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Posted inPolitics

MEDICAL CANNABIS PAVED THE WAY FOR LEGALIZATION IN CALIFORNIA. NOW PATIENTS FEEL
LEFT BEHIND

by Alexei Koseff August 1, 2023August 1, 2023

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Bonnie Metcalf meditates at her Sacramento home on July 20, 2023. Metcalf
suffers from sarcoidosis, an inflammatory disease, and takes cannabis products
to ease the pain. Photo by Rahul Lal for CalMatters

In summary

Frustration runs deep among medical cannabis patients and advocates who say the
commercial market created by Proposition 64 in 2016 isn’t meeting their needs.

Turn off Highway 99 in rural Elverta, drive five miles down the road and you’ll
find a dusty lot crammed with cars on this scorching Friday evening. Behind the
wooden fence, for a $10 entry fee, awaits a gathering akin to a block party
crossed with a high-potency farmers market.

Alongside shirtless young men displaying jars of weed and decorative bongs,
there are tacos and smoothies for sale. A woman in cannabis leaf-patterned
shorts peruses the merchandise, while another with a severe black bob offers dab
hits near the front. The DJ occasionally interrupts his mix of throwback hip-hop
tunes (do you enjoy Coolio’s “Fantastic Voyage”?) to sell tickets for a raffle
raising money for one vendor’s comatose employee.

Next to his booth, a table gives out free cannabis for veterans, who don’t have
to pay to get into the event. Neither do patients with a doctor’s
recommendation, like Dannie, a barber who was shot three times in his left arm
and smokes cannabis to manage pain often inflamed by cutting hair.

Dannie, who agreed to be identified only by his first name, said he carries a
medical recommendation because it’s safer should he ever get stopped by the
police. But he still prefers buying weed at these clandestine pop-ups, where the
products are more potent than at a dispensary.

“I’d rather spend my $30 on something that lasts,” he said.

This is just one of four unlicensed cannabis “seshes” in the Sacramento area
that Bette Braden will host this week, as she does every week. The events
started eight years ago for medical marijuana patients in an era of looser
regulations, before California legalized recreational sales.

Since 2016, when voters approved Proposition 64, the initiative that authorized
a commercial cannabis market in the state, Braden has come to view her seshes as
both a business opportunity and an act of protest. Like many longtime advocates,
she believes all weed use has a medical purpose, and considers it immoral that
high taxes and a lack of dispensaries have made it inaccessible to many
patients.

“The laws are so hideous,” Braden said, as she supervised from a camp chair near
the entrance. “I used to be an activist. Now I’ve gone over to the underground.”

‘NO ONE REALLY CARES ABOUT THE MEDICAL SIDE’

Frustration runs deep among medical cannabis patients and advocates who — by
persuading voters to pass Proposition 215 in 1996 — paved the way for legal weed
in California, but now feel left behind in a post-Proposition 64 era. In a
profit-centered system focused on recreational sales, they argue there is little
consideration for patients and their unique needs.

Collectives that once provided cannabis and community largely dissolved nearly
five years ago, as California transitioned to a new regulatory framework based
around licensed growers and retailers. Dispensaries, which are still prohibited
in many parts of the state by local rules, have not widely embraced a
replacement program that allows them to donate medical marijuana to patients who
cannot afford to buy it. Medical identification cards, which can cost several
hundred dollars to renew annually, confer few tangible benefits.

“No one really cares about the medical side, and that’s a mistake, because
that’s where the value is,” said Richard Miller, who has promoted patients’
rights at the state Capitol for nearly two decades as a member of the American
Alliance for Medical Cannabis and Americans for Safe Access. “I’ve been feeling
over the past year like my work is a failure.”

The shift to treating medical marijuana users more like customers is especially
tough for older patients with limited incomes and those with chronic conditions
who need a large amount of cannabis for treatment. While California physicians
can recommend cannabis for conditions including arthritis, glaucoma, migraines
and seizures, most health insurance plans do not cover medical marijuana because
it remains illegal at the federal level.

> “My life is being messed with. I should not have to continue to…search out
> ways of finding the only medicine that has ever helped me.”
>
> bonnie metcalf, who uses cannabis to ease pain from an immune disease

So some cost-conscious patients seek other ways of getting their supply, such as
the underground seshes sprouting up around the state. That further bolsters an
illicit market that California has struggled to bring under control and alarms
advocates who want patients to have high-quality, safe medicine.

“There are some things in this world that should not have a f—ing price tag. And
feeling good when you’re sick is f—ing one of them,” said Bonnie Metcalf, who
lives in Sacramento County and suffers from sarcoidosis, a disease of the immune
system that fills her body with lumps of inflamed cells called granulomas.

