SAN MATEO -- Phillip Alden has smoked marijuana -- legally, as far as California law is concerned -- for four years. An AIDS sufferer, Alden knows the drug reduces pain in his feet and hands, improves his appetite and controls nausea.
But the 37-year-old unemployed writer has not used marijuana for three weeks and will avoid the substance for three more weeks -- even as those symptoms creep back into his daily regime -- in the hope that his sacrifice eventually will lead the federal government to approve marijuana as a prescription medicine.
Alden is the first of five dozen patients who will participate in a first-of-its-kind study funded by San Mateo County. The study, its organizers hope, will pave the way for larger investigations into medicinal uses of marijuana involving hundreds of patients. The broader analyses, they anticipate, will prove that marijuana in one form or another can aid the ill. Alden, though, needs no convincing.
"In my mind, there's no question that marijuana should be available for medicinal (purposes)," he said. "We've opened the door. We've shown sick people that, here's something that helps you. And we're not going to be able to shut that door again."
The door has swung both ways in recent months. The U.S. Supreme Court struck a blow against medical marijuana proponents when it ruled in May that cannabis clubs prosecuted by federal authorities could not employ a medical-necessity defense.
But President George W. Bush's selection to head the federal Drug Enforcement Administration hedged when asked last month whether investigation of medicinal marijuana distributors and users would be a priority.
And studies delving further into medical marijuana are being planned. Researchers at the University of California, San Francisco, for instance, hope to soon look into whether cannabis can relieve nerve pain in AIDS sufferers. University of California, San Diego, doctors will examine marijuana's effects on multiple sclerosis patients.
The San Mateo study, however, is the first in which HIV patients who had previously used marijuana to lessen painful nerve ailments will be given federally grown pot to smoke at home. A control group of patients, which includes Alden, will be asked to refrain from using marijuana. After six weeks, members of the two groups will switch roles.
Because patients are being added on a continuing basis, the entire study could take two years to complete.
Some data will be collected on marijuana's impacts on the health of the patients, but the study is too small to draw firm conclusions. Instead, the goal is to determine the viability of conducting larger-scale studies of marijuana's impacts on the ill.
"I would call it the first step ... to determine how feasible it's going to be to do more definitive studies," said the study's organizer, Dr. Dennis Israelski, chief research officer at San Mateo County General Hospital.
One vital question Israelski will attempt to answer is whether the study's participants will misuse the marijuana they're given or provide it to someone else.
"To some extent, it's going to depend on trust," the doctor said. "There's just no way around it. There's no clear test that we can do that will tell us that patients are taking their marijuana as we have instructed."
But elaborate steps will help deter diversion. Patients will get only five cigarettes at a time and each will include filter-like tips that must be returned. Participants also will get three bottles -- one for unused cigarettes, one for joints as they are used and one for butts. Eventually, researchers hope to place microchips on the bottles to record when they are opened and closed.
San Mateo County is spending $500,000 to finance the study.
Israelski, who also is chief of infectious diseases at San Mateo General, says he remains unconvinced that marijuana is medicinally useful. But he is confident his research will identify limitations and obstacles that more expansive studies will face later.
"What's really great about this is that we have the scientific approach, but it's also being generated from sincere compassion amongst our political leaders," Israelski said.
That compassion has been led in San Mateo County by Supervisor Mike Nevin, a former San Francisco police officer who watched two friends in recent years battle cancer with chemotherapy and resist the treatment's side effects with marijuana.
Early in his 27 years on the force, he looked for the missing children of people who would call looking for help.
"You'd find their kids overdosed throughout the Haight-Ashbury district," said Nevin. "So I'm well aware of the dangers of drugs."
But as he listened to friends who smoked cannabis medicinally and looked into the subject more, Nevin concluded that marijuana appeared less harmful than other illegal drugs. He decided that Congress acted on political, not scientific, grounds 30 years ago when it placed marijuana on a list of the most dangerous contraband.
"Is this an effort to legalize marijuana? No, not in my case, it's not," he insisted. "I'm trying to answer the question once and for all -- either this substance should be considered as a pharmaceutical or shouldn't, for whatever reason."
The California Narcotics Officers' Association disagrees.
"It is our firm belief that any movement that liberalizes or legalizes substance abuse laws would set us back to the days of the '70s when we experienced this country's worst drug problem," a position paper from the group contends.
For Alden, who has suffered from AIDS for seven years but who still appears vibrant and healthy, the study represents something more personal.
Alden is not now taking one of the more noxious AIDS medications, though he has in the past and knows he will in the future. Marijuana, he said, is the only thing that checks its side effects. It also stimulates an appetite that otherwise would be ruined by a condition that makes it difficult to process food, he said.
Though the pain and decreased appetite have slowly returned in the last three weeks, Alden said he made the right decision to participate in the study. He recalled chats with AIDS, multiple sclerosis and cancer patients whom he would meet when picking up marijuana from a San Francisco cannabis club.
"Just from what I (saw)," Alden said, "I know there's a benefit to people who really, desperately need it."
The Bee's Herbert A. Sample can be reached at (510) 625-9983 or firstname.lastname@example.org.