Marijuana for chronic pain? Texas considers expanding medical use program
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Lawmakers in Austin are considering whether to expand Texas’ medical marijuana program to include chronic pain in instances when opioids would be prescribed.
The Texas Compassionate Use Program, which has grown in recent years to encompass more health conditions, allows doctors to prescribe low-THC cannabis to qualifying patients.
Rep. Stephanie Klick, a nurse and Fort Worth Republican who has worked to broaden the program in past sessions, said she intends to have a medical program that follows the scientific data.
House Bill 1805, which the House Public Health Committee heard Monday, is the next step in expansion, said Klick, the legislation’s author and committee chair. She proposes adding chronic pain when opioids would otherwise be prescribed and “debilitating medical conditions” designated by the Department of State Health Services to the list of qualifying medical conditions.
Patients with autism, cancer, epilepsy, spasticity, multiple sclerosis, seizure disorders, post-traumatic stress disorders, amyotrophic lateral sclerosis or who have an incurable neurodegenerative disease qualify for the program, according to the Texas Department of Public Safety. The Health and Human Services Commission can also allow treatment with medical marijuana if it is part of an approved research program.
The Senate removed a chronic pain provision from a bill signed by Gov. Greg Abbott in 2021.
Mike McKim said he became eligible for the program following the last session when it was extended to PTSD. McKim, who said he’s a U.S. Navy veteran, told lawmakers the disorder caused insomnia, anxiety, and had a negative effect on his quality of life.
“As a result of taking this medication, I’ve actually been able to sleep soundly for the first time in decades, find peace of mind in my waking life, and I’ve stopped abusing alcohol completely,” said McKim, who started Cuvée Coffee.
He and several speakers said they use marijuana as medicine and advocated for expansion of the state program. Speakers also raised concerns about costs associated with accessing legal cannabis and said products should be allowed to have a higher concentration of cannabinoids.
As of January, 45,440 patients were in the state’s compassionate use registry, according to the Texas Department of Public Safety. There were 681 doctors approved to prescribe medical marijuana.
“I appreciate the work you guys have done in the past, but there’s a lot of us left out,” said Elizabeth Miller of Bedford, who has Hypermobile Ehlers-Danlos syndrome, a connective tissue disorder. She uses marijuana illegally to help manage associated pain and medical issues.
In an interview with the Star-Telegram, she said the state should forego its condition-by condition approach to expanding the Texas Compassionate Use Program.
Miller said there are ways she and others with her condition may be able to “cram” into the program with the help of the right doctor. For instance, spasticity is a qualifying condition. But she raised concerns about complications with proving a qualifying medical condition and affording enough cannabis through the program with the state’s cap on the concentration of tetrahydrocannabinols (THC), the component of cannabis that produces a high.
“You can overcome the cap if you have money,” Miller told lawmakers. “The cap discriminates against poor people, frankly, if I’m honest.”
Klick’s bill would allow for stronger medical marijuana. Currently, ”low-THC cannabis” can contain 1% by weight of THC. If Klick’s bill passed as initially drafted, 1% would be upped to 5%.
Klick said Monday she is working on a committee substitute to the bill that would change the THC cap from being measured by weight to being measured by volume, allowing for a more concentrated dosage. The change is meant to reduce unintended gastrointestinal issues that can be caused by consuming an excessive amount of oil, which is sometimes the way the medical marijuana is consumed, she said.
Dr. Matthew Brimberry, who is the medical director for Austin Geriatric Specialists and Texas Cannabis Clinic, said he has had patients leave the program because it is difficult to get the amount of needed cannabis. The program becomes too expensive or they develop gastrointestinal side effects. As a doctor, he’s able to prescribe “extraordinarily concentrated” morphine, he said.
“If I’m afforded that leeway with those dangerous medicines, I feel like as a physician with my medical judgment and knowledge, I should be able to prescribe a concentrated medicine that is safe and effective and is not as addictive,” Brimberry said.
North Texas lawmakers, Rep. Tony Tinderholt and Rep. Nicole Collier, weighed in on the ways medical marijuana can be taken. Cannabis prescribed in Texas cannot be smoked. Klick suggested the use of nebulizers and inhalation devices would also be precluded under the law.
“It sounds like if we’re going to open it up to other conditions, we need to look at also opening up other delivery methods, like the inhaler and nebulizer,” said Collier, a Fort Worth Democrat.
Klick replied there’s a lack of data on possible effects.
Replying to a speaker who described the use of inhalation devices that allow for the heated or unheated delivery of cannabinoids, Tinderholt said people in his district wouldn’t support smoking marijuana.
“It’s nice to hear that there are devices out there that exist to where they could ... get things things that they need without just smoking a joint,” said Tinderholt, an Arlington Republican.
Chase Bearden, the deputy executive director of the Coalition of Texans with Disabilities, praised the portion of the bill that would allow the Department of State Health Services to have say in qualifying conditions. This would allow those working to expand the program to move forward with the state department, rather than returning to the Legislature, which meets every two years, he said.
The legislation would head to the House if it is passed out of the committee. After that it must pass through the Senate before going to Abbott’s desk for approval. It was left pending in committee Monday.
“I’m really optimistic, I’m really hoping that HB 1805 gains momentum,” said J. Canciglia, also with the Coalition of Texans with Disabilities, who has Crohn’s disease and connective tissue disorder. “Because ... expanding the condition list to include chronic pain would be huge, not just for me, but other people with connective tissue disorder, as well as autoimmune disease.”
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This story was originally published March 13, 2023 at 4:58 PM.