With an $1,100 monthly disability payment her only income, Metcalf said she
cannot afford dispensary prices and relies on friends and Braden’s pop-ups for
cannabis.

“It ain’t funny no more. My life is being messed with,” she said. “I should not
have to continue to do this, to have to, you know, search out ways of finding
the only medicine that has ever helped me in a way that I can still have a value
to my life.”

‘IT’S NOTHING BUT PAIN’

Metcalf’s body is snap, crackle, popping as she rolls into the living room in
her motorized wheelchair for breakfast. An excruciating tingle runs from her
neck and shoulders down through her hips and legs, she said, like a limb that
has fallen asleep. It’s a dull, aching, don’t-fricking-talk-to-me kind of
feeling, the same agony she wakes up to every day “until I get some pot in me.”

“As soon as I hit this reality, it’s nothing but pain,” Metcalf said. “It’s the
first thing I think about. Because how can it not be?”

Metcalf does not like the side effects she experienced with pharmaceuticals —
she took a steroid for her lungs that she said gave her diabetes — so she
primarily sticks to cannabis and meditation to treat her sarcoidosis.

“It’s very strange, because there’s a point you get to where you don’t give a f—
that you have pain. You’re so euphoric,” she said. “People would say, ‘Oh,
you’re just doing it to get high.’ Well, yeah, dude, I would rather be in a
euphoric state of mind than, you know, I can’t get comfortable. You can’t eat.
Your muscles are constantly spasming. I’m on hot water bottles. I mean, it’s
ridiculous.”

Bonnie Metcalf prepares to take a cannabis-based product during her medicating
session at her residence in Sacramento on July 20, 2023. Photo by Rahul Lal for
CalMatters

Cannabis has been part of Metcalf’s life for decades: Now 61, she said she first
smoked weed at the age of 8, when an older teen gave her a joint at the park,
and became an activist for cannabis access as a teenager.

While living in San Francisco in the 1980s, she worked with cancer and HIV/AIDS
patients, Metcalf said, advocating for them to be able to use cannabis in
medical settings. She collected signatures for the initiative that legalized
medical marijuana and, after it passed in 1996, moved home to Yuba County, where
she opened her own cooperative. Metcalf said she would drive a bus of patients
down to San Francisco twice a month so they could see a doctor and get their
paperwork in order.

That ended after 11 years, when Metcalf became too disabled to run the
collective any longer. Despite her activism, however, she now refuses to get a
doctor’s recommendation or a medical card or shop at dispensaries. She’s furious
at how Proposition 64 commercialized cannabis in California, prioritizing
getting high over medication and pushing aside longtime activists, growers and
mom-and-pop businesses with expensive licenses and regulations.

“The system that exists is bulls–t,” she said. “These rich people are paying
more for packaging and branding than they are worried about medicine for people.
They don’t care. It’s not a medicine to them. It’s just another money-making
scheme like beer or cigarettes.”

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After eating a sausage scramble with green onions, Metcalf follows a meditative
routine to help her mind vibrate above the pain. For her daily sacraments, she
burns a bay leaf, a bundle of sage and a stick of palo santo, waving them around
her body and each door in the house. She takes off her shoes and sits in the
backyard for a few minutes, sticking her bare feet into the dirt to ground.

Finally, it’s time to medicate. Metcalf said she can no longer smoke weed
because of the granulomas in her lungs. Instead, she takes two daily doses of
FECO, a highly-concentrated cannabis extract — one in the morning to relax her
body and one in the evening to help her sleep.

Bonnie Metcalf lights sage during her morning routine at her Sacramento home on
July 20, 2023. Metcalf spreads the smoke to entrance and exit points to clear
negative energy and promote relaxation in a ceremony rooted in her Indigenous
heritage. Photo by Rahul Lal for CalMatters

Back in her room, Metcalf turns on a playlist of affirmations by the musician
Toni Jones and says a silent prayer (“May all beings live in peace, harmony,
love and bliss”). Then she dips a fork into her jar of FECO and puts a dab of
the oil on her tongue. She spits a chunk back into the jar, then bites another
piece off the fork, until she estimates that she has half a gram.

The sensation starts in her head. She can feel her blood pressure calm. Her eyes
relax and she sees the world in a whole different way. Everything is sparkly.

“It’s like a rain. It just starts raining,” she said, as the relief slowly
washed down her body, loosening her joints before arriving, finally, at her
feet.

“As long as my mind is high, I can control the body,” she said. “I can choose to
disconnect from the pain. I can choose to put it in the background.

‘OUR WHOLE SYSTEM FELL APART’

Though it was the first state in the country to legalize medical marijuana with
Proposition 215, California has always had a fraught relationship with it.

