editorial comment The logic of the state. Thanks for protecting us, Mr. Government......

The best sellers at the Green Cross medical marijuana dispensary here are whipped up in the kitchen of Kevin Reed, the founder and president.

Some of the treats at Alternative Herbal Health Services, a medical marijuana club in San Francisco. Fresh-baked marijuana cakes. Marijuana cookies with Ghirardelli chocolate chips. Marijuana peanut butter, lollipops, peanut brittle and espresso truffles. Each comes packaged with a warning: "Please keep out of the reach of children and pets."

Mr. Reed, 31, a former mobile home salesman from Alabama who moved here after being arrested twice for marijuana possession, said the warning was added to the sweets when a customer reported that "their grandma ate one of them."

The Incredible Edibles, as the confections are called, account for 40 percent of sales at the Green Cross, a thriving nonprofit organization in a neighborhood of hip bars, trendy restaurants and Victorian row houses. The 150 or so customers it serves each day can pay with Visa or MasterCard and need only a doctor's recommendation to gain entry.

It has been nine years since voters in California passed the first state law allowing sick people to use marijuana for medical purposes. The measure passed in San Francisco with 78 percent of the vote, the largest percentage in the state. But the city, where dozens of dispensaries like the Green Cross, known as pot clubs, have sprouted, is now among many struggling with the excesses of the law's success.

Even before the United States Supreme Court last week upheld federal authority over marijuana, even in states where its use for medical purposes is legal, city officials, dispensary owners and medical marijuana advocates in San Francisco had begun questioning how much of the drug was enough.

Last month, the San Francisco Board of Supervisors imposed a six-month moratorium on new dispensaries after health officials counted at least 43 unregulated facilities, including one in a building where formerly homeless people were receiving drug and alcohol abuse counseling. Even with the moratorium, there have been reports of new clubs setting up shop.

"The absence of laws has allowed adverse opportunities to emerge," said Supervisor Ross Mirkarimi, who proposed the moratorium.

Capt. Rick Bruce of the San Francisco police said more marijuana was on the streets than at any other time in his 30 years with the department. Captain Bruce said that while there were many sick people who legitimately turned to the drug for treatment, countless dealers had used the dispensaries as a cover for illegal sales.

"It's a huge scam," said Captain Bruce, who heads the city's Bayview station, which covers some of the highest-crime neighborhoods. "We see guys coming out of these places, and the only description I can come up with is that it looks like a Cheech and Chong movie. They are what you would call your traditional potheads; whether they have a medical condition beyond that is subject to debate."

Though public opinion polls show that Californians continue to support the medical use of marijuana, the problems associated with distributing the drug have troubled many towns and neighborhoods.

In the past year at least five California cities have banned dispensaries because of fears that they would lead to crime and abuse. In addition, 47 cities and counties have imposed moratoriums on new dispensaries, according to a survey by Americans for Safe Access, a marijuana advocacy group in Oakland.

"It seemed like a bit of a panic was spreading," said Hilary McQuie, a spokeswoman for the group.

The State Legislature created guidelines in 2003 for carrying out the medical marijuana law, but local officials across the state still struggle with how to control the dispensaries. So far, only 17 cities and counties have passed ordinances regulating them, according to Americans for Safe Access.

The task was made even more complicated last week with the ruling by the Supreme Court, which affected California and the 10 other states that allow some uses of medical marijuana. (The other states are Alaska, Colorado, Hawaii, Maine, Maryland, Montana, Nevada, Oregon, Vermont and Washington.)

Advocacy groups reported that a handful of small dispensaries closed last week, and state health officials said they were moving more cautiously on a plan to begin a statewide medical marijuana ID card program. An estimated 100,000 people in California use the drug for medicinal purposes, far more than in any other state, according to the Drug Policy Alliance, a group that supports medical uses of marijuana.


"Right now we are analyzing the federal law," said Norma Arceo, a spokeswoman for the California Department of Health Services. "We don't know how much of that affects the state law."

