Here’s your Prilosec, dude

If you were designing a facility to dispense a substance that has recently been legalized for medical use in your state, how would you do it?  The legalization of this substance is a highly controversial, fraught issue, and much of the opposition to its legalization for medical use revolves around questions of how legitimately it can be used as medicine in the first place, and attendant concerns that so-called “medical use” is just a ruse to cover for recreational consumption.  Indeed, though the substance has been legalized in your state, it is still illegal from a federal perspective.  With all that in mind, what kind of space would you create for distributing this tenuously-legal substance?

I think this is the wrong approach:

A medical marijuana dispensary that’s scheduled to open in Portland next month is designed as a California-style wellness center. Its operator is promoting a free coffee and tea bar, acupuncture clinics, support groups, counseling and a “welcoming vapor lounge.”

The new website of Wellness Connection of Maine says, “Patients are always welcome to relax and socialize near our fireplace, or enjoy a free cup of tea with a friend in our cafe space.”

Before I continue, let me state my opinion on marijuana legalization  — I think marijuana should be completely legal for recreational use.  I can honestly think of no good reason for it to be otherwise.  While I think the War on Drugs in general has been a miserable failure, I can at least grok why trying to keep people from using meth or heroin or certain other nasties is good in theory.  Marijuana?  No clue.  If we allow people to smoke tobacco and drink alcohol (which we should, much to my own liking in the latter case), it is absurd that a much less addictive and harmful substance than either is illegal.

That said, if proponents of medical marijuana are trying to create a public image as a legitimate clinical intervention, then I think they’re making a mistake to create a social atmosphere around its distribution.  People don’t typically hang out where they get their medication.  Most retail pharmacies have done a particularly good job of designing a soul-deadening space, inhospitable to all but those with pressing reasons to be there, which practically screams “people are only here for legitimate medical needs!”  Nobody wants to head to Duane Reade to hang out after their pharmacist doles out the pills for their acid reflux.

Conversely, Wellness Connection of Maine proclaims itself to be a space for social interaction.  A cafe and vapor lounge (which is the pot equivalent of a bar, if I read it correctly) are places to relax and spend time with friends.  They do not conform to the idea of what a clinical space looks like, at least not to me.  (Maybe we should consider putting in an espresso bar in one of our exam rooms?)  Creating a space like this gives credence to detractors’ argument that medical use is a scrim of false legitimacy that is meant to hide is real use, which is primarily recreational.

Indeed, the plan is running into just that kind of reaction:

Creating a social setting for the dispensation of medical marijuana is unhealthy because it promotes more marijuana use than is medically necessary and puts users and the public at risk if customers drive home under the influence, said John Thiele of Maine’s Department of Health and Human Services.

In California, which also allows marijuana to be distributed for medical purposes, many dispensaries have become popular hangouts, he said, and that’s one reason California has run into problems with the federal government, which considers all marijuana use illegal.

“We don’t want that to occur here,” Thiele said. “You don’t encourage people to hang out in the local pharmacy.”

As I’ve already stated, I think marijuana should be legal for adult use without qualification, so I don’t really go along with the “unhealthy promotion of medical use” line.  But for people who do, I think the plans as stated confirm their suspicions.

I think there’s a growing consensus that the War on Drugs has been a miserable failure, and in particular that penalizing marijuana use is a silly, counterproductive policy.  While I certainly share my pal’s qualms with Ron Paul, I wholeheartedly endorse his views on ending our current drug policy.  I like to think that his strength in the polls is in some way a reflection that the public is coming to share this view (though in reality it’s probably more a reflection that Paul is neither named Mitt Romney nor patently insane).  However, until there is a clearer move toward decriminalization of marijuana use in general, places like the planned center in Portland may hurt more than help.

Russell Saunders

Russell Saunders is the ridiculously flimsy pseudonym of a pediatrician in New England. He has a husband, three sons, daughter, cat and dog, though not in that order. He enjoys reading, running and cooking. He can be contacted at blindeddoc using his Gmail account. Twitter types can follow him @russellsaunder1.


