David Garrick, San Diego Union-Tribune

With every city in the county declining to allow medical marijuana dispensaries except San Diego, the city could become a sort of mecca for legal pot in the region.

From Poway to Oceanside to Imperial Beach and Santee, people seeking legal medical marijuana will have to rely on the roughly 30 dispensaries expected to start opening in the city of San Diego this spring, or the one dispensary the county government allowed to open last summer near El Cajon.

That’s because voters in six cities — La Mesa, Encinitas, Lemon Grove, Imperial Beach, Solana Beach and Del Mar — have rejected dispensary ballot measures since 2012. And the elected leaders in several other cities, including Chula Vista and Oceanside, have voted to ban dispensaries.

Advocates for legal marijuana say the smaller cities are depriving sick people of convenient access to medicine they need.

“The unfounded fear of marijuana is causing people in convalescent care facilities and hospitals — people that really need it — not to be able to get it,” said Marcus Boyd, vice chair of the San Diego chapter of Americans for Safe Access. “Trying to hide it from everybody is keeping it from the people who need it the most.”

Opponents of legalized marijuana, however, applaud the county’s other 17 cities for refusing to budge, and they say San Diego is making a huge mistake by joining nearly 50 California cities that allow legal dispensaries.

“It’s too bad the city of San Diego didn’t follow the lead of their companion cities all around them,” said Scott Chipman, leader of San Diegans for Safe Neighborhoods. “Somehow, San Diego thinks it’s smarter than everyone else.”

Advocates say if other cities don’t follow San Diego there will be an increase in pollution and clogged roads, because people will be forced to frequently make long trips to San Diego for pot.

They also say suburban cities will struggle to eliminate illegal pot shops because the demand won’t go away, prompting new illegal dispensaries to open every time one gets shut down.

One thing that could change the dynamics might be deliveries, which the dispensaries in San Diego will be allowed to make across city lines.

But advocates said delivery charges could sharply inflate prices, and they questioned how many San Diego dispensaries will be interested in delivering to faraway places like Vista or Julian.

Lance Rogers, legal counsel for the California Cannabis Industry Association, said he’s optimistic many of San Diego County’s other cities will begin allowing legal dispensaries in coming years because that’s been a pattern across the state.

In every region of California, large cities such as Los Angeles and San Francisco have typically legalized dispensaries first, but many of their suburbs have then followed.

For example, Oakland began allowing legal dispensaries in 2004 and San Francisco followed suit in 2005. Since then, the Bay Area suburbs of San Mateo, Richmond and San Leandro have OK’d dispensaries.

“Once there is a track record in the larger cities, the surrounding smaller cities come online after that,” said Rogers, adding that slowly increasing familiarity with marijuana and dispensaries could also help. “It was a foreign idea, but it’s become a lot less foreign idea.”

Jessica McElfresh, an attorney representing groups trying to open legal dispensaries in San Diego, said another reason to believe more local cities might allow dispensaries is the ballot measures in Encinitas and La Mesa last November.

While voters rejected proposals to allow dispensaries, they came closer to passing than four similar measures in 2012.

The La Mesa measure got 46 percent support and the Encinitas one got 44 percent, while in 2012 a measure in Solana Beach got 38 percent, one in Lemon Grove got 40 percent, one in Imperial Beach got 42 percent and one in Del Mar got 44 percent.

“It’s particularly significant that the percentages shrunk because 2012 was a presidential election when higher turnout typically helps,” McElfresh said. “That suggests we may be able to break through in 2016.”

Michael Cindrich, executive director of San Diego’s chapter of NORML, the National Organization for the Reform of Marijuana Laws, said his group is exploring additional ballot measures for 2016 and encouraging residents to pressure their elected leaders.

City Councils in the city’s two largest cities after San Diego, Chula Vista and Oceanside, will apparently need lots of convincing.

Chula Vista’s council voted to ban dispensaries three years ago, citing concerns about crime, violence, increased use by minors and people without medical need gaining access to a drug that’s still illegal under federal law.

Last June, Oceanside did the same, contending dispensaries would be a bad fit for the community and could lead to crime and more drug use by young people.

“I believe it’s just not right for us,” said Deputy Mayor Esther Sanchez. “It’s just too easy to get a letter from a doctor saying that you can use marijuana for medical purposes.”

After years of debate and controversy, San Diego went the other direction last winter and approved an ordinance allowing dispensaries but sharply limiting where they can open. Council members who favored the ordinance described it as the right balance between providing access to medical marijuana and protecting residents.

Four dispensaries are poised to receive final approvals from the San Diego Planning Commission this winter, with the first scheduled for Thursday. Thirty-four other applicants are further back in the approval pipeline, but the city ordinance sets a maximum of 36.

Another variable in the equation is the possibility Californians will vote in 2016 to legalize recreational marijuana, following the lead of Colorado, Washington, Oregon and Alaska.

Dale Geiringer, NORML’s California director, said such a ballot measure could be written to force all cities to allow dispensaries, similar to alcohol laws in California.

“There are no dry cities in California,” he said. “They can regulate where alcohol is sold, but they can’t ban it. And it’s certainly possible to follow that model with marijuana.”