Medical marijuana advocates in the District are grumbling that prospective patients have been left behind in the rush to decriminalize and legalize pot for recreational use.

The District’s program, which has a notoriously restrictive list of just four conditions that qualify a patient to use the drug, has underperformed in the eight months since it was implemented. In the meantime, lawmakers have approved a plan to decriminalize small amounts of marijuana in the city, and an effort to outright legalize the drug appears on its way to a public vote in November.

Medical marijuana supporters say the latest regulatory hoop they face is the Department of Health’s new petition process, by which individuals or groups can ask for new conditions to be added to the list.

The District’s Department of Health announced Monday that it would begin accepting such requests, but advocates say the petition process is burdensome. It requires petitioners to provide copies of medical research data supporting use of medical marijuana for a proposed condition, to describe the effects of the medical condition, to describe any conventional medical treatments for the condition, as well as provide personal information about the petitioner or anyone else who might testify on behalf of the petitioner.

“This petition thing is going way longer than they need to and putting the burden on the patient,” said D.C. Council member David Grosso, at-large independent, who is unhappy with DOH’s rollout of the program.

Officials believe as many as 40,000 of the District’s 640,000 residents could qualify for the city’s medical marijuana program, but only about 200 patients have been approved. Oregon, which has a population of close to 4 million people and allows for 10 qualifying conditions has more than 60,500 medical marijuana patients.

Health department Director Joxel Garcia said at a D.C. Council oversight hearing said he thought officials should not limit the qualifying conditions.

“Personally, I think there should be no list. It should be left for the physician to determine what condition they should be prescribing medical marijuana,” Dr. Garcia said at the March 7 hearing. “If we allow this to be a patient-doctor relationship, I think it will go in a much more proactive way.”

It is unclear if the agency plans to take any steps to expand access to medical marijuana on its own or if it will rely solely on the petition process.

“The Department of Health has the authority to expand the list of conditions as much as they want, and for some reason, he’s going through this song and dance,” Mr. Grosso said of Dr. Garcia.

Health department spokeswoman Najma Roberts did not respond to requests for comment about the program Tuesday.

The city’s medical marijuana program, initially approved by D.C. voters through a referendum in 1998, was delayed by a congressional rider known as the Barr Amendment until 2009.

The city’s first dispensary opened in July, after the D.C. Council approved legislation authorizing the program in 2010 and crafted regulations to fend off any further interference by the federal government.

“We almost have to revisit the whole thing to get it right,” said Mr. Grosso, who also supports legalization of marijuana.

Twenty states and the District have legalized medical marijuana programs. Voters in Colorado and Washington both approved initiatives to legalize recreational use of the drug, and a number of other states are poised this year to pass similar measures.

The quick pace at which local legislators were able to introduce and pass a decriminalization bill highlights how slow progress has been for patients seeking access to medical marijuana, said Mike Liszewski, policy director for Americans for Safe Access.

“It does seem a little strange that we haven’t figured out medical yet and we’re moving on,” Mr. Liszewski said. “We’re just wondering why the patients haven’t been taken care of yet.”

Americans for Safe Access, which supports medical marijuana but takes a neutral stance on recreational use, plans to work with individuals seeking to petition for various conditions to be included in the District’s qualifying-condition list. Likely high on the priority list are petitions to include chronic pain and epilepsy, Mr. Liszewski said.

It is unclear when the Department of Health’s Medical Marijuana Scientific Subcommittee would rule on any petitions. Regulations for the program state that the committee must meet at least twice a year to review petitions. The committee’s next meeting is scheduled for March 27, but it is closed to the public.

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