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Americans For Safe AccessAN ORGANIZATION OF MEDICAL PROFESSIONALS, SCIENTISTS, AND PATIENTS HELPING PATIENTS

MEDICAL CANNABIS DISPENSING COLLECTIVES AND LOCAL REGULATION

Headquarters

1322 Webster Street, Suite 402, Oakland, California, 94612 PHONE: 510.251.1856 FAX: 510.251.2036

National Office

1906 Sunderland Place, NW, Washington DC 20036 PHONE: 202.857.4272 FAX: 202.857.4273

WEB: www.AmericansForSafeAccess.org TOLL FREE: 1.888.929.4367

For more information, see www.AmericansForSafeAccess.org or contact the ASA office at 1-888-929-4367 or 510-251-1856.

2006MEDICAL CANNABIS DISPENSING COLLECTIVESAND LOCAL REGULATIONEXECUTIVE SUMMARYIntroduction ....................................................................................................................1

OVERVIEW About this Report...........................................................................................................3About Americans for Safe Access..................................................................................3The National Political Landscape...................................................................................3History of Medical Cannabis in California ....................................................................4What is a Medical Cannabis Dispensing Collective ......................................................4Rationale for Medical Cannabis Dispensing Collectives ..............................................5Medical Cannabis Dispensing Collectives are Legal Under State Law........................5Why Patients Need Convenient Dispensaries ...............................................................6What Communities are Doing to Help Patients...........................................................6

IMPACT OF DISPENSARIES AND REGULATIONS ON COMMUNITIESDispensaries Reduce Crime and Improve Public Safety ...............................................7Why Diversion of Medical Cannabis is Typically Not a Problem .................................8Dispensaries Can Be Good Neighbors ...........................................................................8

BENEFITS OF DISPENSARIES TO THE PATIENT COMMUNITYDispensaries Provide Many Benefits to the Sick and Suffering ................................10Research Supports the Dispensary Model...................................................................11Many Dispensaries Provide Key Social Services ..........................................................11Conclusion.....................................................................................................................13

APPENDIX ARecommendations on Dispensary Regulations...........................................................14

APPENDIX BOrdinance Evaluation Survey Questions .....................................................................18

APPENDIX CSurvey Answer and Data Analyses ..............................................................................19

APPENDIX DMaps of Ordinances .....................................................................................................20


Americans For Safe AccessAN ORGANIZATION OF MEDICAL PROFESSIONALS, SCIENTISTS AND PATIENTS HELPING PATIENTS

California's original medical cannabis law,the Compassionate Use Act (Prop. 215),directs local officials to implement ways forqualified patients to access their medicine.With the passage of state legislation (SB 420)in 2003, and the 2005 court ruling in Peoplev. Urziceanu, medical cannabis dispensingcollectives (or dispensaries) are nowrecognized as legal entities. Since most ofthe more than 150,000 cannabis patients inCalifornia (NORML 2005 estimate) rely ondispensaries for their medicine, communitiesacross the state are facing requests forbusiness licenses or zoning decisions relatedto the operation of dispensaries.

Americans for Safe Access, the leadingnational organization representing theinterests of medical cannabis patients andtheir doctors, has undertaken a study of theexperience of those communities that havedispensary ordinances. The report thatfollows details those experiences, as relatedby local officials; it also covers some of thepolitical background and current legal statusof dispensaries, outlines important issues toconsider in drafting dispensary regulations,and summarizes a recent study by aUniversity of California, Berkeley researcheron the community benefits of dispensaries.In short, this report describes why:

Regulated dispensaries benefit thecommunity by:

• providing access for the most seriously illand injured

• offering a safer environment for patientsthan having to buy on the illicit market

• improving the health of patients throughsocial support

• helping patients with other socialservices, such as food and housing

• having a greater than average customersatisfaction rating for health care

Creating dispensary regulations combatscrime because:

• dispensary security reduces crime in thevicinity

• street sales tend to decrease • patients and operators are vigilant • any criminal activity gets reported to

police

Regulated dispensaries are: • legal under California state law • helping revitalize neighborhoods • bringing new customers to neighboring

businesses • not a source of community complaints

This report concludes with a sectionoutlining the important elements for localofficials to consider as they move forwardwith regulations for dispensaries. ASA hasworked successfully with officials in KernCounty, Los Angeles, San Francisco andelsewhere to craft ordinances that meet thestate's legal requirements, as well as theneeds of patients and the larger community.Please contact ASA if you have questions:888-929-4367.

EXECUTIVE SUMMARY

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OVERVIEW OF MEDICAL CANNABIS DISPENSARIES

ABOUT THIS REPORTLand-use decisions are now part of the imple-mentation of California's medical marijuana,or cannabis, laws. As a result, medical cannabisdispensing collectives (dispensaries) are thesubject of considerable debate by planningand other local officials. Dispensaries havebeen operating openly in many communitiessince the passage of Proposition 215 in 1996.As a compassionate, community-basedresponse to the problems patients face in try-ing to access cannabis, dispensaries are cur-rently used by more than half of all patients inthe state and are essential to those most seri-ously ill or injured. Since 2003, when the legis-lature further implemented state law byexpressly addressing the issue of patient col-lectives and compensation for cannabis, moredispensaries have opened and more communi-ties have been faced with questions aboutbusiness permits and land use options.

In an attempt to clarify the issues involved,Americans for Safe Access has conducted asurvey of local officials in addition to continu-ously tracking regulatory activity throughoutthe state. (safeaccessnow.org/regulations.) Thereport that follows outlines some of theunderlying questions and provides anoverview of the experiences of cities andcounties around the state. In many parts ofCalifornia, dispensaries have operated respon-sibly and provided essential services to themost needy without local intervention, but

city and county officials are also consideringhow to arrive at the most effective regulationsfor their community, ones that respect therights of patients for safe and legal accesswithin the context of the larger community.

