Born without fingers and toes, Jack O'Brien faces crushing neuropathic pain. He can only sustain short walks on his deformed feet and the shooting pain up and down his arms and legs awakens him each morning.
"It's getting worse and worse," said O'Brien, 55, a disabled fishing-boat captain from Laurel Lake, N.J. "I have pain all the time. It's always there. It's constant."
But smoking marijuana in recent years has had a miraculous effect on O'Brien, working almost instantaneously.
"It's like having a valve on the forearm, turning it and having the coolness of relief through my extremities," he said. "I try to walk on these feet and I can go four or five blocks, with my wife. With marijuana, I can go forever."
New Jersey's outgoing Gov. Jon Corzine will sign into law Tuesday the most restrictive medical marijuana law in the country, one that won't allow people like O'Brien to access legally the one medication that makes their lives bearable.
The New Jersey Legislature made the state the 14th in the nation, joining Maine, Rhode Island and Vermont on the East Coast, to allow patients access to medical marijuana.
But only about a dozen specific chronic illnesses qualify and O'Brien's neuropathy is not among them. Legislators balked at broadening the law over the objections of advocates who say the measure shortchanges those who have legitimate medical claims. Doctors are divided on the issue.
Unlike free-wheeling laws on the West Coast that allow medical marijuana for anything from anxiety to headaches, New Jersey will only authorize use for people who suffer from diseases such as multiple sclerosis, cancer, glaucoma, epilepsy, Crohn's disease, AIDS, muscular dystrophy and Lou Gehrig's disease, but not for chronic pain.
Within about nine months, patients will be able to get a prescription from their doctors to buy up to two ounces a month of marijuana at one of six dispensaries throughout the state.
The law, which passed with bipartisan support -- 48-14 in the General Assembly and 25-13 in the State Senate -- forbids patients from growing their own or using it in public and regulates the drug in the same rigid way as prescribed opiates such as OxyContin and morphine.
Patients will be issued identification cards by the New Jersey Department of Health and Senior Services and may designate a registered caregiver to assist in obtaining marijuana.
There is a provision within the bill that other medical conditions could eventually be added with approval from the state Board of Health after its review in two years. But, until then, O'Brien said, he will have to break the law to ease his pain.
"I've never been arrested but I am waiting for it to happen at any moment," he said. "I am sick in my stomach because I don't want to break the law. I am not a criminal and I don't have a criminal record."
State Assemblyman Reed Gusciora, who was the prime sponsor of the bill, said legislators wanted to take a "measured approach" and didn't want to mirror California, where "every college student qualifies for medical marijuana and they allow patients to grow their own and it seemed to be spiraling out of control."
"I have great empathy for them and don't think we should be turning people with illnesses into criminals," he said. "But, at the same time, we had to do a measured approach. In two years, we will revisit the issue and add ailments. But people have gone without medical marijuana all this time and they will have to wait for another day."
The New Jersey State Nurses Association passed a resolution in support of medical marijuana in 2002, one that was followed by the national organization in 2003.
Ken Wolski, a trained nurse and executive director of New Jersey's Coalition for Medical Marijuana, which fought for a more liberal approach, said the law is too restrictive.
"There are a great many other patients who could benefit from medical marijuana in New Jersey," Wolski said. "It disqualifies half the patients.
"Migraine headaches can be disabling and so can anxiety," he said. "And for people to minimize these conditions proves the legislators are not medical people."
Doctors are divided about the effectiveness of medical marijuana. The active ingredient in cannabis is tetrahydrocannabinol (THC), a chemical that has only been proven to help reduce eye pressure in glaucoma, ease nausea and vomiting associated with chemotherapy in cancer patients and stimulate appetite in AIDS patients.
Marijuana can be added to food or administered in a sublingual spray or through a vaporizer that heats it just below the boiling point to eliminate the byproducts of smoking.
But scientists say medical marijuana shows promise in a host of other conditions. A 1999 report from the Institute of Medicine, chartered by the National Academy of Sciences, concluded that the active ingredients could be isolated and developed into effective pharmaceuticals.
