Jim calls it "looking out for angels." He's talking about the terminally ill, people dying from AIDS and HIV-related cancer. Sometimes they're in their thirties, but often they're older — in their sixties and seventies — and many are indigent. "It's really not a pleasant process that someone can go through," Jim said.
An optimist, Jim is 56 years old and has a weary-yet-resolute Australian accent. He's also somewhat of an expert on the great beyond. He's a two-time cancer survivor himself, he's HIV positive, and he once had a brain aneurysm. But he's also worked for ten years as a social worker in hospices and has witnessed 167 deaths.
At the end of a person's life not many drugs actually work, and many of them can make dying worse, Jim said. Modes of delivery are limited, too, he noted. "It actually has to be, like, rectum or under the tongue," he explained.
That's why Jim endorses the use of medical marijuana in the form of drops from a concentrated tincture placed under the tongue. "It's nice to see someone go through it relaxed and not thrashing around, you know, screaming out," he said, referring to what sometimes happens to people as they near death.
Naturally, Jim was furious when US Attorney Melinda Haag declared war on medical cannabis in California on October 7. Haag held a press conference with three other federal prosecutors and said they were targeting illegal exporters and profiteers. But Haag's actions also have led to the closure of three permitted dispensaries in San Francisco. Hundreds, in fact, have closed statewide, while cities and counties have stopped issuing permits for new dispensaries. In short, the medical marijuana industry is under siege again.
Jim, as a result, didn't want his real name used for this story, nor did some of the Bay Area hospices secretly providing donated cannabis to end-of-life patients. They're federally funded so they worry that they could lose everything. "These judges and people that make decisions for patients, I really wish they could do chemotherapy — so they could see," Jim said.
Fifteen years after Proposition 215 enshrined in the California Constitution a medical right to cannabis for the sick and dying, the sick and dying have the hardest time getting it. In fact, seniors and the sick had a difficult time getting access to medical marijuana even before the federal crackdown, back when many California patients had little trouble buying it, and the difficulty only increased as they progresssed from independent living to assisted living, nursing homes, hospitals, and in many instances, hospice.
"I think one of the greatest disappointments of the last sixteen years is that we have not been able to provide sufficient access for folks at the end of life," said Stephen DeAngelo, founder of Harborside Health Center in Oakland. "If you take a look at the things cannabis is most effective for, it reads like a laundry list of ailments afflicting seniors: stress, depression, anxiety, pain, insomnia. This is a tremendously underserved population."
Seniors themselves are often the first to resist using medical cannabis because of societal concerns about using a drug that the federal government deems illegal. And when they do want to use medical pot, they often don't know where to go, or how to get it. Many cities ban cannabis clubs, and seniors in assisted living facilities, nursing homes, or hospitals often find access impossible.
Nick's dad liked jazz. And weed. "My dad was a cannabis smoker all the way back to the Thirties and Forties," recalled Nick.
Nick ran a skilled nursing facility in California, so he's deeply familiar with the conflict between medical cannabis law in California and the national medical system. The Express agreed to not publish his real name because it could cost him his job.
When Nick's dad found himself hospitalized with a stroke, "He wanted to smoke but he couldn't and it was horrible for him," Nick said. "You could tell all he wanted was to get high and listen to some jazz, that would be really great for him, but it was not an option.
"I got a taste of it then — [that] this is going to be a pleasure that will be denied to me when I am at this stage of my life. Unless we change it."
Valerie Leveroni Corral is head of Women's Alliance for Medical Marijuana in Santa Cruz, an eighteen-year-old dispensary that specializes in outreach to women, seniors, and the sick and dying. After working all over the state, she said the landscape is still very bleak for seniors in assisted living and beyond.
"One assisted care facility had a paralyzed marijuana patient smoking on the sidewalk — that's just asking for trouble."
Fights for access result in temporary gains, then the facility is bought and policy changes, she said. "There's been a huge shift in assisted care facilities, consolidation that I'm not sure who's behind. These facilities leave people in pain."
When seniors progress beyond independent living and state-licensed assisted living they cross the Reefer Rubicon, as it were, and often enter into the weedless world of nursing homes. Such "skilled nursing facilities" take federal funds and cannot by law allow a Schedule 1 controlled substance like marijuana on the premises. Same goes for seniors' next destinations — hospitals and hospice care facilities.
