A year after Hawaii’s first legal sale of pakalolo and nearly two decades after the state approved the drug for medicinal use, the Big Island still has no retail dispensaries.

Six out of eight dispensaries, which sell medical marijuana that is tested for quality and safety, have opened on all the major islands except Hawaii island, which for years has had by far the most patients. The island recently was surpassed by Oahu, which now has 38 percent of patients compared to 31 percent. There were 21,705 patients statewide as of July 31.

A Big Island dispensary was expected to open as early as December 2016. But county permitting and other government requirements caused significant delays for Lau Ola, run by Richard Ha, and Hawaiian Ethos, whose CEO, Bill Richardson, died in November. He was replaced by interim CEO Luis Mejia.

“Going through the county processing did cause some delays, more than expected by any of us,” said Keith Ridley, chief of the state Health Department’s Office of Health Care Assurance, who oversees the dispensary program. “They do have the authority to regulate things somewhat differently. While mostly they’re aligned, there can be some differences that can result in either fewer or more requirements. More requirements mean, of course, longer processing times.”

The state legalized medical cannabis in 2000, but patients had no legal way to obtain the drug until the opening of the first dispensary, Maui Grown Therapies, on Aug. 8, 2017, followed the next day by Aloha Green Apothecary in Honolulu.

The Big Island facilities have had a harder time getting off the ground partly because of geography.

“Both dispensaries had issues with their locations and adequate water supply for firefighting. They had other issues with other agencies but for the fire department that was the main issue,” said Robert Perreira, battalion chief of the department’s Fire Prevention Bureau. “They put it in locations that didn’t have the proper infrastructure. One facility ended up having to install their own water source and fire pump, which took a long time. Then the other facility also had issues with water supply and also had operational issues they needed to get through.”

A smaller part of the issue is being able to build facilities with labor shortages, Ridley said, adding that he is expecting at least one dispensary to open by the end of summer, though both have yet to obtain all the required county permits.

“We have a general concern that without revenue, we’re hopeful that they have the financial resources to be able to continue through the permitting process that will get them through the cultivation and the selling stage,” he said.

In May, Green Aloha Ltd., doing business as Have a Heart, received the Health Department’s approval to open for business. Besides Maui Grown and Aloha Green, the other pot retailers that have opened are Pono Life Maui, Noa Botanicals and Cure Oahu.

“We feel a great weight to get open. We’re getting inquiries on our website consistently from patients who’ve been waiting for dispensaries,” said Zachary Taffany, Hawaiian Ethos’ chief operating officer, adding that an exact timeline is still unpredictable. “I predicted two dates in the past. It was obviously not grounded in the reality of the process. We made the mistake of predicting dates, but they’re not in our control.”

While the volcanic eruption on the Big Island has taken the vast majority of time and attention of county officials, “you’re talking about something that has been happening for two months, whereas this project has been going on for two years,” Taffany said. “Both licensees on the Big Island still haven’t received permission to cultivate. There must be some extra compliance processes we’re having to go through in permitting.”

Ha, a Big Island farmer and the CEO of Lau Ola, also is eager to get his business running after multiple permitting delays and having to replace a cooling system to control temperature and humidity in his growing facility six months after installing the wrong one. Marijuana factories must be free of pesticides, heavy metals, molds and mildews to keep the weed clean and safe for consumption.

“The permitting is more difficult the more technical you get — that’s a lot of the reason we were slower,” he said.

Both dispensaries are hoping to open by year’s end.

“Time is money. It just kills us to delay but if we want to have a long-term successful operation we got to do it just precisely,” said Ha, who has invested millions into the marijuana venture. “The longer it takes to get cash flow in, the scarier it is.”