ABOUT AMERICANS FOR SAFE ACCESSAmericans for Safe Access (ASA) is the largestnational member-based organization ofpatients, medical professionals, scientists andconcerned citizens promoting safe and legalaccess to cannabis for therapeutic uses andresearch. ASA works in partnership with state,local and national legislators to overcome bar-riers and create policies that improve access tocannabis for patients and researchers. Wehave more than 30,000 active members withchapters and affiliates in more than 40 states.

THE NATIONAL POLITICAL LANDSCAPEA substantial majority of Americans supportsafe and legal access to medical cannabis.Public opinion polls in every part of the coun-try show majority support cutting across politi-cal and demographic lines. Among them, aTime/CNN poll in 2002 showed 80% nationalsupport; a survey of AARP members in 2004showed 72% of older Americans support legalaccess, with those in the western states polling82% in favor.

This broad popular consensus, combined withan intransigent federal government which

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"As the number of patients in the state of California who rely upon medical cannabis for their treatmentcontinues to grow, it is increasingly imperative that cities and counties address the issue of dispensaries inour respective communities. In the city of Oakland we recognized this need and adopted an ordinancewhich balances patients' need for safe access to treatment while reassuring the community that these dispensaries are run right. A tangential benefit of the dispensaries has been that they have helped to stimulate economic development in the areas where they are located."

- Desley Brooks, Oakland City Councilmember


refuses to acknowledge medical uses forcannabis, has meant that Americans haveturned to state-based solutions. The laws vot-ers and legislators have passed are intendedto mitigate the effects of the federal govern-ment's prohibition on medical cannabis byallowing qualified patients to use it withoutstate or local interference. Beginning withCalifornia in 1996, voters passed initiatives ineight states plus the District of Columbia --Alaska, Colorado, Maine, Montana, Nevada,Oregon, and Washington. State legislaturesfollowed suit, with elected officials in Hawaii,Maryland, Rhode Island, and Vermont takingaction to protect patients from criminal penal-ty, and the California legislature amending itsvoter initiative in 2003.

Momentum for these state-level provisions forcompassionate use and safe access has contin-ued to build as more research on the thera-peutic uses of cannabis is published. And thepublic advocacy of well-known cannabispatients such as the Emmy-winning talkshowhost Montel Williams has also increased publicawareness and created political pressure forcompassionate state and local solutions.

Twice in the past decade the U.S. SupremeCourt has taken up the question. In the mostrecent case, Gonzales v. Raich, a split courtupheld the ability of federal officials to prose-cute patients if they so choose, but did notoverturn state laws. In the wake of that deci-sion, the attorneys general of California,Hawaii, Oregon, and Colorado all issued legalopinions or statements reaffirming theirstate's medical cannabis laws. The duty ofstate and local law enforcement is to theenforcement and implementation of state,not federal, law.

HISTORY OF MEDICAL CANNABIS INCALIFORNIALocal officials and voters in California haverecognized the needs of medical cannabispatients in their communities and have takenaction, even before voters made it legal in1996. In 1991, 80% of San Francisco voters

supported Proposition P, a ballot initiativewhich recommended a non-enforcement poli-cy for the medical use, cultivation and distri-bution of marijuana. In 1992, citing both theinterests of their constituency and theendorsement of therapeutic use by theCalifornia Medical Association, the SanFrancisco Board of Supervisors adopted a res-olution urging the mayor and district attorneyto accept letters from recommending physi-cians (Resolution No. 141-98). In 1993, theSonoma Board of Supervisors approved a res-olution mirroring a Senate Joint Resolutionpassed earlier that year, noting that a UNcommittee had called for cannabis to bemade available by prescription and calling on"Federal and State representatives to supportreturning [cannabis] preparations to the list ofavailable medicines which can be prescribedby licensed physicians" (Resolution No. 93-1547).

Since 1996 when 56% of California votersapproved the Compassionate Use Act (CUA),public support for safe and legal access tomedical cannabis has only increased. Astatewide Field poll in 2004 found that "threein four voters (74%) favors implementation ofthe law. Voter support for the implementa-tion of Prop. 215 cuts across all partisan, ideo-logical and age subgroups of the state."(field.com/fieldpollonline/subscribers/Rls2105.pdf)

Even before the release of that Field poll,state legislators recognized that there is bothstrong support among voters for implement-ing the safe and legal access promised by theCompassionate Use Act (CUA) and little direc-tion as to how local officials should proceed.This led to the drafting and passage of SenateBill 420 in 2003, which amended the CUA tospell out more clearly the obligations of localofficials for implementation.

WHAT IS A CANNABIS DISPENSARY?The majority of medical marijuana (cannabis)patients cannot cultivate their medicine forthemselves or find a caregiver to grow it forthem. Most of California's estimated 200,000patients obtain their medicine from a Medical

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Cannabis Dispensing Collective (MCDC), oftenreferred to as a "dispensary." Dispensaries aretypically storefront facilities that provide med-ical cannabis and other services to patients inneed. There are more than 200 dispensariesoperating in California as of August 2006.Dispensaries operate with a closed member-ship that allow only patients and caregivers toobtain cannabis and only after membership isapproved (upon verification of patient docu-mentation). Many dispensaries offer on-siteconsumption, providing a safe and comfort-able place where patients can medicate. Anincreasing number of dispensaries offer addi-tional services for their patient membership,including such services as: massage, acupunc-ture, legal trainings, free meals, or counseling.Research on the social benefits for patients isdiscussed in the last section of this report.

RATIONALE FOR CANNABIS DISPENSARIESWhile the Compassionate Use Act does notexplicitly discuss medical cannabis dispen-saries, it calls for the federal and state govern-ments to "implement a plan to provide forthe safe and affordable distribution of mari-juana to all patients in medical need of mari-juana." (Health & Safety Code § 11362.5) Thisportion of the law has been the basis for thedevelopment of compassionate, community-based systems of access for patients in variousparts of California. In some cases, that hasmeant the creation of patient-run growingcollectives that allow those with cultivationexpertise to help other patients obtain medi-cine. In most cases, particularly in urban set-tings, that has meant the establishment ofmedical cannabis dispensing collectives, or dis-pensaries. These dispensaries are typicallyorganized and run by groups of patients andtheir caregivers in a collective model of patient-directed health care that is becoming a modelfor the delivery of other health services.

