Two years after the state’s medical marijuana program was signed into law, the Department of Health has called for program revisions that include doubling the number of dispensaries and allowing nurse practitioners to certify patients, and is still considering a home delivery service.

In a report released this month, the DOH also recommended providing more brand options for patients and adding chronic pain to the list of qualifying conditions. The law mandated a two-year progress report.

Local advocates, patients and officials said the report highlights the program’s problems with accessibility, which primarily stem from high prices and too few dispensaries and doctors.

Five companies were licensed by state officials in July 2015 to manufacture and sell the drug under the Compassionate Care Act, which was passed by the State Legislature in June 2014. Twenty dispensaries were planned statewide, including one each in Nassau and Suffolk.

The law allows the registered organizations to sell the drug in pill, oil and tincture forms to patients who are registered with the state and have prescriptions. It does not allow smokable forms of the drug.

The program’s five organizations are authorized to operate four dispensaries each, but only 17 of the 20 have opened. Half the dispensaries, the first of which opened in January, are clustered in southern New York, with nine across New York City and Long Island, according to the DOH report. On Long Island, one dispensary opened in Lake Success and another in Riverhead.

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Dr. James D’Olimpio, an oncologist at Northwell Cancer Institute in Lake Success, said that patients are struggling with the medicine’s cost and that he has had to send patients to Suffolk’s dispensary because the type of marijuana they need is not available in Nassau, which carries only one product.

“A lot more needs to be done, especially given the need,” D’Olimpio said. “The need is not being met. . . . Many patients can’t afford it.”

Prices for medical marijuana products, which are fixed until July 2017, can vary across dispensaries. The facilities don’t publish prices, but patients report paying from a few hundred dollars to more than several thousand dollars for a month’s supply.

Among the report’s 12 listed recommendations is registering five additional organizations, which would double the number of dispensaries from 20 to 40 over the next two years. A DOH representative would not comment on whether this would increase the number of dispensaries on Long Island.

Assemb. Richard Gottfried (D-Manhattan), a longtime advocate of medical marijuana and a sponsor of the state Compassionate Care Act, said the shortage of dispensaries remains one of the biggest barriers to accessing the program.

In January, Gottfried proposed a bill that would require the DOH to license five more registered organizations this year and allow existing organizations to open additional dispensaries.

“The notion that 20 dispensaries can serve the whole state makes no sense,” Gottfried said.

Struggle to find doctors

Finding physicians remains another major hurdle for patients, and in its report the DOH reaffirmed its commitment to establishing a list of registered doctors. Without it, some patients have waited months to find a doctor and register with the program, advocates and patients said.

Longtime advocate and Atlantic Beach resident Missy Miller said finding a doctor for her son Oliver, 16, who has epilepsy, was a “daunting task” that took two months.

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According to the DOH, as of June there were about 600 registered doctors for 5,000 certified patients in the program statewide. About 34 percent of patients have neuropathies, followed by 25 percent with cancer. Long Island has the second-highest number of registered patients, with 1,274 as of June. New York City’s five boroughs have about 1,600 patients combined.

Doctor-to-patient ratios are low across the state’s counties, according to the report. In 31 counties, there is either only one certified practitioner or none at all. In Nassau, there are 67 certified practitioners who can prescribe medical marijuana for 542 patients. In Suffolk, there are 55 certified practitioners for 732 patients.

Kate Hintz is a patient advocate at Manhattan-based nonprofit Compassionate Care New York. Hintz, whose 5-year-old daughter has epilepsy, said there are not nearly enough doctors, which forces some severely ill patients to travel long distances to procure medicine, she added.

D’Olimpio said he has had to turn down prospective patients but supports a public list of physicians being made available.

The DOH is also considering authorizing nurse practitioners to certify patients for medical marijuana, which would support rural areas with fewer physicians available, the report said.

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Call to add chronic pain

The DOH report recommended exploring making more brands of medical marijuana available. Registered organizations are responsible for manufacturing and selling up to five brands of medical marijuana. Patients said product range varies across dispensaries, and that there are shortages for some types of medicine, especially a cannabidiol oil, an active ingredient in cannabis used to treat epilepsy.

Nicholas Vita, CEO of Columbia Care, which operates Suffolk’s dispensary, said that as operations grow he expects both the supply and selection of medicines to increase as prices moderate. Officials at Bloomfield Industries, which operates the dispensary in Lake Success, could not be reached for comment.

The report’s other recommendations include adding chronic pain to the roster of qualifying conditions. Donna Schwier, a Medford resident who has chronic pain from fibromyalgia, said that would give her significant relief from the constant nausea she experiences from dosing with opiates.

“There are many, many people who can’t access the program still,” Schwier, 59, said. “It’s not a success.”

The DOH is reviewing its recommendations and will “advise on next steps in process and substance within the next two weeks,” a representative said. That frustrates and disappoints Gottfried.

“It’s troubling to see them proposing to take actions that they have long said they were already doing,” he said. “It’s troubling to see them making recommendations to themselves rather than telling us that they have studied something and are going to take action.”