Expanded access to medical marijuana gains traction as Texas House passes bill

AUSTIN, Texas - Texans who suffer from chronic pain and potentially other debilitating conditions would be able to access the state’s medical marijuana program under a bill approved by the Texas House on Wednesday.

The bipartisan legislation, sponsored by House Public Health chair Stephanie Klick, is an expansion on the state’s 2015 "Compassionate Use" law — which has, in a number of legislative changes since it was created, allowed a growing number of patients in Texas to legally use cannabis to treat debilitating symptoms of conditions such as epilepsy, autism, cancer and post-traumatic stress disorder, or PTSD.

House Bill 1805 won initial approval Tuesday, and then received a final vote Wednesday, passing 127-19. It now heads to the Senate.

The bill would allow doctors to prescribe 10 milligram doses of cannabis for chronic pain cases that might normally call for an opioid pain management prescription. Some conditions that could cause such pain would include Crohn’s disease and rheumatoid arthritis.

The bill also authorizes the Texas Department of State Health Services to further expand the list of conditions that it could be used for in the future, without needing to change state law anymore.

Klick’s bill also changes the way the legal level of tetrahydrocannabinol, or THC — the active psychoactive agent in cannabis — is measured, from a concentration to a set volume of 10 milligrams per dose, which supporters say allows it to be delivered more efficiently and in a wider variety of ways. The THC found in cannabis has been found by some patients and doctors to be effective against pain, depression, anxiety, appetite problems and nausea.

There was no debate on the House floor, nor any vocal opposition in a committee hearing on the bill last month.

As research has expanded in the area of low-THC medical marijuana, currently delivered to patients in mostly tincture oils and gummies, Texas lawmakers have been in favor of expanding access to the program, Klick said.

"My intent then and still is to have a truly medical program that follows the scientific data," said Klick, R-Fort Worth, who sponsored the legislation creating the original program.

The Compassionate Use Program in Texas has registered some 45,000 patients since it first began, with about 10,000 to 12,000 active participants, said Nico Richardson, the interim chief executive officer of Austin-based Texas Original, the state’s largest medical cannabis provider. By comparison, a similar but much more inclusive program in Florida has about 700,000 people currently enrolled in the program.

During a March 13 public hearing before the House Public Health Committee, military veterans told lawmakers how medical marijuana had helped them overcome both trauma and pain since they were able to access it under the Compassionate Use Program.

Several said they knew of other veterans in tremendous pain who were not in the program and for whom opioids were not an option, so they obtained their cannabis through illegal channels.

"It doesn’t make me high," said Navy veteran Ramona Harding, who was able to obtain marijuana through the state program and said she suffers from PTSD because of military sexual trauma. "It just helps the pain subside so I can function."

Klick’s bill passed out of her committee in mid-March on a vote of 10-0.

Only one person, a member of the socially conservative group Texas Eagle Forum, registered against the bill in the committee hearing. Supporters of the legislation included advocates for people living with disabilities and mental health issues, as well as the Libertarian Party, the Texas Chapter of the American College of Physicians and the Center for Health Care Services, which is the mental health authority for Bexar County.

"For decades, I annoyingly suffered from PTSD, which led to insomnia, then anxiety," U.S. Navy veteran Michael McKim said last month. "I worked with counselors to ease my symptoms and I still found myself unable to ease my mind."

McKim said as a result of taking medical cannabis, he has been able to sleep soundly for the first time in decades and his alcohol abuse has stopped completely.

"I’m truly fortunate to have access to legal quality medical cannabis, which has ultimately been the key to bettering my life," he added.

Chase Bearden, deputy executive director of Coalition of Texans with Disabilities and director of policy and advocacy for Texas Patients First, credits the Compassionate Use Program for getting him off opioids.

"I was on hydrocodone opioids for over a decade while I was up here working, constantly in pain," he said. "Being in the program has kept me off of those and I am more than happy to never take those again."

Veteran Elizabeth Miller told committee members that she appreciates the proposal in the legislation that would change how THC is measured, from 1% of volume to 10 mg per dose because she has a hard time ingesting the other ingredients in tinctures and gummies.

The change means that patients don’t have to ingest large quantities of oil or other non-THC substances in order to make it legal, which Klick said would reduce gastrointestinal issues in patients and allow them to more efficiently take the treatment.

Currently, the limit on the amount of THC per volume restricts the way medical cannabis can be delivered, mostly in tinctures and edibles that are not always optimal because they can have delays or cause GI discomfort in some patients, among other reasons, said Jokūbas Žiburkus, a cannabis expert, University of Houston neuroscience professor and co-founder and CEO of Adendox, a private company focused on cannabis intellectual property development and branding.

One comparison Richardson likes to make is that if the active ingredient in Advil, ibuprofen, were to be restricted to 1% of the total volume of each dose, then reaching the suggested dose of 400 mg for a headache would require 40 Advil tablets.

By allowing a single dose of medical cannabis to reach 10 milligrams, as Klick’s bill does, it opens the door to other delivery systems such as sublinguals, which can be absorbed under the tongue, as well as creams, sprays, patches and suppositories, Richardson said.

"It makes a lot more sense for the industry, and it’s how all the other markets do it," Richardson said.

Žiburkus said he also hoped Texas law would eventually open the door to medically approved devices that allow medical cannabis to be inhaled, one of the most efficient ways to ingest THC.

Medical marijuana is not prescribed as a smokable substance mainly because doctors don’t recommend burning something and inhaling it as part of a healthy treatment plan, Žiburkus said. Texas law prohibits medical marijuana to be prescribed in smokable form, as one might do recreationally in a joint.

"When we talk about inhalation, one has to keep in mind that we do not want folks that are medically being treated to smoke or burn anything," Žiburkus said. "However, there are very clever devices that have been developed around the world. And these devices allow for heated or even unheated delivery of cannabinoid inhalation."

While medical marijuana has gained acceptance among conservative lawmakers in recent years, and has been legalized in nearly four-fifths of the country, social conservatives who still hold powerful sway in Texas GOP circles have made the movement go a bit slower in this state.

Much of that resistance is to the idea of marijuana as a party drug, not as a medical product that can be used to treat real conditions, some lawmakers said.

State Rep. Tony Tinderholt, an Arlington Republican, said the fact that medical marijuana is currently, and would still be, delivered in edibles and gummies instead of "smoked in a joint" will make it easier for him to explain his support in his conservative district.

"We have to vote [with] the people in our district, and I’ve knocked on tens of thousands of doors, and I know that the people in my district would struggle with it if I were voting yes to actually smoking marijuana," he said during the hearing. "And it’s nice to hear that there’s devices out there that exist to where they can actually get the things that they need without just smoking a joint."

Disclosure: Coalition of Texans with Disabilities and University of Houston have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

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