MEDICAL CANNABIS DISPENSARIES ARELEGAL UNDER STATE LAWIn an effort to clarify the voter initiative of1996 and aid in its implementation across the

state, the California legislature enactedSenate Bill 420 in 2004, which expressly statesthat qualified patients and primary caregiversmay collectively or cooperatively cultivatecannabis for medical purposes (Cal. Health &Safety Code section 11362.775). This provisionhas been interpreted by the courts to meanthat dispensing collectives, where patientsmay buy their medicine, are legal entitiesunder state law. California's Third DistrictCourt of Appeal affirmed the legality of col-lectives and cooperatives in 2005 in the caseof People v. Urziceanu, which held that SB420, which the court called the MedicalMarijuana Program Act (MMPA), provides col-lectives and cooperatives a defense to mari-juana distribution charges. Drawing from theCompassionate Use Act's directive to imple-ment a plan for the safe and affordable distri-bution of medical marijuana, the court foundthat the MMPA and its legalization of collec-tives and cooperatives represented the stategovernment's initial response to this mandate.By expressly providing for reimbursement formarijuana and services in connection with col-lectives and cooperatives, the Legislature hasabrogated earlier cases, such as Trippett,Peron, and Young, and established a newdefense for those who form and operate col-lectives and cooperatives to dispense marijua-na. (See People v. Urziceanu (2005) 132Cal.App.4th 747, 33 Cal.Rptr.2d 859, 881.)

This new case law parallels the interpretationof SB 420 provided to the League of Cities lastyear by Berkeley Assistant City AttorneyMatthew J. Orebic, in his presentation"Medical Marijuana: The conflict betweenCalifornia and federal law and its effect onlocal law enforcement and ordinances." As hestates in that report:

In the 2004 legislation, Section 11362.775… expressly allow[s] medical marijuana tobe cultivated collectively by qualifiedpatients and primary caregivers, and bynecessary implication, distributed amongthe collective's members… Under the col-lective model, qualified patients who areunwilling or unable to cultivate marijuana

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on their own can still have access to mari-juana by joining together with other quali-fied patients to form a collective.

Orebic also notes that the law allows forthose involved to "receive reimbursement forservices rendered in supplying the patientwith medical marijuana."

WHY PATIENTS NEED CONVENIENTDISPENSARIESWhile some patients with long-term illnessesor injuries have the time, space, and skill tocultivate their own cannabis, the majority inthe state, particularly those in urban settings,do not have the ability to provide for them-selves. For those patients, dispensaries are theonly option for safe and legal access. This is allthe more true for those individuals who aresuffering from a sudden, acute injury or illness.

Many of the most serious and debilitatinginjuries and illnesses require immediate relief.A cancer patient, for instance, who has justbegun chemotherapy will typically needimmediate access for help with nausea, whichis why a Harvard study found that 45% ofoncologists were already recommendingcannabis to their patients, even before it hadbeen made legal in any state. It is unreason-able to exclude those patients most in needsimply because they are incapable of garden-ing or cannot wait months for relief.

WHAT COMMUNITIES ARE DOING TOHELP PATIENTSMany communities in California have recog-nized the essential service that dispensariesprovide and have either tacitly allowed theircreation or, more recently, created ordinancesor regulations for their operation. Dispensaryregulation is one way in which the city canexert local control over the policy issue andensure the needs of patients and the commu-nity at large are being met. As of August2006, twenty-six cities and seven countieshave enacted regulations, and many more areconsidering doing so soon. See appendix D.)

Officials recognize their duty to implementstate laws, even in instances when they maynot have previously supported medicalcannabis legislation. Duke Martin, mayor protem of Ridgecrest said during a city councilhearing on their local dispensary ordinance,"it's something that's the law, and I willuphold the law."

"Because they are under strict city regulation,there is less likelihood of theft or violence andless opposition from angry neighbors. It is no

longer a controversial issue in our city." -Mike Rotkin, Santa Cruz

This understanding of civic obligation wasechoed at the Ridgecrest hearing byCouncilmember Ron Carter, who said, "I wantto make sure everything is legitimate andabove board. It's legal. It's not something wecan stop, but we can have an ordinance ofregulations."

Similarly, Whittier Planning Commissioner R.D.McDonnell spoke publicly of the benefits ofdispensary regulations at a city governmenthearing. "It provides us with reasonable pro-tections," he said. "But at the same time pro-vides the opportunity for the legitimateoperations."

Whittier officials discussed the possibility of anoutright ban on dispensary operations, butGreg Nordback said, "It was the opinion ofour city attorney that you can't ban them; it'sagainst the law. You have to come up with anarea they can be in." Whittier passed its dis-pensary ordinance in December 2005.

Placerville Police Chief George Nielson com-mented that, "The issue of medical marijuanacontinues to be somewhat controversial inour community, as I suspect and hear itremains in other California communities. Theissue of 'safe access' is important to some andnot to others. There was some objection tothe dispensary ordinance, but I would say itwas a vocal minority on the issue."

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DISPENSARIES REDUCE CRIME ANDIMPROVE PUBLIC SAFETYSome reports have suggested that dispen-saries are magnets for criminal activity orother behavior that is a problem for the com-munity, but the experience of those cities withdispensary regulations says otherwise. Crimestatistics and the accounts of local officials sur-veyed by ASA indicate that crime is actuallyreduced by the presence of a dispensary. Andcomplaints from citizens and surroundingbusinesses are either negligible or are signifi-cantly reduced with the implementation oflocal regulations.

