MR. KOJO NNAMDIFrom WAMU 88.5 at American University in Washington welcome to "The Kojo Nnamdi Show", connecting your neighborhood with the world. Later in the broadcast, a new star-studded film tells the story of a White House butler who served eight presidents. But before we get to that, the first medical marijuana dispensary opened in the District last week, and it did so under some of the strictest regulations anywhere in the country.

MR. KOJO NNAMDIOn the other end of the spectrum, California legalized medical marijuana nearly 20 years ago. And the city of Los Angeles has allowed shops to open under some of the loosest rules in the country. They've since tried to rein in hundreds of dispensaries operating around the city. As the tide turns in favor of legalizing medical marijuana, states and cities are hoping to learn some lessons and get oversight right. Joining us to discuss this is David Guard. He is the general manager of Capital City Care, the District's first medical marijuana dispensary. David Guard, thank you for joining us.

MR. DAVID GUARDIt's an absolute pleasure to join you today, Kojo. We're big fans at the dispensary.

NNAMDIReally appreciate that. And joining us by phone from Newport Beach, Calif. is Justin Hartfield. He is the CEO of WeedMaps. That's a company that helps patients find nearby medical marijuana dispensaries. He's also on the board of the Marijuana Policy Project and the NORML, the National Organization for the Reform of Marijuana Laws, where he's also treasurer. Justin Hartfield, thank you for joining us.

MR. JUSTIN HARTFIELDGood afternoon, guys.

NNAMDIGood afternoon to you. You, too, can join this conversation. Do you have questions for the proprietor of the first medical marijuana dispensary in the District? Call us at 800-433-8850. David, D.C. residents first approved medical marijuana back in 1998, 15 years ago, but there were some bumps along the way. Remind us of how we got here.

GUARDSure, sure. It has been a long road. You're right. And essentially it was passed by initiative. And we had 69.1 percent of the population here vote for it. Congress has control over D.C. appropriations bills. And so what they did was they put what are known as riders on every bill saying, listen, you're not allowed to implement this program.

GUARDWell, in 2009 congress lifted that ban. They didn't place riders anymore, stopping the District from moving forward. So the District council, you know, held lots of hearings. They went through a lot of, you know, best-practice searches, and they came up with what we have now.

NNAMDIThere are only three licensed facilities at this point. Yours is the only one open so far. Being the first, I imagine people have a lot of questions about how it works. So how does it work?

GUARDRight. Well, you know, it's relatively simple. There are patients out there, and you have to be a very specific kind of patient, what is, you know, considered a serious ill patient, folks with, you know, MS, cancer, AIDS-HIV, glaucoma, you know, other spasticity disorders as well, folks undergoing chemotherapy, radiology. So folks that would actually take protease inhibitors are also qualified, so you can get Hep C folks in there as well.

GUARDBut, you know, a patient goes to their doctor, their primary care physician, you know, they have an ongoing relationship with. And they say, this is something I'm interested in. And the doctor then gives them a recommendation. It's on a form from the Department of Health. And that patient then takes that down to the Department of Health along with some proof of residency, a small fee, and some passport-type pictures. And, you know, within five to seven days, they receive in the mail, you know, their license to come to our facility.

NNAMDID.C.'s medical marijuana program is designed for "seriously ill" patients. And the rules strictly enforce this. Can you talk a little more about what conditions qualify here in D.C.?

GUARDSure, sure. Yeah, it's for folks with, you know, AIDS-HIV, spasticity disorders, you know, things like MS or Parkinson's disease, glaucoma or cancer and those undergoing chemotherapy and these kinds of things. These are folks that I think everyone would consider to be seriously ill. And they've -- you know, there's many studies out there that show things of the symptoms of these disease and ailments are very well treated by medical marijuana.

NNAMDIIf you'd like to join the conversation, give us a call, 800-433-8850. Do you think marijuana should be legal for medical use? Do you think the rules in D.C. are too restrictive or not enough, 800-433-8850? What about recreational use. You also might want to send us an email to kojo@wamu.org or a tweet, @kojoshow. You mentioned that parents need to get the marijuana card from the Department of Health in order to be able to shop at a dispensary here in D.C. Those people also have to be D.C. residents?

GUARDThey sure do. Yeah, I should've added that. They have to be D.C. residents undergoing treatment from a D.C. doctor as well. You know, in the future we're hoping, you know, to see more conditions, you know, added to the list. And there will be. So this part of the program, just the initiation of it really is being quite careful with every move it makes. And so, you know, in about another year or so we should see some new conditions added.

