George McMahon smokes ten joints a day, over a quarter ounce of marijuana. The street value of that amount of marijuana is over $100, but since 1992, McMahon has been getting it for free. Once every four months, he drives from his Texas home to Iowa, where he picks up four metal canisters, each containing 300 joints — about a half pound of marijuana — grown, rolled, prescribed and distributed by the federal government.

George McMahon is a numerical impossibility. Diagnosed with a genetic condition known as Nail Patella Syndrome (NPS), which afflicts only one out of every 50,000 people, he is also one of only a handful of people in the country officially immune, in all 50 states, from arrest or prosecution for possession of marijuana. He used to take as many as 17 medications, 51 pills, every day. They alleviated some of his symptoms, but they left him with inescapable nausea, and in 1986 he found himself in the hospital with renal failure, a common complication of NPS. He was wasting away, told that he had only a few hours to live, when a dying cancer patient offered to trade a joint for one of McMahon’s hand-rolled cigarettes.

"I'm 54," George says over the phone. "They told me when I was 38 I might make it another 5 hours. They repeatedly told me before that I was going to die young. After having rheumatic fever, I wrote an essay for school and said that I wouldn't see 35. All of these things come from things doctors said to me, as they coached me and set me up for the next doctor. You know, 'I can't fix you, or tell you what's wrong with you, but he can.' So I've had a lot of predictions, but they're always short. And now, recently, my doctor said he expects me to have a normal life span because of the marijuana."

The characteristic features of Nail Patella Syndrome are fingernail and occasionally toenail defects. Knee abnormalities occur in almost all NPS patients. Sometimes the kneecap is square, misplaced or undersized. Sometimes it's just not there. Elbows, too, are deformed in most cases: the elbow joints become dislocated, and cause incomplete extension of the forearm, as well as mobility problems in the wrist. Skin and tissue tightens along the joint, giving the elbow a webbed appearance. And in nearly all cases, patients develop iliac horns, a crest or spur in the pelvic bone, a symptom unknown in any other human disease, or indeed, in any other species at all. Kidney problems happen in about one-third to one-half of NPS sufferers, as well as open angle glaucoma. Some patients' symptoms are mild, allowing them to lead full, active lives. Others, like McMahon, can become, as he describes himself once, "extremely terminally progressively ill."

10 states have passed laws legalizing, or decriminalizing, the possession and use of marijuana for medical purposes. But in essence, those laws are nothing more than symbols. Even if state authorities won't arrest medical marijuana users, or will, as in California, supply users with the drug, federal authorities have repeatedly demonstrated a willingness to bust up state medical marijuana programs. Federal law supersedes state law, and the federal government is clear on one thing: marijuana has no medicinal value, and is illegal to use, distribute, or possess at any time or for any reason except federal research programs.

In 1976, Robert Randall, a glaucoma patient in his late 20's, was arrested for growing marijuana. In 1972, he was told that his eyesight would be gone within a few years, and he started smoking marijuana to relieve the ocular pressure that glaucoma produces, eventually destroying the ocular nerve and with it, the patient's eyesight. Unable to afford street prices, he began to grow his own marijuana, and lacking experience, was caught. Before he went to trial, he underwent medical testing which proved that no drug was as successful in treating his glaucoma as marijuana, and he used that testing to mount a "medical necessity" defense. On December 28, 1976, Judge James A. Washington Jr. agreed, dismissing all charges. Even before the decision, though, the government enrolled Randall in a drug study, supplying him with marijuana. Then they abruptly cut off the supply. Randall sued the government, asking for inclusion in the government's Compassionate Investigational New Drug (IND) program. The two parties settled in 1978, and the federal government began to again supply him with legal marijuana, which it did until his death in 2001 of AIDS-related complications. He never lost his sight.

