As she battles symptoms of lupus and depression, Alexandra Rice says she depends on easy access to medical marijuana to control widespread pain and to improve her mood.

The 21-year-old resident of Grand Terrace, near Riverside, has pictures of cannabis flowers on her Twitter profile and friends whose livelihoods depend on the pot industry. She’s also an unlikely opponent of a November ballot initiative that would legalize marijuana for all adults in California.

“If it is legalized, more people who don’t respect it and just want to get high are going to take advantage of that,” Rice said. “And people who genuinely need it as medicine will be misplaced and thrown to the side.”

When it comes to permitting recreational cannabis use, reaction from the medical marijuana community ranges from enthusiastic advocacy to passionate opposition — with many left somewhere in the middle, confused and torn.

“I’m completely on the fence about it,” said Robert Taft, a longtime medical marijuana advocate who owns 420 Central licensed medical marijuana dispensary in Santa Ana.

Some medical cannabis users fear the measure, Proposition 64, would impose stricter regulations that would affect where they could consume marijuana and how much marijuana they could grow.

Those concerns have persisted even as Prop. 64 backers and experts argue that the language of the ballot measure doesn’t affect the rights of medical marijuana patients established when Californians passed the Compassionate Use Act in 1996.

Indeed, the language of the initiative supports the view that properly credentialed medical patients would still be permitted to smoke the drug most places tobacco smoking is allowed. And, while recreational consumers would be limited to growing six plants at a time, medical marijuana patients would continue to be allowed to cultivate up to 100 square feet of pot plants.

“It preserves the existing regulatory scheme that we worked so hard for in California,” said Don Duncan, California director of Americans for Safe Access, an organization that fights for medical marijuana rights but stays neutral on recreational cannabis legalization. “I don’t see any huge landmines for patients.”

The initiative’s backers argue legalization will actually broaden access and rights for the state’s estimated 1 million medical marijuana users.

“The sky is not going to fall,” said Matt Kumin, a San Francisco attorney who’s represented medical marijuana clients for two decades. “I think this is actually a new day for medical cannabis patients.”

Still, anxiety is widespread over how the measure would impact the price of medical marijuana and what would become of the state’s 20-year-old market in the shadow of a far larger recreational marijuana industry that would be sure to attract a flood of new players.

“There’s a lot of concern about that,” said Dale Gieringer, California director of the legalization advocacy group NORML. “There is not a lot of enthusiasm I’ve seen in the activist community in general.”

HOW IT WOULD WORK

California’s massive medical marijuana economy will change dramatically over the next several years, no matter the outcome of the November vote on Prop. 64.

State regulators are rolling out a comprehensive new system to regulate cannabis growth, manufacturing and sales. Those regulations — the result of legislation approved last year — are expected to rein in underground retailers and make cannabis safer while at least marginally increasing the price of medical marijuana.

The proposed ballot initiative would largely extend the same regulatory framework to recreational marijuana production, testing and sales.

Some predict that post-legalization, many California dispensaries would simply have two lines: one for patients and one for recreational consumers.

In Colorado, which legalized cannabis in 2012, recreational sales are 60 percent to 70 percent of the market. But both sectors keep expanding, with $486 million in total sales in the first five months of 2016.

That’s why many of California’s medical marijuana businesses welcome legalization: It offers potential to significantly grow their markets.

And if Colorado is a guide, there could be longer-term economic advantages for the medical marijuana sector should the initiative pass.

Recreational prices recently plummeted in the Rocky Mountain state thanks to a glut in supply, but medical prices have held steady. In addition, the California ballot measure would exempt cannabis patients from paying sales taxes, which would help keep consumer costs down.

A lot of how Prop. 64 plays out here would depend on how cities and counties react, Gieringer said, since they’d control what types, if any, of marijuana businesses could operate within their boundaries. They also could impose additional local taxes, which some local governments are already gearing up to do.

“We could have a lot of communities in California where they will allow medical dispensaries and not adult use,” Gieringer said. “In that scenario, medical will have a stronger future.”

BENEFITS FOR PATIENTS

For Californians who don’t have major medical problems — such as those who nibble an edible rather than swallow sleeping pills to doze off — legalization means they’d no longer have to spend time and money getting a doctor’s recommendation to use marijuana.

“The average patient who doesn’t have really special needs in cannabis is probably better off,” Gieringer said.

Distinguishing casual users from people with more serious medical conditions might also offer patients some of the legitimacy they’ve long struggled to get.

Here are other protections Prop. 64 offers for medical marijuana patients:

It lowers penalties for many marijuana-related crimes, with those changes applied retroactively, which potentially means resentencing and clearing records for those who’ve long worked in and benefited from the medical marijuana industry.

It says marijuana use alone can’t be used to restrict custody rights for patients complying with state law.

It caps fees at $100 to get optional ID cards confirming their status as patients. Many counties now charge $150 to $175. The measure also protects card data under the state’s Confidentiality of Medical Information Act.

And with California the world’s sixth-largest economy, experts predict a boost in protections here could increase access for medical marijuana patients throughout the country.

CONCERNS FOR PATIENTS

For many patients, their biggest concern is how the measure might impact the price of their medicine.

Prop. 64 would tax all marijuana sales at 15 percent and cultivation at $9.25 per ounce for dry flowers or $2.75 per ounce for leaves.

If patients have a government-issued ID card, they can skip the state sales tax. They’d still pay the 15 percent tax imposed by Prop. 64, plus whatever portion of the cultivation tax and regulatory compliance costs might get passed along. And they may face additional local taxes allowed under the measure.

The intent is to keep medical marijuana affordable enough that patients can still buy it without making it so comparatively cheap that recreational users will stay in that market, said Richard Miadich, a Sacramento attorney representing the legalization campaign.

For those who use marijuana for minor health conditions or to get high, Rice said higher prices under legalization may be worth it to avoid doctor’s recommendations or legal issues. But for people like her, who use the drug daily to function, those taxes could mean a big hit.

“It’s going to make people who genuinely need medication not be able to get it at a reasonable price,” she said.

Two legislators are attempting to tax medical marijuana even if the ballot measure doesn’t pass.

Assemblyman Jim Wood, D-Healdsburg, is pushing a bill that would tax medical cultivators at a rate nearly identical to what Prop. 64 proposes. And Sen. Mike McGuire, D-Healdsburg, authored a bill that calls for a 10 percent medical marijuana tax.

Some medical marijuana advocates still have a lingering distrust of the people who are the face of the ballot initiative.

Sean Parker, a billionaire who co-founded Napster, is the campaign’s largest contributor. And Lt. Gov. Gavin Newsom has been a key supporter, though he’s repeatedly said he doesn’t like marijuana.

“If you disconnect from the people who built this, they will disconnect from you,” Taft said.

But campaign spokesman Jason Kinney points out that hundreds of stakeholder groups helped draft the measure.

“We encourage both patients and business owners to look beyond the internal divisions that have hindered the marijuana activist community in the past and read the measure in full,” Kinney said. The initiative, he insisted, “takes great pains to protect the rights of those who have been on the front lines of this fight.”