NNAMDIBut you mentioned it has to be also from a D.C. doctor. So if a seriously ill person comes here from some other part of the country and has a recommendation from a doctor, that person -- if that person is going to be resident in the District of Columbia, would also have to go to see a District of Columbia-based doctor?

GUARDThey sure would. There's no, what they call reciprocity in D.C. I believe there's five states currently that have reciprocity, meaning that you can travel from one state to another that has medical marijuana and then get your medical marijuana at those dispensaries there. In the future, maybe D.C. considers something like that.

GUARDI know it's a bit frustrating. Trust me, we have a lot of patients that call us that are just over the border. I mean, come on, D.C.'s a very small, you know, 63-square-mile type of carve out, right, you know. And so we have very desperate patients, you know, who unfortunately can't...

NNAMDIBecause it's my understanding that, even though just seven patients have so far been approved to get medical marijuana from your facility here in D.C., that you have been extraordinarily busy. What kinds of calls have you been getting?

GUARDOh, boy, you're absolutely right. We've been inundated. We opened two Mondays ago. And since then, the phone has been ringing off the hook. We do nothing but constantly talk to patients with very serious ailments. And we want to take the time to really, you know, hold these persons hand through this process, give them whatever assistance they need. You know, it's not difficult for them, but sometimes people that are suffering from these ailments, you know, have conditions, you know, that they can be confused. And so they need some help.

NNAMDIDavid Guard is the general manager of Capital City Care, the District's first medical marijuana dispensary. He joins us in studio. Justin Hartfield joins us by phone from Newport Beach, Calif. He is the CEO of WeedMaps, a company that helps patients find nearby medical marijuana dispensaries. Justin, as we've said, Los Angeles has what are seen as some of the more relaxed rules in the country. What conditions qualify someone to use medical marijuana where you are, or in Los Angeles?

HARTFIELDWell, you know, in California, it's a slightly different system. In D.C. there's specific ailments that are recommended through the medical marijuana bill. But in California the way Prop 215 was written in '96 and the way it was passed, it allows more discretion for the doctor to prescribe marijuana for "serious conditions" or chronic pain.

HARTFIELDAnd so, you know, some people estimate that chronic pain is by far -- 80, 90 percent of the medical marijuana prescriptions issued in California, and maybe even Colorado. So, you know, it's a lot freer because you don't have to be on your death bed in order to qualify to get marijuana here in California.

NNAMDIWe have three approved dispensaries so far here in the District, and Los Angeles officials are not even sure how many dispensaries there are. The numbers are well into the hundreds. And city officials there have been trying to rein them in for some time. But after a recent ballot measure, they might be having more success reining them in. What's going on there?

HARTFIELDWell, you know, success is a relative term and what's happened in L.A. is kind of like what's -- the opposite of D.C. in the sense that all of these businesses sprang up totally unregulated and because there is so much profit. And, you know, what's happened is there's been a blowback from the community, and, you know, some say it increases crime, although that may or may not be true. But for certain, there's a lot of dispensaries in Los Angeles.

HARTFIELDAnd so what the voters -- or the city council put to the voters is a cap. It's called Measure D, and it's going to limit -- or what they want to do is limit the dispensaries to about 100 approved that are not within a certain radius of schools or other kind of buildings. So, you know, it's -- but they haven't had -- you know, they still don't know exactly how many there are. And they haven't really begun to implement it yet because, you know, L.A. changes so much and the businesses come in and out, that it's much more difficult than in D.C.

NNAMDIJustin, it looks as if Los Angeles is facing the challenge of trying to regulate after the fact. As most states now legalize medical marijuana, Illinois becoming the most recent along with Colorado and Washington State approving recreational use last year, what is some of the oversight missteps, if you will, that officials here and elsewhere might be looking to avoid?

HARTFIELDWell, you know, it's -- I think there's kind of two extremes. D.C., maybe New Jersey and then Los Angeles. And I think, you know, the right way to regulate is kind of somewhere in the middle. That may be something more like what they have in Colorado, which is a completely for-profit medical marijuana system, you know. But I think the challenges come from it being federally illegal.

HARTFIELDAnd, you know, the patients will always suffer when marijuana is under this prohibition because we simply can't do research. The market can't innovate and create new products for the patients. And, you know, there's just a tremendous amount of federal barriers that are kind of blocking the way. But, you know, so what states are trying to do is trying to regulate everything they can up front so that the federal government doesn't get involved. And so far it's been successful in Colorado. But sometimes cities may take that too far and restrict access for patients that really could, you know, use this plant.

