Advocates for the medical use of marijuana said the governor’s actions were welcome. “A lot of the recommendations that the Department of Health made are things that the patients have been asking for for a year and a half,” said Kassandra Frederique, the state director of the New York office at the Drug Policy Alliance, which advocates more liberal drug laws.

In particular, Ms. Frederique said delivery options could ease the problems posed by the state’s size and the lack of geographic diversity in the current dispensaries.

Indeed, delivery could make a huge difference for patients with debilitating pain, like Jessica Hargrave of Rochester. The closest dispensary is a 10-minute drive from her home, but it has only tinctures, which are meant to be put under the tongue. She bought $155 worth of tinctures, but said she got no relief. “It did nothing; it was like putting water under my tongue,” she said. “It was a big waste of money.”

Mrs. Hargrave, 34, would like to try other formulations but cannot sit in a car for three hours to get to the next closest dispensary in Syracuse. “I need more options at my local dispensary,” she said.

The cost of the drug will not be addressed, though for those suffering from financial hardship, the state does intend to extend a waiver for a $50 registration fee. Unlike most medicines, marijuana is not paid for by insurance, so it is an entirely out-of-pocket cost for patients who are sometimes on disability and struggling to make ends meet; patients and providers say the cost of the drug can run anywhere from $200 to $1,000 a month.

“That’s a lot of money for an MS patient because many are unemployed,” said Dr. Michelle Fabian, an assistant professor of neurology at the multiple sclerosis center at Mount Sinai Hospital, where she has several patients taking cannabis for excruciating muscle spasms.

The five companies that have been operating in the state since January have also reported that it has been difficult to be profitable with the current volume of patients. According to the Health Department, about 675 physicians have been registered, with about 7,000 patients certified. But not all of those patients are necessarily consistent customers.