Understanding Texas’s Compassionate-Use Program

In 2015, the Texas Compassionate Use Act, Senate Bill 339, was enacted, requiring the Texas Department of Public Safety (“DPS”) to create a secure registry for qualified physicians to treat patients suffering from a limited list of medical conditions, such as ALS and intractable epilepsy, with low-THC cannabis. In 2019, the Texas Legislature expanded the Texas Compassionate Use Program (“TCUP”) via House Bill 3703 to include additional medical conditions, e.g., incurable neurodegenerative diseases, and physician specialties in which low-THC cannabis can be prescribed. Moreover, the Compassionate Use Registry of Texas (“CURT”) has been updated in accordance with the expanded TCUP to allow for a simpler process for physicians to register and prescribe low-THC cannabis to their patients. 

“Low-THC Cannabis” & TCUP Covered Medical Conditions

Under Texas law, “Low-THC cannabis” is defined as “the plant Cannabis sativa L., and any part of that plant or any compound, manufacture, salt, derivative, mixture, preparation, resin, or oil of that plant that contains not more than 0.5 percent by weight of tetrahydrocannabinols.” Tex. Occ. Code § 169.001. This definition of “low-THC cannabis” is mostly distinguishable from Texas’s definition of “hemp” by its 0.5 percent THC threshold as compared to hemp’s 0.3 percent THC threshold. Texas has received ample criticism for its medical marijuana only being permitted a 0.5 percent THC limit. Advocates seek, at the very minimum, to have this raised to a 1.0 percent THC limit. 

Currently, the Texas Compassionate Use Act allows for low-THC cannabis to be prescribed and used for the following, limited, list of medical conditions: epilepsy, multiple sclerosis, spasticity, autism, ALS, terminal cancer, and incurable neurodegenerative diseases. As described in the introductory section of this blog, TCUP was expanded in 2019 to include “incurable neurodegenerative diseases” to the list of qualifying medical conditions for low-THC cannabis prescription. The list of incurable neurodegenerative diseases includes, but is not limited to, diseases such as: Spinal Muscular Atrophy, Vascular Dementia, Huntington’s Disease, Alzheimer’s Disease, Parkinson’s Disease, Kearn Sayers Syndrome, and Galactosemia. See 25 Tex. Admin. Code 1, §1.61. If a physician is treating a patient with an incurable neurodegenerative disease that is not included in the aforementioned list, the treating physician may submit a request to the Texas Department of State Health Services (“DSHS”), by means of a form provided online by DSHS, to have the disease added. See id. 

TCUP Qualifications for Patients

A qualified physician may prescribe low-THC cannabis to a patient if:

1. A patient is a permanent resident of the state;
2. A patient is diagnosed with one of the qualifying conditions; and
3. The qualified physician determines the risk of the medical use of low-THC cannabis by a patient is reasonable in light of the potential benefit for the patient.

See Tex. Occ. Code § 169.003. Moreover, there are no statutory limitations on the age of the patient and the patient will not have to register or pay a fee. As described further in the following section, the patient’s qualified physician will enter all the necessary information into the Compassionate Use Registry of Texas (“CURT”). The patient, or the patient’s legal guardian, will then be able to go to one of the three dispensaries to have the prescription filled but must provide identification and the patient’s last name, date of birth, and last five social security numbers. Currently, the only three dispensing organizations licensed by DPS are Compassionate Cultivation, Fluent, and Surterra Texas. Based on the market, prices for prescribed low-THC cannabis are set by these licensed dispensing organizations as DPS does not regulate the cost of the product.

TCUP Qualifications for Physicians

Physicians must be qualified with respect to a patient’s particular medical condition in order to prescribe low-THC cannabis. Under Texas law, a physician is qualified under TCUP if the physician:

1. is licensed under this subtitle;
2. is board certified in a medical specialty relevant to the treatment of the patient’s particular medical condition by a specialty board approved by the American Board of Medical Specialties or the Bureau of Osteopathic Specialists; and
3. dedicates a significant portion of clinical practice to the evaluation and treatment of the patient’s particular medical condition.

Tex. Occ. Code § 169.002. Moreover, qualified physicians who wish to prescribe low-THC cannabis to qualifying patients must register in CURT. The physician’s registration must include the following information:

1. the physician’s name;
2. the patient’s name and date of birth;
3. the dosage prescribed to the patient;
4. the means of administration ordered for the patient; and
5. the total amount of low-THC cannabis required to fill the patient’s prescription.

Id. at § 169.004. Once registered in CURT, a qualified physician may then prescribe the low-THC cannabis, and the dispensing organizations can search for the patient in the system and dispense the medication according to the prescription. According to DPS, the CURT system is available to physicians and dispensing organizations 24-hours a day.

Update: Additional qualifying conditions were added to the program in 2021.

As cannabis and hemp lawyers, the lawyers at Ritter Spencer Cheng are prepared to advise your hemp or cannabis business in all facets of the industry, including formation and transactional issues and in cannabis litigation. Contact Ritter Spencer Cheng or give us a call at 214.295.5070 for more information.