Cannabis in California:

Proactive Structuralism vs
Mis and Malfeasance
Tod H. Mikuriya, MD
President
California Cannabis Research Medical Group

 California Compassionate
Use Act of 1996
(Health & Safety Code §11362.5)
Safe and affordable access to cannabis
Compassion and respect for civil rights
“…any other illness for which marijuana provides relief.”
“..no physician in this state shall be punished or denied any right or privilege, for having recommended marijuana to a patient for medical purposes.”

No provision for Implementation & Compliance
Widespread failure in county government to develop guidelines
Criminal Justice entities have effectively blocked efforts
Physicians & health institutions have refused compliance

Public and private sectors fail
to obey the law throughout the state.
While more liberal and urban areas like the San Francisco Bay Area appear more accepting, there is significant resistance by certain special interest groups.
In Southern California and rural areas policies are repressive with widespread official ignorance.

Barry R. McCaffrey threatens California Physicians    12/30/96
Removal of DEA Rx license
Drop from Medicare
Federal law suits
IRS audits
Termination of grants

Physicians and health institutions continue non compliant and fearful.
Physicians and health institutions are dependent on federal money
Mass self censorship in response to federal threats and despite a court injunction
Widespread fear of the psychotic 8,000 lb federal intrabeltway gorilla

Gridlock, fear of federal intervention, and ignorance presents opportunity
Prohibitionist elements and special interests dependent on status quo
The numbers of individuals protected produce a strong and continuing demand
Increasing physician recommendation and approval

Intrabeltway federal interagency gridlock
White House Office of National Drug Control Policy
National Institute on Drug Abuse
Food And Drug Administration
Drug Enforcement Administration
Health and Human Services
Congress

Criminal justice chaos
No effective legislative oversight
Civil forfeiture and slush funds
No General Orders
No Training or Information bulletins
No fiscal audits
Excessive discretionary power
No standard possession or cultivation

State and local government blocked
Passive or captive AG
Refuses to intervene locally
Constitutionally mandated
Deputy AG’s, BNE, local DA’s, prosecutors, judges, and police  block implementation and compliance.
Narcotics Officers Association opposition
Unaccountable to deliberative and executive governance.
Opportunities for mis and malfeasance

CALIFORNIA HSC §11362.5 IMPLEMENTATION AROUND THE STATE
ARCATA: police card ID system
BERKELEY: 10 plants and 2.5 lbs
BUTTE COUNTY: Sheriff and DA agree: 2 outdoor                        plants or 4 indoor or 1 lb
CALAVERAS COUNTY: 6 plants and 2 lbs
COLUSA COUNTY: No firm policy, generally same as Butte County

"EL DORADO COUNTY:"
EL DORADO COUNTY: Sheriff and DA agree: 6 plants or 1 lb or 1 oz in vehicle
HUMBOLDT COUNTY: 10 plants or 2 lbs
MARIN COUNTY: 12 plants, 6 in flower,
    and/or  ½ lb
MENDOCINO COUNTY: Sheriff and DA agree: 12 plants, 6 flowering, and or 2 lbs
NEVADA COUNTY: 10 plants or 2 lbs
OAKLAND: 96 plants, 48 flowering,
    and/or 1.5 lbs

"SAN FRANCISCO:Health Department Card..."
SAN FRANCISCO:Health Department Card ID
HUMBOLDT COUNTY: Health Department Card ID
SHASTA COUNTY: Sheriff, DA and local police agree; 2 outdoor plants or 6 indoor
    (3 flowering) or 1 1/3 lbs
SIERRA COUNTY: 3 outdoor plants or 6 indoor plants
SONOMA COUNTY: Sonoma Medical Association reviews claims
TEHEMA COUNTY: Sheriff’s policy of 18 immature or 6 mature plants
YUBA COUNTY: 5 plants or 1.5 lbs

Counties with some implementation and compliance

Compassionate Use Act of 1996-
Diagnostic tool of government dysfunction
Passing a law is not enough
Deliberative executive disconnect
Budgetary obfuscation and opacity
Fiefdoms and centers of influence
Elective and non elective covens