NNAMDIFor those people who may not know it, federal law still prohibits marijuana under the Controlled Substances Act and they've cracked down in places like California in the past. On to the telephones now. Here is Jay in Frederick, Md. Jay, you're on the air. Go ahead, please.

JAYHey, Kojo, thanks for taking my call. I have a few conditions that smoking marijuana eliminates my symptoms. And I've had a few doctors say that it was okay that I use it, but none have been really willing to give me a recommendation.

NNAMDIOne of the points that, I guess, David Guard wants to make here is that a lot of people like you, Jay, who are calling the dispensary have chronic conditions, a lot of those people have chronic pain, for instance, but they apparently don't qualify, David.

GUARDThat's right. And it's quite disheartening to have to break someone's heart and notify them of that. We are aware that there are many conditions -- many more that are helped by this. You know, Justin's mentioned other states, and, you know, we're aware that, you know, some new bills come out in those states passed by legislatures. And they might have 30 different, you know, conditions, you know, there that are completely treatable.

GUARDYou know, I think of things like Crohn's disease, you know. I look at epilepsy, you know, and the spasticity involved with that. And chronic pain is a big issue. You're right. I think it's a good 40 million Americans that suffer from it at some point in their lifetime. And that's significant. But, once again, the council was very careful how they approached this considering our, you know, locale.

GUARDAnd, you know, they wanted to not draw the ire of the federal government in any way. They're smart to do so, you know, largely. And the way the Department of Health has implemented this has been careful and controlled. And once again, there will be more conditions added. They're going to be reviewing this over time. And so we are looking forward to those days where we can help those other patients.

NNAMDITalk about how you got involved in this issue in the first place.

GUARDIt's funny you say that. Here I am sitting in an American University studio and it was at American University where I received my Masters in public policy. And this is back in '99. And a professor of mine, Prof. Emeritus Arnold Trebach had introduced me to these notions while taking some classes. And I did get involved here, very minor way, working the polls in 1998 when they passed the initiative. But it was really my best friend I met here at American University, Jack and his girlfriend.

GUARDBut Jack, a couple years out from graduation, she called me and said, David, we have to help Jack. Something's wrong. It turned out he had a glioblastoma. It's a level four brain cancer multiform. It's a death sentence we found out. And his doctors in Virginia, five doctors encouraged him to use medical marijuana. He did so, and I'm happy to say that he lived to the 99.99 percentile for his disease. His disease is what Ted Kennedy died of. It's typically something 75-year-old men get, not 32-year-old men.

NNAMDIOn to Jeffery in Northwest Washington. Jeffery, you're on the air. Go ahead, please.

JEFFERYHi, Kojo. Actually, this is Rabbi Jeff Con from Tacoma Wellness Center, D.C. second medical marijuana dispensary. David's doing a great job, and I just wanted to remind your listeners that there's more than one medical marijuana dispensary...

NNAMDIThree.

MR. WIL HAYGOOD...now in D.C. to serve patients there. There are three. And then I don't think we should give the impression that you have to be on your death bed, as someone just said, to qualify for medical marijuana in the District. It's true that we have only -- we're limited to five conditions to begin with but the Department of Health plans to expand conditions. And I think we're going to be a small but extremely useful program.

NNAMDILet me tell our listeners what those conditions are -- HIV, Acquired Immune Deficiency Syndrome or AIDS, glaucoma, conditions characterized by severe and persistent muscle spasms such as multiple sclerosis and cancer. Those are the five conditions. Thank you very much, Jeffery. David, where do you get your product? I understand there are three cultivation centers licensed to grow medical marijuana for D.C.'s dispensaries and you operate one of them. What products do you offer?

GUARDThat's right, Kojo. We were very happy to be chosen by the Department of Health as to be the only company here in D.C. that's able to both grow and sell medical marijuana. So we're proud to be able to tell, you know, our patients that we have extreme quality control measures over what we produce. We'll have our own product out of our facility, Capital City Cultivation in about five, six weeks. But we, in the meantime, had to purchase ours from Holistic Remedies, another cultivation center here in town.

NNAMDIHere is Benjamin in Bethesda, Md. Benjamin, quibble, if you will, over price.

BENJAMINHi, Kojo. Big fan, first-time caller. I was doing some research, and I noticed that the cheapest ounce is going for $320 in the dispensaries in the District. I was just wondering why such a high cost compared to other prescription drugs. And how does this high cost affect the patients who need to spend this much money to get their medicine?

