It has been years in the making, derailed by Congress three times in about as many years, but medicinal marijuana could soon be heading to the nation's capital.

In 1998, voters in Washington put themselves near the forefront of the budding medical-marijuana movement when they voted nearly 7 to 3 for doctor-prescribed dope — a greater majority than those in any of the other eight statewide ballot initiatives that have passed around the country. (Watch a video about medical-marijuana home delivery.)

But no celebratory smoke-outs have followed — not yet, at least. Instead, poll workers spent that election night obscuring the results of the vote, in deference to a last-minute congressional amendment pulling funds from D.C. for the processing of any drug-legalization initiative. (Ballots had been printed prior to the ban, but the D.C. Board of Elections and Ethics decided that to follow the intent of the law it had to withhold the results after the votes had been cast.) "I know of no case where a federal entity has told another entity they cannot even announce the results," says WTOP analyst Mark Plotkin. "We're not even talking about the implementation of the law." (See pictures of the drug's unofficial national holiday.)

Twelve years later, the political landscape appears to be profoundly changed. The sponsor of the 1998 congressional ban, Bob Barr, has gone from a drug hawk to a libertarian, legalize-it presidential candidate — even lobbying against the law he once wrote. Fourteen states have legalized medical marijuana in the 14 years since California became the first to do so; several more are working on legislation now.

In December 2009, a Congress dominated by Democrats quietly lifted the Barr Amendment, giving the city an opportunity to enact its old dope law. (Watch a video about taxing marijuana in California.)

A few weeks later, city council member David Catania moved to do just that, introducing a bill that would implement Initiative 59, with the co-sponsorship of nine of the 13 council members. Don't ask him if there are more serious issues he should be working on. "Every time someone says that, I think my head should explode," he says. "As far as I'm concerned, this is an important issue. The evidence I've seen certainly suggests a powerful medicinal use for marijuana that can stimulate appetite and can reduce pain and suffering. So frankly that's my decision, and I'm capable of doing more than one thing at a time, as are my colleagues and as is this government." (See "The Year in Health 2009: From A to Z.")

Catania acknowledges that the policy details still have to be worked out — how many dispensaries to allow, whether they'll be nonprofit or private, for which diseases prescription pot will be available, where the stuff will be grown. He leans toward more restrictive implementation, knowing that any legal-weed law can be struck down by future governments. "The voters approved the medical use of marijuana, not the recreational use of marijuana," he says. "The more professional and controlled and evidence-based our system is, the greater likelihood it will be sustained going forward."

Such a system, Catania says, might create five to 10 nonprofit dispensaries around the city, which would have to be at least 1,000 feet away from places like schools, parks and other dispensaries. In contrast, for years Los Angeles has had hundreds of dispensaries, privately owned, with a 500-foot rule. But its city council passed a revised dope law just hours after D.C. outlined its own, adopting D.C.'s 1,000-foot rule and cutting the number of dispensaries allowed to around 150. (See a brief history of medical marijuana.)

A spokesman for the D.C. city council says the bill is likely to get through the council by the end of the spring, and may be approved in Congress by the end of summer.

Studies have found medical cannabis to be effective in mitigating nausea, stimulating needed appetite in AIDS and cancer patients and acting as a general pain reliever, among other effects. The American Medical Association "calls for further adequate and well-controlled studies of marijuana and related cannabinoids in patients" in a policy statement that takes a cautious position on the issue.

Some of the leading activists for Initiative 59 are equally ambivalent, even as they reach what appears to be light at the end of the tunnel. "It's a victory, but it's not something that I really feel like celebrating," says Wayne Turner, whose partner Steve Michael originally sponsored Initiative 59 before dying in the months leading up to its vote. "Democracy has been denied for over 10 years, and we've lost a lot of people along the way."

The voting bloc of recreational weed smokers is likely to be even less enthusiastic if Catania gets his way. "I do not see this as the camel's nose under the tent to the broad legalization of marijuana, nor the recreational use, nor do I ever envision supporting the use of marijuana for anxiety or hangnails," he says. "This is for people who are profoundly sick."

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