Although D.C. legalized the production and sale of marijuana for medical purposes just over 20 years ago, activists familiar with the city’s implementation of the program say it has become known for its long delays in approving patients for medical marijuana use.

People following the D.C. Department of Health’s operation of the city’s medical marijuana program say improvements were put in place in the past two months that appear to be streamlining a cumbersome bureaucratic process that they say discouraged many patients in need of medical marijuana.

Patricia Hawkins, a clinical psychologist and former deputy director of D.C.’s Whitman-Walker Health, said city delays in approving a patient’s application for a city approved medical card needed to allow the patient to buy medical marijuana at licensed dispensaries prompted some patients to resort to buying the marijuana from “pop-up” dealers who operate illegally, sometimes selling marijuana on the street.

“That’s the last thing we need them to do,” said Hawkins, who noted that the purity and content of marijuana bought on the black market is unknown and could have harmful additives such as pesticides.

She said street drug dealers also have the reputation for attempting to sell people other harmful drugs such as heroin.

Hawkins noted that LGBT and AIDS activists played an important role in persuading the city to enact the medical marijuana program in the late 1990s just prior to the availability of effective AIDS drugs. She said marijuana treatment was shown to be helpful to AIDS patients suffering from severe weight loss by increasing their appetite.

D.C.’s medical marijuana program is run by the Department of Health’s Division of Medical Marijuana and Integrative Therapy. Under rules established by the DOH, in order to become authorized to buy marijuana for medical purposes a patient must first obtain a written recommendation from his or her primary care physician.

“This recommendation must assert that the use of marijuana is medically necessary for the patient for the treatment of a qualifying medical condition or to mitigate the side effects of a qualifying medical treatment,” a statement on the DOH website says. The statement says the written recommendation must include the physician’s signature and license number.

The physician must then send that to the DOH. The patient is required to submit to the DOH a completed application form that shows proof of residency in D.C. and include a photo copy of a government issued identification document such as a driver’s license. A $100 registration fee is also required, with a $25 fee for a patient that qualifies for low-income status.

One D.C. patient who spoke to the Washington Blade about the process on condition that the patient not be identified said that in the recent past it took between two and four months for the DOH to process the patient’s application and send the needed medical card.

Under the city’s medical marijuana program, the medical card expires after one year and a new application must be submitted to have it renewed along with the $100 fee.

The patient that spoke to the Blade said only a few doctors in the city have the training or the desire to prescribe medical marijuana as a treatment for a medical condition.

“The waiting rooms are overfull and there’s a long time you have to wait to see the doctor,” said the patient.

“And then last year the Department of Health lost my paperwork so I had to go through the whole process again,” said the patient. “It’s just frustrating and annoying. And it’s way more cumbersome and way more bureaucratic than is necessary.”

Under changes made earlier this year, the DOH website now says applications for the medical card are processed within 30 business days.

Linda Green, owner of Anacostia Organics, one of six licensed medical marijuana dispensaries currently operating in the city, said the DOH last month began offering patients the option of submitting their application for the medical card online.

“The processing time has been cut down considerably,” she said. “The DOH says the process now can take just one week. They are saying it takes five to seven days to get your card,” added Green, who said she’s “very hopeful” that the streamlined process will encourage more patients in need of medical marijuana to enter the program.

The National Holistic Healing Center, another D.C. medical marijuana dispensary located near Dupont Circle, told the Blade in a statement there have been “considerable improvements to the process for obtaining a medical card.”

The statement, which doesn’t identify the person who wrote it, says National Holistic has patients who have received their medical card from the DOH in two to three weeks through the online application process.

Green of Anacostia Organics and the National Holistic statement said there are a wide range of different types of cannabis, the preferred name for marijuana by the dispensaries, from which a patient can choose to best meet their medical needs. Experts at the dispensaries will help the patient select the type best for them, some of which are inhaled, ingested, or absorbed through the skin.

DOH spokesperson Alison Reeves told the Blade in a statement the processing time for a medical marijuana card may vary from patient to patient. She said an incomplete patient application form can result in “increased processing time.”

She said the time of year a patient submits their application may also be a factor in the timing. She noted that the largest number of applications are submitted between February and April, with processing time possibly made longer during that peak period.

“It is our policy to process applications and issue cards within 30 business days, however processing time is normally much faster,” Reeves said. “For example, in the first quarter of this year the average processing time for completed applications was 8.5 business days – six days for electronic applications and 11 days for paper applications,” she said.

About nine months ago, according to Reeves, the DOH began accepting credit card payments.

“Originally, many banks would not allow this for any marijuana activities,” she told the Blade. “This change allowed patients to submit and pay online, which greatly decreased processing time.”