Hawaii’s medical marijuana industry has made slow but meaningful strides since pot dispensaries opened a year ago.

The number of patients certified to use cannabis rose by 3,086 to 21,705 as of July 31, up 16.6 percent from 18,619 patients in August 2017 when the first dispensaries, Maui Grown Therapies and Oahu’s Aloha Green Apothecary, began legal sales of pakalolo.

“One year after opening, we see a much greater acceptance of medical cannabis therapy in our community, particularly among those over the age of 50,” said Teri Gorman, spokeswoman for Maui Grown, which has served 2,985 customers over the past year.

Doctors, nurses and other health professionals have begun to see the effectiveness of marijuana for managing symptoms, while more patients are seeking alternative, natural therapies. Family caregivers also have turned to cannabis, which is still considered federally illegal, to improve the quality of life of their loved ones, she said.

“We also see a growing desire for quality education about the medical use of cannabis,” Gorman added. “This is evidence that minds are opening and any remnants of stigma are fading fast.”

Over the past year, dispensaries have complained that staffing issues at the state Health Department, which oversees the medical cannabis program, and other government regulations have delayed progress in getting the industry off the ground. However, there’s been a pent-up demand from patients eager to finally get their medicines legally.

“For one you can’t get busted, for two they got a lot of different flavors,” said Jisko Jones, a 27-year-old medical marijuana cardholder from Kalihi. “You don’t know what you’re getting (on the black market). At least when you’re dealing with these guys, you know everything’s on the up-and-up.”

During its first year of operations, Aloha Green said it has served more than 4,500 customers and hired more than 90 employees with two more retail dispensaries in the works.

“This industry can become an economic pillar for the state of Hawaii,” said spokeswoman Helen Cho.

Dionisios Nicholas, a retired U.S. Marine who was severely injured in an overseas training accident in 2005 and was immobile for two years following spinal surgery, said the opening of cannabis retailers has been life-changing in helping him manage his pain and depression.

“Being a Marine for 23 years … we live a very conservative, upright life. We’re held to high standards. You can’t just change your mode of thinking so it was very difficult for me, but I suffer from a lot of pain,” said the 56-year-old Mililani resident, who uses a prosthetic device to help him walk. “I’ve been suffering a long time. I had 15 surgeries within one year. What I like about it is … you have results. At least we can hold these (dispensaries) accountable.”

Patrick Marn, an assistant manager at Aloha Green, became a patient a year ago due to back pain and insomnia from injuries sustained while playing sports. He said he has seen a significant shift in the way the public views pakalolo even among his own family, including his 70-year-old mother, Linda, who suffers from Parkinson’s Disease.

“She at first was very reluctant to try as most older patients are. She came from a time where it was not OK to smoke marijuana,” he said. “So opening her eyes was really big for me. People are growing more towards that thought (of using cannabis), and … away from the pills because they see what the opioid epidemic is doing to people.”