The Compassionate Use Act allowed people with a valid doctor’s recommendation,
as well as their caregivers, to cultivate cannabis for their personal medical
use — opening the door for collectives where patients unable to grow their own
medicine could pool their resources to pay “caregivers” to do it for them.
Compassionate care programs offered weed to the sickest and poorest patients for
minimal or no cost.

But federal pressure from the “War on Drugs” remained, and the state was
reluctant to jump into regulating medical cannabis until 2015, largely leaving
the task to local jurisdictions. Writing recommendations became a lucrative
business for some unscrupulous physicians, while illicit operators took
advantage of the enforcement gaps to open hundreds of what were functionally
retail dispensaries, enhancing skepticism about the legitimacy of the medical
marijuana system.

That changed in 2019, after the passage of Proposition 64, when California began
requiring collectives to get licensed like a commercial dispensary. Unable to
complete the expensive and complex process, many shut down. More than 60% of
cities and counties in the state still ban cannabis retailers, even for medical
use, though starting in January, they can no longer prohibit medical cannabis
delivery.

“Overnight, our whole system fell apart,” said Valerie Corral, founder of the
groundbreaking cooperative Wo/Men’s Alliance for Medical Marijuana in Santa
Cruz. “They were so busy counting tax dollars that they put us all out of
business.”

Corral received a license, but she sold it after it became clear opening and
operating a dispensary would cost hundreds of thousands of dollars that her
donation-based organization did not have. Now she grows cannabis and works with
local dispensaries to donate it for free to patients — the result of a 2019 law
that, after a multiyear effort, established a replacement to California’s
traditional compassion programs.

Leona Powell, a former member of Corral’s collective who smokes weed daily to
deal with lingering pain from a 1978 airplane crash, said she misses
volunteering in the garden and connecting with other patients at weekly
meetings, where they would share information and potluck dinners. Living
primarily on Social Security payments, the 75-year-old Powell said she relies on
donated cannabis from a local dispensary, because she otherwise cannot afford
the price of a standard eighth of an ounce, which typically costs $40 or more
plus tax.

“That’s only a couple of joints. That’s two days’ worth. Now what?” she said. “I
don’t have that kind of money.”

Efforts to formalize the medical marijuana system in California also lagged. In
2003, the state established a medical identification card for patients, mainly
as a way to defuse interactions with law enforcement, but made it voluntary. Few
people applied for one, perhaps afraid to register themselves with the
government — though some activists did as a political statement.

At its peak, in the 2009-10 fiscal year, counties issued 12,659 annual medical
cards, according to data from the state Department of Public Health. Surveys at
the time estimated hundreds of thousands, if not more than a million, medical
cannabis patients in California. By last year, the number of medical cards
dropped to just 3,218, among the lowest on record.

Advocates say there is little reason to get a card, which carries an annual fee
of as much as $100, on top of the cost of the doctor’s recommendation. With the
card, patients are exempted from the state sales tax on their cannabis but not
other state and local taxes, so they would need to spend hundreds of dollars per
month at a dispensary to realize any savings. Californians can also get medical
cards before they turn 21, when it is legal to buy weed for recreational use,
and cardholders can purchase more cannabis per day.

“There’s a tendency to be dismissive of cannabis users” among the medical
establishment, which is then reflected in policy, said William Dolphin, a
University of Redlands lecturer who researches and writes about medical
cannabis. “We’ve seen across the country a desire to wash their hands of it.”

Cannabis products on display at A Therapeutic Alternative in Sacramento on July
19, 2023. Photo by Miguel Gutierrez Jr., CalMatters

The state Department of Cannabis Control points to extensive testing and
labeling requirements in the licensed market as a major benefit for patients,
ensuring that Californians with potentially compromised immune systems are not
using products tainted with hair, rat feces, heavy metals, illegal pesticides or
mold.

In May, the department awarded UCLA two grants to study medical cannabis use in
California, including what conditions patients are treating, what products they
prefer and how they are accessing them.

“If they’re turning to the unlicensed market, we want to understand why they’re
doing that so we can craft policies to bring them into the licensed market,”
said Devin Gray, a policy analyst with the department’s policy and research
division.

‘WE SELL PRODUCTS TO STAY ALIVE’

Even dispensaries and other organizations dedicated to the philanthropic
tradition of compassionate care are struggling amid a broader industry downturn.

Kimberly Cargile owns A Therapeutic Alternative, which opened in a converted
house near downtown Sacramento in 2009 to serve medical marijuana patients.
These days, it also has a license for recreational sales — and one of the only
compassion programs in town, allowing low-income patients to receive cannabis
for free.