NNAMDIDavid.

GUARDSure. Well, to be honest with you, it's not actually that high of a cost, you know, compared to pharmaceutical drugs. In fact, it would be low compared to those. But I think what the caller is saying is that there are other jurisdictions where medical marijuana could be offered cheaper. And where there are, there also aren't.

GUARDI mean, ours is really pretty much the going rate. However, I should say, the price really reflects the market here in Washington, D.C. We are limited to 95 plant grow. We can only ever have at one time 95 plants growing. So, you know, this plays a role in supply and demand. And the amount of capital we've had to invest due to the stringent rules, you know, adds to the cost as well.

NNAMDIThank you very much for your call, Benjamin. Justin, there's an economic side, as Benjamin underscored, to all of this. Medical marijuana, legal now in 20 states plus the District is already a billion dollar business. And someone now citing what they call Big Marijuana -- that's what they call that business -- as a force against full legalization. Can you explain?

HARTFIELDYeah, you know, recently as, you know, medical marijuana and legalized marijuana started to enter the conversation, you know, there's been some blowback by the existing medical marijuana community, you know, trying to protect their current government monopoly on marijuana.

HARTFIELDAnd so they're trying to fighting a fight similar to what we saw in California with the last Prop 19. You know, some of the growers came out against it because they just wanted to protect their contraband profits. And, you know, sometimes when you have a monopoly and it's going your way, you know, you don't really want to change things.

NNAMDIIn Los Angeles, weren't some of the dispensaries themselves behind the push for more oversight and a limit on the number of shops?

HARTFIELDRight. Exactly. So we saw it in Los Angeles with Measure D. Some of the dispensaries that were backing Measure D were the very same ones that would be allowed to remain open while their competition would be forced out.

NNAMDIDavid, we heard the caller earlier who was talking about the price of it. How do people pay for it? Does insurance cover this treatment?

GUARDUnfortunately, insurance does not currently cover it. But, you know, so it's an out-of-pocket cost, but we do offer discounts. The Department of Health actually issues three different kinds of identification cards. One for, you know, a regular average patient. Another is -- has a different border, and it indicates to us that that person is a low-income patient. And they get a discount. And then there's also an ID for minors.

NNAMDIAnd finally this from Steve in Columbia, Md. Steve, you're on the air. Go ahead, please.

STEVEHi, Kojo. A big fan of the show. Just wanted to bring up that Dr. Sanjay Gupta had actually posted -- an article was posted on CNN.com today.

NNAMDIYep, saw it.

STEVEAnd Dr. Gupta described how he has recently changed his mind on his stance from being against medical marijuana use to being for it. An interesting point that he makes as a -- I don't remember the exact politician. I don't have the article on me. But the man who recommended that back in the 1970s, that marijuana be considered a (unintelligible) substance, he made the recommendation on the fact that not enough research had been done, not on -- not based on proof that it was hazardous but based on a lack of proof either way.

NNAMDIAnd...

STEVEAnd I wanted to just ask you what you thought about -- what you guys thought about how it's been stigmatized since then, since that...

NNAMDIDr. Sanjay Gupta essentially apologized and said that he was on the wrong side of this discussion, that the science in fact proved that marijuana can be of assistance to people who are suffering with certain kinds of conditions. And Steve wants to know the extent to which you feel that marijuana has been demonized, if this kind of thing -- if this kind of statement from somebody like Dr. Gupta can help.

GUARDSure. I, too, saw that this morning around eight o'clock and of course was thrilled to see someone like that. I think what he's going to do is help to inspire other medical professionals, other physicians here in town who have maybe, you know, not taken a deep look at whether they'd like to recommend this to their patients to actually do so. It's -- Sanjay is, you know, obviously a national prominence and can really help get the word out, so, yeah, thankfully he did that.

NNAMDIDavid Guard is the general manager of Capital City Care, the District's first medical marijuana dispensary. There are two more that will be opening. David Guard, that you very much for joining us.

GUARDThank you.

NNAMDIJustin Hartfield is the CEO of WeedMaps. That's a company that helps patients find nearby medical marijuana dispensaries. Justin Hartfield, thank you for joining us.

HARTFIELDThanks, Kojo.

NNAMDIGoing to take a short break. When we come back, we'll talk about that new star-studded film that tells the story of a White House butler who served eight presidents. I'm Kojo Nnamdi.