. And what that means is requirements will vary from neighborhood to neighborhood. But I think at a minimum this day and age adequate security would involve professional security guards, and appropriate physical security measures to protect the patients, protect the community, and to protect the medication.

Being a good neighbor has to do with preventing the nuisance activity. You don't necessarily want loitering. You definitely don't want diversion of medication in the cars or on the street corners, which was seen in some locations with the concentration of cannabis clubs. That good neighbor policy has to do with keeping that neighborhood safe, in good repair, clean . . . some of the dispensaries operate neighborhood clean-up days where we go up and down and sweep the sidewalk and make sure the litter is picked up so that we can demonstrate to the community that we're committed to their well being as well.

The good neighbor policy has to do with educating members because the patients are going to be, in many ways, ambassadors to the community; they need to know about the law, they need to know about their rights. They need to know about how to represent their dispensary in their community. Very early in my experience in Berkeley, we had an incident that turned up in a police report that was amusing and also troubling on some level. After the dispensary had been open a short time, a patient went walking out with a brown paper bag and a curious, suspicious neighbor said to the person "What's in the bag?" And the patient, lacking any other training, said "Oh, those are magic cookies. You can't have any". And those sort of neighborhood interactions are an opportunity to educate people and to allay their fears. So a properly educated patient base can deal with those issues, and can represent in the community in a way that reflects positively on dispensing collectives overall.

I think a good neighbor policy also deals with open lines of communication with your neighbors. Even in the best run dispensary, you will have complaints. Somebody's going to smell marijuana. Somebody's going to worry about their children walking home from school. And having open lines of communication will facilitate the kind of dialogue that keeps those things from being a crisis at the dispensary.

One of the things that we've experimented with at several dispensaries is putting phone numbers on the sign out front, so that if someone needs to reach the dispensary; instead of having a complaint that festers and they don't know where to go and they wind up calling the police department, there's a phone number there and if they have a concern about a facility, they can just call the phone number. And a simple step like that will help address those community concerns.

In West Hollywood, the neighborhood there was quite impacted by cannabis clubs. West Hollywood, the city is only 1.9 square miles. There were seven dispensing collectives in that city when they moved to regulate. And the neighborhood between the one I operated and the closest one, only about a hundred and fifty yards of housing between the two dispensaries. There was a tremendous impact - a lot of parking issues, smoking in the cars, that sort of thing. And the way we dealt with that, without getting the police department involved, was to just go around door to door and pass out business cards for both dispensaries. We said "Hey, when you've got a problem, call us up. We'll send someone to deal with it right away. You won't have to deal with this". Not only did that alleviate the nuisance activity, it really persuaded the neighbors that we were committed to protecting their neighborhood and looking out for their values. And that was a tremendous step forward as well.

And that of course leads to what I think is probably an important part of the good neighbor policy, and that is the response to the community concerns whether they be from the elected officials, or from the neighbors. We have to remember that being responsive to those concerns is the thing that's going to avoid the problems and keep the dispensary open. And in a situation where your mission is safe access, it's paramount to keep the doors open and keep serving the patients. And very few of us thankfully will ever have to face the D.E.A. But as medical cannabis becomes more and more a part of the daily routine of health care in California, virtually every dispensing collective and every group of patients is going to face the zoning board, and the business license department, and their City Council or Board of Supervisors. So having those open lines of communication and being responsive to those concerns is going to go a very, very long way to protecting the dispensaries.

I believe it's the fundamental responsibility of the dispensary operator to be a good neighbor, and to be a legitimate business. We are past the sort of "wild west" days of medical cannabis. We are coming of age as a legitimate health care industry, and it's so, so very important that these dispensary operators and the patients who visit them are committed to that kind of integrity, and that kind of good behavior in the community. And I always encourage patients . . . I hear a lot of grumbling from patients about this dispensary or that. And I always encourage them to use their ultimate authority in supporting those dispensaries that are good, and that are positive in the community, and helping to improve, or perhaps ultimately avoid those dispensaries that are not. That, I think, is going to shore up our credibility and protect these dispensaries in the future. I hope after the session you all will get down and be able to pick up this small booklet which is for patients − it's called "Medical Cannabis 101", and it talks a bit about choosing medicine. But germane to this conversation in the back it talks a bit about choosing dispensaries. Because it is an important part of this process that we bring to bear the market forces on those dispensaries that are good, and are committed to giving more, and are involved on a deeper level in medical cannabis. And support those and help those grow, because if that's the reality that we want to see in medical cannabis, then that's what we have to support, when we go in and we spend our money and our reimbursement, and that is what's going to make a difference. Thank you.

Jeff Jones: Thanks Don for your presentation and for your tireless efforts to bring safe access to communities that don't have it currently.