Texas Compassionate Use Program (Updated!)


LEGISLATIVE UPDATE: A watered down version of HB 1535 has passed by the House and the Senate; it now heads to Governor Abbott’s desk.


More than a dozen medical cannabis bills (see below) were introduced for consideration by the 87th Texas Legislature. Since she’s the chair of the Public Health Committee, Rep. Stephanie Klick’s HB 1535 was the only proposal to even get a hearing.

Overview: Texas Compassionate Use Program

The Texas Compassionate Use Program (T.CUP) was established in 2015, expanded in 2019, and further expanded during the 2021 legislative session. T.CUP provides access to low-THC cannabis for those with a few medical conditions. Here’s an overview of the program, including recent changes, which go into effect on Sept. 1:

● Qualifying Medical Conditions
○ All epilepsy and seizure disorders
○ Multiple sclerosis or spasticity
○ Incurable neurological disorders (Alzheimer’s, Parkinson’s, etc.)
○ Autism
○ Amyotrophic lateral sclerosis (ALS)
NEW: All Cancer patients qualify, not just those will terminal cancer
NEW: Post traumatic stress disorder

● Dosing is restricted to 1% THC by weight, but there are no restrictions on other cannabinoids or terpenes.

Note: There are no restrictions on the number of milligrams that can be in T.CUP products as long as the THC content doesn’t exceed 1% of the product’s total weight.

NEW: HB 1535 authorized the establishment of “Institutional Review Boards,” which will facilitate research and track the impact of medical cannabis on patients participating in the program.

Licensing and Regulation

The Department of Public Safety (DPS) is responsible for regulating T.CUP and issuing business licenses to “ensure reasonable statewide access.” Currently, there are three licensed businesses, but only two are operational. Because patient access has been so limited, these companies have been able to adequately deliver high quality, low-THC medicine to those who qualify.

To accommodate recent changes in the law, DPS has been tasked with establishing new rules for the program by December 1, 2021. Since patient access has been expanded by HB 1535, there’s a chance DPS opens up licenses to new applicants. If this happens, it’s likely to be soon after they adopt their new rules. Sign up for our news letter for updates.

Background on HB 1535

Rep. Stephanie Klick’s HB 1535 (the only medical cannabis bill given hearing) was passed by the House with overwhelming bipartisan support, but stalled in the Senate. Advocates were told nothing relating to medical cannabis would pass this year, but we rallied the grassroots!

Amid tremendous public pressure, Lt. Gov. Dan Patrick finally referred the bill and the Senate State Affairs Committee held a very brief hearing (see below). The bill was amended to allow access for all patients with cancer and PTSD, but not chronic pain. Notably, they removed the provision that would have empowered the Department of State Health Services to add new qualifying conditions through their administrative rule-making process.

Originally, the bill aimed to raise the cap on THC to 5% and create “Institutional Review Boards,” which will facilitate research and track the impact of medical cannabis on patients participating in the program. The amended version keeps IRBs, but caps THC at 1% by weight.

While this is a step forward, it’s disappointing that the Texas Legislature continues to inch ahead while 37 other states (most recently, Alabama!) take meaningful action to allow safe and legal access to medical cannabis. Texas patients deserve better, so we’ll keep fighting!

Sign up for our news letter for updates.

Watch the Senate Committee Hearing

As advocates, our work continues! Here are the changes we’d still like to see made to the Compassionate Use Program:

  • Allow Doctors to practice medicine by authorizing them to determine the optimal strength and dosage for each individual patient’s medical needs. This means there should be no list of qualifying conditions/symptoms nor any THC cap, both of which restrict a doctor’s ability to properly treat their patients.
  • Move from percentage based dosing to weight based dosing like other prescription medicines. Doctors should be able to recommend how many milligrams of THC, CBD, or other cannabinoids a patient needs rather than using a complicated formula to determine weight from the percentage restriction.
  • Protect doctors from federal interference by allowing them to “recommend” (not “prescribe”) low-THC cannabis, which is still a Schedule I controlled substance. This is how all 36 states with effective medical cannabis laws operate.
  • Establish patient protections to eliminate the threat of arrest, prosecution, or penalty in any manner. These protections cover any denial of right or privilege, civil penalty, or disciplinary action, by a court or occupational licensing entity. Parental rights should never be denied, and students cannot be subject to any form of discipline solely because of possession or use of their legal medicine.
  • Authorize independent, third-party testing by certified labs for consumer protection and industry accountability. Currently, no independent lab can test medicine dispensed under the Compassionate Use Program.

