ST. PAUL — There will be no baggies of pot awaiting patients next week when Minnesota joins 21 other states in offering medical marijuana. No glass pipes, no plants to tend at home. Instead, the nation’s latest medical marijuana program is a world of pill bottles and vials of marijuana-infused oil.

For the qualifying patients seeking relief from pain, medical marijuana advocates and some lawmakers, Wednesday isn’t the finish line, but the first step. The state’s restrictive approach, unseen in the industry, is likely to mean high costs, long drives and reluctant doctors.

“The door is opening,” said Bob Cappechi of the Marijuana Policy Project, a national outfit that pushes to loosen marijuana laws. “This will start helping people out. That’s really what this is all about.”

Minnesota’s medical marijuana advocates snatched an unlikely victory from the Legislature last year after years of failed efforts, but there was little celebration. What emerged to assuage skeptical law enforcement lobbyists and a wary governor was one of the strictest programs in the nation.

Smoking the plant is forbidden. Pills, oils and vapors are only available to patients suffering from severe conditions, such as cancer, epilepsy, HIV and AIDS. And the medicine can only be sold in eight locations, hundreds of miles away from some in Minnesota’s rural expanses.

The two companies growing, cultivating and selling marijuana for the state say Minnesota stands out for its a medical approach to a nearly 20-year-old industry that uses terms like “budtender” (salesmen) and “California Kush” (a strain of marijuana).

“The industry doesn’t do it this way,” Dr. Kyle Kingsley said just days before opening Minnesota Medical Solutions’ first dispensing clinic in Minneapolis. “It’s all new.”

Kathy Schroeder’s difficult path shows how the medical polishes on Minnesota’s program look more like hurdles to some patients. On paper, her multiple sclerosis and glaucoma — two of the nine conditions that qualify — made her a perfect fit. But like many residents, the 63-year-old struggled to get a doctor’s signature to sign up for the program.

Prodding a second doctor paid off for her, but Schroeder isn’t sure whether she can even afford a month’s worth of medicine, which Kinglsey said may sell for up to $600. Still, she’ll make the 180-mile round trip Wednesday from her home near Rochester to MinnMed’s Minneapolis facility.

“I knew it was going to be bad, I had no idea it was going to be this bad,” her daughter, Maren Schroeder, said.

Rep. Carly Melin sympathizes. The Democrat faced criticism for watering down her medical marijuana bill to get police and Gov. Mark Dayton on board.

“We weren’t going to get anything done if we didn’t pass this law,” Melin said.

Kinglsey said he’s confident doctors and hospital systems will eventually approve, but it’s made for a slow start to a program that’s supposed to sign up 5,000 people. As of Friday morning, just 65 patients were completely registered and another 74 were being processed.

Cappechi and other advocates already have ideas for how to improve it: allow more than eight dispensaries, add more manufacturers and patients who suffer from chronic pain, and perhaps lift the ban on smoking the drug.

But before expanding, Dr. Andrew Bachman, co-founder of the state’s other medical marijuana manufacturer called LeafLine Labs, said they need time to show lawmakers and doctors alike that the new industry works.

That starts Wednesday, he said.

“Ideology does not change overnight. It’s important to start somewhere,” he said.