    • My qualms remain. They are, however, ancillary to the point of this post, and there’s already ample discussion of Paul and the legacy of his newsletters elsewhere in the LOOG-sphere, so I’d be inclined to avoid making this yet another Paul-dominated thread.

  1. Transform’s outstanding book titled, After the War on Drugs: Blueprints for Regulation, provides specific proposals for how drugs could be regulated in the real world.

    The book is available for free online. If you would like to read it then here it is:

    It doesn’t take much imagination to realize that most of the ‘at present’ prohibited (available 24/7 at a dealer near you) drugs are derived from fast growing weeds like the cannabis plant, the poppy and the coca bush. These can all be cultivated legally and easily in many different regions on our planet without the aid of terrorist organizations.

  2. I think its a great approach. Whats wrong with it? You go to a wellness center to feel better. Why can’t I now have these other amenities along with my medication? Doctors offices give free coffee or tea. They also inject medicines. It will be nice to have all those quality procedures along with my medicine all in one place. I guess you just want a place to go to just to pick it up? People dealing with pain or mental issues need the counseling and support.. They also want to feel safe. What exactly is wrong with free coffee and tea bar, acupuncture clinics, support groups, counseling and a “welcoming vapor lounge.” I can see if you combined distribution with gambling and guns or other illegal activity. When you combined medical marijuana with free coffee and tea bar, acupuncture clinics, support groups, counseling and a “welcoming vapor lounge.” It is a welcome change in healthcare because unlike mainstream healthcare, these people will listen not pass judgment or throw crazy statistics in your face. All any medical marijuana user wants is compassion and caring. I couldn’t count how many doctors I have went to that don’t even want to discuss the topic. There is nothing wrong with what they are going to offer people. Maybe just maybe I will have a place to go that could offer me all those things. I really don’t care how they do it as long as it gets marijuana out of the hands of cartels and gangs. I can grow my own and take care of me. The only thing with that is its not just about me. I want to see others feel better. I don’t want people to go to a doctor and be treated like a criminal or get put down because thats all these mainstream doctors do.

    • In an ideal world, I would have nothing to say contrary to your opinion. I have no intellectual objection to having a more social and convivial atmosphere in clinical setting. It would probably be a nice change.

      But that’s not the world we live in. Yes, some doctor’s offices offer coffee or tea, but nobody would mistake them for a cafe. With a few exceptions (certain support groups and hospice care spring to mind), clinical settings have a distinctly different character than social ones. I’m not arguing that this is how it should be, but that’s how it is. While I can understand why the prospective proprietors of a medical marijuana dispensary in Portland might want to create the kind of space described above, from a pragmatic point of view given the complexity and controversy surrounding the issue, I think it’s a bad idea.

  3. That’s not my take on it, precisely.

    If you’re like me, you’ve been to a half-dozen different kinds of bars. Bars where everyone is high energy and dancing, bars where everyone is low energy and listening to slow music on the jukebox, bars where everyone is depressed, old man bars that cater to sitting quietly with one’s thoughts… so on and so on and so on. (There’s one bar up in Palmer Lake where they have a grill in the middle of the room. You order a steak, they give you a raw piece of meat and tell you to cook it your goddamn self. It’s a piece of heaven, it is.)

    Reading the above, I wasn’t struck with an idea about how much like a medical facility it was, but how it struck me as a respectable place for people to, ahem, “imbibe”. It’s got a very particular atmosphere, it’s got all kinds of people whose job it is to co-pilot… and they even come out and tell you that what you’re doing is fine. All they need is a jukebox.

    (Note: the whole “driving” thing can be a problem but that’s something that a DD can avoid… taxi services, that sort of thing.)

  4. Reading the above, I wasn’t struck with an idea about how much like a medical facility it was, but how it struck me as a respectable place for people to, ahem, “imbibe”

    Well, me too. That’s the problem, as far as I can tell. Skeptics of medical marijuana are going to see the facility and, rather than thinking “That’s a legitimate medical concern peddling legitimate medical care,” will think “they’re all hanging out getting baked.”

