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Texas Compassionate Use Program


Once upon a time there was a girl who knew a lot about cannabis. You might even go so far as to say that cannabis became her entire personality for a while. Then, her life exploded and outside of consumption – and pretending she was smarter than everyone else – cannabis lost some of the joy it used to bring. Cut to today, where she has the opportunity every month to learn something new about cannabis and share it with you guys, the cannabis community that she loves and desperately misses sometimes.

I felt like I had to share that part before we get into the real meat of the article because in all honesty, sometimes I feel a little disconnected from the cannabis community and I let myself fall behind on things that I feel like I should have known. Granted, there are some extenuating circumstances that keep me out of the loop, but boy did this one feel like something I definitely should have known.

Texas has a medical marijuana program, y’all – and this is where it gets embarrassing – since 2015.

TCUP Basics

What was I doing in 2015? No idea, honestly. I had lived in Texas for around two years at this point and was likely in the middle of some… other stuff. Regardless of whatever I was up to at this point, in 2015 the Texas Compassionate Use Act passed and the Texas Compassionate Use Program (CUP) began. The CUP, or TCUP as I lovingly think of it now, initially began as a treatment option for intractable – difficult to treat or manage – epilepsy patients only. Physicians registered with the Compassionate Use Registry of Texas (CURT) were now able to prescribe low dose THC to their patients.

Four years later, the Compassionate Use Program expanded to cover more conditions. In 2019, the program was expanded to cover all forms of epilepsy and other seizure disorders, autism, Amyotrophic Lateral Sclerosis (ALS), multiple sclerosis (MS), terminal cancer and a range of neurodegenerative disorders such as Parkinsons and Alzhiemers. The program was expanded again in June 2021 with the passing of HB 1525 to cover all cancer diagnosis and PTSD, as well as changing the THC limit from… wait for it… 0.5% to 1% THC. The current iteration of the bill will be in effect by the time you’re reading this and now covers over 100 qualifying conditions. Physicians are only legally allowed to prescribe low dose THC treatments and the only cannabis products legally available to patients are lozenges, oils, tinctures, inhalers and lotions, all with 0.5% THC (1% in September).

Just like everything I write for Cannabis Cactus, this is just my opinion, but as excited as I am that Texas has taken any kind of step towards cannabis reform, this feels like bare minimum effort. I understand the logic behind a slow roll out and that there are probably some things I don’t understand about dealing with cannabis production and regulation in a state this physically large and populated, but seriously, I don’t think anyone knows about this program. Initially, that makes a lot of sense to me; only a very specific portion of the population was eligible for the Compassionate Use Program. Now, however, with the inclusion of more qualifying conditions, it’s estimated that there are over 2 million Texans that may be eligible.

Despite there being an estimated 2 million Texans that may benefit from the TCUP, according to the Texas DPS website, at the end of 2020 there were less than 4,000 registered patients in the entire state. There was a link to a 2021 graph, but it was unfortunately blank, so those are the most current patient statistics I could find. In addition to what I believe is a pretty shockingly low number of registered patients, there were less than 400 registered physicians as of July 2021. Fortunately that graph was up to date and actually shows an increase in registered physicians since the beginning of the year, with the number of physicians increasing from 263 to 379.

All that is to say that it’s surprising to me that more Texans don’t know about this program. There are a handful of people in my life that, if I didn’t know had alternative methods of acquiring their cannabis medication, would probably benefit a lot from TCUP, but I have never heard anyone talk about it. Some of it makes sense to me, of course. The list of qualifying conditions, even with the recent expansions, is still relatively restrictive, especially in comparison to some other medical states. There is also some evidence to support advocate claims that the Texas Compassionate Use Program is still full of barriers for patients trying to legally acquire cannabis medication. The legal THC limit is low. Not so low that it’s ineffective – we’ll cover low dose and micro dosing THC soon – but it may be ineffective for some patients. The experience of medicating with cannabis can vary so widely from patient to patient, and the restrictions on THC limit and available cannabis products may limit the effectiveness of the program for many patients.

TCUP From a Former Patient’s Perspective

How did I find out about the TCUP? How does anyone my age find out about anything anymore? I’m 31 so if you guessed TikTok then I’m embarrassed and you win. I was scrolling through aimlessly when a video popped up on my For You Page about working at a Texas MMJ dispensary. For a moment I was confused. A dispensary in Texas? How? When? It’s legal and I missed it? And the obvious question for me: Am I eligible? I went straight to the website from TikTok, Texas Original Compassionate Cultivation (TOCC), and started to learn about the Texas Compassionate Use Program.

For transparency’s sake, Texas Original was the first and only licensed dispensary website I visited, and for what it’s worth, of the three licensed grow facilities in Texas, they are the only Texas based company. The first thing I noticed on the TOCC website was that the process for patients seems very similar to my days of working at the co-op, in the early days of Arizona’s medical program. You can easily find a list of qualifying conditions and set up a free consultation with one of the “key physicians” they’ve partnered with to review your eligibility. It’s unclear whether these “key physicians” are the same CURT registered physicians that will be prescribing your cannabis medication. TOCC also makes the process feel very streamlined for the patient; all of these appointments seem to be done virtually and you can pick up your medication at one of their dispensary locations – they’ll even deliver your medication anywhere in the state once you’ve been approved and prescribed. The legal information on the website is easy to find and understand, and TOCC seems to put an emphasis on being a “Texans serving Texans” business, which we just love out here.

You might remember that I mentioned a little earlier that there are still some significant barriers for patients – which may explain the low numbers – so much so that medical cannabis advocates have a hard time calling CUP a medical cannabis program at all. According to one source I saw, patients are required to have prescriptions from two doctors as well as provide proof that other treatments have been ineffective or had adverse effects. That almost immediately rules me out. Not because my diagnosis isn’t included in the list of qualifying conditions, but because access to treatment and doctors is incredibly difficult and expensive, and not just for me. Who knows, maybe TOCC planned for this and both physicians you see during the patient process count as registered, prescribing physicians. That would definitely make a difference for me, but having to prove that traditional treatments haven’t worked in the past would be basically impossible. Treatment for my diagnosis has only been available for a few years and while it may be effective for me, my cannabis use targets aspects of my disability that the treatment may not. Variables, man, so many variables.

I went into this article with every intention of just praising the crap out of Texas. We did it! Finally progressive cannabis reform and accessibility for patients! Don’t get me wrong, I’m still proud, but I’m also underwhelmed. It’s hard to point at any one state and say that they did medical cannabis perfectly, but there are so many models to take from and mistakes to learn from that it’s hard to be excited about our lukewarm, under the radar cannabis laws. Texas has a pretty big population of patients that might greatly benefit from a more comprehensive and accessible medical cannabis program, and while the Texas Compassionate Use Program is undoubtedly a step in the right direction, there’s still an opportunity to make cannabis medicine a real, viable option for Texans. I think Texas can do better for patients than this and I sincerely hope that they do.




Kelly Mahoney worked at a medical cannabis Co-op with her mother, Laura Mastropietro, dealing mainly with helping new patients acquire their medical cards and helping them find the best strains and methods. Diagnosed at a young age with spinal muscular atrophy, she was also a medical cannabis patient and still advocates for the incredible benefits, and downright fun, of cannabis. She now lives in a prohibition state as a cat mom and gamer wife.

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