BOSTON -- Proposed changes to Massachusetts' medical marijuana regulations aim to make it easier for patients in hospice care to access medical marijuana. But patient advocates say the new rules will not address the fact that the process takes too long and would not help patients who are being cared for at home.

"Hospice patients are literally out of time," said Elizabeth Dost, clinical director for the Massachusetts Patient Advocacy Alliance, which represents medical marijuana patients. "The patient's average length of stay (in hospice) in Massachusetts is 35 to 45 days. By the time they access cannabis, they are often deceased."

Four years after Massachusetts voters legalized medical marijuana, nine dispensaries have opened. The Massachusetts Department of Public Health is considering a range of changes to program regulations meant to streamline processes, clarify language and improve patient access and public safety. A public hearing in Boston Tuesday on the new regulations drew attention to challenges patients face with the program, both under the current rules and under the proposed changes.

"Four years after the institution of the laws, we still wait for safe access with only nine dispensaries being opened," Dost said. "The medicine is expensive and often cost-prohibitive."

Under DPH's proposed rules, certified nurses, not just doctors, would be able to sign off on a patient's use of medical marijuana.

The current rules define a 60-day supply of medical marijuana as 10 ounces. But there is little scientific evidence backing up that number, and the new rules would let a doctor define a 60-day supply as less than that.

The proposed rules would let a medical facility -- like a hospice provider or nursing home -- become registered to offer medical marijuana, whereas today only a particular employee can apply to be a prescriber.

The new rules would maintain the current structure of independent testing labs, but would require labs to only test marijuana from registered medical dispensaries -- not, for example, marijuana grown by a patient or caregiver.

Other proposals relate to allowing more flexibility in a marijuana facility's security system, allowing cultivation from clones and not just seeds, allowing nonorganic cultivation and letting dispensaries post price lists on their websites.

There has been dissension over the proposed changes to the 60-day supply. Peter Bernard, president of the Massachusetts Grower Advocacy Council, said the state should leave the possession limit alone.

"Ten ounces might be a lot to some people, but when you talk about people with epilepsy or people with cancer or people that need highly concentrated forms of cannabis ... it takes a lot more than that 10 ounces to produce a 60-day supply," Bernard said.

Bernard said there is not enough scientific or medical data for a doctor to know an exact dosage. It depends on patients' tolerance and reactions and on the particular crop, he said.

Jeremiah MacKinnon, co-founder of the Cannabis Society of Massachusetts, said keeping the 10-ounce limit ensures patients get "equitable treatment." He said most patients do not buy that amount anyway because of high prices. The proposed change, he said, would also create a legal disparity, since possession of less than 10 ounces of marijuana is now legal under Massachusetts' new recreational marijuana law.

But Jordan Tishler, a doctor specializing in medical marijuana, said he would "welcome the ability to limit amount of the cannabis (patients) can buy."

Now, Tishler said, dispensaries have a financial incentive to get patients to purchase more marijuana, and he has had patients who have trouble regulating their own use. "The current system encourages overuse," Tishler said.

Patient advocates also criticized the proposed rule limiting labs to testing for dispensaries and not for patients. MacKinnon said that increases the risk that patients who grow their own marijuana or buy it on the street will be exposed to mold or other contaminants or will not properly understand the drug's potency.

"It would present public health and safety dangers," MacKinnon said. "DPH shouldn't deny patients and caregivers access to a regulated testing service."

Maggie Kinsella, a medical marijuana patient who works for the Northeastern Institute of Cannabis, said creating obstacles to patients to testing their medicine "can put their life at stake."

"The variance in cannabis is too broad for patients to trust a product sold at a dispensary," Kinsella said.

Patient advocates also asked state public health officials to go further than is proposed by the current rule changes. Nichole Snow, executive director of the Massachusetts Patient Advocacy Alliance, said the state should drop a $50 fee for patient registration cards, which she said causes financial hardship for some patients. She suggested streamlining the process for terminally ill hospice patients who cannot wait three to six weeks after filling out paperwork to get marijuana. The current system, she said, "is inhumane."

A second public hearing will be held at 10 a.m. Thursday at the Holyoke Community College Kittredge Center for Business and Workforce Development.

The Department of Public Health will consider testimony from both hearings before releasing final rules.

"Our top priority continues to be promoting safe patient access while balancing public safety and promoting transparency in the Medical Use of Marijuana program," said DPH spokesman Tom Lyons. "We believe the proposed changes will advance those goals. Input from stakeholders is an important part of the regulatory process; we welcome the feedback and will closely review all comments submitted during the public comment period and make changes as necessary."

This story was updated with Lyons' comments.