Former Democratic Massachusetts Representative Barney Frank has been speaking and writing for years about the similarities between the fight for gay marriage and that for legal marijuana. He pointed out in a 2015 editorial for Politico that “advocates for legalizing marijuana faced the same frustrating vicious cycle that encircled same-sex marriage supporters. We could not demonstrate that the alleged social harm it would cause was a myth until we could point to real-world experience, but we could not gain that experience until we could refute the allegations.”
While Frank acknowledges that most people are “hard-pressed to deny [those] suffering severe pain the right to […] otherwise unavailable relief,” what he doesn’t discuss is how fundamental LGBTQ and AIDS activists were to creating the inertia that led to the very first substantial medical marijuana programs.
The fact is that without the work put in by people with AIDS (PWAs) and their caretakers in the early period of the outbreak, America likely wouldn’t have taken what Frank refers to as the first step in legalization at all. It wasn’t coincidence or good will from the government that led to the passing of a number of medical marijuana bills in the 1990s. Rather, what allows us to experience medical marijuana as it is today was the confluence of the time limit imposed by a vicious, mysterious and fast-acting illness and the dedication of the community of activists that it afflicted.
Medical Marijuana before AIDS
Before the first dispensaries were set up in California, options for people looking to obtain medical marijuana (MMJ) were slim. In addition to black market avenues existed a federal program that, though complicated to apply to and not well known, gave MMJ access to a handful of patients. The Compassionate Use Investigational New Drug (IND) program provided cannabis “cigarettes” grown at the famed University of Mississippi federal farm that were cured and rolled in Raleigh, N.C. by the National Institute on Drug Abuse (NIDA), the joke apparently lost on them. These federal joints are packaged together in bundles of 300 and shipped monthly to patients in austere ration tins that look like something you’d pick up in a video game.
In the three years before AIDS that the Compassionate IND program existed, MMJ supply was restricted just to patients with certain cancers, glaucoma or rare illnesses that were aided by the use of marijuana. Even after the outbreak, at its height the federal government’s MMJ program only ever supplied at most 30 active patients.
Requests to the NIDA from researchers for access to cannabis began to grow in the 1970s when it was revealed that the plant could help combat a cancer-caused wasting syndrome in which people lose 10 percent of their body weight in addition to having diarrhea, weakness and/or fever for 30 days or more. Researchers from California alone requested one million cannabis cigarettes for study of the plant’s medical potential, which is when the NIDA realized that they’d have to consider some alternative production techniques for their little farm to keep up with demand.
But instead of expanding the Mississippi grow-op to provide researchers and patients with the whole plant, the FDA opted instead to push for the development of synthetic THC. The operation was built on a 1972 study by Harris Rosenkrantz showing you could deliver THC into a person’s system orally via sesame oil, and even though a 1975 study published in the New England Journal of Medicine suggested that smoking offered a more reliable route of THC absorption than gastrointestinal uptake, the Food and Drug Administration (FDA) went ahead with their plan for an oral ingestion method anyway.
The resulting drug, Marinol (generic name dronabinol), was a pill of synthetic THC made by New Jersey-based pharmaceutical company Unimed. It was swiftly given Schedule II drug status (compared to marijuana’s higher classification of Schedule I) alongside methadone, fentanyl and cocaine (yes, coke is in a lower drug class than weed—it was moved down to Schedule II when dronabinol was put there).
It’s obvious to us now, on this side of relatively sophisticated medical and recreational cannabis production chains and markets, that a THC extract alone ignores CBD and the other therapeutically beneficial cannabinoids in marijuana. The debate on ingestion methods notwithstanding, had research been done into the plant as a whole and not just THC, we might have known earlier about the possible use of cannabinoids in blocking signaling between HIV and the body’s receptor cells. (But to be fair, even coverage of research today—and perhaps the research itself—is largely lacking a holistic approach to looking at cannabis. In the few brief news pieces that arose a couple of years ago about the possibility of cannabinoids helping slow the progression of HIV, THC is the only one referenced by name even though cannabis contains at least 112 other compounds.)
But in the epidemic’s nascent stages in the early ’80s, it was difficult enough to get the FDA to approve a traditional pharmaceutical treatment for AIDS let alone alternative therapies like cannabis. According to AIDS historian Randy Shilts’ seminal book And the Band Played On, in 1982—a year in which 853 people in the U.S. died from HIV/AIDS—the National Institutes of Health (NIH) was spending $34,841 on research for every death caused by Legionnaire’s Disease but only $8,991 for each one from AIDS. To be fair, this was up from $3,225 per person for the 121 deaths in 1981 when it was still called “gay cancer.”
