Becky DeKeuster of Berkeley Patients Group

On December 17th, our post dealt with the State of Maine setting up their medical marijuana program. A few days later we received a comment on our post via Live Journal from Becky DeKeuster of Berkeley Patients Group. We shared Becky DeKeuster's comments with you on December 31, 2009, and we promised to respond to Ms. DeKeuster. Please see below our comments.

Dear Ms. DeKeuster,
Thank you for taking the time to respond to my post and for so eloquently sharing important information. I understand that you needed to correct my statement: "The same people who are helping Maine set up a medical marijuana program are also trying to have full on legalization voted on in the next year in California." I will agree with you this statement is rather broad. Without enough research, I implied, based on an assumption from the news articles that the Berkeley Patients Group would be in favor of full legalization. I did not mean to imply that you have or would take an official stand on legal or recreational use of cannabis. After all, as far as legal use, medicinal legal use was passed in California in 1996 and Berkeley Patients Group was founded in 1999. I understand now that recreational legalization is not part of BPG's agenda.

I have now visited your web site and read your mission statement. I have also taken the time to read the PDF "Declare Saturday, October 31 2009, 'Berkeley Patients Group Day' In the City Of Berkeley." This declaration was very informative, providing a historical review of Proposition 215 and Berkeley Patients Group activities over the past 13 years.

I appreciate your clarification and your wish for a "do-over" regarding the wild-west metaphor. I, too, have been following this topic for a number of years and I recognize that each state finds they must individually navigate these waters very carefully and diligently. I am frequently amazed at the obvious differences in how medicinal marijuana dispensaries are managed in northern California towns and cities, as compared to what I see and read about in Southern California.

I don't think we are too far apart regarding the pharmacology issues. I did not mean to imply that I believe that marijuana should only be available in pharmacies distributed in THC pill form. What I wanted to assure is that it be regulated and, therefore, look forward to it not only in a synthesized formula, but also the natural herbal form being distributed by pharmacies. I do understand that patients indicate that the delivery format of the herbal form appears to be more efficient for pain relief, not unlike, I would think, the surgical patient receiving a morphine drip, as opposed to a Vicodin tablet.

The bigger question remains, should marijuana be approved for recreational sale and use, like alcohol? And if it is, how will it be managed, controlled, sold, distributed? We know addiction is a disease. Many people use marijuana, but like alcohol drinkers not all are abusers. Addiction affects minimally 25% of the population. Managing medicinal marijuana use will be perhaps left to our health care providers, who will need to decide if herbal marijuana is the correct course for each individual patient.

Going forward we will continue our work to educate and assist those seeking recovery and sobriety.

"Thank You, and Some Corrections"

On December 17th, our post dealt with the State of Maine setting up their medical marijuana program. A few days later we received a comment on our post via Live Journal from Becky DeKeuster of Berkeley Patients Group. We would like to share her thoughts with you as we close out 2009. Next week we will be back to respond to Becky's comments.

Thank you, and some corrections
Greetings, and thank you for addressing the important work that Maine's medical cannabis task force is undertaking to ensure that qualified patients have safe access to medical cannabis there. In the interest of an open exchange of ideas and facts, I write to address some of the concerns you express in this posting, and to clarify certain inaccuracies therein.

First I must correct your statement that "The same people who are helping Maine set up a medical marijuana program are also trying to have full on legalization voted on in the next year in California." Berkeley Patients Group takes no official stand on legal or recreational use of cannabis, and has not contributed to the ballot initiative that California voters may vote on in 2010. To do so would in no way advance our mission, which is as follows:

"The mission of the Berkeley Patients Group is to provide the purest, most effective, and affordable medical cannabis along with integrated holistic health services. We create and maintain the standards of excellence for medical cannabis in all that we do. We foster a compassionate community that advances understanding and inspires action."

As we enter our second decade of operations, BPG is still guided by the vision of our founder Jim McClelland, who died of AIDS-related complications in 2000. To blur the bright line between legalized medical use and legalized adult use would be to do a disservice to Jim, and to the patients who rely on us for medicine, services, and support. We are expert at successful, legal dispensary operations. Legalization is not on our agenda.

My second point refers to the perception that "the west is a mess." If I had a do-over button I would not have used the "Wild West" metaphor in that media interview. It's an easy shorthand, but it paints an inaccurate picture of what is actually happening in western states with medical cannabis laws. (These include Alaska, Washington, Oregon, California, Hawaii, Montana, Arizona, Nevada, and New Mexico.) Each of these states is dealing with implementation in its own way and each is facing various complexities.

It is important to keep in mind that these states are working separately because our federal government has so far refused to accept the findings of its own DEA Chief Administrative Law Judge Francis Young, who ruled in 1988 that "marijuana, in its natural form, is one of the safest therapeutically active substances known." He further stated that "the provisions of the Controlled Substances Act permit and require the transfer of marijuana from Schedule I to Schedule II," and that "it would be unreasonable, arbitrary and capricious for the DEA to continue to stand between those sufferers and the benefits of this substance."

