The water, the lights, the seeds, the soil. The problem could be several things.
Some patients will learn how to grow, said Claude Miller, a Nevada medical marijuana consultant. Some won't.
"There's patients who can't grow a flower," he said. "Much less medical marijuana."
That's part of the reason he started his business. Many of the 900 patients in Nevada's program know little about the plant when they register.
But those patients, despite a provision in state law, must grow their marijuana themselves or find a state-approved "caregiver" who will grow it for them.
"(Marijuana) is a godsend and it really helps people," said Miller, who supports medical marijuana only under a tightly regulated system.
Patients, however, will not be able to get the drug like other prescriptions the state recognizes unless the federal government changes its stance.
Following a 2000 ballot initiative, the state Legislature wrote the constitutional amendment into law including a section that ordered the University of Nevada School of Medicine to research marijuana and develop a program to distribute it to patients.
The 2001 law says the Legislature understands the state's "obligation" to research a distribution program, but also says it must do it with the permission from the federal government.
The ballot initiative, approved by 65 percent of voters, called for "appropriate methods for supply of the plant to patients authorized to use it." These patients include residents diagnosed with illnesses such as cancer, glaucoma and AIDS.
The federal government, however, rejects the opinion of the 12 states with medical marijuana programs.
"Smoked marijuana has not withstood the rigors of science," according to the Web site of the U.S. Drug Enforcement Administration. "(It) is not medicine, and it is not safe."
Federal policy, supported by the past three presidents, has stalled research and development of a state distribution program.
Dr. Dave Lupan, an associate dean at the state school of medicine, said the university has made "no progress whatsoever" on the legislature's mandate. It will stay that way at least until there is a new president, he said.
It is unlikely the policy will change under the next administration, though. Republican presidential candidates John McCain and Mitt Romney do not support legalizing medical marijuana. Democratic presidential candidates Hillary Clinton and Barack Obama are undecided.
But the university would have more problems than policy if it tried to start a program. Not only does the federal government have no interest in the school's research, Lupan said, the state has given no money for it.
"It's not only a matter of bucking federal government authority," he said, but of finding doctors to work for free.
The federal government itself has had medical marijuana evaluated several times. A 1999 federally-commissioned study by the Institute of Medicine reported, "the accumulated data indicates a potential therapeutic value for cannabinoid drugs, particularly for symptoms such as pain relief, control of nausea and vomiting and appetite stimulation."
The Federal Drug Administration, however, said in 2006 the medical use of the drug is not supported by science.
Green and black thumbs
A change in federal policy that led to state distribution could, according to supporters, help many patients.
Jennifer Bartlett, who manages the current state program through the Nevada Department of Agriculture, said "there are some who can't grow it, and it's a struggle."
She has not endorsed state distribution, however, and said many patients have no problems growing their own marijuana or finding a caregiver.
A state program would help all patients, though, not just those who have difficulty growing it, said Dan Hart, who managed the group that led the medical marijuana ballot initiative.
The state could make sure the medicine was good quality, he said, and this also would particularly help patients with a debilitating disease.
But some medical marijuana advocates, such as Chandler Laughlin, said the state should not be involved with marijuana and that a state-run program is a bad idea.
The Silver City resident and radio host did say many patients like him can't grow high quality marijuana.
"I have a black thumb," he said.
Bruce Mirken, who supports marijuana legalization, said a state-run program could make it easier for the state to both guarantee effective use for patients and track illegal use by others.
It can't be difficult for patients to get the medicine they need under the current program, he said.
"You could grow your own tomatoes, but if all your plants die, you don't have a salad that day," said Mirken, a representative for the Marijuana Policy Project, which has unsuccessfully pushed ballot initiatives in Nevada to partially legalize marijuana.
A model program
If Nevada eventually does set up a distribution program, it probably won't be the first state to do it.
New Mexico, which legalized medical marijuana in April, is working on the rules its department of health would need to run a distribution program.
This will allow patients to get the drug the way other patients get their medicine, said Reena Szczepanski, director of the anti-drug prohibition New Mexico Drug Policy Alliance. It would help prevent patients from going to the black market, she said.
But New Mexico's system might not work for Nevada, because of the state's sparsely populated areas. She said a state-run system where the drug is distributed through pharmacies might be better for Nevada.
The federal government itself has the only active government-run distribution program in the country. The Compassionate Investigational New Drug program was started in 1978 and closed to new patients by President George H.W. Bush in 1991. A few people are still in the program, though, and they get monthly supplies of marijuana grown at the University of Mississippi.
Miller, head of Nevada Medical Marijuana Consultants, said a state-run distribution program could be good for Nevada, but the state should be careful not to legalize it or regulate it the way California does, with marijuana available at licensed clubs.
"We don't want a bunch of drug-dealing thugs in this," he said.
But Miller, who became a patient after a spine surgery, said the drug is more safe and effective for many people who would otherwise be prescribed pain killers. Those people, he said, deserve to have their medicine.
Opponents, he said, don't understand the research or the state's program.
"We're not just a bunch of yahoos smoking reefer," he said.
• Contact reporter Dave Frank at firstname.lastname@example.org or 881-1212.