Cargile said many dispensaries are reluctant to establish these programs because
of the expense. Hers, serving an estimated 200 people, runs between $1,000 and
$2,000 per month for staff time to manage applications, intake stock and consult
with patients.

That’s a bigger sacrifice than it used to be. After a statewide surge in
cannabis sales during the early days of the coronavirus pandemic, Cargile said
sales dropped by $3 million, or 20%, at her dispensary over the past two years.
She’s been looking for savings everywhere she can to stay afloat, though the
compassion program will remain a priority for as long as she can manage.

Kimberly Cargile, CEO of A Therapeutic Alternative, at the dispensary in
Sacramento on July 19, 2023. Photo by Miguel Gutierrez Jr., CalMatters

“We’re doing everything we can to stay true to our mission,” she said. She
doesn’t want a cancer patient to feel forced to turn to “dirty” products on the
illicit market.

“The whole entire reason I’ve dedicated my life to patients’ rights is because I
want them to have access to high-quality, lab-tested products to treat their
symptoms,” Cargile said.

Jude Thilman, who runs Dragonfly Wellness Center in Fort Bragg, said it is
financially impossible for cannabis businesses to focus solely on medical use
anymore. That has meant dispensaries providing less education for consumers,
manufacturers of therapeutic products shutting down because they cannot adapt to
new rules and a heritage slowly disappearing. Of the seven medicine makers that
Thilman personally knew before Proposition 64, she said five have gone under and
the other two are operating illegally.

“We sell products to stay alive,” Thilman said, “and then we sell products to
help people.”

Medical donations through compassion programs increased over the first three
years of the 2019 law, according to data collected by the state Department of
Cannabis Control, though the reach remains relatively small. Last year, 440
dispensaries reported donating cannabis products to patients, fewer than a
quarter of California’s nearly 2,000 licensed retailers.

Retailers reported 13,278 donations in 2020, 41,775 donations in 2021 and 47,371
donations in 2022. Each donation is counted separately, so the number of
patients served is likely much lower.

Advocates said they initially benefited from an oversaturated commercial market,
with businesses donating more products that they could not sell. But in recent
months, as a dramatic price drop caught up to growers and decimated cannabis
communities, supply has been scarcer.

“What’s been heartbreaking is that extinction of all the small farmers who have
been our most loyal donors,” said Ryan Miller, who founded Compassionate
Veterans, until recently known as Operation EVAC, a program that combines peer
support sessions with free cannabis to prevent suicides. “The corporations are
not stepping up, to be honest.”

After his pioneering San Francisco collective had to stop handing out cannabis
to patients in 2019, Joe Airone, known as Sweetleaf Joe, turned his attention to
logistics for compassion programs, helping find and deliver donations. He said
his efforts connected more than 3,000 patients with 1,600 pounds of free medical
cannabis last year — but without more support, such as tax write-offs, for
participating businesses, securing donations is getting more difficult.

“All of our partners are taking a financial hit to do this,” he said. “There’s
no incentive to do this. Zero.”

‘HOW MUCH ARE YOU REALLY HELPING PEOPLE?’

In spite of the triple-digit heat, Metcalf was among some 400 people who
attended the underground marketplace in Elverta that Friday evening. After
visiting with Braden, she stopped by a booth for The Sisters Edibles, where she
sometimes buys gummies.

Metcalf eyed the table stacked with tubs of colorful CBD-infused bears and
worms, packaged by the generous handful, available for $10 each or three for
$25. It was a fraction of the cost of what she could get at a dispensary, where
a tin with 10 doses would be $20 plus tax.

“If you limit it, how much are you really helping people?” said the owner, Jen,
who said she started taking cannabis three years ago to treat her migraines and
moved into manufacturing her own products to supplement her veteran disability
payments. She declined to share her last name out of privacy concerns. “I have
so many people who come up to me and say, ‘I can get out of bed now.’”

Metcalf continued on to find some weed for her caretaker. At another small
booth, she held brown mason jars to her nose, inhaling the scents of dried
cannabis flowers. Dank. Like a cheese.

“That has a nice little sweet kickback smell,” she said. “I’ll take a half.”

With only two $20 bills, Metcalf was $10 short of the price for half an ounce.
The vendor, who asked to withhold his name so as not to jeopardize applications
he has submitted for cannabis delivery and manufacturing licenses, waved it off.

Touched by his generosity, Metcalf asked for his number. She knew a lot of
people who might want to order from him.

“Do you have a medical card?” he asked. He said he didn’t charge patients
delivery fees.

Metcalf, a self-proclaimed outlaw, shrugged at the idea and threw up her middle
fingers.

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