About 73 percent of Americans say adults should be allowed to legally use marijuana if their doctors prescribe it, according to an October poll by NBC and the Wall Street Journal.
Brian Sercus, a 28-year-old Wharton resident who has cystic fibrosis, won't have access to medical marijuana under New Jersey's new law. The chronic disease causes thick, sticky mucus to build up in the lungs and digestive tract.
"In the later stages, wasting is a problem.," said Sercus, who left a job in Boston as a health care analyst in October to move back with family in New Jersey. "My appetite just goes. I end up losing weight because my body consumes a lot of calories just to maintain itself. It takes a lot of energy to fight the constant infection in my lungs."
Sercus must take in a minimum of 5,000 calories a day and is prescribed Marinol, a synthetic form of THC, to keep his appetite up. But he said marijuana, which he adds to baked goods, works better. It also helps his mood.
With a condition so serious that he is considering a lung transplant, Sercus combats bouts of depression and anxiety with the help of marijuana. Marijuana also helps the arthritis that he developed as a result of the illness.
"In college, it was something fun to do but, as I got sicker, it really helped me out psychologically," he said. "I was fortunate never to run into the law."
Curious about the effects of marijuana on those with cystic fibrosis, Sercus went online and discovered many others found it helpful for their symptoms.
"It has inflammatory effects and helps breathing," he said. "It's an expectorant and brings the mucus up. Some people even say their lung function tests better, at least temporarily. It's hard to tease out what is psychological and what is long-term.
"I do think it should be used broadly and for more people, but the fact that it's moving in this direction is very encouraging," he said of the New Jersey law.
But Dr. Andrew Kaufman, assistant professor of anesthesiology at the New Jersey Medical School, said doctors still do not have the scientific research on the benefits of medical marijuana and determining what doses are effective is a challenge.
"How do we prescribe for it; one puff, two puffs?" he said. "Who will manage the centers that grow it? I'd like to see standards so if we are writing it, you are getting the same thing every time."
Marijuana is effective as an appetite stimulant, he said, but is not as reliable for pain relief.
"I've had a few patients say they tried it and it didn't do anything for them," he said. "A few others, a smaller subset, tried once in a awhile and it seems to quiet the pain down."
The American Medical Association has urged the federal government to reconsider its classification of marijuana -- now in the most restrictive category with LSD and heroin -- to open the door to more of the research Kaufman is looking for.
As director of University Hospital's Comprehensive Pain Center, Kaufman deals with "people at the end of the road."
"They come to me not because they are starting their journey, but ending their journey," he said. 'I have a patient with MS with burning pain all over her body and I am going to use every tool in my chest. But I have a problem with marijuana because of the way it is delivered; smoking."
Marijuana contains more than 400 different chemicals, including some of the most dangerous ones found in tobacco smoke, according to the U.S. Drug Enforcement Administration. Unlike tobacco, it is smoked without filters.
Now, under the new law, Kaufman might consider prescribing marijuana in conjunction with other medicines. But, he said, morphine works better for overall pain.
But he still has reservations.
"There are marijuana addicts," he said. "Now we get into another can of worms with addiction and behavioral problems."
But that hasn't been the case with O'Brien.
"I go right to the edge, just before the high, and the pain in my hands and feet stops," he said. "I could get stoned out of mind but I don't want to. I want pain relief; that's what I'm after."
He said he worries more about addiction with the strong pain medications his doctors have prescribed over the years and which "cloud" his thinking.
One doctor put him on an antidepressant. "I am nowhere near depressed," he said. "The last doctor wanted to put needles in my fingers and toes with an experimental drug, which was absolutely ridiculous."
O'Brien, the father of a 22-year-old son and a 21-year-old daughter, has been honest with his children about his illegal marijuana use.
"As far as teaching our children, we can't lie to them," he said. "They are smart enough to see the difference when they see the pain I go through daily. This is my only option."