This trend has led multiple cities and countiesto consider regulation as a solution. KernCounty, which passed a dispensary ordinancein July 2006, is a case in point. The sheriffthere noted in his staff report that "regulato-ry oversight at the local levels helps preventcrime directly and indirectly related to illegaloperations occurring under the pretense andprotection of state laws authorizing MedicalMarijuana Dispensaries." Although dispensary-related crime has not been a problem for thecounty, the regulations will help law enforce-ment determine the legitimacy of dispensariesand their patients.

The sheriff specifically pointed out that,"existing dispensaries have not caused notice-able law enforcement of secondary effectsand problems for at least one year. As aresult, the focus of the proposed Ordinanceis narrowed to insure Dispensary compliancewith the law" (Kern County Staff Report,Proposed Ordinance Regulating MedicalCannabis Dispensaries, July 11, 2006).

The presence of a dispensary in the neighbor-hood can actually improve public safety andreduce crime. Most dispensaries take security

for their members and staff more seriouslythan many businesses. Security cameras areoften used both inside and outside the prem-ises, and security guards are often employedto ensure safety. Both cameras and securityguards serve as a general deterrent to crimi-nal activity and other problems on the street.Those likely to engage in such activities willtend to move to a less-monitored area, there-by ensuring a safe environment not only fordispensary members and staff but also forneighbors and businesses in the surroundingarea.

Residents in areas surrounding dispensarieshave reported improvements to the neighbor-hood. Kirk C., a long time San Francisco resi-dent, commented at a city hearing, "I havelived in the same apartment along theDivisadero corridor in San Francisco for thepast five years. Each store that has opened inmy neighborhood has been nicer, with manynew restaurants quickly becoming some ofthe city's hottest spots. My neighborhood'scrime and vandalism seems to be going downyear after year. It strikes me that the dispen-saries have been a vital part of the improve-ment that is going on in my neighborhood."

Oakland's city administrator for the ordinanceregulating dispensaries, Barbara Killey, notesthat "The areas around the dispensaries maybe some of the most safest areas of Oaklandnow because of the level of security, surveil-lance, etc…since the ordinance passed."

Likewise, Santa Rosa Mayor Jane Bendernoted that since the city passed its ordinance,there appears to be "a decrease in criminalactivity. There certainly has been a decrease incomplaints. The city attorney says there havebeen no complaints either from citizens norfrom neighboring businesses."

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IMPACT OF DISPENSARIES AND REGULATORY ORDINANCESON COMMUNITIES IN CALIFORNIA


Those dispensaries that go through the per-mitting process or otherwise comply withlocal ordinances tend, by their very nature, tobe those most interested in meeting commu-nity standards and being good neighbors.Cities enacting ordinances for the operationof dispensaries may even require securitymeasures, but it is a matter of good businesspractice for dispensary operators since it is intheir own best interest. Many local officialssurveyed by ASA said dispensaries operatingin their communities have presented no prob-lems, or what problems there may have beensignificantly diminished once an ordinance orother regulation was instituted.

Mike Rotkin, fifth-term councilmember andformer four-term mayor in the City of SantaCruz, says about his city's dispensary, "It pro-vides a legal (under State law) service for peo-ple in medical need. Because it is well run andwell regulated and located in an area accept-able to the City, it gets cooperation from thelocal police. Because they are under strict cityregulation, there is less likelihood of theft orviolence and less opposition from angryneighbors. It is no longer a controversial issuein our city."

Regarding the decrease in complaints aboutexisting dispensaries, several officials said thatordinances significantly improved relationswith other businesses and the community atlarge. An Oakland city council staff membernoted that they, "had gotten reports of breakins. That kind of activity has stopped . Thatdanger has been eliminated."

WHY DIVERSION OF MEDICAL CANNABISIS TYPICALLY NOT A PROBLEMOne of the concerns of public officials is thatdispensaries make possible or even encouragethe resale of cannabis on the street. But theexperience of those cities which have institut-ed ordinances is that such problems, whichare rare in the first place, quickly disappear. Inaddition to the ease for law enforcement ofmonitoring openly operating facilities, dispen-saries universally have strict rules about how

members are to behave in and around thedispensary. Many have "good neighbor"trainings for their members that emphasizesensitivity to the concerns of neighbors, andall absolutely prohibit the resale of cannabisto anyone. Anyone violating that prohibitionis typically banned from any further contactwith the dispensary.

"The areas around the dispensaries may besome of the most safest areas of Oakland nowbecause of the level of security , surveillance,

etc. since the ordinance passed."-Barbara Killey, Oakland

As Oakland's city administrator for the regula-tory ordinance explains, "dispensaries them-selves have been very good at self policingagainst resale because they understand theycan lose their permit if their patients resell."

In the event of street or other resale, local lawenforcement has at its disposal all the manylegal penalties the state provides. This all addsup to a safer street environment with fewerdrug-related problems than before dispensaryoperations were permitted in the area. Theexperience of the City of Oakland is a goodexample of this phenomenon. The city's leg-islative analyst, Lupe Schoenberger, statedthat, "…[P]eople feel safer when they'rewalking down the street. The level of marijua-na street sales has significantly reduced."

Dispensaries operating with the permission ofthe city are also more likely to appropriatelyutilize law enforcement resources themselves,reporting any crimes directly to the appropri-ate agencies. And, again, dispensary operatorsand their patient members tend to be moresafety conscious than the general public,resulting in great vigilance and better pre-emptive measures. The reduction in crime inareas with dispensaries has been reportedanecdotally by law enforcement in severalcommunities.

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DISPENSARIES CAN BE GOOD NEIGHBORS Medical cannabis dispensing collectives aretypically positive additions to the neighbor-hoods in which they locate, bringing addition-al customers to neighboring businesses andreducing crime in the immediate area.

Like any new business that serves a differentcustomer base than the existing businesses inthe area, dispensaries increase the revenue ofother businesses in the surrounding area sim-ply because new people are coming to accessservices, increasing foot traffic past otherestablishments. In many communities, theopening of a dispensary has helped revitalizean area. While patients tend to opt for dis-pensaries that are close and convenient, par-ticularly since travel can be difficult, manypatients will travel to dispensary locations inparts of town they would not otherwise visit.Even if patients are not immediately utilizingthe services or purchasing the goods offeredby neighboring businesses, they are more like-ly to eventually patronize those businessesbecause of convenience.

