But like other municipal officials across Massachusetts, Fitzgerald is newly wary of medical dispensaries. In March, he joined his colleagues in deciding to not permit any in Marshfield until state lawmakers and regulators finalize new rules for the sale of pot.

Marshfield Selectman Jim Fitzgerald is a firm believer in the medical benefits of marijuana. His mother used it when she suffered from liver cancer in the 1970s to manage the side effects of chemotherapy.

The concern? That medical dispensaries would quickly expand to include sales of recreational marijuana, too. As written, the law approved by voters in November would allow that to happen without any additional local permission.


“There’s a big difference between medical marijuana facilities and recreational facilities,” Fitzgerald said. “Until the state gets its act together, any discussion of a dispensary is just a waste of time and air.”

Patient advocates said the fears of municipal officials about recreational pot are exacerbating a shortage of options for medical marijuana, especially in less populated areas of the state. More than four years after voters approved medical marijuana’s use, only 10 licensed dispensaries are currently selling prescription marijuana products in Massachusetts.

There are plenty waiting in the wings — more than 80 dispensaries have cleared initial regulatory checks and locked up locations around the state.

But just like cities and towns, many are in a holding pattern, struggling to finalize business plans and attract financing as Beacon Hill lawmakers contemplate sweeping changes to marijuana laws. Just this week, legislators threatened to strip oversight of the recreational industry from state Treasurer Deborah Goldberg, a move Goldberg has warned will waste a year of preparation by her office and prolong the current confusion.

Meanwhile, the clock is ticking: Under rules set by the Massachusetts Department of Public Health, which regulates the medical marijuana system, each dispensary has just one year to find a location once it passes a state screening. Any delays or false starts at the local level eat into that tight timeline.


Another uncertainty: threats by the Trump administration to enforce federal laws against marijuana, especially recreational pot, in states that have legalized the drug.

“We don’t know what the regulations are, so we can’t do anything,” said Jeremy Bromberg, chief operating officer of MassMedicum, which has preliminary licenses for medical dispensaries in Amherst, Holbrook, and Taunton but has delayed construction on them amid the regulatory turmoil. The federal threats, in particular, “at one point caused some would-be investors to pull back altogether,” Bromberg said.

Under the recreational law, medical dispensaries that opened or received preliminary approval from the state before Dec. 15, 2016, are allowed to apply for recreational licenses up to one year before other applicants.

The law also says municipalities can’t stop approved medical shops from applying to the state to sell recreational pot, unless residents vote to ban all recreational facilities in a townwide referendum. And if the state misses a July 2018 deadline to establish regulations for the recreational industry, existing medical facilities can simply begin selling marijuana to any adult.

Those provisions have kept local authorities from allowing many medical marijuana dispensaries to open.

“Dispensaries have had trouble locating to begin with, but as we approached the [recreational] ballot initiative, it became controversial again,” said Nichole Snow, executive director of the Massachusetts Patient Advocacy Alliance , which represents medical marijuana patients. “It’s totally bottlenecking all the applicants at the local level.”


Some communities balked even before the passage of the recreational law. Last June, for example, selectmen in Sturbridge rescinded approval of a medical dispensary, Heal Inc., after learning the proposed ballot initiative could allow it to sell recreational marijuana. The town restored the approval only after Heal promised not to sell recreational pot until 2021.

Mary Blanchard, chairwoman of the Sturbridge Board of Selectmen, said that concession was necessary to assuage residents’ concerns.

“We didn’t want the whole ball of wax all at once,” she explained.

Since the November vote, more municipalities have moved to limit marijuana businesses, including Westborough, where residents recently voted to ban any recreational companies. According to the Massachusetts Municipal Association, five towns have enacted temporary moratoriums on recreational marijuana, while another 74 communities will soon vote on moratoriums or bans. Still others, including Boston, have enacted buffer zones that establish a minimum distance between dispensaries.

Some of these local measures make no distinction between recreational and medical marijuana operations. Town Meeting members in Ashland, for example, voted in November to refuse applications from both recreational and medical applicants until 2018, or until the town enacts zoning regulations for recreational shops.

Such delays have frustrated the owners of planned medical dispensaries, especially those who say they have no interest in recreational marijuana.


For example, the proposed Elevated Access Center medical dispensary has been turned away from several towns, including Groveland and Marshfield. Robert Proctor, its chief executive, said his nonprofit wants to specialize in medical-grade products, and has even pledged to donate to charities for pediatric cancer patients.

“The progress we were making was great — until the recreational vote,” Proctor said. “All the towns where we were deep into negotiations said, ‘We’re going to wait until we see what happens with recreational.’ . . . We came to talk about medical, but all they hear, see, and think is ‘pot shop.’ ”

Proctor argued the state should change the deadlines dispensaries face. First, he said, DPH should increase the window medical shops have to find a location beyond one year. A DPH spokesman noted health officials last August extended the time dispensaries have to find a location, and said the department would consider individual extension requests.

Secondly, Proctor said, once dispensaries have locked down a site, they should then face a deadline to open. He said some dispensaries that have held municipal approvals for years haven’t even started construction, boxing out other applicants.

Perhaps justifying towns’ caution, several medical dispensaries have said they are interested in selling recreational pot, including MassMedicum, Coastal Compassion , which plans to open in Fairhaven this year, and New England Treatment Access , which has shops in Brookline and Northampton. Other dispensaries won’t pledge to remain medical-only until they see the new rules drafted by regulators and lawmakers.


“A lot of communities are now seeking commitments from dispensaries not to do recreational. We’ve been asked to do that a number of times,” said one dispensary owner, who asked not to be named because he feared alienating towns where his company is seeking approvals. “You’re essentially waiving your future rights around a statute that’s not even finalized yet.”

There is evidence other dispensaries are also considering recreational pot: in the fall of 2015, DPH received a flurry of new applications for medical shops just before the deadline to qualify for the recreational licensing headstart.

Selling recreational pot would dramatically expand a medical dispensary’s potential customer base, from the roughly 40,000 patients registered with DPH to any adult.

The prospect of a larger market is attractive, said Boston investor Douglas Leighton, who is financing the Coastal Compassion dispensary in Fairhaven. Leighton is entitled to an equity stake if the nonprofit dispensary spins off a for-profit to sell recreational pot.

“We invest on the medical side first,” Leighton said. But, “you’re sort of hoping for recreational.”

Dan Adams can be reached at daniel.adams@globe.com. Follow him on Twitter @Dan_Adams86. Adam Vaccaro can be reached atadam.vaccaro@globe.com. Follow him on Twitter @adamtvaccaro.