"They'll just say, 'It's impossible,'" Nick said, referring to how medical staff at these facilities respond to the idea of bringing in medical cannabis for patients. "It's like, if a family member brings in BenGay for their patient, we have to tell them, 'You can't do that unless you bring it to us and we have to run it by the doctor and we need to have a telephone order.' That's the context. That's how controlled it is."
Yet in nursing homes, there are plenty of patients whose lives would be better if they had access to medical cannabis. "There are all these patients who have chronic pain, insomnia, loss of appetite, depression, Parkinson's, agitation from Alzheimer's — all of the patients who are on a million medications to handle these things and the medications are creating a lot of the need for other medications. It was frustrating to know there wasn't a way to even try to see whether or not these patients would even benefit from cannabis."
Nick said he would be surprised if any but the smallest nursing facilities secretly allowed the drug on the property. "That's a huge risk for the owners to take," he said. "My hat's off to them. If there's nursing homes doing that, they need to be commended, because it's a huge risk. I don't know of anybody who's doing it."
But there are people secreting pot to the sick and dying, sometimes under the nose of administrators, sometimes with their tacit permission. An Oakland social worker we'll call Gladys said nursing home seniors in two facilities she knows of use cannabis for pain and anxiety, and in a dementia group "for hunger. Getting them to eat. They forget to eat. They don't want to eat. Food is not on their radar. ... And for sleep.
"A few have medical cannabis cards, but ... they can't show [them]," Gladys continued. "No controlled substances. Period. Not even if you have a medical marijuana card."
Gladys also requested that her real name not be used in this story because she could lose her job.
But some people have no such fears. Erich Pearson, founder of the SPARC medical cannabis dispensary in San Francisco, has spent ten years secreting marijuana to hospices. "They were skeptical at first and I was a bit nervous," he said of the hospice staff. "I went to the first meeting with the entire staff and I was young, 22, and the entire staff is all dressed up in nursing garb. I was getting looks like, 'What are you doing here bringing medical marijuana?' But the executive director was behind it and three weeks later, 9:30 at night I got a call from them: 'We got a new patient, can you bring marijuana right now?'"
The federal crackdown is making his partners cautious, but they're not willing to stop what they're doing. "I think they see the advantages of it — I don't think the program is tenuous," he said. "But it's certainly not on the books, for obvious reasons."
When Pearson approached a patient named Jim, he was resistant to smoking cannabis even though he was beginning to waste away because the nausea from chemotherapy was overwhelming and he couldn't eat. "I got to the point where I couldn't even stand the smell of food; it would make me throw up — just the smell," Jim said. "It got to the point where I was ready to have a feeding tube put in. Erich had approached me before and I had said, 'No, I'm really not interested. I just thought they were just, like, hippies and I really wasn't into that whole scene. It's just a totally different scene than I was used to."
But then came the harsh reality of eating through a feeding tube. "I said 'Okay.' I smoked it," Jim said of the cannabis that Pearson offered him. Jim said his quality of life changed quickly. "I was able to stand the smell of food. Then I was able to handle small plates of food. So the feeding tube was canceled."
That was in 2000. Pot helped Jim with his second cancer chemo — and with the pain from having his lymph nodes surgically removed.
About 213,000 people will die in California this year, many from complications related to heart disease and cancer. Meanwhile, dispensaries are closing in San Francisco, making it harder to get medical cannabis. "It makes me very angry," Jim said. "I think it's wrong.
"I'm just very disappointed in Obama regarding it, too," he continued. "It's about the same or worse than Bush. It's just very disappointing."
Neither of the state's two hospice associations has staked out a public position on medical marijuana. California Hospice and Palliative Care Association President Susan Negreen said the issue has come up but the board declined to take a position. Vitas — a mega-hospice corporation in California — declined to comment.
Caren Woodson, delivery dispensary manager from The Green Cross in San Francisco, said the service delivers lots of edibles to hospitals and senior patient care facilities. "We're personally experiencing a situation where more older home facilities and hospitals and hospice care facilities are creating policies that welcome use of cannatherapies," she said. "However the individual operation creates that particular rule rather than any general acceptance."
