Mass Alternative Care received preliminary approval to open three medical marijuana dispensaries in Western Massachusetts in 2016.

Those dispensaries still have not opened. But this month, the state's Cannabis Control Commission approved Mass Alternative Care for "priority certification," which gives the company a leg up in applying for a recreational marijuana license.

Michael Schneider, an attorney who works with Mass Alternative Care, declined to speak to a reporter about the company's plans.

Mass Alternative Care is not unique. All 20 registered marijuana dispensaries that were given priority review status for the recreational industry have yet to open their medical dispensaries.

Patient advocates are raising concerns that the companies will go straight into the recreational market and will not serve patients. They say awarding priority to unopened dispensaries violates Massachusetts' marijuana law.

"This is how they're going to kill the medical program," said Michael Latulippe, development director of the Massachusetts Patient Advocacy Alliance, which advocates for medical marijuana patients.

But state regulators interpret the law differently. And advocates for the marijuana industry say they hope - and anticipate - that dispensaries will sell to patients even if they also sell to the general public.

James Smith, an attorney and founding partner at Smith, Costello and Crawford who represents cannabis companies, said medical marijuana likely will make up around 25 percent of a business that sells both medical and recreational products.

"Given that you spent a fortune to build a store and cultivation, why would you not want to carry a complete supply of products?" Smith said. "It would be like a beer and wine store that decides to not carry red wine."

While any adult can buy marijuana from a recreational store, a patient can get the benefits of the medical marijuana program -- tax-free marijuana, a financial hardship discount, access to certain doses, a record accessible by their physician -- only at a dispensary connected to the state's medical marijuana computer system. Stores that sell medical and recreational marijuana are also required to set aside a portion of inventory for patients.

Massachusetts law authorizes "priority certification," which lets registered medical marijuana dispensaries and "economic empowerment" applicants, who work in areas disproportionately affected by marijuana enforcement, apply beginning Tuesday for a license to open a recreational marijuana business. Other businesses have to wait until May 1 or June 1.

Most of the companies given priority certification obtained their provisional certificate, a step partway through the medical marijuana approval process, in 2016 or 2017.

The other Western Massachusetts company to get priority certification is GTI-Massachusetts NP Corp., which received permission in 2016 to build dispensaries in Amherst and Holyoke. A message left for GTI through its attorney was not returned.

Today, there are 24 dispensaries approved to sell medical marijuana, and another approximately 100 with provisional certificates.

While dispensaries have to put an expected opening date on their application, there is nothing compelling them to open then. There are many reasons a company with a provisional certificate might not have opened. The company might be building its facility and working through the inspections process. It might have run out of cash. Or it might be waiting for the recreational market to become legal.

The latter option worries Latulippe's group.

"There's nothing in regulations that forces those applicants to commit to registered qualified patients in their community," said Nichole Snow, executive director of the Massachusetts Patient Advocacy Alliance.

Latulippe said patients advocated to city and town officials on behalf of medical marijuana dispensaries. "If they think they're not going to serve patients, I'll have the same patients come out and speak against their facilities," Latulippe said.

The Massachusetts Patient Advocacy Alliance wants the Cannabis Control Commission to require applicants to provide a time frame in which they will open for medical patients.

Latulippe said he believes the commission is disregarding the law, although his group does not have money to sue.

State law authorizes priority certification for dispensaries with "provisional or final certificates of registration in good standing ... that are operational and dispensing to qualifying patients." That language is ambiguous because dispensaries with provisional certificates are not allowed to dispense.

The Cannabis Control Commission interpreted it to allow dispensaries with provisional certificates to get priority certification.

Gov. Charlie Baker introduced a provision in a supplemental budget bill that would remove the language of "operational and dispensing." The bill has not yet passed.

Jim Borghesani, a spokesman for the Yes on 4 group that supported legalization, said the spirit of the law was to grant anyone with a provisional certificate priority, since they are already vetted.

"I certainly hope that if anybody decides to change their business plan and not include medical marijuana, they should be very aware of the pushback they're going to get from the town," Borghesani said. "It would not be a good idea to start your host community agreement while being accused of a bait and switch."

Some experts say they do not see patients' fears coming true. Smith said just because a medical dispensary applied for priority certification does not mean it is prepared to open. Smith advised clients to apply even if they were not ready to open, so when they were ready, they would be prioritized.

It is also possible that a dispensary that ran out of money and wants to sell its license will apply for certification to increase the license value.

Smith said the first businesses to open will be those with an existing store in a place zoned for recreational marijuana.

Medical sales will be as lucrative as recreational sales, so there is no reason a dispensary would forego that, Smith said.

Adam Fine, a Massachusetts attorney for Vicente Sederberg who specializes in marijuana law, said it costs $81,500 to get a provisional certificate and $50,000 annually to maintain it. He thinks few businesses would want to hold a license to wait for the recreational market because of the cost. Most have probably been delayed by building, raising money, litigation, changing staff or other hurdles.

"I don't think a lot of people are sitting on licenses with the intent of applying for recreational," Fine said.

Like Smith, Fine said businesses have a financial incentive to sell to patients, because it increases the size of the market.

But Maggie Kinsella, a spokeswoman for the pro-marijuana group MassCann/NORML, said other states have seen medical marijuana programs disappear after legalization. She worries that the licensing decision is a step in that direction.

"I feel like this is abandoning the program," Kinsella said.