Eight other states that have passed medical marijuana laws -- Arizona, Alaska, Colorado, Maine, Nevada, Oregon, Washington and Hawaii -- could be affected as well, should the feds decide to act against them. In Oregon, Leland Berger, legal counsel to the political action committee Voter Power, says that his state's legislation was written so narrowly, with definite limits as to weight and the number of plants, that the ruling will have essentially "no effect on the Oregon medical marijuana act." Berger adds that the federal acting solicitor general arguing the government's case before the high court admitted that any ruling will not impact state statutes: "States can pass laws independent of the federal government and independent of the federal Controlled Substance Act," in Berger's words.

As to the specific legal fallout from the ruling, few expect the federal prisons to suddenly swell with buyers' club operators serving hard time. (Patients are even less likely to be prosecuted: As Dave Fratello says, the federal government is "terrified of the horrible P.R." of a criminal prosecution of patients.) The federal government finds itself boxed in: If it opts to criminally prosecute the clubs, it can't expect many victories -- Hallinan's claims notwithstanding, it seems unlikely that many juries are prepared to send people to jail for distributing medical marijuana. And a civil injunction, once it moves to the contempt stage, involves a jury as well. Still, should some unlucky patient or buyers' club employee fall under federal jurisdiction, given federal mandatory minimums, the penalties are far harsher.

In the end, responsibility to break out of the current situation rests with Congress -- whose ancient classification of marijuana as a dangerous drug on a par with heroin allowed the court to maintain the dysfunctional status quo. Rep. Barney Frank, D-Mass., has introduced a bill in Congress that would reclassify marijuana as a Schedule II drug, meaning doctors could prescribe it, with restrictions. But action on the part of Congress, now or in the foreseeable future, is unlikely. Unwilling to appear "soft on drugs," afraid to allow scientific studies or even hearings, Congress has simply buried its head in the sand. Medical marijuana advocate Fratello said, "There's been no electoral consequences for Congress' cruelty for supporting the ban on medical marijuana. They just refuse to take on the issue. They won't even hold hearings, because they don't want to be confronted by patients." Public pressure on Congress hasn't materialized. While three-quarters of the public supports medical use, said Fratello, it isn't a pocketbook issue. Only when a family member has cancer or AIDS does the issue hit home -- and then people of all political stripes, from the most liberal to the most conservative, support medical use, he says.

With no action expected on the part of Congress, the arena moves to the states. It will be interesting to see if state legislatures move to legalize medical use in the face of Monday's ruling. Fratello notes that two states that have legalized medical pot, Maine and Nevada, now have bills active in their legislatures to provide for some form of state-authorized distribution -- which might be legal under the court's narrow ruling. Fratello feels the two bills have an "excellent chance" of passage.

There is also considerable wiggle room for ingenious distributors to get around the court's ruling. Advocate Zeese notes that advocates have been selling marijuana clones aggressively, and that it would also be hard to forestall cooperatives sending out "consulting gardners." Moreover, it's possible for marijuana-growing establishments to rent out space (and expertise) to individuals to grow a single plant or three, which might thwart a ruling based on distribution.

But all grow-it-yourself alternatives have a serious problem. As buyers' club operator Scott Imler points out, "Starting chemotherapy, you only get a few days' notice. You can't wait the five months it takes to harvest a plant."

As for how patients will react to the ruling, most will probably keep their heads down and continue trying to obtain their medicine as best they can. San Francisco district attorney Hallinan does not anticipate civil disobedience or people seeking arrest. Lindesmith lawyer Abrahamson said, "There'll be a few demonstrations. But most patients want to get on with their lives discreetly. They don't want to wave a flag to the feds. If you have too high a profile, that invites federal prosecution."

But advocate Fratello thinks a more confrontational road may lie ahead. "This case came out of open defiance of federal courts, and you may see more," he said. One activist, who asked not to be identified, noted there are already plans circulating on the Internet calling for "rash disobedience." Some activists may descend on the federal growing operation at the University of Mississippi to highlight the hypocrisy of the federal government's growing pot but forbidding others to do so.

The court's ruling, it's clear, is far from the last salvo in this struggle.

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