Washington, D.C.'s medical marijuana program has enrolled just 59 patients since the first city dispensary opened for business in July — far below estimates for participation.
Operators of cultivation centers and dispensaries and their potential customers told the D.C. Council on Monday that the city's strict policies have stifled the program's growth by severely limiting who is eligible to receive medical marijuana. They also said patients and doctors remain fearful of breaking federal law by participating.
"We believe that far too few D.C. physicians understand the benefits of medical marijuana," said Rabbi Jeffrey Kahn, who operates the Takoma Wellness Center dispensary in Northwest.
Testifying Monday at the council's Health Roundtable on Medical Marijuana, advocates suggested that to help the program succeed the council needs to change regulations that allow medical marijuana to be prescribed to treat only four illnesses — HIV/AIDS, cancer, glaucoma, and conditions characterized by severe and persistent muscle spasms such as multiple sclerosis.
Officials from the District's Department of Health initially thought they might be overwhelmed by demand for medical marijuana.
"We were prepared to see up to 200 to 300 patients showing up into our offices," said Feseha Woldu, a senior deputy director at the D.C. Department of Health. "That did not happen."
In a November 2010 fiscal impact statement from the District's chief financial officer, officials estimated that 800 patients would qualify and be registered to use medical marijuana and the number would increase 50 percent each year for the first five years.
An onerous application process and difficulties finding doctors who will prescribe medical marijuana also have complicated the process, would-be patients and advocates said.
To prove her point, Steph Sherer, of the medical marijuana advocacy nonprofit Americans for Safe Access, unfurled the lengthy medical marijuana application packet that patients must complete. Though she has dystonia, a neurological movement disorder that causes pain and spasms, Ms. Sherer said, her doctor wouldn't attempt to prescribe medical marijuana because her illness is not one of the four specifically outlined in the regulations.
"My physician didn't want to even try," Ms. Sherer said. "It's not listed. She doesn't want to get put on a list for no reason if I'm not even going to qualify."
The Department of Health tracks the number of medical marijuana recommendations made by doctors, and anyone who provides more than 250 recommendations in a calendar year is audited.
"Anything that is going to add to the hassle of putting their license in jeopardy, they are going to push off onto someone else," said Dan Riffle, the Marijuana Policy Project's federal policy director.
The city is still in the process of forming a medical marijuana advisory committee, which would review petitions for the approval of additional qualifying medical conditions and could make other recommendations to change the city's policies.
"Maybe if we can make the physicians more comfortable, and then the advisory committee recommending more conditions, then I think we can be where we need to be," said Dr. Woldu, adding that only 62 physicians have requested patient recommendation order forms, which are required before a patient can receive medical marijuana.
Some advocates who spoke Monday suggested that the D.C. Council enact legislation that would add other qualifying conditions to those for which medical marijuana is allowed while others maintain that the government has no business deciding which illnesses should qualify and would like it left up to doctors and patients. About half of the D.C. patients who have received medical marijuana cards have HIV/AIDS, according to the Department of Health.
The city has worked cautiously to develop its regulations — among the strictest in the country — to guide an industry still considered illegal by the federal government. D.C. voters supported a medical marijuana program in 1998, only to have it held up by a congressional rider known as the Barr Amendment until 2009.
Dr. Woldu noted that the District's program is under great scrutiny because it is in the nation's capital and home to federal lawmakers and agencies.
"We are not far from the attorney general's office and other offices, and we want to make sure we are running an airtight program," he said. "The continuity of the program is much more important for us. We want to make sure the program is sustainable and has a future."
Four medical marijuana dispensaries and six cultivation centers were given approval to operate in the District, but not all have been able to open for business. Given the dearth of patients, there doesn't seem to be a big hurry.
"All medical marijuana businesses are operating at a loss," said David Guard, of Capital City Care dispensary which operates in Northeast.
Bob Simmons, of the cultivation center Alternative Solutions, said he fears for the future of the program as a result of the slow business.
"So far, all we have been doing is bleeding cash," he said.
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