The Seeds of Change
Things would have likely remained bleak for much longer were it not for the primary community that AIDS affected. In the early days as now, people with AIDS were predominantly gay and bisexual men. But these first PWAs were not just any gay men; they were men fresh from the first decade of agitation for gay rights—men with political experience.
The epidemic first flared 12 years after the gay rights movement’s catalyzing Stonewall riot and only three years after the 1979 White Night riots in San Francisco that followed lenient sentencing of ex-cop and ex-supervisor Dan White for the assassination of openly gay SF Board of Supervisors member Harvey Milk and his political ally, city mayor George Moscone.
Though no one could have known it at the time, Milk’s assassination sparked the fervent community activism machine that would eventually mobilize local funds for AIDS care and research and agitate for California-wide medical cannabis. Outrage over Milk’s death and White’s sentencing would energize a community unknowingly on the brink of an emergency and make lifelong activists out of many LGBTQ individuals in time for when they would need it most.
Although Milk was killed a few years before AIDS hit, at least one person who had worked in the supervisor’s administration ascended to political power during the initial outbreak. AIDS activist Cleve Jones was elected in 1982 to the San Francisco Democratic County Central Committee where he served for three terms, demonstrating that local SF politics were accepting of AIDS activists not only as part of the community, but as policymakers. As crucial as the ensuing community-led agitation was for funding AIDS research and care, the effort arguably would not have been nearly as effective if it hadn’t fallen on compassionate ears.
Luckily, PWAs and AIDS activists found the sort of audience they were looking for in the San Francisco Board of Supervisors, undoubtedly the result of Harvey Milk’s championing for LGBTQ civil rights during his time on the board.
Cannabis historian Clinton Werner notes in his 2001 essay “Medical Marijuana and the AIDS Crisis” that the SF BOS allocated a million dollars of spending for AIDS programs in 1982 and then $2.1 million more in 1983—together more than the funding from the NIH for the entire country’s extramural AIDS research. The New York Times reported in 1983 that “spokesmen for homosexual groups say they are generally pleased at the way the city has responded to the epidemic” suggesting a measure of collaboration, or at least an open ear on the part of the board.
But while San Francisco was keeping itself somewhat afloat when it came to AIDS funding, the search for a treatment hit a federal roadblock. As San Francisco General Hospital’s Ward 86—the world’s first AIDS clinic, which was established with that BOS money—was leading the way on clinical research and care, the FDA was dragging its feet when it came to testing and making available promising AIDS treatments from France and Israel.
But this time, PWAs wouldn’t wait for the government to help.
“I can’t wait for the FDA”
“You’re going to die from the disease one way or another,” an anonymous PWA is quoted as saying in Susan Maizel Chambré’s book Fighting for Our Lives, “anything you can do to prolong your life is worth a try. It’s my body. My choice. I can’t wait for the FDA.”
The very first buyers’ clubs—the spiritual predecessors to dispensaries—were established under that ethos, but they didn’t deal with cannabis then. At first they were established simply as an import and distribution network for bringing promising experimental AIDS treatments in from overseas and therefore circumventing the FDA’s lengthy approval time.
Eventually the project grew to include vitamins and herbs, Werner says, when in 1987 the network established brick-and-mortar spaces in San Francisco and New York. It was after use of the antiretroviral drug AZT, which caused side effects that included severe nausea, became widespread (also in 1987) that people turned to medical cannabis at unprecedented levels. “For many AIDS patients,” Werner writes, “smoking or eating cannabis became a primary component of their unorthodox treatment arsenal.”
Doctors, who often had close relationships with AIDS patients in the sense that they shared details of what unprescribed medications and methods helped relieve their symptoms, began to advocate for patient usage of cannabis to fight AIDS’ wasting syndrome (the same sort of cachexia, as it’s known, that is seen and treated with cannabis in cancer patients). In 1991, an initiative called the Marijuana/AIDS Research Service (MARS) was launched by Robert Randall and the Alliance for Cannabis Therapeutics (ACT) that helped expedite access to and assist in completion of the FDA-approval form for MMJ.
In response to the level of MMJ applications that came in from AIDS patients, in June of 1991—three months after MARS was formed—the Compassionate Use Investigational New Drug program ceased shipments to existing patients. Werner details the public follow-up, which quickly became national scandal:
“The reason for the withholding of the marijuana became clear on June 21 when Dr. James O. Mason, Chief of the US Public Health Service[,] announced the closure of the [program saying,] ‘If it’s perceived that the Public Health Service is going around giving marijuana to folks, there would be a perception that this stuff can’t be so bad. It gives a bad signal… there’s not a shred of evidence that smoking marijuana assists a person with AIDS.’”
