There are 600 government-issued marijuana cigarettes in a San Mateo County public hospital freezer waiting to be distributed -- but so far only one patient deemed trustworthy and sick enough to take a few home.
The county has been recruiting for its pioneering medicinal marijuana study for three weeks, since the arrival of the cannabis from a federal farm in Mississippi.
But only AIDS activist and free-lance writer Phillip Alden has met the study's strict criteria. Within weeks, he'll be smoking carefully marked joints on his second-floor balcony overlooking San Francisco Bay. He says he's doing it for science -- and to help prove that a remedy he has long relied on can save other lives as well.
That's why Alden doesn't much care if neighbors in his upscale condominium complex see him smoking. "I'm not embarrassed or ashamed of using medical marijuana," he said. "In fact, I'm a huge fan of it."
San Mateo County's cannabis study is out to separate science from anecdotes such as Alden's. The county-funded study is unique in that it releases marijuana into the possession of patients at home. Most marijuana studies require smoking in hospital wards or other clinical settings.
Participants being recruited will be free to smoke as many as 35 joints a week, but they must keep detailed logs of their smoking as relief for HIV-related pain.
Alden, 37, is the first to meet the study's 18 requirements. He's accepted the inconveniences of multiple physical exams and at-home observations, in part to repay his doctor, Dennis Israelski, who oversees AIDS treatment and research at the county hospital. Alden, who has no medical insurance, lives with his partner, a high-tech patent attorney.
Israelski is well-known among HIV patients on the Peninsula, who like his personal approach and ability to work comfortably with patients from varied ethnic and socioeconomic backgrounds.
"He wants to make a difference, and I want to help him," Alden said. "I'm hoping Dennis' study will legitimize the use of medical marijuana."
Jonathan Mesinger, the study's program manager, said dozens of inappropriate people have called wanting to participate in the study, which has room for 60 patients. Recruits must be infected with the human immunodeficiency virus and have neuropathy, a hard-to-treat condition causing excruciating pain in the arms, feet, hands and legs.
What's more, they must be experienced smokers with no recent record of abuse. They must have a stable home life and be reliable enough to keep the marijuana cigarettes in a locked box.
This presents a challenge for recruitment among the HIV patients at the county hospital, many of whom got infected through intravenous drug use and worry that marijuana could cause them to relapse.
Participants must know how to smoke marijuana, but can't indulge in other drugs.
"Everybody in this trial has to have been a user before," Mesinger said. "We're not introducing anybody to this drug. We don't want to start anybody smoking."
Alden -- diagnosed with HIV in 1994 -- has smoked marijuana for medicinal purposes for the past four years. He had to stop smoking for six weeks to participate in the county drug trials. He will then spend six weeks smoking, and the two time periods will be compared by researchers.
Alden said pot counteracts nausea he gets from his HIV medicine. A daily toke before dinner also helps build up his appetite. For years, he has suffered from an AIDS-related chronic wasting syndrome. No matter what he eats, his body doesn't absorb the nutrients.
But when he smokes, he's hungry. And a good appetite is crucial to keeping a patient with wasting disease alive.
"I start cooking dinner and take a couple hits off my pipe," he said. "Then I eat dinner, dessert, snacks -- and keep eating right up until bedtime. I eat the extra food I need to eat."