Randall was initially the only federally approved marijuana user, but in 1982, Irvin Rosenfeld, a stockbroker from Florida, joined the IND program. Rosenfeld has a disease that causes benign tumors to continually grow in his bones. Before he tried marijuana, he could not remain sitting for more than ten minutes due to the intense pain. Elvy Musikka became the third patient in 1988. Musikka suffers, like Robert Randall, from glaucoma. Like Robert Randall, she was busted for growing her own marijuana. Arrested in March 1988, she was acquitted of all charges when she mounted a medical necessity defense, and after threatening to sue the government, she was accepted into the IND program that October. Corinne Millet, another glaucoma sufferer, was the fourth to receive federal marijuana. George McMahon was the fifth.

Over the years, Robert Randall became an activist for medical marijuana, starting the Alliance for Cannabis Therapy, publishing a book and putting out a pamphlet for AIDS sufferers on how to apply for the Compassionate IND program. Applications rose yearly from only five to thousands, but Randall's success backfired - the first Bush administration, worried that the public might get the wrong idea, decided to shut down the program. Some people who had been accepted, but not yet received their marijuana, were told that they would never receive it. The patients already in the program were grandfathered in. The numbers on them are shaky: estimates vary from 12 to 34, although a dozen seems to be the most accepted. The program will end when those patients remaining die. The numbers on those deaths are shaky, too, but George McMahon believes there are five to seven left.

The marijuana distributed to those still in the Compassionate IND program is delivered to a Class I Pharmacy - the only kind licensed to dispense marijuana. A Class I Pharmacy is a lockable building inside of a locked building, with guards outside 24 hours. The marijuana is grown in a seven-acre farm at the University of Mississippi in Oxford. The seeds and stems are left in with the smokable buds, freeze-dried to ensure quality, and rolled using a machine into Pall Mall cigarette papers. 300 of the joints are put into a can and covered with a layer of Styrofoam. The can bears a plain white storage label that reads like this, as described by McMahon:

Marijuana Cigarettes

Approximately 300 cigarettes per can

Net Weight = 271.14 g

Average Weight per cigarette = .901g

Manufactured April, 1999

I.D. No: 9497-0499-103-4683

Research Triangle Institute

George McMahon is not what you'd expect of a marijuana user - he's not an aging hippie or flower child; his voice is rough and gravelly, with a slight hint of a Midwestern drawl. His hair is short and graying, his dress conservative. For many years, he worked as a coal miner - after, he owned his own auto body shop. He sees his mother, who lives only a block away, daily. "My wife and my mother get along real well," he says, "so they do quite a bit together. We go down and fix things for her."

McMahon was never a healthy child - in one string of illnesses, he developed pink eye, then chicken pox, strep throat and finally rheumatic fever. Lifting weights never helped him to develop muscle mass. His muscles outdistanced his bones in strength, and the bones in his arms broke often from lifting heavy weights. By 21, he had lost all his teeth. In 1964, surgery to improve flexibility in his right elbow went awry, and a nerve was damaged, leaving him without feeling in his forearm.

McMahon had tried marijuana a few times in the 1960's, and though he noticed it helped relieve his pain, he never thought much of it. In the mid-70's, though, he was working as a coal miner, and his hands hurt him constantly. His landlord, an elderly Mexican woman, rubbed a tincture of marijuana in alcohol on his hands. McMahon returned daily, and more, for the salve. After a few weeks, the pain and swelling was gone for good. It was a turning point - he started to smoke marijuana for his constant pain, finding that it relieved him better than prescription painkillers, and left him more aware and alert.

McMahon took a turn for the worse in 1985 when his right kidney shut down. He underwent nine surgeries, none of which were completely successful, and his life hung in the balance. George hadn't slept in six weeks, hadn't eaten in thirty days. His eyes were incapable of blinking when a doctor told him he had five hours to live. But that night, a dying cancer patient in a room a few doors down sent a sympathetic nurse as a messenger. He had noticed that McMahon had a tattoo of a rolling paper company's logo on his arm; would McMahon trade a hand-rolled cigarette for a joint? Later that evening, the nurse came back with the joint. Fifteen minutes after smoking it, McMahon called the nurse's station to ask for solid food. That night, he slept for the first time in six weeks.

