This is part four in a five-part series. Click here to read the other four parts.
Bass-heavy music thumps through a dimly lit West Hollywood café on a Thursday night, while smoke fills the air. This smoke isn't from cigarettes, which are banned in California restaurants. These are vapors from marijuana.
The Original Cannabis Cafe is the nation’s first eatery where customers can order pot products with their meals. Ricardo Baca sits on an island overlooking the patio. He's a renowned independent marijuana journalist and was the first cannabis editor for The Denver Post.
"This is the first time we’ve had bud flowers and concentrates being served in this type of restaurant environment really in the modern world," Baca says as he surveys the room. "You look around this is pretty normal. There’s people from all ages, all walks of life."
In 1996, California was the first state to legalize medical marijuana. In 2016, the state’s voters made recreational marijuana legal. The cafe opened in October.
"I think what this tells us about where we are is that culturally cannabis has finally arrived in the mainstream," Baca said.
But while pot may be increasingly part of our popular culture, scientific research on the benefits of marijuana remains scarce. This is because the federal government, which funds the vast majority of medical research in this country, still considers marijuana a dangerous drug in the same category as heroin.
However, over the last decade, states like California have stepped up to close research gaps. And studies showing consumers the risks and benefits of marijuana use are just starting to accelerate.
A centuries-long clinical trial
There's evidence of marijuana being used 2,500 years ago in Central Asia for mourning rituals. In the late 1800s, pharmacies across Europe and the United States carried cannabis extracts to treat patients' stomach problems.
In recent times more people have used medical marijuana to treat issues like insomnia, anxiety and pain.
Yet, there’s still not enough science to really know what it does to the human body and brain. This despite that it's been over fifty years since THC — the molecule in marijuana that produces the high — was discovered.
"That should have signaled a wave of international research and yet American drug policy is a powerful being and prevented research from happening in most parts of the world," Baca said.
San Diego researchers are leading the effort to change that. Most of the work is happening at UC San Diego’s Center for Medicinal Cannabis Research.
"There’s a lot of research the government has supported on how does it work what are the negative effects, but until recently there hasn’t been much focus on the medicinal benefits," said Igor Grant, the center’s director.
The center began in 2000, a few years after California legalized medical marijuana. Some of its funding is from federal sources, but over half comes from the state and private donors. Additional funding from the state has been coming in since recreational marijuana was legalized in 2016.
"We did some of the early studies that showed actually that marijuana or the constituents of marijuana could be helpful in controlling certain kinds of pain," Grant said.
He is talking about chronic hypersensitivity pain that is not well controlled by medicines like aspirin and Advil.
"And they are actually not that well controlled by opioids either," he said. "It turns out THC in low doses is actually quite good in controlling this type of pain in some patients."
Researchers at the UC San Diego center have already completed seven cannabis clinical trials with humans and more are underway.
Grant says new research is focused on endocannabinoids. These natural molecules in the human body send signals to different cells, regulating processes like pain and appetite. And it turns out certain compounds in marijuana work just like those molecules.
"Some of the other kinds of work moving forward are: Could cannabidiol which is a non-psychoactive ingredient in marijuana be useful in managing severe symptoms of autism? [...] Could it be helpful in managing the early symptoms of psychosis we see in schizophrenia?" Grant said.
But, he says, that Schedule 1 federal classification on marijuana still limits research.
"People are often saying California legalized marijuana — why can’t we, for example, just go to one of the dispensaries and buy a bunch of whatever it is and do a clinical study?," Grant said. "It’s absolutely illegal at the federal level. We have this conflict between state and federal law that really inhibits the research."
An ongoing appetite for answers
While Grant works in his lab, consumers seeking help for their medical problems are still going to dispensaries hoping to get better.
Chris Simpson is a budtender at dispensary Urbn Leaf in Mission Valley.
"A lot of customers would call us and say what can I take for Parkinson's? What can I take for down syndrome, restless leg syndrome?" Simpson said.
At any given time, as many as two dozen customers are packed into the store. Some are there strictly for recreation. Others ask for help with health problems.
"A lot of [budtending] has to do with your own personal experience and with your own research," Simpson said.
Simpson says he’s done his research on marijuana and its effects. And he's happy to help customers with their medical needs. But he doesn’t like being seen as a doctor because he feels like it's a lot of pressure.
"We’re not going through four to five maybe ten years of medical training," said Simpson. “We’re going off our research and our client’s trial and error.”