    • Perhaps they are… but there are going to be people there who would not feel comfortable just buying a bag and then going home and smoking/watching a Quantum Leap boxed set. (Man, that was a good series. Remember that finale? It’s getting dusty in here…)

      The only way they’d feel comfortable is in an atmosphere like the above. “This isn’t sitting around getting baked. This is medicinal! They’ve got homeopathic bottles of ‘essence of Libra’ and everything!”

  5. Russell is point to an important issue: how much does medical cannabis have to assimilate itself to the mainstream medical model to survive, and to what extent is it even possible to do so?

    There are things about cannabis as a plant that put it at odds with the drug approval system in the US, which has tended toward the purification, isolation, and synthesis of single-molecule drugs.

    But it is cannabis’s status as a cultural symbol that is really at issue here. What looks like a simple medical / recreational divide may actually be much more complex. Although R. Saunders’s reading of the likely public perception of the proposed facility emphasizes the ways it is bound to appear recreational, rather than medical, there is another aspect here that I think deserves attention.

    If you read _Dying to Inhale_, a study of Santa Cruz’s Wo/Men’s Alliance for Medical Marijuana (WAMM), the authors spend some time discussing the ways that cannabis therapy presents not only alternative therapeutic agents (cannabis products), but also an alternative approach to healing, one that emphasizes fellowship. (Some of the patients there, the authors report, didn’t really like this aspect, and just wished to get their cannabis and leave, something that the group’s community style made difficult.)

    In short, there are multiple ways that cannabis runs afoul of how we do medicine, and we desperately need more refined categories than “medical” and “recreational.”

    The problem is, there are those who would make cannabis sink or swim based on the success of their attempts at shifting the paradigm–people like Steve DeAngelo of Harborside in Oakland, who defends a notion of “wellness” like that discussed here.

    His strategy appears to involve the gradual broadening of the conditions for which medical cannabis may be obtained, with the goal of reaching a situation where it is considered as exciting (and dangerous) as aspirin.

    Many now think this strategy will not work to make cannabis more available to those who want it, as increasingly restrictive “condition lists” accompany recent medical marijuana laws. There are plenty of good reasons to make the argument that responsible adults should be able to choose cannabis without legal repercussions.

    Probably it will be easier to add cannabis to our list of (non-medical / recreational) “intoxicants” such as wine than it will be to get non-believers to accept a revolution in medicine led by cannabis devotees.

    It will have the added advantage of setting aside the medical gotcha-game, in which many people looking to “get legal” don’t even see themselves as sick.

  6. While I understand the concern about the image, I suspect part of the reason for the hang-out thing at medical marijuana dispensaries is an attempt to foster an environment where patients not only feel safe and comfortable obtaining marijuana but people in the neighborhood feel safe & comfortable with people obtaining marijuana near them (that is, not like they’re just going somewhere to buy drugs, because w/ the latter in the case of marijuana some still think “pushers” rather than “pharmacy” — lack of real distinction between the two in many cases notwithstanding).

  7. This is sort of tangential, but I actually wonder the degree to which non-pot smokers will want to go to these places for the “cool factor.”

    I could actually see them wanting to, but then getting agitated by the smoke, demand that they have a smoke-free section, then demand that the pot smokers go outside so that they can enjoy their coffee in peace.

      • The subject of smokerias has been on my mind lately, I guess. I do wonder about the same thing in both instances. Even leaving aside any cool factor, what happens if such a place is the only coffee place open late in a given area? It could draw non-partakers, who then might want the same consideration there as in bars (albeit with different kinds of smoke).

        • I’m sure that Burt can clarify but there’s a legal concept called something like “Moving to a Nuisance”. You can’t buy a house next to Fort Carson and then sue Fort Carson because you hear their live-round tests during the day. (Or whatever.)