Sanctions against physicians
Criminal subpoenas abuse
A mandatory appearance
Milking the cow through the fence percipient vs expert witness
Slander:
This letter of approval is not recognized
Exclusionary attempts
Local M.D.’s only, peer review
Malicious referrals to Medical Board

Medical Board of California
Criminal justice complaints; not from any patients or families
47 abusive accusations with scary letters to patients.
4 compliant with threats to subpoena records
Unrestrained fishing for evidence
Review by anonymous experts
Illicit sharing of information
United Airlines MRO, Medicare
Accusatory sanction on medical practice
No new Blue Shield insured patients
Recredentialling problems
“have you ever….?”

Gridlock and ambiguity: Opportunity for Proactive Structuralism
Proactive structuralism: “If it walks like a duck and quacks like a duck it’s probably not a criminal conspiracy.” Traditional precedential behavior
Oakland Cannabis Buyers Co-op
Organized and self governed
Safe and affordable cannabis
City government agency
Community resource
Supreme Court litigant

California Cannabis Research
Medical Group
Accredited medical group oriented to clinical & social research
Ambulatory medical group model bylaws for research
Non Profit Educational 501c3 status
Comparative efficacy, long term effects, biomonitoring
Coordinate & facilitate  cannabis center harm reduction

 Treatment Programs in Cannabis Centers- clean, safe, well lighted places to buy and visit.
Chronic illness alienates
Negative social contract
Withdrawal
Diminished self image
Marginalization
Criminality worsens and aggravates
Fear, vulnerability, victimization
Cannabis centers offer fellowship without dogma or control
Structured for comfort and safety
Non intrusive but supportive

Cannabis center harm
reduction: substitution for non medical drugs and fellowship.
Education
Safe use of cannabis
Vaporize
Oral
Harm reduction peer support groups
Egalitarian, non-authoritative, supportive without enabling
Monday morning caffeine and cannabis
Identify health/social services needs
Liaison with community with suitable referrals

Medical Cannabis Association
Promote and re establish the legitimacy of the medical cannabis industry.
Assure that all patients have access to safe, affordable, and consistent supply of effective cannabis medicines.
Develop and promote standards for quality and safety of medicinal cannabis.
Advocate for public policy supporting medicinal cannabis
Develop self governance with highest ethical standards

Medical Cannabis Association Membership Categories
Providers-dispensaries
Growers Manufacturers
Patients
Caregivers
Distributors
Lawyers
Doctors
Nurses
Associates
Sponsors
Pharmaceutical Companies

Technology
Internet
Benefits of instant communication and sharing of information
Risks of vulnerability to hackers:
Viruses and worms
Privacy
2 way video: 8x8 Via TV
Benefits of Plain Old Telephone service but choice of movement or resolution
Fax and conference calls
Drawbacks & benefits: Not as good as in person but practical and useful for clinical and administrative applications

Cannabis centers for alternative medicine
Education programs with non pharmaceutical intervention
Phytopharmacognosy
Massage, physical therapy
Nutrition
Exercise
Harm reduction support groups

Cash Based Products and Services
“He Who Pays the Piper Calls the Tune.”
A Restaurant Model
Ultimate cost containment
No Accounts Receivable
Customer patients in control
No 3rd party payers
No audits or gratuitous interference

Self sustaining, self funded
A secular business model
Dime  a dance, pot luck
Ultimate cost containment
Independent from public funding vagaries
Last to be funded, first to be cut
Community treatment resource
Cannabis centers that serve customers the best survive and prosper
Sales and medicated socialization

Like Vietnam After the Tet Offensive
Compassionate Use Act of 1996 passage sent a message to the federal government
Collaborators and federal money corrupted lackeys
County by county combat for the new law
Eventual victory
Most cannabis treated conditions chronic and not rapidly fatal
Implemented and compliant areas not likely to surrender gains

Civil suits
Federal
Conant et al. v McCaffrey
State
Shasta & Tehema counties
Medical Board

Contributions to California physician and patient civil suits may be made to:
California Cannabis Research Medical Group (CCRMG)
1168 Sterling Ave.
Berkeley, CA 94708-1757