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.