That being said, for the purposes of this comment I will limit my focus to California, which I suspect is the true target of the "wild west" concerns. Of course, the issues that L.A. is facing make for great media and so, unfortunately, those are the reports that the nation hears.

What is less often reported is that there are cities and counties in California where medical cannabis cultivation, dispensing, and use happen with reasonable oversight and without negative impact on local communities or patients. Oakland, San Francisco, Sebastopol, and Berkeley all come to mind as examples. These local governments early on implemented sensible regulations that allowed for, and put reasonable checks on, how patients, dispensaries, and communities can co-exist. And in the case of Berkeley, voters last year authorized a city commission to oversee dispensary operations and safety standards. In short, locales that allow for dispensary operations within clear, fair guidelines simply do not have the proliferation issues that we are seeing in the southern part of CA today. Because their programs are successful, because they work for their communities and don't make waves, they are not sensationalized in the media. The last media BPG received before this past Tuesday was an article in the Oakland Tribune about the City Council of Berkeley unanimously proclaiming our 10th birthday as "Berkeley Patients Group Day" in our city this year. [here is a link to the city's proclaimation "Berkeley Patients Group Day CA 2009" ]

I understand your call for cannabis to be treated as other pharmaceuticals. We have heard it again and again here in California--why can't they just have it in pharmacies? You can get synthesized THC in your local pharmacy, with a prescription. It's called Marinol, or Sativex. Patient responses, though, indicate a strong preference for the natural herbal form of the medicine, which can be self-titrated, and which offers a plethora of strains for the patient to choose from--and yes, scientists here, in Holland, and elsewhere are working hard to match specific strains to relief from specific ailments, and why. We know from our patients' anecdotal experience that various strains work best for different illnesses, but are currently working to link chemical components of each strain to the types of health issues that respond best to each strain. (Again, such research is taking place on a self-regulated basis and under considerable legal restraints, due to the federal government's refusal to address this important concept.) There are even four patients in the U.S. who receive 300 pre-rolled joints a month from the federal government itself, which operates a grow facility at a university in Mississippi.

So. Why can't we dispense it in pharmacies? Well, the folks who make Marinol would like that very much, but the patients say that THC compounded synthetically in a lab doesn't approach the efficacy of using whole plant medicine. Furthermore, cannabis is proven to be less lethal than aspirin. Yes, over the counter aspirin. In terms of patient needs, and taking into account societal impacts, this is not a medicine that requires Schedule I handling (also on Schedule I: heroin and fentanyl. Cocaine and meth are both Schedule II).

Finally, I want to say that I personally appreciate the work you do to help those with addictions to various substances. Your concerns about Maine's implementation of this law are understandable. However, it is especially vital for those in your profession to fully understand the facts about medical cannabis, and to consider Maine's law, and our advisory role, not as a threat but as an opportunity to learn more and to help debunk damaging myths about this substance. I would invite you to research more on the issues I have stated above, and to also consider the emerging role of medical cannabis as a valuable harm reduction tool.

Again, thank you for taking up this issue. I look forward to continued conversation with you as Maine crafts regulations that encourage safe access and sensible medical use standards.

Be well,

Becky DeKeuster
Berkeley Patients Group

Maine has Turned to California for Help Setting up a Medical Marijuana Program

Maine has turned to California for help setting up a medical marijuana program; the hope is that they will be able to implement what has worked well in the past. With over 10 years of experience in California they have had plenty of time to make mistakes and to have hopefully learned from them; considering that we are on the edge of what appears to be full on legalization in the next five years. Maine proceeds cautiously into this new territory, hopes to figure out a system that addresses both public safety and the needs of those recommended patients for marijuana. Maine is trying to avoid the craziness that exists out west, dispensaries opening and closing daily and it doesn't seem like any one really understands what is happening - in short the west has become a mess. A task force has been set up, "figuring out how many medical marijuana patients there are in Maine and how many distribution clinics or dispensaries are needed to serve them. At least one member of the panel said he's not sure if the state needs one, 10 or 50", according to ABC News. The task force is composed of 14 members, they will determine rules effective within 120 days; the task force hopes to be able to take every factor into account in order to give the voters exactly what they voted for. Becky DeKeuster, of the Berkeley Patients Group said, "This should not have a negative connotation. This is a medicine. This is essentially a pharmacy with a community center component in our model".

If marijuana is going to be considered a medicine then it needs to be held to the same standards as every other pharmaceutical, the same laws and restrictions should apply to weed as they do to Vicodin. There is no other way to make this a legitimate program, therein lies a huge problem with the legality of marijuana; some are trying to have a medicine and others are trying to have a recreational drug, like alcohol. The same people who are helping Maine set up a medical marijuana program are also trying to have full on legalization voted on in the next year in California. It is noteworthy that Maine is taking the time to create a successful program, but it seems like all of this is a slippery slope and no matter what, all the factors present cannot be addressed. "This task force is not going to be able to accomplish the dotting of every 'I' and the crossing of every 'T', but addressing the issues ahead of time is crucial so that you don't end up with a wild-west situation", DeKeuster said.