The Austin Chronic: Proposed Bill Would Mark “A Step in the Right Direction” for Medical Marijuana in Texas

Medical cannabis products being created in a lab setting at Texas Original in Austin (photo courtesy of TXOG)

Last month, as the House Public Health Committee closed a hearing on House Bill 46, Chairman Ken King considered how medical marijuana may be beneficial for people at the end of their lives.

“I’ll tell you right now – y’all have heard me over the years talk a lot about my mother – and I watched her die over 10 and a half weeks in hospice. If I had it to do over again, instead of giving her the poison they were shoving down her, I’d have gone to Colorado and bought a joint,” King told the committee. “That’s just me. I don’t use it myself, but I hope for your favorable consideration on this bill.”

King, an oil businessman who has spent six terms representing the Panhandle as a Republican, authored HB 46. The legislation represents only a slight expansion of Texas’ medical marijuana program, but his closing remark made clear his belief that Texans deserve increased access to medical cannabis.

Here’s a lay of the land for Texas’ Compassionate Use Program, which is overseen by the Department of Public Safety: It currently allows for only three licenses, and those dispensaries are disadvantaged by regulatory hurdles that make their medicines more expensive than similar products on the open market. Licensees can currently dispense items like medicinal quality edibles, tinctures, shots, and balms, but not marijuana flower. There are about 10 different qualifying conditions that many people can get a prescription under. Texas prohibits insurance from covering prescription costs so patients have to pay cash for their medicine.

One accessibility hurdle that HB 46 looks to fix is an existing rule that dispensaries, which provide medicine statewide, must keep their inventory at one primary location. The bill would allow dispensaries to keep inventory at satellite locations across the state and dispense from them.

Nico Richardson, CEO for the state’s largest dispensary – the Austin-based Texas Original – says the rule change would decrease the amount of time it takes for patients to get their medicine and also decrease costs.

“From a business standpoint, it’s just really expensive if our inventory has to stay in Austin. We’ll take 10 or 12 orders to El Paso or the Rio Grande Valley and then the driver has to come back home, which is going to take a day, with no revenue to recover.”

“It makes no sense what we’re currently doing,” Richardson continues. “Part of the reason our products are more expensive than the completely unregulated options is because we have huge regulatory costs and sometimes those regulations don’t actually make our program safer, they’re just a burden on operators and the patients themselves.”

Additionally, King’s legislation – which is similar to another bill in the Senate, SB 1505 – would increase the number of dispensaries in TCUP from three to 11, a change that would drastically increase how quickly patients can get medicine. The legislation would also add aerosolized cannabis delivery. THC inhalers look just like the “puffer” that I used for asthma in elementary school and they’ll benefit patients because their effects kick in immediately.

“It’s the most effective and efficient way to deliver the medicine: through the lungs in a medically compliant manner,” says Richardson. “Pretty much every medical market has that ... other than us.”

During the House’s Public Affairs Committee hearing, many of those who testified in support of HB 46 did so while also pointing out its shortcomings and potentially problematic language. Rep. King acknowledged those grievances, characterizing the bill as “a step in the right direction” while seemingly leaving the door open for rewrites.

Piper Lindeen is as familiar with TCUP as anyone. Her son, who endures severe seizures, was the second patient to be enrolled in the program. Witnessing medical cannabis efficacy for her son’s condition inspired Lindeen to pursue a master’s degree in the field from the University of Maryland School of Pharmacy.

During her testimony, Lindeen asked lawmakers to view medical cannabis as more than THC and CBD isolates and ensure the program permits the 100-plus other cannabinoids in marijuana.

“The entourage effect, the way cannabis molecules work together, is critical for effectiveness,” Lindeen said. “Isolates don’t cut it. We need full-spectrum options. It is not prohibited by law, but it is by policy and limited by license caps.”

Lindeen also called for the program to allow physicians to be able to use their professional discretion on whether cannabis could be helpful for their patients, instead of relying on a limited number of qualified conditions.

Dr. Matthew Brimberry, an Austin-based family practice physician who has helped thousands of Texans get treatment through TCUP since it began, agrees.

“This is a medical program and we should allow our medical professionals to make the judgment on the conditions that are appropriate,” he told the Chronic.

Dr. Brimberry testified in support of HB 46, but is urging lawmakers to redefine several aspects of the bill.

One such aspect relates to a discussion about adding language to the law which would allow doctors to prescribe cannabis for chronic conditions where opiates would be otherwise prescribed.

“We have good evidence that there’s other diagnoses out there that patients should be able to access this program, such as fibromyalgia and inflammatory bowel disease, that we would not consider prescribing opioids. We shouldn’t be limiting those patients,” he told the committee.

Dr. Brimberry is also concerned about language in the bill saying “Each prescription issued ... may only provide for a 90-day supply.”

“That’s obscure,” he says. “It could be interpreted as: You as a patient can only be certified for 90 days. Could you imagine having to make an appointment for a prescription every three months?”

Brimberry says that only certifying patients for 90 days is a predatory practice some clinics already use to make more money on appointments and that it falls short of the industry standard of one year.

Finally, Brimberry is pleased that HB 46 would stop capping THC as a percentage (.03 percent of the product’s weight) and instead use volumetric measurements, but says the maximum dose being defined as 20 mg will limit effectiveness for some patients.

“Based on my survey of my patients, 90 percent of them would do fine with 5 to 20 mgs per dose, but that leaves 10 percent who would not be able to continue in the program with a lesser dose,” he cautions. “If we increase that to 40 or 50 mg we’ll be able to take care of 95 percent and if we increase that to 100 mgs, we’ll be able to take care of 99 percent. Well, that’s great ... but what patients are taking more than 100 mgs? That’s our terribly ill, palliative care, oncology patients who are having to take 150 mg per dose in order to alleviate their symptoms. So you’re basically cutting out the people who the program is made for.”

Postscript: After I filed this column, Texas’ 15th Court of Appeals ruled that Austin cannot enforce a law decriminalizing personal amounts of marijuana, which has been in effect since 2022. The successful appeal relates to a lawsuit from Ken Paxton, Texas’ attorney general and now Senate candidate, who argues that cities have to follow state laws. Paxton has been less stringent on state laws as it pertains to himself, having last year paid $300,000 to settle several longstanding felony indictments on securities fraud charges. More on the friction between city and state marijuana laws in the next Austin Chronic.