          It seems that this concept is disappearing…

          • You can’t sue, but in some circumstances if you get enough people you can enact an ordinance.

            My wife and I were looking at moving to a college town. There was (and maybe is) a hot button issue there involving noise ordinances in a particular part of town by the university. Basically, the college part of town was the “cool” part of town, so it draw older people, who then hated all of the noise and were trying to pass an ordinance. I don’t know what came of it, though.

            (I hope that Russell doesn’t mind this digression. If he does, I’ll write a separate post on the subject. Maybe I should anyway.)

          • This is good to hear. I hear about complaints regarding Fort Carson all the time (specifically, the helicopters) and see arguments in support of a smoking ban in bars that say, pretty much, “I don’t like going out with friends and smelling like smoke when I get home.”

            I worry that “moving to a nuisance” is being eroded by these sorts of intuitions.

          • Just ask anyone who runs an airport about whether “Moving to a Nuisance” means anything.

    • Interesting point, Will. Unlike tobacco, though, you can at least eat cannabis–it’s considerably more potent when ingested compared to smoking it, but at least people are spared the harmful effects of second-hand smoke which are much, much worse with pot.

      How many people would you guess, are using it for medical reasons compared to recreational use? Maybe 10%. Hey, I bet Dark Side Of The Moon is the number #1 request at these centers for spiritual resuscitation and achieving Cosmic Consciousness.

      • Just wanted mention I was also a total, complete Pink Floyd fanatic–still love them—Dark Side Of The Moon never ceases to amaze me in that it never loses it’s freshness–a very, very, rare quality with rock music–and Schubert I think would absolutely LOVE, “Us And Them” although this might quite work…(Forgive the poor German, Blaise!—do I sort of have it right?) Got it mixed up the, “there’s someone in my head but it’s not me” with the song from Atom Heart Mother, “If”–if I go insane, please don’t put your wires in my brain”.
        Wir und die
        Und nach allem, was wir sind nur gewöhnliche Menschen
        Ich und du (mich und dich?)
        Gott allein weiß, es ist nicht das, was wir zu tun wählen….

        • Sorry Doctor–just realized I ventured off into the Pink Floyd conversation which was going on in another thread. That’s what pot will do to ya! Just kidding—yes, I have smoked it but find it’s a substance that rather quickly has diminishing returns and just becomes a very dull and boring experience. I also tried Datura stramonium, aka Jimson weed, which was the most terrifying experience I’ve ever had in my life. I was entirely incapable of differentiating between what was happening in my mind and imagination and what was happening before my very eyes. The separation between reality and mind completely disintegrated. Unless total psychotic terror attracts you, never, ever venture into this land of demons. Curiosity has almost killed me too many times.

    • If the dispensary opening in Maine is anything like the one’s I’ve experienced (from afar mind you) on the west coast you will need to show your medical card just to get in. This would cut down on the visitors who do not intend to purchase marijuana for medicinal use.

      “If you were designing a facility to dispense a substance that has recently been legalized for medical use in your state, how would you do it?”
      I would do it like this. Of course, if I wanted it to stay open and stand a chance I would go with a setting which is less controversial until the practice became main stream. Then you can do whatever the heck you want.

  8. I have nothing to say on this topic — I just wanted to mention that whenever I see an entry on the front page’s Gifts of Gab for a comment to this post, I initially read the comma as ending the title of the post and attach the “dude” to the beginning of the comment. So everyone’s like “dude, this is good to hear” or “dude, please” or “dude, my qualms remain”. Makes me nostalgic for my old crowd.

  9. “If you were designing a facility to dispense a substance that has recently been legalized for medical use in your state, how would you do it? ”

    Well I can roll into the grocery store near my house and buy a bottle of aspirin and a bottle of whiskey, so I think we already know how to do it.

    Or else we don’t, in which case we have a more fundamental problem than marijuana.

  10. I will say that the whole issue is that legal distribution of marijuana has been forced to pretend that it’s a medical thing, rather than a recreational thing. If people just legalized it then nobody would care.

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