OKLAHOMA CITY (AP) — Pot advocates celebrated the culmination of a yearslong effort to ease restrictions on the use of cannabis last month when nearly 60 percent of Oklahoma voters approved medical marijuana.

Oklahoma’s proponents had even included a two-month deadline for the implementation in their measure so as to avoid the years of delays they had seen elsewhere.

But that has not stopped state health officials and the Republican governor from making drastic changes . Within weeks of the election, they signed off on tough new restrictions, including a ban on the sale of smokable pot. The change was supported by groups representing doctors, hospitals and pharmacists who opposed medical marijuana, but infuriated supporters of the state question and has already led to lawsuits.

In this Tuesday, July 10, 2018 photo, Tom Bates, interim commissioner of the Oklahoma Board of Health, listens during a meeting in Oklahoma City. When nearly 60 percent of voters in Oklahoma approved medical marijuana last month, pot advocates celebrated a hard-fought victory that was the culmination of a years-long effort to ease restrictions on the use of cannabis. But within just a few weeks, state health officials and the Republican governor signed off on tough new restrictions. (AP Photo/Sue Ogrocki)

“It’s like they snatched defeat out of the jaws of victory,” said Chip Paul, who helped write Oklahoma’s medical marijuana state question and push for its approval. “You try to do something the proper way. You follow the rules. And then you win and you get screwed.”

Even in conservative states such as Oklahoma, which became the 30th in the U.S. to legalize medical marijuana, attitudes are shifting in favor of easing restrictions on pot. But there remains resistance from policymakers, especially in Republican-controlled areas, where the rollout of medical marijuana has frequently been restricted by lawmakers or bogged down in court battles.

After more than 70 percent of Florida voters approved medical marijuana in 2016, the Republican-controlled Legislature there imposed a similar ban on smokable pot. A judge last month ruled that such a ban was unconstitutional.

In Arkansas, 53 percent of voters approved medical marijuana in 2016, but a legal challenge has delayed the program. Michigan voters approved medical marijuana in 2008, only to be followed by years of court fights.

In Texas, the GOP-led Legislature approved a restrictive medical marijuana law in 2015, then proceeded to institute strict regulations. It allowed only three dispensaries in a state of 27 million people and imposed the highest licensing fees in the country.

Marijuana advocates say the restrictions on how medical marijuana can be used or the additional burdens placed on doctors may wind up undermining the initiatives and laws.

“The extent of limitations really serves to deprive people of the key goal, which is letting people use medical marijuana without being punished,” said Karen O’Keefe, director of state policies for the Marijuana Policy Project.

Efforts to heavily restrict medical marijuana in Arkansas — including an outright ban on smoking it and an attempt to delay the program’s launch until marijuana was legalized nationwide — failed in the majority-Republican Legislature last year. But the program’s launch has stalled and medical marijuana likely won’t be available until sometime next year.

The problem stems from legal challenges over the state’s licensing process for medical marijuana. The state Supreme Court last month cleared the way for the program to begin, reversing a lower judge’s ruling that the licensing process was flawed and violated the constitutional amendment legalizing medical marijuana. An unsuccessful applicant had sued over the process.

In this Tuesday, July 10, 2018 photo, Chip Paul, who helped write the medical marijuana state question and push for its passage, answers a question for a reporter before a meeting of the Oklahoma Board of Health in Oklahoma City. When nearly 60 percent of voters in Oklahoma approved medical marijuana last month, pot advocates celebrated a hard-fought victory that was the culmination of a years-long effort to ease restrictions on the use of cannabis. But within just a few weeks, state health officials and the Republican governor signed off on tough new restrictions. (AP Photo/Sue Ogrocki)

More than 5,500 patients have been approved to use medical marijuana in the state, and Arkansas will issue them registry cards about a month before the drug is expected to be legally available.

“If I was a patient, I would be coming unglued. I think they are coming unglued,” said attorney David Couch, who authored Arkansas’ medical marijuana amendment.

Oklahoma’s State Question 788 , the result of an activist-led signature drive, passed overwhelmingly despite fierce opposition and more than $1 million in spending by chambers of commerce, clergy, doctors, hospitals, law enforcement and pharmacists.

Term-limited Republican Gov. Mary Fallin, who typically doesn’t comment on state questions, said days before the measure passed that it was too loosely written and would essentially allow recreational use.

After it passed, the same medical groups that opposed it recommended the ban on “smokables” and the pharmacist requirement. On Friday, separate lawsuits were filed in two Oklahoma counties accusing state health officials of improperly imposing the strict rules.

“Smoking of any kind is unhealthy,” said Oklahoma State Medical Association President Jean Hausheer, an ophthalmologist from Lawton. “This issue is not an option and really is more of an absolute demand.”

DeMillo reported from Little Rock, Arkansas. Associated Press writer Paul Weber in Austin, Texas, contributed to this report.