She also said that the federal backlash against medical marijuana appears to only be coming from the US Department of Justice. "The Obama administration has issued both Veterans Affairs recommendations and HUD recommendations around the use of medical cannabis specifying that local authorities have the right to make those decisions or exercise that discretion as they see fit," she noted.
In fact, she said that medical cannabis bans enacted in cities throughout California have had the most significant impact in terms of shutting off access for most seniors — even more than the crackdown. "The biggest factor in determining whether or not people who need access the most have access to it is whether or not your local jurisdiction has laws that permit and regulate access or ban access outright."
When dispensaries close, "seniors are the ones that are affected the most," she added.
And yet many seniors, who suffer from all types of ailments, don't realize that medical cannabis can make the final years of their lives better and more manageable.
Time and the economy have not been kind to the Eastmont Mall in deep East Oakland. The Subway franchise in the parking lot is walled off with bulletproof glass. Inside the mall, a food stamp center, senior center, and other Alameda County social services inhabit spaces that retail outlets once occupied.
Inside, United Seniors of Oakland and Alameda County has taken up residence. Serving 2,000 Alameda County seniors for 25 years, United Seniors has turned the space into an information clearinghouse, meeting room, and office. The walls are covered with colored fliers advertising classes on a variety of subjects for seniors, from taking mass transit to avoiding pill overdoses.
The back meeting room is always packed for board meetings and presentations. Sue Taylor, chief of senior outreach for Harborside Health Center, recalled meeting with seniors there in February. Taylor, a 64-year-old African-American mother of three, who says she's "very healthy," said she found the reception at the center to be rather hostile. "They received me with their hands crossed and arms folded, like, 'I'm not going to let anyone in and let them tell me nothing about marijuana.'
"Most are African American, and they see this as a touchy subject," she said of the seniors who come to the center. "A lot of our young men are strung out on heavy drugs and unless they are educated, they don't know that marijuana is totally different."
As a lifelong motivational speaker on nutrition and wellness, Taylor knew what to say. "I went in there and I spoke to them about what pharmaceutical drugs are doing to the baby boomers and our population and how many boomers I've lost to pharmaceutical drugs," she said. "I just want people not to shut their doors on it, to look at the facts about the medical benefits it can bring to them.'
Taylor doesn't smoke pot, but she uses a cannabis rub on her sore knees. And if she can't sleep, she'll use some tincture under the tongue. She became an advocate after her son tried to get her to open a dispensary with him. They didn't open one, but she learned about the plant, and then she saw more and more cancer patients using it safely and effectively.
Taylor, who has lived in the Oakland hills for more than thirty years, connects with many seniors who are wary about trying pot because she doesn't look like a stoner. She went to Catholic school as a girl and went on to become a principal at two schools. Her three sons also went to Catholic schools before attending college. "We're a pretty middle-class family," she said.
When Taylor finished her presentation at the center, the board of directors of United Seniors voted unanimously to partner with Harborside on education and outreach. Taylor said that members of the center started telling her "one after another how their husband or themselves were hooked on certain drugs and couldn't get off, and the side effects. They were prescribed two pills a day, but taking a total of thirteen pills from the side effects of the two. I had three people in that group come up to me and say, 'I use marijuana. It's the only way I can survive. Nobody in the group knew that."
United Seniors added Harborside pamphlets to their shelves and invited Taylor and Harborside to their annual Health Fair at the Oakland Zoo in July. United Seniors board member Karen Smulevitz said she had smoked pot as a young adult, but stopped when she got older. She raised three kids in Oakland, and has lived in town for forty years. "I got to be a PTA mom," she said.
Thin, with long white hair, sharp eyes, and a sweet smile, Smulevitz said two doctors have recommended cannabis to her but she hasn't sought it out. "I have a great problem with insomnia," she said. "I go a long time without sleeping. I'll sleep an hour, then that's it the whole night. Then I'm dragging during the day and I'll take a nap because I can't stay up any longer.
"I'm thinking of using cannabis because I'm afraid of sleeping pills," she continued. "I've tried them and I don't like them. I don't like the way they control your body. Cannabis is natural. It's not some chemical manufactured in a factory. I'm more afraid of that kind of thing."
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