Mason was soon after quoted in the Washington Post as being concerned that PWAs who were using medical cannabis “might be less likely to practice safe behavior.” It’s unsurprising to hear Mason let slip such a homophobic infantilization of a population of adults considering that, as Werner explains, “as director of the CDC, confronting the expanding AIDS crisis, Mason […] ‘couldn’t bring himself to utter the word ‘gay’ when he met a gay delegation during the first day on the job.’” Such attitudes were of course systemic and endemic of the reason that federal response to the crisis was so slow, which is what necessitated PWAs going to extraordinary lengths to receive care.
A New Beginning
With the Compassionate IND program shut down to new applicants (it eventually resumed sending out steel-barreled joints and still does so to this day, albeit only to four grandfathered-in patients), people looking for medical marijuana were in dire straits. Newly approved patients would have to settle with a prescription for dronabinol as an anti-emetic, but Weber points out the painful cosmic irony of making a nauseous person hold down a large pill to stop vomiting.
PWAs knew the answer to at least this one question—what could mellow the side effects of AZT?—and now so too did their doctors and the government, and yet options were still limited.
Patients and their caretakers decided to take matters into their own hands and open buyers’ clubs that included or revolved around giving PWAs access to cannabis.
The San Francisco Cannabis Buyers’ Club was established in 1992 by gay activist and career bud dealer Dennis Peron along with the others (including the renowned “Brownie Mary”) who would go on to draft California’s Compassionate Use Care Act of 1996. Building off of an already existing framework established for the club in 1990 by AIDS patient Thomas O’Malley (who passed away in 1992), Dennis set up shop on San Francisco’s Church Street.
Peron’s club didn’t only open access to MMJ, it also “provided a setting in which people who were using cannabis for medical purposes could compare notes and get a sense of their numbers,” as a 1996 article on it in the New Yorker written by Fred Garder explains. “Berkeley psychiatrist Tod Mikuriya, seeing ‘a unique research opportunity,’ signed on as medical coordinator and began interviewing members about their conditions, pattern of marijuana use, and results.”
More than just increasing availability, Peron set a tone for the future of MMJ with his dedication to cultivating a community of care amongst people who otherwise faced a horizon devoid of options. To this day, MMJ remains a land reliant on largely patient-guided information: It’s on you to research what strain works best for your condition, and at best you can find a budtender with the same affliction or at least some knowledge of which direction to point you in. With little testing or reliable research documentation about what levels of cannabinoids work best for which conditions, we are literally left to self-medicate, relying on crowdsourced information online to mimic the patient-to-patient communication that Peron so dutifully set up in his club.
The Path to Legal Medical Access
Using the political prowess he’d learned from his friend Harvey Milk, Peron mobilized the passing of San Francisco’s Proposition P a year after his own partner’s death of AIDS in 1990. Proposition P—a citywide resolution that represented San Francisco’s support for medical cannabis programs—passed with 79 percent of the vote, and others cities like Santa Cruz followed suit with their own supportive legislation. Peron organized a political action committee (PAC) to rally for a bill establishing an in-state medical cannabis system and in 1995 started the push for Proposition 215. When the PAC, Californians for Compassionate Use, needed help gathering signatures, it turned to a group of philanthropists that included George Soros to help pay for professional canvassers.
In 1996, Prop 215 passed with 55.6 percent support, encouraging Alaska, Oregon and Washington to follow suit and set up their own state-run MMJ programs in 1998.
In 1999, dronabinol was moved down from a Schedule II to a Schedule III drug.
And it was only earlier this August—36 years after the Drug Enforcement Administration (DEA) chose to manufacture synthetic THC instead of widening access for researchers to the complete cannabis plant—that the DEA finally announced a policy change to their supply chain. This addition of more DEA-approved marijuana farms outside of the small one at the University of Mississippi would, in their words, “provide researchers with a more varied and robust supply of marijuana.”
It’s certainly about time.
"It is with a heavy heart that I announce the passing of my brother Dennis Peron," wrote Jeffrey Peron on January 27, 2018 on his Facebook page. "A man that changed the world."
The gay rights and medical cannabis activist passed away in a San Francisco hospital at the age of 72. Peron, whom many call the Father of Medical Marijuana, played a major role in legalizing medical cannabis in San Francisco and then in California through the 1996 passage of Prop. 215. The former Vietnam War vet is an icon in cannabis activism.