A History of Weed, Part III: The Age of Medical Marijuana

February 24th, 2022

Written by Zack Ruskin

The third installment of our ongoing series traces the medical marijuana era from its origins in the HIV/AIDS epidemic to the dawn of states beginning to legalize adult-use sales.

The story of legal cannabis in America is a perfect encapsulation of what it means for the night to be the darkest before the dawn. As we’ve already covered in previous installments of this series, the history of weed begins with ancient roots and continues with the implementation of severe prohibitions against its use and sale.

By the time we reach the 1990s, past policy implemented by a slew of U.S. presidents had led to historically high rates of incarceration and a public understanding of cannabis that existed at great odds with available science. For example, in July 1991, a survey was issued to the members of the American Society of Clinical Oncology intended to measure “the attitudes and experiences of American oncologists concerning the antiemetic use of marijuana in cancer chemotherapy patients.”

Even though 608 (63%) of the respondents surveyed said they felt cannabis could be beneficial in such treatments, federal law continued to list cannabis as a Schedule I substance under the 1970 Controlled Substances Act. This action followed in the footsteps of other notable objections from the medical profession stretching all the way back to 1937, when the American Medical Association stated its opposition to the (soon-to-become-law) Marihuana Tax Act.

Later, in 1972, the Shafer Commission delivered its findings in a report titled “Marijuana: A Signal of Misunderstanding,” serving as a potential major blow to then-President Richard Nixon’s efforts to cast cannabis and other drugs as dangerous societal evils.

Comprised of a group of 13 high-profile elected officials — the majority of whom were appointed by Nixon — the Shafer Commission ultimately concluded that “the criminal law is too harsh a tool to apply to personal possession, even in the effort to discourage use.” Furthermore, they noted, “[the] actual and potential harm of use of the drug is not great enough to justify intrusion by the criminal law into private behavior, a step which our society takes only with the greatest reluctance.”
Despite these objections, the federal status of cannabis as a Schedule I controlled substance remains in effect to this day. And yet, clearly some type of major shift has managed to take place as we now have major universities like UCLA hosting cannabis research initiatives and even an FDA-approved drug featuring CBD now available to prescribe to patients with certain forms of severe epilepsy.

How did the war on drugs being waged in the1990s evolve into the policies that created the state-legal medical and recreational markets we now enjoy today? The answer, sadly, begins with tragedy.


Prior to the success of California’s Prop 215 in 1996, efforts to see cannabis rescheduled under the Controlled Substances Act were largely court battles that tended to drag on for years and which usually ended in defeat for those fighting in favor of reform.

Meanwhile, in San Francisco, a blossoming scene centered on queer culture and acceptance had attracted a large demographic of gay men and women to the area throughout the 1970s and 1980s. Thus, when the HIV/AIDS crisis erupted in the 1980s, the San Francisco Bay Area was hit especially hard. That’s when a man named Dennis Peron — regarded by some as “the father of medical marijuana” — realized that cannabis could provide health benefits to those battling AIDS.

In an obituary of Peron, Leafly’s Bruce Barcott details the role Person and a crew of trusted allies played, not only in providing comfort and compassion to those in need, but also in spearheading the efforts that would make California the first state to pass a statewide medical marijuana legalization law.

“Peron and many others in the city knew their friends and partners fighting AIDS were finding some relief with cannabis,” Barcott writes. “As the AIDS crisis unfolded in the 1980s, Peron’s neighborhood, the Castro, became ground zero for activists and AIDS patients alike. Peron’s partner, Jonathan West, succumbed to the disease in 1990.”

There are many names worth celebrating from this period, including Mary Jane Rathbun (better known as “Brownie Mary”) and renowned oncologist Dr. Donald Abrams. It thus makes sense to credit many of their successes as the results of a group effort, though Person’s singular determination and passion for compassion was undeniably pivotal.

Regardless, on Nov. 5, 1991, the voters of San Francisco passed Proposition P with a convincing 80% of the vote. Considered by those behind it to be, essentially, symbolic “because it was just a city initiative,” Prop P still represented what amounts to the first victory cannabis reform had enjoyed since the 1970s.

Fortunately, another, far bigger, victory was just around the bend.


Open any feature on the legal history of cannabis and mention of Prop 215 is all but a given. It makes sense when you consider just how seminal this piece of legislation truly was in shifting the public perception of pot from crime to medicine.

Approved by 56% of California’s voters on Nov. 5, 1996, Prop 215 (aka the Compassionate Use Act of 1996) allowed for patients with a valid doctor’s recommendation to possess and cultivate cannabis for personal medical use. As the first medical marijuana ballot initiative passed at the state level, the implementation of the legislation the following year would put California at odds with federal law.

This would then initiate on ongoing conflict centered on states’ rights versus federal authority, with medical marijuana dispensaries and patients often caught in the cross-fire.

At the same time, the advent of a state-legal medical cannabis market in California gave birth to the first regulated products to ever be conceived of or sold in the U.S. Consisting, at first, mostly of flower and select edibles, soon enough the offerings would expand to include tinctures, rudimentary concentrates, and, of course, the pre-roll.

Inspired by California’s example, Alaska, Oregon, and Washington legalized medical marijuana in 1998. By 2000, Maine, Hawaii, Colorado and Nevada had joined the party too. Though it might appear this was what ultimately lead us to 2012 — the year Colorado and Washington simultaneously became the first two states to legalize recreational cannabis — there were still some substantial final hurdles to clear before the adult-use era would truly begin.

More on those last challenges — plus a look at the first years in America with state-legal adult-use markets — in our next and final installment – A HISTORY OF WEED, PART IV: ADULT-USE, EQUITY, WHAT COMES NEXT?


Zack Ruskin

Zack is a freelance cannabis and culture reporter. He served as San Francisco Weekly's "Pacific Highs" columnist for six years, covering local equity programs, Bay Area cannabis news, and interviewing everyone from Willie Nelson to Rep. Barbara Lee. His other bylines include the San Francisco Chronicle, Leafly, California Leaf Magazine, The Nib, Vanity Fair, KQED, and Variety. Follow him on Twitter: @zackruskin.