The voters of Washington, DC first approved medical cannabis in 1998 with the passage of Initiative 59 (I-59), but implementation of the law was blocked by Congress via a budget amendment that was attached to the District’s federal spending bill every year until 2009. Once Congress dropped its opposition, the DC Council passed B18-0622: Legalization of Marijuana for Medical Treatment of 2010 Initiative, which replaced I-59. Under the initiative registered patients could purchase up to two ounces of usable cannabis or its equivalent in other forms (e.g., edibles, tinctures, topicals, etc.) in a 30-day period, and in 2016 the purchase limit was raised to four ounces. 

The District’s medical cannabis program permits patients whose income is less than 200 percent of the federal poverty level to purchase medicine at a reduced rate, and also allows patients to pay a lower application fee when obtaining and renewing their medical cannabis cards. In 2014, the D.C. Council passed emergency legislation to allow physicians to recommend cannabis for any condition for which treatment with medical cannabis would be beneficial, and to increase the registered cultivation center plant limit from 95 to 500 plants. In 2015, the Council increased the plant limit to 1,000 plants. Adult-use possession and use of cannabis was approved by 64 percent of District voters in 2014, with the measure going into effect in 2015.  The initiative permitted possession and use of cannabis for persons 21 years of age and authorized home cultivation of up to three mature and three immature plants.  Congress opposed the legal sale of cannabis in the District, and today adults still may not purchase cannabis from licensed medical dispensaries in the city.  In November 2016, the DC Council passed B21-210, which required the Department of Health to license independent laboratories for product testing, removed drug conviction restrictions on individuals allowed to work in dispensaries, and required the Department of Health to create the District-wide tracking system that enabled the above-mentioned improvements regarding reciprocity and dispensary access.  2016 also saw the council pass legislation to expand the number of authorized dispensaries from five to six and to mandate that the sixth dispensary be located in Ward 7 or Ward 8, which are areas of the District that had been underserved. The sixth dispensary opened in Ward 8 in January 2019.

Prior to April 6, 2018, D.C.’s medical cannabis patients had to pick one dispensary from which to obtain medication and this dispensary was identified on the patients’ medical cannabis card. Patients now may go to any licensed dispensary in the District, increasing both patient access to cannabis and the variety of cannabis and cannabis-derived products available to each patient. Also in 2018, reciprocity was extended to patients from jurisdictions with medical cannabis programs functionally equivalent to the District’s.  As of the time of this writing patients from 19 states are able to obtain medical cannabis from one of DC’s dispensaries.

The District’s city council has been proactive in protecting workplace rights for patients, passing an emergency measure each year since 2018 to protect employees from being discriminated against for medical cannabis use.  Council members had organized a set of much-needed reforms for the District’s medical cannabis program for consideration in 2020, however that work was derailed by the need to focus on COVID-19 emergency measures. These included declaration of cannabis businesses as essential, enabling curbside pickup and delivery, and allowing for telehealth for renewals.