ASA's survey of officials whose cities havepassed dispensary regulations found that thevast majority of businesses adjoining or neardispensaries had reported no problems associ-ated with a dispensary opening after theimplementation of regulation.

Kriss Worthington, longtime councilmemberin Berkeley, said in support of a dispensarythere, "They have been a responsible neigh-bor and vital organization to our diverse com-munity. Since their opening, they have donean outstanding job keeping the building clean,neat, organized and safe. In fact, we have hadno calls from neighbors complaining aboutthem, which is a sign of respect from the com-munity. In Berkeley, even average restaurantsand stores have complaints from neighbors.”

Mike Rotkin, fifth term councilmember andformer four term mayor in the City of SantaCruz said about the dispensary that openedthere last year, "The immediately neighboringbusinesses have been uniformly supportive orneutral. There have been no complaints either

about establishing it or running it."

Mark Keilty, Planning and Building director ofTulare, when asked if the existence of dispen-saries affected local business, said they had"no effect or at least no one has complained."

And Dave Turner, mayor of Fort Bragg, notedthat before the passage of regulations therewere "plenty of complaints from both neigh-boring businesses and concerned citizens,"but since then, it is no longer a problem.Public officials understand that, when itcomes to dispensaries, they must balance boththe humanitarian needs of patients and theconcerns of the public, especially those ofneighboring residents and business owners.

"Dispensaries themselves have been very goodat self policing against resale because they

understand they can lose their permit if theirpatients resell." -Barbara Killey, Oakland

Oakland City Councilmember Nancy J. Nadelwrote in an open letter to her fellow col-leagues across the state, "Local governmenthas a responsibility to the medical needs of itspeople, even when it's not a politically easychoice to make. We have found it possible tobuild regulations that address the concerns ofneighbors, local businesses law enforcementand the general public, while not compromis-ing the needs of the patients themselves.We've found that by working with all inter-ested parities in advance of adopting an ordi-nance while keeping the patients' needsforemost, problems that may seem inevitablenever arise."

Mike Rotkin of Santa Cruz stated that sinceSanta Cruz enacted an ordinance for dispen-sary operations, "Things have calmed down.The police are happy with the ordinance, andthat has made things a lot easier. I think thefact that we took the time to give peoplewho wrote us respectful and detailed expla-nations of what we were doing and whymade a real difference."

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DISPENSARIES PROVIDE MANY BENEFITSTO THE SICK AND SUFFERINGSafe and legal access to cannabis is the reasondispensaries have been created by patientsand caregivers around the state. For manypeople, dispensaries remove significant barri-ers to their ability to obtain cannabis. Patientsin urban areas with no space to cultivatecannabis, those without the requisite garden-ing skills to grow their own, and, most critical-ly, those who face the sudden onset of aserious illness or who have suffered a cata-strophic illness - all tend to rely on dispen-saries as a compassionate, community-basedsolution that is an alternative to potentiallydangerous illicit market transactions.

Many elected officials around the state recog-nize the importance of dispensaries for theirconstituents. As Nathan Miley, formerOakland City councilmember and nowAlameda County supervisor said in a letter tohis colleagues, "When designing regulations,it is crucial to remember that at its core this isa healthcare issue, requiring the involvementand leadership of local departments of publichealth. A pro-active healthcare-basedapproach can effectively address problemsbefore they arise, and communities candesign methods for safe, legal access to med-ical marijuana while keeping the patients'needs foremost."

Likewise, Abbe Land, mayor of WestHollywood says safe access is "very impor-tant" and long-time councilmember JohnDuran agreed, adding, "We have a very highnumber of HIV-positive residents in our area.Some of them require medical marijuana tooffset the medications they take for HIV."Jane Bender, mayor of Santa Rosa, says,"There are legitimate patients in our commu-nity, and I'm glad they have a safe means of

obtaining their medicine."

Oakland's city administrator for ordinances,said safe access to cannabis is "very impor-tant" for the community. "In the finding thecouncil made to justify the ordinance, theysay 'have safe and affordable access'."

And Mike Rotkin, the longtime Santa Cruzelected official, said that this is also an impor-tant matter for his city's citizens: "The councilconsiders it a high priority and has taken con-siderable heat to speak out and act on theissue."

It was a similar decision of social consciencethat lead to Placerville's city council putting aregulatory ordinance in place. CouncilmemberMarian Washburn told her colleagues that "asyou get older, you know people with diseaseswho suffer terribly, so that is probably what Iget down to after considering all the othercomponents."

While dispensaries provide a unique way forpatients to obtain the cannabis their doctorshave recommended, they typically offer farmore that is of benefit to the health and wel-fare of those suffering both chronic and acutemedical problems.

Dispensaries are often called "clubs" in partbecause many of them offer far more than aclinical setting for obtaining cannabis.Recognizing the isolation that many seriouslyill and injured people experience, many dis-pensary operators chose to offer a wider arrayof social services, including everything from aplace to congregate and socialize to help withfinding housing and meals. The social supportpatients receive in these settings has far-reaching benefits that is also influencing thedevelopment of other patient-based caremodels.

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BENEFITS OF DISPENSARIES TO THE PATIENT COMMUNITY


RESEARCH SUPPORTS THE DISPENSARYMODELA 2006 study by Amanda Reiman, Ph.D. of theSchool of Social Welfare at the University ofCalifornia, Berkeley examined the experienceof 130 patients spread among seven differentdispensaries in the San Francisco Bay Area. Dr.Reiman's study cataloged the patients' demo-graphic information, health status, consumersatisfaction, and use of services, while alsoconsidering the dispensaries' environment,staff, and services offered. The study foundthat "medical cannabis patients have createda system of dispensing medical cannabis thatalso includes services such as counseling,entertainment and support groups, all impor-tant components of coping with chronic ill-ness." She also found that levels ofsatisfaction with the care received at dispen-saries ranked significantly higher than thosereported for health care nationally.

