SEATTLE — There should be, one might think, a note of triumph or at least quiet satisfaction in Muraco Kyashna-tocha’s voice. Her patient-based cooperative in north Seattle dispenses medical marijuana to treat seizures, sleeplessness and other maladies. And with the state gearing up to open its first stores selling legal marijuana for recreational use, the drug she has cultivated, provided to patients and used herself for years seems to be barreling toward the mainstream.  But her one-word summary of the outlook for medical marijuana is anything but sunny: “Disastrous,” she said, standing in her shop, Green Buddha, which she fears she will soon have to close.  The legalization of recreational marijuana for adults in Washington, approved by voters in 2012 and now being phased in, is proving an unexpectedly anxious time for the users, growers and dispensers of medical marijuana, who came before and in many ways paved the way for marijuana’s broader acceptance.  In the 16 years since medical marijuana became legal here, an entire ecosystem of neighborhood businesses and cooperative gardens took root, with employees who could direct medical users to just the right strain; there are now hundreds of varieties with names like Blue Healer, Purple Urkle and L.A. Confidential, each with a variety of purported medicinal benefits. Medical users could also start gardens in their backyards and keep large amounts of marijuana at home. It was all very folksy — and virtually unregulated, which the authorities say led to widespread abuses.  Now, under pressure from the federal government, the state is moving to bring that loosely regulated world, with its echoes of hippie culture, into the tightly controlled and licensed commercial system being created for recreational marijuana, which goes on sale this summer. (The first license to grow marijuana was issued on Wednesday.) This week, the Legislature is debating bills that would reduce the amount of the drug that patients can possess or grow, eliminate collective gardens under which most dispensaries operate, require medical users (unlike recreational users) to register with the state and mandate that all marijuana be sold only by new licensees, effectively shutting down the medical dispensary system.  Proponents say the changes are needed to stamp out fraud and help ensure that Washington has a uniform system, supplying the medical products people need and want while at the same time passing muster with guidelines issued by the federal government last summer, even though marijuana remains illegal under federal law. But many medical marijuana users and dispensary owners say the rules will inadvertently discourage the legitimate use of marijuana to treat illness and pain even as science has increasingly been validating its therapeutic effects.  Trusted dispensaries will be closed, they contend, and choices will diminish, with the varieties that marijuana medical users prefer squeezed off the shelves by more profitable recreational varieties grown for their greater, high-producing THC content, not for headache or nausea relief. In Seattle alone, about 200 dispensaries will have to close, replaced by 21 licensed retailers, and under current state regulations, employees in those shops will not be allowed to even discuss the medical value of the products for sale.  A medical marijuana user will certainly be able to enter a shop and buy marijuana once the new stores are open in June, but the old system of medical advice and supply, however flawed or beloved, is over, say both critics and supporters of the new rules.  “Prepare for the end,” said Hilary Bricken, a lawyer in Seattle who works mostly with the marijuana industry, summarizing the advice she is giving her medical marijuana dispensary clients.  Washington State’s struggles — and the inevitable comparison with Colorado’s different, smoother path toward retail marijuana — are being watched around the nation, Ms. Bricken and other legal experts said.  California, for example, with a medical marijuana system far larger but otherwise similar to Washington’s in its absence of state controls, also has active voter-initiative efforts pushing toward legalization. Twenty states as well as the District of Columbia allow medical marijuana, and at least 14 more are considering some form of it this year. Oregon’s Legislature is wrestling with how to administer its dispensary system even as efforts continue to put legalization on the ballot.  Colorado avoided trouble mostly by acting early. There, state regulators stepped in with strict rules for medical marijuana long before full legalization. And after voters approved legalization in 2012, those regulated dispensaries were put first in line for licenses, forming the backbone of the new recreational market. The dispensaries had supplies of the product in the pipeline — and expertise — which is why recreational marijuana sales started there from the first day of legalization, on Jan. 1, while Washington’s are still weeks away.  In Washington, some dispensaries might be well run, others poorly, but without oversight, state officials could not know which was which. So a clean sweep was seen as the only way forward, legislators say.  “We’re moving from the wild, wild West to the regulated West,” said State Senator Ann Rivers, a Republican and a sponsor of one of the leading bills. A similar bill, sponsored by a Democrat from Seattle, Representative Eileen Cody, passed the House last month.  Ms. Rivers emphasized that her goal was to protect, not punish, marijuana patients, though she said she understood their fear of change. Without formalized rules allowing patients to continue growing their own plants, for example (I-502, the initiative legalizing recreational marijuana, prohibits that), and to have more than one ounce in their possession, arrest and federal prosecution are a real risk, she asserts. Her bill allows both.  A mandatory registry, she said, provided the legal spine to those protections. Under her bill, a registered patient buying medical marijuana at a licensed store with an “endorsement” from the state to sell medical marijuana would also be exempt from the 25 percent retail tax charged to recreational buyers. (Other state taxes, assessed on growers and producers, would already be included in the retail price.)  “The feds have been very clear, that if we don’t get our ducks in a row, they are going to bring it to a screeching halt,” Ms. Rivers said. “We have a chance right now to define our destiny with this, and if we don’t we will most definitely allow the feds to define our destiny.”  To many patients and providers, though, the proposed mandatory registry is not a good thing. Some patients, especially those receiving Social Security or other federal aid, have said they will refuse to sign up because that would be a legal admission of drug use that they said could jeopardize their benefits. Others have told lawmakers they fear a loss of private information.  Some dispensary owners concede that the medical system was rife with abuses but that patients were now about to pay the price.  “The state failed to regulate, allowing doctors to write these prescriptions to 20-year-old gangbangers on the street who said, ‘Oh, I hurt my knee playing basketball,’ ” said Karl Keich, a dispensary operator and founder of the Seattle Medical Marijuana Association, a group of collective gardens.  Andrea Mayhan, who takes medical marijuana to control muscle spasms and seizures that she suffers as a result of a degenerative disorder, says she believes she will be able to get the strains of marijuana she wants because she knows what to ask for. New patients, though, might walk in — or, like her, roll in using their wheelchairs — and find a clerk less familiar with medical strains, or prohibited by state rules from giving advice.  “They’re going to be lost,” she said.  A version of this article appears in print on March 7, 2014, on page A11 of the New York edition with the headline: Providers of Medical Marijuana Face New Fears. Order Reprints|Today's Paper|Subscribe
With the advent of recreational marijuana in Washington State, new rules for medical providers could shut down dispensaries.