Getting inside the dispensaries, many patients say, is not difficult. Under the state law, would-be marijuana users seeking relief from a range of ailments, from chronic pain or nausea to cancer or AIDS-related symptoms, must receive a doctor's recommendation, which is roughly the equivalent of a prescription for federally approved medicines. If their usual doctors are reluctant to make a referral, patients can turn to "compassionate physicians" who advertise their services in newspapers and on the Web.

One of those physicians, Dr. R. Stephen Ellis, whose practice is explained on www.potdoc.com, promises to refund examination fees if an appointment does not result in a recommendation. MediCann, a chain of 10 clinics in the state run by a Santa Cruz doctor, Jean Talleyrand, processes about 700 patients a week, with about three-quarters of them getting a recommendation, said a spokesman, Nicholas Jarrett.

"Our concern is always about the patients," Mr. Jarrett said. "We want them to have access to whatever medicine they need."

Dr. Joshua Bamberger, the medical director for housing and urban health at the San Francisco Department of Public Health, said the department issued about 4,000 medical marijuana ID cards a year. Patients pay a $25 fee, provide the doctor's recommendation and agree to have their photograph taken. The card is offered to make buying medical marijuana more convenient and is accepted at dispensaries in San Francisco and five nearby counties.

But Dr. Bamberger said the county had no ability under the law to control how much marijuana patients buy with the cards. To prevent federal authorities from using county records to prosecute cardholders, the county does not keep records of who has received a card or the name of the doctor who provided the recommendation, but it does number each card for tracking purposes.

When some drug dealers are arrested, even with large quantities of marijuana, Captain Bruce said, many of them produce a medical marijuana card and insist they have done nothing wrong.

"It might as well be the summer of love out here," Captain Bruce said.

The complaints in San Francisco worsened last year when Oakland, across the San Francisco Bay, passed an ordinance limiting the number of dispensaries, leading to a migration of clubs here. In March, Mayor Gavin Newsom called for new controls on the clubs, and Supervisor Mirkarimi held public hearings on the problems.

Mr. Mirkarimi said regulation was the only way to save the dispensaries from a public backlash.

"We will probably see a thinning out and recalibration of many clubs," he said. "But at least it will be a legitimizing process of the club infrastructure, so these clubs don't have to operate in a subterranean atmosphere."

Ms. McQuie of Americans for Safe Access said advocacy groups had reached the same conclusion and had been working with city and county officials across California to devise rules for the clubs. Regulation would not only defuse opposition, she said, but also demonstrate to the federal government that California lawmakers stand behind the state's medical marijuana law.

"We want licenses, we want zoning, we want permits," Ms. McQuie said. "Since states are meant to be the social laboratories, we want to show how well medical marijuana can work."

Many operators of the dispensaries, which under state law must be not-for-profit establishments run by patients, have joined the call for greater oversight. Some have gone to great lengths to make their clubs appear more like a "Walgreens pharmacy than a drug house in the middle of Ghettoville," said Mr. Reed of the Green Cross.

Mr. Reed collects sales tax on purchases - $10,000 last month - provides health and other benefits to his 10 employees and has 16 security cameras at the dispensary. A bouncer is posted at the door, and an employee outside keeps the sidewalk free of loiterers.

"I am in this to help people and show people it can be done right," Mr. Reed said, "not to go to prison."

Mr. Reed sells his confections for $5 each, but if patients prefer to bake their own, or smoke the marijuana instead, they can choose from an assortment of dried marijuana buds. Prices for the 50 or so strains in stock are uniform: $300 an ounce.

The so-called budtenders who work behind large glass display cases provide assistance in selecting the best strain. All of them are medical marijuana users, and they typically are medicated while working.

"We have a great time here," said Mr. Reed, preparing marijuana buds to treat a back injury he sustained in a car accident 13 years ago. "And we make people smile."

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