Patients who use the dispensaries studied uni-formly reported being well satisfied with theservices they received, giving an 80% satisfac-tion rating. The most important factors forpatients in choosing a medical cannabis dis-pensary were: feeling comfortable and secure,familiarity with the dispensary, and having arapport with the staff. In their comments,patients tended to note the helpfulness andkindness of staff and the support found in thepresence of other patients.

Patients in Dr. Reiman's study frequently citedtheir relationships with staff as a positive fac-tor. Comments from six different dispensariesinclude:

"I love this spot because of the love they give,always! They treat everyone like a familyloved one!"

"This particular establishment is very friendlyfor the most part and very convenient forme."

"The staff and patients are like family to me!"

"The staff are warm and respectful."

"The staff at this facility are always cordial

and very friendly. I enjoy coming."

"This is the friendliest dispensary that I haveever been to and the staff is always warm andopen. That's why I keep coming to this place.The selection is always wide."

MANY DISPENSARIES PROVIDE KEYSOCIAL SERVICES Dispensaries offer many cannabis-related serv-ices that patients cannot otherwise obtain.Among them is an array of cannabis varieties,some of which are more useful for certainafflictions than others, and staff awareness ofwhat types of cannabis other patients reportto be helpful. In other words, one variety ofcannabis may be effective for pain controlwhile another may be better for combatingnausea. Dispensaries allow for the pooling ofinformation about these differences and theopportunity to access the type of cannabislikely to be most beneficial.

"There are legitimate patients in ourcommunity, and I'm glad they have a safe

means of obtaining their medicine." -Jane Bender, Santa Rosa

Other cannabis-related services include theavailability of cannabis products in otherforms than the smokeable ones. While mostpatients prefer to have the ability to modu-late dosing that smoking easily allows, forothers, the effects of edible cannabis productsare preferable. Dispensaries typically offer edi-ble products such as brownies or cookies forthose purposes. Many dispensaries also offerclasses on how to grow your own cannabis,classes on legal matters, trainings for health-care advocacy, and other seminars.

Beyond providing safe and legal access tocannabis, the dispensaries studied also offerimportant social services to patients, includingcounseling, help with housing and meals, hos-pice and other care referrals, and, in one case,

11


even doggie daycare for members who havedoctor appointments or work commitments.Among the broader services the study foundin dispensaries are support groups, includinggroups for women, veterans, and men; cre-ativity and art groups, including groups forwriters, quilters, crochet, and crafts; andentertainment options, including bingo, openmike nights, poetry readings, internet access,libraries, and puzzles. Clothing drives andneighborhood parties are among the activi-ties that patients can also participate inthrough their dispensary.

Social services such as counseling and supportgroups were reported to be the most com-monly and regularly used service, with two-thirds of patients reporting that they usesocial services at dispensaries 1-2 times perweek. Also, life services, such as free foodand housing help, were used at least once ortwice a week by 22% of those surveyed.

"Local government has a responsibility to themedical needs of its people, even when it's not

a politically easy choice to make. We have foundit possible to build regulations that address the

concerns of neighbors, local businesses lawenforcement and the general public, while not

compromising the needs of the patientsthemselves. We've found that by working withall interested parities in advance of adopting an

ordinance while keeping the patients' needsforemost, problems that may seem inevitable

never arise." -Nancy Nadel, Oakland

Dispensaries offer chronically ill patients evenmore than safe and legal access to cannabisand an array of social services. The studyfound that dispensaries also provided othersocial benefits for the chronically ill, an impor-tant part of the bigger picture:

[T]he multiple services provided by the

social model are only part of the culture ofsocial club facility. Another component ofthis model … is the possible benefit thatsocial support has for one diagnosed witha chronic and/or terminal physical or psy-chological illness. Beyond the support thatmedical cannabis patients receive fromservices is the support received from fellowpatients, some of whom are experiencingthe same or similar physical/psychologicalsymptoms…. It is possible that the mentalhealth benefits from the social support offellow patients is an important part of thehealing process, separate from the medici-nal value of the cannabis itself.

Several researchers and physicians who havestudied the issue of the patient experiencewith dispensaries have concluded that thereare other important positive effects stemmingfrom a dispensary model that includes a com-ponent of social support groups.

Dr. Reiman notes that, "support groups mayhave the ability to address issues besides theillness itself that might contribute to long-term physical and emotional health outcomes,such as the prevalence of depression amongthe chronically ill."

For those who suffer the most serious illness,such as HIV/AIDS and terminal cancer, thesegroups of like-minded people with similarconditions can also help patients through thegrieving process. Other research into thepatient experience has found that manypatients have lost or are losing friends andpartners to terminal illness. These patientsreport finding solace with other patients whoare also grieving or facing end-of-life deci-sions. A medical study published in 1998 con-cluded that the patient-to-patient contactassociated with the social club model was thebest therapeutic setting for ill people.

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Dispensaries are proving to be an asset to thecommunities they serve, as well as the largercommunity within which they operate.

ASA's survey of local officials and monitoringof regulatory activity throughout the State ofCalifornia has shown that, once working reg-ulatory ordinances are in place, dispensariesare typically viewed favorably by public offi-cials, neighbors, businesses, and the communi-ty at large, and that regulatory ordinancescan and do improve an area, both socially andeconomically.

Dispensaries - now expressly legal underCalifornia state law - are helping revitalizeneighborhoods by reducing crime and bring-ing new customers to surrounding businesses.They improve public safety by increasing thesecurity presence in neighborhoods, reducingillicit market marijuana sales, and ensuringthat any criminal activity gets reported to theappropriate law enforcement authorities.

