The different factions of the Texas Legislature rarely agree on much, but the recent expansion of medicinal marijuana in the state received sponsorships as diverse as Republican Briscoe Cain and Democrat Raphael Anchia, who famously sparred over recent voting legislation. But some advocates say the bill didn’t go far enough and will continue to harm patients that need it.
HB 1535 will expand the state’s Compassionate Use Program to include patients with cancer and post-traumatic stress disorder, significantly expanding the number of people eligible for the prescription. Previously, the law only allowed cannabis to be prescribed for those with terminal cancer and other seizure disorders.
The bill also doubled the THC concentration in the medicine, which is usually taken in the form of oil-based tinctures or lozenges, from .5 percent to 1 percent. Both legislative houses overwhelmingly approved the bill and sent it to Governor Abbott’s desk, where it will become law as long as he doesn’t veto it (he doesn’t technically have to sign it).
The original bill, authored by Fort-Worth area representative and registered nurse Stephanie Klick, included patients with chronic pain and grew the THC concentration to 5 percent. It was unanimously passed out of committee in the House and easily passed in the House, 134–9.
But the Senate stripped out chronic pain and reduced THC concentration from 5 to 1 percent. Last month, Klick pleaded with her House members to accept the new version of the bill, saying her colleagues were not going to budge, the Texas Tribune reported. Forty-seven states now have some version of medicinal marijuana, but the National Conference of State Legislatures put Texas in the bottom 11 for accessibility. There are fewer than 6,000 Texans registered on the Compassionate Use Registry, which allows patients to access the medical marijuana. The new legislation would open up the registry to millions of Texans.
The reduction in THC concentration is particularly impactful for patients. The law does not mandate how much of the medication can be prescribed, so physicians often prescribe large amounts of the tincture to make sure patients in pain get enough THC. But with such a low concentration, patients often have to consume massive amounts of the oil to get enough medicine. As a result, what could be one syringe of oil ends up being 12 syringes, says Dr. Marie Caire, a preventative medicine physician in Dallas who is on the compassionate use registry.
“These people with debilitating diseases are also suffering unnecessarily because we have to give such huge volumes to control seizures, and it causes horrible digestive symptoms that result in terrible diarrhea,” Caire says. “It is degrading to have to deal with and puts unbelievable stress on the caregiver.”
The removal of those with chronic pain was also a blow to many hoping to have cannabis as an alternative to opioids. For many chronic pain patients, who have been experiencing constant pain for 3–6 months, opioids are the only option. “We find this shocking,” says Jax Finkel, executive director of Texas National Organization for the Reform of Marijuana Laws. “Especially since the CDC and the DEA have shown that there have been no fatal overdoses from marijuana, but we see 45,000 Americans overdosing on opioids every year.”
When the bill flew out of the House, it looked to be a rare bipartisan win, but the bill sat with Senate leadership for weeks until it had removed use for chronic pain and diluted the allowed THC concentrate. When the new version of the bill was sent to the House, there wasn’t time for public comment or in-depth debate, because the end of the session was near.
“Our sickest patients in Texas got left out in the cold,” Caire says. She testified before the House during the original public comment period. “People who are not physicians are forcing their personal views without going to medical school, and so now we have this inferior bill.”
While other conservative states, such as Oklahoma and Alabama, approved much more accessible medicinal marijuana policies, the Texas Senate remained steadfast in their limited expansion. “As a pharmacist and as a physician, I feel strongly that our limited medical program, with appropriate rules and oversight, is the right path for patients in Texas seeking symptom relief,” Schwertner said alongside his changes to the bill.
But the public doesn’t seem to echo Schwertner’s sentiments. A study from Texas Tribune and the University of Texas at Austin found that 60 percent of Texans said possession of small or large amounts of marijuana for any purpose should be legal. Another study by Texans for Expanded Access to Medicinal Marijuana found that 81 percent of Texas voters wanted to expand medical cannabis’ use, and 86 believe that the doctors should decide which patients can access medical marijuana, not the state.
“In the right hands, this is one of the most beneficial medications that we have available to us for pain, nausea, PTSD, debilitating anxiety, and other mental conditions,” Caire says.
Supporters of medical marijuana expansion are happy that Texas inched forward, even if it still lags compared to other places. “I’m very proud of the activists and the patients working on this, because they applied pressure when they needed to and allowed the process to move forward when it was time for that,” Finkel says.
But passion is still high for those who want medicine to be available to more people. “It’s an egregious abuse of power,” Caire says. “In the saddest way, it is affecting the most innocent and the most vulnerable. These people are suffering with the most unbelievable pain on a daily basis.”
