News broke Monday that Texas' first medical marijuana dispensary will open on Feb. 8, near — where else — Austin.
Compassionate Cultivation will be the first of the three licensed dispensaries to open in the state, but will be followed, in theory, by the other two companies that received licenses last year under the Texas Compassionate Use Act, which was passed in 2015.
But where will the prescriptions come from? As large a state as Texas is, only 15 doctors are legally allowed to prescribe the medical marijuana oil used to treat intractable epilepsy. Under the Compassionate Use Act, the debilitating condition is the only one for which medical marijuana oil can be prescribed.
One of the two prescribing doctors in North Texas is M. Scott Perry, the director of neurology at Cook Children's Medical Center. He joined Cook in 2009 and is actively involved in studying how effective and how safe cannabidiol oil (CBD) is for treating patients suffering from various ailments. CBD oil is derived from marijuana plants that have been cross-bred to have extremely low levels of the plant's psychoactive ingredient, tetrahydrocannabinol, according to the law's requirements.
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Bishnu Sapkota, a board certified neurologist with Lone Star Medical Group in Weatherford, is North Texas' other . He is also affiliated with Weatherford Regional Medical Center, according to his profile on WebMD.
Clearly, Texas is not the next Colorado — not by a long shot. Perry and Sapkota are North Texas' only CBD prescribers at the moment, but the list is growing. According to a December Houston Chronicle story, there were only seven registered Compassionate Use doctors in Texas right before the New Year.
"We just had an Epilepsy Foundation meeting [Tuesday], and we had a lot of questions about this," Perry said. "I came away with the immediate feeling that a lot of doctors are going to stay away from adding their named to the registry, and seeing what happens as more research comes out."
"We know enough right now to say we're not crazy to think this plant can help these patients," Perry said. "So by and large, doctors are not averse to using it. But we are rightly hesitant to put anything in a patient's body that hasn't been thoroughly tested and proven, so we're not just jumping to automatically recommend cannabidiol."
So, how is this going to work for the roughly 500,000 Texans diagnosed with epilepsy, and will patients be flooding Perry's and Sapkota's offices looking to get their hands on the new treatment?
Not exactly. Perry told the Star-Telegram he sees hundreds of intractable epilepsy patients, between 20-25 of whom he would consider prescribing CBD oil under the current law. Intractable epilepsy means that at least two other medications, administered properly, have failed to effectively treat the patient's seizures.
Those treatments are usually anticonvulsants like Lamictal. Perry said CBD oil does offer the roughly 130,000 Texas patients with intractable epilepsy patients a clinical option that comes with fewer side effects.
Shannon Robbins, assistant director of Epilepsy Foundation Texas, told the Texas Observer that requirement leaves out more than 345,000 of the roughly 500,000 epilepsy patients in Texas, right off the bat."
Those whose epilepsy is deemed intractable have to get a prescription from one of these 15 doctors. There are five prescribers in the Houston area, four in the San Antonio area, three in Austin and one apiece in Fort Worth, Weatherford and Tyler.
Once one registered doctor has made the initial recommendation for CBD oil treatment, a second registered doctor must approve it.
One of the major shortcomings of the Texas Compassionate Use Act, according to medical marijuana advocates, has been its restrictive nature. Until Compassionate Cultivation opens on Feb. 8, there has not been a site where a patient could legally fill those prescriptions.
Once it does open, the dispensaries will begin filling them, both through physical locations and delivery services.