More importantly, dispensaries benefit thecommunity by providing safe access for thosewho have the greatest difficulty getting the

medicine their doctors recommend: the mostseriously ill and injured. Many dispensariesalso offer essential services to patients, such ashelp with food and housing.

Medical and public health studies have alsoshown that the social-club model of most dis-pensaries is of significant benefit to the over-all health of patients. The result is thatcannabis patients rate their satisfaction withdispensaries as far greater than the customer-satisfaction ratings given to health care agen-cies in general.

Public officials across the state, in both urbanand rural communities where dispensary reg-ulatory ordinances have been adopted, havebeen outspoken in praise of what. Their com-ments are consistent on and favorable to theregulatory schemes they enacted and thebenefits to the patients and others living intheir communities.

As a compassionate, community-basedresponse to the medical needs of more than150,000 sick and suffering Californians, dis-pensaries are working.

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CONCLUSION


RECOMMENDATIONS ON DISPENSARYREGULATIONSCannabis dispensaries have been operatingsuccessfully around California for a decadewith very few problems. But since the legisla-ture and courts have acted to make theirlegality a matter of state law more than localtolerance, the question of how to implementappropriate zoning and business licensing iscoming before local officials all across thestate. What follows are recommendations onmatters to consider, based on adopted codeas well as ASA's extensive experience workingwith community leaders and elected officials.

COMMUNITY OVERSIGHTIn order to appropriately resolve conflict inthe community and establish a process bywhich complaints and concerns can bereviewed, it can often be helpful to create acommunity oversight committee. Such com-mittees, if fair and balanced, can provide ameans for the voices of all affected parties tobe heard, and to quickly resolve problems.

The Ukiah City Council created such a taskforce in 2005; what follows is how theydefined the group:

The Ukiah Medical Marijuana Review andOversight Commission shall consist of sevenmembers nominated and appointed pursuantto this section. The Mayor shall nominatethree members to the commission, and theCity Council shall appoint, by motion, fourother members to the commission. Each nom-ination of the Mayor shall be subject toapproval by the City Council, and shall be thesubject of a public hearing and vote within 40days. If the City Council fails to act on a may-oral nomination within 40 days of the date

the nomination is transmitted to the Clerk ofthe City Council, the nominee shall bedeemed approved. Appointments to the com-mission shall become effective on the datethe City Council adopts a motion approvingthe nomination or on the 41st day followingthe date the mayoral nomination was trans-mitted to the Clerk of the City Council if theCity Council fails to act upon the nominationprior to such date.

Of the three members nominated by theMayor, the Mayor shall nominate one mem-ber to represent the interests of City neigh-borhood associations or groups, one memberto represent the interests of medical marijua-na patients, and one member to representthe interests of the law enforcement commu-nity.

Of the four members of the commissionappointed by the City Council, two membersshall represent the interests of City neighbor-hood associations or groups, one membershall represent the interests of the medicalmarijuana community, and one member shallrepresent the interests of the public healthcommunity.

DISPENSARIES REGULATIONS ARE BESTHANDLED THROUGH THE HEALTH ORPLANNING DEPARTMENTS, NOT LAWENFORCEMENT AGENCIESReason: To ensure that qualified patients,caregivers, and dispensaries are protected,general regulatory oversight duties - includingpermitting, record maintenance and relatedprotocols - should be the responsibility of thelocal department of public health (DPH) orplanning department. Given the statutorymission and responsibilities of DPH, it is the

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APPENDIX A


natural choice and best-suited agency toaddress the regulation of medical cannabisdispensing collectives. Law enforcement agen-cies are ill-suited for handling such matters,having little or no expertise in health andmedical affairs.

Examples of responsible agencies and officials:

• Angels Camp - City Administrator • Atascadero - Planning Commission • Citrus Heights - City Manager • Los Angeles - Planning Department • Plymouth - City Administrator • San Francisco - Department of Public

Health • Selma - City Manager • Visalia - City Planner

ARBITRARY CAPS ON THE NUMBER OFDISPENSARIES CAN BE COUNTER-PRODUCTIVEReason: Policymakers do not need to set arbi-trary limitations on the number of dispensingcollectives allowed to operate because, aswith other services, competitive market forcesand consumer choice will be decisive.Dispensaries which provide quality care andpatient services to their memberships willflourish, while those that do not will fail.

Capping the number of dispensaries limitsconsumer choice, which can result in bothdecreased quality of care and less affordablemedicine. Limiting the number of dispensingcollectives allowed to operate may also forcepatients with limited mobility to travel fartherfor access than they would otherwise need to.

Artificially limiting the supply for patients canresult in an inability to meet demand, whichin turn may lead to such undesirable effects aslines outside of dispensaries, increased prices,and lower quality medicine.

Examples of cities and counties withoutnumerical caps on dispensaries:

• Dixon • Elk Grove • Fort Bragg

• Placerville • Ripon • Selma • Tulare • Calaveras County • Kern County • Los Angeles County • City and County of San Francisco.

RESTRICTIONS ON WHERE DISPENSARIESCAN LOCATE ARE OFTEN UNNECESSARYAND CAN CREATE BARRIERS TO ACCESSReason: As described in this report, regulateddispensaries do not generally increase crimeor bring other harm to their neighborhoods,regardless of where they are located. Andsince for many patients travel is difficult, citiesand counties should take care to avoid unnec-essary restrictions on where dispensaries canlocate. Patients benefit from dispensariesbeing convenient and accessible, especially ifthe patients are disabled or have conditionsthat limit their mobility.

It is unnecessary and burdensome for patientsand dispensaries, to restrict dispensaries toindustrial corners, far away from public transitand other services. Depending on a city's pop-ulation density, it can also be extremely detri-mental to set excessive proximity restrictions(to schools or other facilities) that can make itimpossible for dispensaries to locate any-where within the city limits. It is important tobalance patient needs with neighborhoodconcerns in this process.

