Until some kind of legal accommodation makes it possible for patients to obtain marijuana without violating the law, buyers' clubs are the best approach to the problem. Yet the federal government, including the White House, the Drug Enforcement Administration and federal law enforcement at all levels, remains opposed to the idea. While for a short period of time after the publication of the Institute of Medicine report, "Marijuana and Medicine: Assessing the Science Base", the Feds retreated somewhat from their position that marijuana has no therapeutic value, they are now working diligently to close the cannabis clubs.

Many, if not most, advocates who recognize the importance of buyers' clubs believe that the first model is preferable to that represented by the San Francisco club. The former is more businesslike, conforms more closely to the pharmacy model and at least appears to be more vigilant about checking the documentation of people who present themselves as patients. The San Francisco model club, largely because of the on-site marijuana smoking and its relaxed atmosphere, appeared to be more casual in its commitment to confirming medical need, which made even the supporters of buyers' clubs a little nervous. Yet the importance of the social aspect of buyers' clubs cannot be underestimated and, in my view, offers a medically significant new model for future conventional use of cannabis as a medicine. It is becoming increasingly clear that emotional support, contacts with and help from fellow-patients, friends, family, co-workers and others, plays a salutary role in battling many illnesses. This kind of support improves the quality of life, and there is growing evidence that it may even prolong life. In one study, socially isolated women were found to be five times more likely to die from ovarian and related cancers than women with networks of friends and families. In another study, women with breast cancer were found to be 50 percent less likely to die in the first few months after surgery if they had confidants. In a four-year study of 133 breast cancer patients, married women had a longer average survival time. Researchers have consistently found that support groups are effective for patients with a variety of cancers. Participants become less anxious and depressed, make better use of their time and are more likely to return to work than patients who are given only standard care, regardless of whether they have serious psychiatric symptoms. There is evidence that even brief supportive therapy can have benefits that last for months. Some researchers have made the controversial claim that mere participation in support groups can prolong cancer patients' lives. The San Francisco buyers' club functioned very much as an informal support group. It was not designed by psychiatrists and social scientists to provide supportive group therapy, but there is reason to believe it did. One of the properties of marijuana may have contributed to its effectiveness: when people use cannabis, they tend to be more sociable and find it easier to share difficult thoughts and feelings. If there is even one kernel of truth to the idea that talking about the stress, setbacks and triumphs in the battle against an illness can help a patient cope and recover, it is clear that the San Francisco model provides the best environment for the dispensing of medicinal marijuana. Furthermore, the existence of this kind of medical service would solve a difficult problem for the physician who recommends marijuana to a patient, particularly an older one who lacks experience. Unlike most prescriptions which require little more preparation than providing the patient with an understanding of the possible toxic ("side") effects, many marijuana-naïve patients will require someone to teach them how to use it comfortably. Such instruction is readily available at a San Francisco-type facility. Unfortunately, we live in a culture that considers such a facility a public nuisance and criminalizes a compassionate form of caring out of loyalty to a symbolic war on drugs. In any event, the present federal government is not going to allow the development of a separate distribution system, and certainly not on the San Francisco model, for this one medicine. Now that the federal government has embarked on a cruel and so far successful campaign to close down buyers' clubs, what options are available to the many thousands of patients who find cannabis of great importance, even essential, to the maintenance of their health? They can either use Marinol, which most find unsatisfactory, or they can break the law and use marijuana. Why is a government which considers itself compassionate ("compassionate conservatism") criminalizing these patients? What is the government's problem with medical marijuana? The problem as seen through the eyes of the government is the belief that as growing numbers of people observe relatives and friends using marijuana as a medicine, they will come to understand that this is a drug which does not conform to the description the government has been pushing for years. They will first come to appreciate what a remarkable medicine it really is; it is less toxic than almost any other medicine in the pharmacopoeia; it is, like aspirin, remarkably versatile; and it is less expensive than the conventional medicines it displaces. They will then begin to wonder if there are any properties of this drug which justify denying it to people who wish to use it for any reason, let alone arresting more than 700,000 citizens annually. The federal government sees the acceptance of marijuana as a medicine as the gateway to catastrophe, the repeal of its prohibition. In so far as the government views as anathema any use of plant marijuana, it is difficult to imagine it accepting a legal arrangement that would allow for its use as a medicine, while at the same time vigorously pursuing a policy of prohibition of any other use. Yet, there are many who believe this type of arrangement is possible and workable. In fact, this is the option the Canadian and Dutch governments are presently pursuing as are various states in the United States. Let us consider what might be involved in establishing and maintaining such a legal arrangement in this country.