A steady stream of people, all of them claiming to have a painful and debilitating illness, arrived yesterday at O'ahu's first clinic devoted to signing up patients for the state's medical marijuana program.

The downtown clinic, which is run by the nonprofit Hemp and Cannabis Foundation from Portland, Ore., opened its doors yesterday with 25 people hoping to be certified. Another 25 people have appointments today.

The foundation will only open the clinic when it has 25 people scheduled and organizers anticipate that demand on O'ahu will keep them open three to five days a month. To make an appointment with the clinic, call the foundation's toll-free number: (800) 723-0188.

The clinic does not dispense marijuana, but instead certifies that a patient's condition requires marijuana for relief, said Dr. Tom Orvald, a heart surgeon from Seattle who will travel to Hawai'i to review cases.

Orvald works with the foundation's clinics in Seattle and said he can easily spot a person whose pain is not real.

"I am the gate you have to get through and I'm no dummy," he said.

Under the state's five-year-old program, patients must have a "debilitating medical condition" such as cancer, AIDS, glaucoma or other chronic disease and must obtain annual certification from a doctor to qualify for marijuana use.

Once certified, residents are allowed to grow small amounts of marijuana but cannot purchase it. And there are strict rules about when and where it can be used, Orvald said.

One of the patients Orvald certified yesterday was Nalani Kalilikane, a 28-year-old 'Aiea woman suffering from multiple sclerosis. The disease of the central nervous system gives her painful, daily spasms, especially in her right leg, she said.

"It's something I wake up with and something I go to sleep with," she said.

But even with certification, she won't grow the plants at home. She's tried that and the plants were often stolen.

The state's law does not specify how seeds for medical marijuana may be obtained, but certified patients will be told to look to a designated friend or family member, the Internet or fellow patients for help, said Paul Stanford, executive director and founder of the cannabis foundation.

"I wish we could do more, but the way the law is written, we're limited," he said.

Stanford said he and Orvald met Tuesday with the state Narcotics Enforcement Division, which oversees the program. Keith Kamita, administrator of the program, was unavailable for comment yesterday but has said he will closely monitor the clinic.

Through Friday, the state had registered 2,788 people for medical marijuana. Most of them — 1,436 — were on the Big Island, followed by Maui (618), Kaua'i (396), O'ahu (321), Moloka'i (8), Ni'ihau (5) and Lana'i (4).

Reach Mike Gordon at mgordon@honoluluadvertiser.com.