Despite his previous experiences with marijuana's beneficial effects for him, McMahon had always been wary of the drug, considering it a "recreational drug of abusers." In that moment, he was convinced that marijuana had saved his life, and he began to fight to be able to use it legally.

"In my case it was provable that [marijuana worked], and we proved it," he says over the phone. "Over and over again. We had a lot of hospitals and doctors that I'd been to over the years and they all said the same thing and the final call was, 'We give up, we can't do anything for him.'"

Once confined to a wheelchair, George McMahon now walks without even the aid of a cane. "My day does consist of a lot more creative things," he says. "I have a workshop here, I have a bicycle I like to ride." Much of his quality of life is determined by the quality of marijuana he's smoking. Lately that quality has been uniformly low. Still, he leads what he describes as "a pretty pleasant life."

"I get up about 6 in the morning, sit on my porch, I get my coffee ready, I give my dogs their snacks. Then I smoke a joint and I eat something. Generally I get up because of nausea or spasms. After 7 or 8 hours without marijuana, I'm already having some of my symptoms again... [I do] work in the yard, and my wife and I have our time in the morning to drink coffee and talk. I smoke about every hour, but sometimes in the morning I'll have to smoke two quite close together, depending on the weather... I'm active in my community, I'm active in my community organization, we live in a gated community. So I'm semi-active. Way more active than a person in my condition should be."

And like Robert Randall, George McMahon has become a reluctant activist. One reason is that Nail Patella Syndrome is undoubtedly a genetic disorder, and much of his family is afflicted with it. His sister died from it at 44. His mother has it. He believes his brother has it, though his brother won't admit it. His daughter has it, too, and it clearly pains him.

"My daughter didn't believe marijuana could be medicine, especially for her. But as she's grown older, she's... started looking at the prescriptions and cutting them down... So the only thing we can think of is marijuana... And she can't use marijuana, she uses marijuana she goes to prison, gets her kids taken away." He pauses and laughs, but it is a hard, nervous laugh. "I mean, how much closer to the bone can it be? This is my own flesh and blood and I can't help her."

But McMahon has helped others. "My message is almost completely grassroots... So it was never a matter of me to be in the position to be saying, 'I want to be making a big media hullabaloo.' I don't even think I do. I want to talk to everyone that wants to talk about it. To me that's how grassroots work. All the changes that we've had so far have been grassroots. It's been an overwhelming cry of the populace... To me that's very gratifying. I didn't do that, I touched maybe some of them. But the message has gone out, that's important, to us as people, that's important. It's not only our rights, it's our lives."

In 1995, George had a relapse. It lasted three years, but in 1998 he found "a doctor who would treat me for what I had." Healthier, he and his wife Margaret set out on a two-year trek around the country. "All we did was live in our motor home and go from engagement to engagement to court speech to state congressional meetings and just about everything you can imagine. And they would pay our gas and our expenses so we could eat... I really found out people love each other and don't even know each other. It was the most amazing thing in my life. I found office workers, nurses, doctors, people who weren't involved at all who went way out of line to bat for me. It was an odyssey and it was an amazing one."

This fall, George and his friend Christopher Largen are embarking on a tour in support of their new book Prescription Pot: A Leading Advocate's Heroic Battle to Legalize Medical Marijuana. Traveling is a burden on George: other patients in the IND program have run into trouble with their medicine at airports, and so, to avoid any potential hassles, they will be driving cross-country. It is quite a production: George makes a point of calling the police in every place they're traveling through to tell them who he is. The whole thing is a stress on his body: Largen says that, "George's urine turns the color of tomato juice when we're traveling," and he needs a caretaker with him, a role that Largen fulfills. It's tough, but for George McMahon, it's always been tough, and like always, he presses forward.