It's an exciting week for Texas residents interested in the Compassionate Use program. To date, the program has been very limited, and excluded chronic pain (one of the most common qualifying conditions in many other medical cannabis states).
But the brick wall of opposition appears to finally be cracking.
The final version of HB46 contains tremendous wins (as well as tremendous disappointments). This report will cover the details and the remaining timeline for passage and implementation of Texas's medical cannabis expansion bill as of Friday, May 30.
HB 46 Wins
- The final, amended Senate version of HB 46 now adds chronic pain (with limitations), and patients on hospice care for any condition.
- They have finally agreed to allow inhaled versions of cannabis like inhalers or vaporizers (but not smoking natural flower) for faster relief.
- The bill will allow for nine additional dispensaries (increasing the number to 12), and allow satellite pickup locations statewide.
HB 46 Disappointments
- The definition of chronic pain appears to require patients to try narcotic pain killers before they can be prescribed cannabis.
- It may inadvertently exclude patients with severe chronic pain conditions for which cannabis appears to be more effective than opiates, such as neuropathic pain.
- The original House bill would have allowed veterans to be prescribed cannabis for any condition, but the Senate struck this provision.
What's Next for HB 46?
The Texas bill hasn't become law just yet. Legislators are still furiously working in the background. The House must now vote to approve or disapprove of the Senate's amendment. If approved, the bill will go to Governor Abbott's desk, where he has until June 22 to sign or veto it.
If Governor Abbott signs the bill, the new law will take effect on Sept. 1, 2025.
The new law won't be immediately implemented. First, the Texas Department of Public Safety and Texas Medical Board will need to propose new rules. They have until October 1, 2025 to make the required proposals.
Did Texas Ban Hemp?
The ban of all hemp products in Texas is now all but guaranteed. The ban will re-criminalize CBD products with any amount of THC, including compounds like Delta 8 and Delta 10. This will put roughly 50,000 industry and support jobs at risk, and eliminate billions in sales tax.
Meanwhile, the Senate's proposed definition of chronic pain in HB 46 appears to require patients to try opiates for 90 days before they can be prescribed cannabis for their pain.
"Chronic pain" means pain that is not relieved with acute, post-surgical, post-procedure, or persistent non-chronic pain treatment and is associated with a chronic pathological process that causes continuous or intermittent pain for more than 90 days from the date of the initial prescription prescribing treatment with an opioid."
These co-occurring moves create the impression that the state is banning hemp THC products and forcing hemp users to try opiates for 3 months before allowing access to the medical cannabis program.
Is Texas Attempting to Force Opiate Use?
Almost certainly not. The House's original proposed version didn't contain a definition for chronic pain and simply added it to the list of qualifying conditions, using the phrase "a condition that causes chronic pain, for which a physician would otherwise prescribe an opioid," which makes sense if the intent is to steer chronic pain patients away from opiates.
The problem in the Senate's definition of chronic pain is a great example of the type of unintended consequence that can occur when legislators attempt to micromanage medical decisions.
“We don't want to force anyone to take narcotics,” Sen. Roland Gutierrez, D-San Antonio, said on the Senate floor May 27. “As a matter of fact, we're trying to help... keep them from taking narcotics, from getting addicted, from possibly overdosing.”
Unfortunately, the unintended consequence of the Senate's amendment to the House's original chronic pain language is that it would force current hemp users, who are about to lose access to THC products, into a three month course of opiates before they can become legal cannabis patients.
Can the Senate's Flawed Chronic Pain Definition Be Fixed?
Probably not in the bill itself. They have a few limited options to resolve any language disagreements over the weekend, but it would be very difficult to solve this problem by Monday's deadline.
If the House rejects the Senate's version, the most likely result is the bill's death. But this is unlikely given the current fury over the state's hemp ban.
If the bill passes with the flawed definition of chronic pain, the intent of the language could be cleared up in the medical board's rulemaking process. A statement of intent from the legislature could help provide valuable guidance for the medical board as they compose the new program rules.
Let's hope the Texas legislature can work out their differences in time for this much-needed expansion. We should know the fate of this legislation for sure by June 22 at the latest.
Keep up with your state's cannabis laws and regulations, and sign up for NuggMD's Weekly Sesh newsletter for consumer stories, tips, and analyses on how changing regulations and resources may impact patients.
The information in this article and any included images or charts are for educational purposes only. This information is neither a substitute for, nor does it replace, professional legal advice or medical advice, diagnosis, or treatment. If you have any concerns or questions about laws, regulations, or your health, you should always consult with an attorney, physician or other licensed professional.