PATIENTS BENEFIT FROM ON-SITECONSUMPTION AND PROPERVENTILATION SYSTEMSReason: Dispensaries that allow members toconsume medicine on-site have positive psy-chosocial health benefits for chronically illpeople who are otherwise isolated. On-siteconsumption encourages dispensary membersto take advantage of the support services thatimprove patients' quality of life and, in somecases, even prolong it. Researchers haveshown that support groups like those offered

15


by dispensaries are effective for patients witha variety of serious illnesses. Participants activein support services are less anxious anddepressed, make better use of their time andare more likely to return to work thanpatients who receive only standardized care,regardless of whether they have serious psy-chiatric symptoms. On-site consumption is alsoimportant for patients who face restrictions tooff-site consumption, such as those in subsi-dized or other housing arrangements thatprohibit smoking. In addition, on-site con-sumption provides an opportunity forpatients to share information about effectiveuse of cannabis and to use specialized deliverymethods, such as vaporizers, which do notrequire smoking.

Examples of localities that permit on-siteconsumption (many stipulate ventilationrequirements):

• Berkeley • San Francisco • Alameda County • Kern County • Los Angeles County

DIFFERENTIATING DISPENSARIES FROMPRIVATE PATIENT COLLECTIVES ISIMPORTANTReason: Private patient collectives, in whichseveral patients grow their medicine collec-tively at a private location, should not berequired to follow the same restrictions thatare placed on retail dispensaries, since theyare a different type of operation. A too-broadly written ordinance may inadvertentlyput untenable restrictions on individualpatients and caregivers who are providingeither for themselves or a few others.

Example: Santa Rosa's adopted ordinance,provision 10-40.030 (F)

"Medical cannabis dispensing collective,"hereinafter "dispensary," shall be construedto include any association, cooperative, affilia-tion, or collective of persons where multiple"qualified patients" and/or "primary caregivers," are organized to provide education,

referral, or network services, and facilitationor assistance in the lawful, "retail" distribu-tion of medical cannabis. "Dispensary" meansany facility or location where the primary pur-pose is to dispense medical cannabis (i.e., mar-ijuana) as a medication that has beenrecommended by a physician and where med-ical cannabis is made available to and/or dis-tributed by or to two or more of thefollowing: a primary caregiver and/or a quali-fied patient, in strict accordance withCalifornia Health and Safety Code Section11362.5 et seq. A "dispensary" shall notinclude dispensing by primary caregivers toqualified patients in the following locationsand uses, as long as the location of such usesare otherwise regulated by this Code or appli-cable law: a clinic licensed pursuant toChapter 1 of Division 2 of the Health andSafety Code, a health care facility licensedpursuant to Chapter 2 of Division 2 of theHealth and Safety Code, a residential carefacility for persons with chronic life-threaten-ing illness licensed pursuant to Chapter 3.01of Division 2 of the Health and Safety Code,residential care facility for the elderly licensedpursuant to Chapter 3.2 of Division 2 of theHealth and Safety Code, a residential hospice,or a home health agency licensed pursuant toChapter 8 of Division 2 of the Health andSafety Code, as long as any such use compliesstrictly with applicable law including, but notlimited to, Health and Safety Code Section11362.5 et seq., or a qualified patient's orcaregiver's place of residence.

PATIENTS BENEFIT FROM ACCESS TOEDIBLES AND MEDICAL CANNABISCONSUMPTION DEVICESReason: Not all patients smoke cannabis.Many find tinctures (cannabis extracts) or edi-bles (such as baked goods containingcannabis) to be more effective for their condi-tions. Allowing dispensaries to carry theseitems is important to patients getting the bestlevel of care possible. For patients who haveexisting respiration problems or who other-wise have an aversion to smoking, edibles are

16


essential. Conversely, for patients who dochoose to smoke or vaporize, they need toprocure the tools to do so. Prohibiting dispen-saries from carrying medical cannabis con-sumption devices, often referred to asparaphernalia, forces patients to go else-where to procure these items. Additionally,when dispensaries do carry these devices,informed dispensary staff can explain theirusage to new patients.

Examples of localities allowing dispen-saries to carry edibles and deliverydevices:

• Angels Camp • Berkeley • Citrus Heights • Santa Cruz • Sutter Creek • West Hollywood • Alameda County • Kern County • Los Angeles County.

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MEDICAL CANNABIS DISPENSARYORDINANCE EVALUATION SURVEYQUESTIONS

1. What is your name and position?

2. How important is safe access to medicalmarijuana in your community?

3. On what date did your city/county pass itsordinance?

4. Were there medical cannabis dispensariesin your district before the ordinance? Howmany?

5. If any, were there any complaints againstthem before the ordinance was passed? If yes,who made the complaints? What were thespecific complaints that were made? How fre-quently were complaints made?

6. Were there any objections to passing anordinance to regulate medical cannabis dis-pensaries?

7. If so, what were the primary objections?Who were the main objectors?

8. Has the ordinance implementationallayed or amplified those concerns?

9. How many medical cannabis dispensariesare there now? What is the estimated popula-tion of the area that may utilize them? Doyou think the current number of dispensariesis enough to address the needs of the com-munity?

10. Has there been an increase or decrease incriminal activity related to dispensaries sincethe regulations were implemented?

11. How has the ordinance improved thepublic safety in your community? Has it wors-ened the public safety? How?

12. Has the existence of dispensaries affect-ed local business? How do neighboring busi-nesses view dispensaries?

13. What would you advocate be changedin the current regulations?

14. Do you have anything else you wouldlike to say in evaluation of the medicalcannabis ordinance?

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APPENDIX B

SURVEY ANSWER AND DATA ANALYSISSummary

• The majority of responses were positive. • Safe access is important to every

community. • Complaints of dispensaries generally

decrease after regulation.

• Objections to the ordinance were allayedafter implementation.

• Regulation improved public safety. • Crime decreases or shows no effect affect

after regulations • Most businesses are either supportive of

or neutral about neighboring dispensaries.

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APPENDIX C


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© Copyright 2006 Americans for Safe Access. All rights reserved.

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