The D.C. government may not be sure the pain of Kristin’s endometriosis needs to be treated, but she is. “It can be very, very sharp and stabbing, it can be very deep and gnawing,” she says. “Sometimes it feels like all of your organs are being dragged out of your body.”

The 31-year-old Eckington resident, pictured above, has already undergone two surgeries and various other procedures for the condition, which is caused when tissue resembling the lining of the uterus forms on other organs and ligaments in the pelvic region. Unless Kristin opts for a hysterectomy, she’ll live with endometriosis for the rest of her life, with the pain ebbing and spiking with the same predictability of her period, when she says it can become so debilitating she stays home from work and cries.

To manage the pain, Kristin’s doctor has prescribed Tramadol, but she tries not to take the opiate too often because it puts her to sleep. Five or six years ago, however, a friend introduced her to an alternative: marijuana. Kristin, who asked that only her first name be used because of professional concerns, doesn’t use it much—she admits she sucks at purchasing illegal drugs—but says a small amount every few days would make the pain more manageable.

With D.C. finally launching its long-delayed medical marijuana program—the first dispensary should be taking pot deliveries any day now—you might think Kristin would finally have a shot at attaining some relief without breaking the law. No such luck.

The rules governing who can purchase and use medical marijuana in D.C. are notably restrictive: If you don’t have cancer, glaucoma, HIV/AIDS, or a condition that causes severe muscle spasms (such as multiple sclerosis), or you aren’t undergoing chemotherapy, radiation, or using protease inhibitors, don’t bother trying yet. *

When it comes to qualifying conditions, D.C. is among the strictest of the 19 jurisdictions that have legalized medical marijuana in the United States. Other states allow medical marijuana to treat conditions ranging from Alzheimer’s and Crohn’s to wasting syndrome; many include catch-all categories for any condition that causes severe or chronic pain or nausea, letting physicians decide whether marijuana is the best treatment.

In D.C.’s medical marijuana regime, the treatment of conditions beyond the big four can be “determined by rulemaking.” In practice, that means that Kristin and other patients in her situation will have to make their case to a seven-person advisory committee whose members haven’t yet been appointed and who will only meet twice a year once they are.

That D.C. officials still want to make some people wait—15 years after voters approved a ballot initiative legalizing the use of marijuana for medicinal purposes—speaks to how conservatively the city has been about implementing it. After the 1998 initiative passed, after all, Congress spent a decade preventing the city from even counting the votes (initially) or putting it into practice, despite support from 69 percent of District voters.

When the congressional restrictions were finally lifted in 2009, D.C. officials did everything to avoid raising any additional attention from Capitol Hill or the federal government. They crafted a tightly regulated system that limits who can get marijuana, who can prescribe it, how much they can get, and where they can get it from. And despite the original language of the initiative—which said that patients with “chronic illnesses” should have access to marijuana if their doctor recommends it—the 2010 bill that gave shape to the program limited its scope.

In a sense, D.C. is the anti-California. The Golden State’s medical marijuana program, which originated only two years before D.C. voters gave approval to theirs, is everything that critics love hating about pot for patients: a loosely regulated system that has given rise to thousands of dispensaries, cultivators, and doctors prescribing weed for everything from headaches to HIV.

The board that Kristin will have to appeal to—officially called the Medical Marijuana Advisory Committee—was created to allow the city’s medical marijuana regime to evolve as needs warrant. Its seven members, including three medical experts as well as designees from the Department of Consumer and Regulatory Affairs, Metropolitan Police Department, City Administrator’s office, and Department of Health, can add qualifying conditions, increase the amount of marijuana patients can get (currently two ounces a month), and even weigh in on whether patients should be allowed to grow their own marijuana at home. For proponents, it’s a means to let the medical marijuana program grow—albeit quietly and incrementally. For skeptics, it’s a bureaucratic hurdle standing between doctors and patients.

D.C.’s restrictive version of medical marijuana is fine with Wayne Turner, a health-care attorney and former AIDS activist who was one of the lead proponents of the 1998 initiative. “This is a medical issue, a patient-choice issue,” he said during a 2010 Council hearing. “And, as in any triage situation, we need to take care of the sickest people first.”

But for Steph Sherer, executive director of Americans for Safe Access, the new layer of bureaucracy is just another burden on patients who have already waited too long for medication. “We’re concerned any time medical cannabis is treated differently than any other treatment,” Sherer says. “There isn’t an advisory panel formed every time a new prescription comes out. This is just another frustrating hurdle for people who doctors have said that this is the medication they need.”

Stone, as he likes to be called, is one of those people. Since 2001, the 34-year-old has suffered from Aplastic anemia, a rare bone marrow disease that causes deficiencies in three types of blood cells. A special treatment at the National Institute of Health 10 years ago saved his life, but the resulting chronic joint pain can only be managed by a narcotic he’d rather avoid. Marijuana, which his doctors advise using, is his best option. But he’ll have to make his case to the advisory committee just as Kristin will.

“My choices are eat a bunch of morphine every day or ingest cannabis, and I’ve spoken to my doctor at NIH and also a doctor at Washington Hospital Center, and they both agree that cannabis is a better course of treatment than a narcotic pain reliever,” Stone says.

Stone’s complaints echo those of many local advocates who argue that the decision on whether to use medical marijuana should be left to the patient and doctor, not a committee of city bureaucrats. They also say that the program has enough other protections built in: Patients have to have established relationships with their doctors, who will face additional scrutiny if they dole out too many marijuana recommendations.

“I’m not going to approach the D.C. government about trying to get my condition covered,” Stone says. “I’m just going to try and have my doctor write a recommendation that’s very clear that this is a worthwhile treatment for me, and if D.C. chooses to go up against one of the most respected physicians in the whole world on a disease that’s so incredibly rare that less than 100 people a year get diagnosed—if they want to try and play medical expert on that, I’ll take them to court.”

It’s unclear if Stone will have much of a case, but he does seem to have public opinion on his side. According to a recent Public Policy Polling survey on attitudes toward marijuana sponsored by the Marijuana Policy Project and the Drug Policy Alliance, 78 percent of D.C. residents favor expanding the list of qualifying conditions for medical marijuana, as long as a physician signs off. Much like the 1998 initiative, support cuts across racial and geographic lines; in no ward was support under 50 percent.

Sherer says a local chapter of Americans for Safe Access is preparing material that it will present to the advisory committee when it first meets as a means to expand the range of conditions that medical marijuana can be used for. “The laws and regulations are a work in progress. Passing a law, while it’s a big hurdle, is actually the least amount of work that we do. Actually making the laws work so they meet the needs of patients is really the lion’s share of the work, and it’s a continual process,” Sherer said.

Despite her own ordeal—and the fact that she might have to wait for an undetermined period of time before she gains legal access to marijuana—Kristin sounds surprisingly understanding about the situation.

“As far as what is ideal or what is great, I’m grateful there’s an option and there’s a process. It’s different for a patient who’s dying tomorrow,” Kristin says. “I’m not dying tomorrow and I’ve dealt with this for a long time so I’ve come to accept that the process is annoying and cumbersome.”

* Correction, May 14: Due to a reporting error, this article originally incorrectly stated multiple sclerosis was one of four conditions that would qualify patients for medicinal marijuana in D.C. In fact, MS is listed in the rules as one example of an unspecified number of conditions causing severe muscle spasms, any of which could qualify.

Photo by Darrow Montgomery