Medical Cannabis Bills – 87th Texas Legislature

SB 90 by Sen. José Menéndez (Medical Cannabis)
Relating to authorizing the possession, use, cultivation, distribution, transportation, and delivery of medical cannabis for medical use by qualifying patients with certain debilitating medical conditions and the licensing of dispensing organizations and testing facilities; authorizing fees.

HB 43 by Rep. Alex Dominguez (Medical Cannabis)
Relating to authorizing the possession, use, cultivation, distribution, transportation, and delivery of medical cannabis for medical use by patients with certain eligible medical conditions and the licensing of dispensing organizations; changing a fee.

HB 94 by Rep. Ron Reynolds (Medical Cannabis)
Relating to authorizing the possession, use, cultivation, distribution, transportation, and delivery of medical cannabis for medical use by qualifying patients with certain debilitating medical conditions and the licensing of dispensing organizations and testing facilities; authorizing fees.

HB 567 by Rep. James Frank (Securing Parental Rights for Patients)
Relating to the procedures and grounds for terminating the parent-child relationship, for taking possession of a child, and for certain hearings in a suit affecting the parent-child relationship involving the Department of Family and Protective Services.
UPDATE: Passed into law! Effective Sept. 1, 2021.

SB 190 by Sen. Bryan Hughes (Securing Parental Rights for Patients)
Relating to the procedures and grounds for terminating the parent-child relationship, for taking possession of a child, and for certain hearings in a suit affecting the parent-child relationship involving the Department of Family and Protective Services.
UPDATE: Considered by the Senate State Affairs Committee. Left pending.

HB 809 by Rep. Julie Johnson (Medical Cannabis for PTSD)
Relating to authorizing the possession, use, cultivation, distribution, transportation, and delivery of medical cannabis for medical use by patients with post-traumatic stress disorder and the licensing of medical cannabis dispensing organizations; authorizing fees.

SB 250 by Sen. Carol Alvarado (Medical Cannabis)
Relating to authorizing the possession, use, cultivation, distribution, transportation, and delivery of medical cannabis for medical use by patients for whom a physician determines medical use is the best available treatment for the patient’s medical condition or symptoms and the licensing of medical cannabis dispensing organizations; authorizing fees.

HB 1001 by Rep. Eddie Lucio III (Low-THC Cannabis for PTSD)
Relating to the medical use of low-THC cannabis by certain patients with post-traumatic stress disorder under the Texas Compassionate Use Act.

SB 327 by Sen. Eddie Lucio II (Low-THC Cannabis for PTSD)
Relating to the medical use of low-THC cannabis by certain patients with post-traumatic stress disorder under the Texas Compassionate Use Act.

HB 1109 by Rep. Alex Dominguez (Medical Cannabis for PTSD)
Relating to the use of medical cannabis by veterans for post-traumatic stress disorder and the licensing of associated cultivating or dispensing organizations; authorizing fees.

HB 1233 by Rep. Jasmine Crockett (Medical Cannabis)
Relating to prescribing low-THC cannabis under the Texas Compassionate Use Program.

HB 1982 by Rep. Leo Pacheco (Medical Cannabis)
Relating to the prescription and dispensing of medical cannabis; requiring an occupational license; authorizing a fee.

HB 2932 by Rep. Harold Dutton (Securing Parental Rights for Patients)
Relating to certain procedures in suits affecting the parent-child relationship filed by the Department of Family and Protective Services.

HB 1535 by Rep. Stephanie Klick (Expanded Low-THC Access)
Relating to the medical use of low-THC cannabis by patients with certain medical conditions and the establishment of compassionate-use institutional review boards to evaluate and approve proposed research programs to study the medical use of low-THC cannabis in the treatment of certain patients.
UPDATE: Approved by the House and Senate. Sent to Governor Abbott.

HB 3137 by Rep. Lyle Larson (Medical Cannabis Research)
Relating to a medical cannabis research program.

SB 1440 by Sen. Donna Campbell (Low-THC Cannabis for PTSD)
Relating to the medical use of low-THC cannabis by veterans with post-traumatic stress disorder under the Texas Compassionate Use Act.

HB 4307 by Rep. Eddie Lucio III
(Cannabis Insurance Coverage for State Employees)
Relating to coverage for low-THC cannabis under certain group benefit plans for governmental employees.
UPDATE: Voted out of Committee. Awaiting a vote in the Texas House.

SB 2040 by Sen. José Menéndez (Medical Cannabis)
Relating to authorizing the possession, use, cultivation, distribution, delivery, sale, and research of medical cannabis for medical use by patients with certain medical conditions and the licensing of medical cannabis organizations; authorizing fees.